Milestones and key performance indicators:
Definitions and Calculations
The 15 key indicators are defined below in eight thematic areas. Composite scores were used to calculate some of the indicators, the details of which are also described below.
1. Workforce:
1.1 Organization of RRT
1.2 Roster system
1.3 Number of teams and team members at the national and sub-national levels.
1.4 Retention rate of RRT members
1.5 Skill status of RRT members (training status and participation rate)
2. Presence of standard operating procedures (SOPs)/ protocols for RRT operations.
3. Financial support of the RRT
4. Logistic support for the RRT operation
5. Timeliness
5.1 Timeliness of verification of outbreak alerts,
5.2 Timeliness of deployment of teams,
5.3 Timeliness of initiation of control measures
6. Completeness of outbreak response (completeness of documentation and reporting)
7. Risk communication and community engagement activities as an indicator for interventional response
8. Monitoring and evaluation
8.1 Presence of a country mechanism for monitoring and evaluation of RRTs
8.2 Internal post-deployment RRT review or assessment meeting
Workforce
1.1 Organization of RRT:
It is an input indicator (Figure 1 and Table 1). It corresponds to the planning in the non-emergency phase of the RRT cycle (Figure 2 & Table 2). A composite indicator using 3 aspects used to measure the organization of RRTs. One- constitution of a multidisciplinary RRT within the emergency response system/organogram, two- regular team meetings, and three- presence of clearly defined and documented roles and responsibilities of RRT. RRT organization is classified as adequate, evolving, or challenging based on these three items.
1.2 Roster system.
This is an output indicator (Figure 1 and Table 1) and refers to rostering in the non-emergency phase in the RRT cycle (Figure 2 and Table 2). It is a composite indicator based on the presence of a formal category-wise roster for RRT members (epidemiologists, social mobilization/communication specialists, and clinicians) as well as the frequency of updating the roster. This indicator is graded as adequate, evolving, and challenging, using a composite score.
1.3 Number of team members and the national or subnational level
Input/ process indicator (Figure 1 and Table 1). It refers to planning in the non-emergency phase of the RRT cycle (Figure 2 & Table 2).
1.4 Retention rate of RRT members
Retention rate is the proportion of members who continue to be in RRT at the end of one year compared to the total number of RRT members at the beginning of the reference period. It is an outcome indicator for the RRT logic model (Figure 1 & Table 1). It corresponds to rostering in the non-emergency phase of the RRT cycle (Figure 2 & Table 2).
1.5 Skill status of RRT members
This is assessed using two measures-
a) Participation of RRT members in operations (participation rate). The participation rate was measured as the proportion of RRT members who have attended at least one RRT operation during the previous six months.
b) Training status of RRT members. The training status of RRT members was measured as the proportion of RRT members who had attended training/re-training/simulation exercises during the previous six months. These are outcome indicators for RRT (Figure 1 and Table 1). They correspond to training in the non-emergency phase of the RRT cycle (Figure 2 and Table 2).
Presence of Standard Operating Procedures (SOPs) for RRT operations
The proportion of countries reporting the availability of SOPs related to RRT activation, deployment, demobilization, monitoring, and evaluation is expected at the national level. This is an input indicator in the RRT log model (Figure 1 & Table 1) and refers to planning in the non-emergency phase of RRT (Figure 2 and Table 2).
Financial support for RRT operations
This is a process indicator in the log frame of RRT (Figure 1 and Table 1) and refers to planning in the non-emergency phase of the RRT cycle (Figure 2 and Table 2). Financial support is assessed using two measures: the presence of an established mechanism to fund RRT operations in the country, and timely fund release as reported for the last three deployments.
An established mechanism may be a regular budget for RRT or another formal financing mechanism through the ministry of health or partners to fund RRT whenever needed. The financial support is rated “adequate”, “satisfactory”, “evolving”, or “challenging” as per the following criteria. If the answer to the first question is "Yes", and if the fund was released before the team left for the field in all three deployments, financial support is considered "adequate". If the answer to the first question is "Yes" or "Partially", and if the fund was released before the team left for the field in at least two out of the last three deployments, then financial support is considered "satisfactory". If the answer to the first question is "Yes" or "Partially", and if the fund was released at least while the team was in the field in at least two out of the last three deployments, then funding is considered "evolving". If the answer to the first question is "No", or if the fund was never released at all, or if the fund was released after the deployment at least in two out of the last three deployments, then funding is considered "challenging".
Logistics support for RRT operations
This is a process indicator in the log frame of RRT (Figure 1 & Table 1) and refers to pre-deployment in the emergency phase of the RRT cycle (Figure 2 & Table 2). We considered three components for this indicator i.e. provision for RRT members’ health and safety like PPE; transportation of team, and provision for per diem during field deployment.
Timeliness of response
Refers to outcome indicators in the RRT log model (Figure 1 and Table 1) and corresponds to pre-deployment and deployment actions in the emergency phase of the RRT cycle (Figure 2 and Table 2). There are three indicators on timeliness:
a) Timeliness of verification of outbreak alert
Pre-deployment emergency phase: - For the last 3 outbreak alerts received, the percentage of alerts verified within 24 hours from the time of the alert.
b) Timeliness of deployment of RRTs
Deployment emergency phase. For the last 3 outbreaks, the percentage of RRT deployments within 48 hours from the time of confirmation of the outbreak.
c) Timeliness of application of control measures
Post-deployment emergency phase. -For the last 3 outbreaks, the percentage of initiation of control measures within 72 hours from the time of deployment.
Completeness of RRT response:
Completeness of documentation and reporting is an outcome indicator according to the RRT Log-model (Figure 1 and Table 1) that is corresponding to post-deployment in the emergency phase of the RRT cycle (Figure 2 and Table 2). Completeness of RRT response is assessed based on the submission of situation reports (SitReps) including line list and is expressed as the percentage of RRT deployments for which situation reports including line list were submitted daily. This indicator is measured by the submission of daily situation reports in case of RRT deployment for the last 3 outbreaks.
Interventional response to outbreaks
Initiation of Risk Communication and Community Engagement (RCCE) activities is considered a proxy indicator for the interventional response. It is an outcome indicator (Figure 1 and Table 1) corresponding to post-deployment in the emergency phase of the RRT cycle (Figure 2 and Table 2). It is calculated as the percentage of outbreak responses that had documented risk communication and community engagement activities.
Monitoring & evaluation of RRT operations:
This is assessed using 2 indicators:
a) Presence of a country mechanism to monitor and evaluate RRT operations and performance in the country: This is an input indicator (Figure 1 & Table 1) and relates to planning in the RRT cycle (Figure 2 & Table 2).
b) Performance of internal post-deployment RRT review or assessment meeting. This meeting aims to identify the challenges faced. The indicator is calculated as the percentage of RRT deployments followed up by an internal post-deployment RRT review or assessment meeting among the 3 most recent outbreaks in each country. This is an outcome indicator (Figure 1 & Table 1) and is related to post-deployment in the RRT cycle (Figure 2 & Table 2).