This document discusses developing and strengthening monitoring and evaluation (M&E) systems for national tuberculosis (TB) programs. It identifies key elements of an effective M&E system and outlines five steps to strengthen implementation: 1) assessing current M&E practices, 2) developing an M&E plan, 3) establishing an M&E unit, 4) implementing the M&E plan, and 5) managing quality control. The document provides guidance on conducting a situation analysis, developing indicators and data collection methods, building M&E capacity, and ensuring quality monitoring and use of data.