Electronic Consent Form

The Philippines National Tuberculosis Program (NTP), with the support of TREAT TB, is conducting an assessment of the NTP’s Supervision, Monitoring and Evaluation system (SME system) – particularly as it relates to programmatic management of drug-resistant TB (PMDT). The goal of the assessment is to understand the strengths, weaknesses, and gaps of the SME system, so that the NTP can improve the impact of monitoring, evaluation and supervision activities.

This survey is being conducted as part of the NTP’s assessment, to understand the SME system and activities undertaken at your office/facility, as well as to solicit your feedback on how to improve the functioning of the system and the support provided to you by national and regional offices of the NTP.  

Your input is important to us.  Although we would greatly appreciate your participation in the survey, your participation is completely voluntary and you may choose not to participate. If you decide not to complete the survey, you will not be penalized.
 
We estimate that it should take you about ½ hour to complete the survey. Please note that only one person from your facility needs to complete the survey, but he/she should collaborate with staff to answer the questions. The survey does not have to be completed all at once. You may save your responses and then come back to the survey as many times as needed before submission. 
Your responses will be confidential and we will not collect identifying information from you that will allow us to connect your answers to you.  We will store all survey answers in a manner appropriate to protect your confidentiality. 

Your survey responses will be used by the NTP only in connection with the SME assessment.

If you have any questions about the survey or the SME assessment, please contact Melvin B. Marzan at mmarzan@treattb.org.

Note:  Technology, Research, Education, and Technical Assistance for Tuberculosis (TREAT TB) is a multiyear project funded by USAID that seeks to contribute to new knowledge through field evaluations of diagnostic tools, clinical trials of priority research questions, and targeted operational research benefitting global, regional, and country TB control efforts.

* 1. ELECTRONIC CONSENT: Please select your choice below.

Clicking on the "agree" button below indicates that:

• you have read the above information
• you voluntarily agree to participate

If you do not wish to participate in the survey, please decline participation by clicking on the "disagree" button.

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