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Performance improvement in Ethiopia through use of
aggregate data
Tsigereda Gadisa MD,MPH M&E Director, ICAP-Ethiopia
July, 2010
Progress of Site level data use Supported ICAP-Ethiopia
September 2005 – June 2010
Management commitment Key to Build Results Oriented
Culture• Use Data routinely; Started slow; non-judgmental way• Leadership committed for program improvement;
through data use• Involved all concerned; support the team to arrange
mentoring and ask input from all
• Stimulate positive action and encourage innovation
• Take responsibility; no blaming; focus on what can done
• Encourage learning; review & learn from success & failure
• Reward and reinforce; use rewards & recognition timely
M&E Status ICAP-E Supported Sites September 2005– Number of Facilities Providing Services were 6
(1st and second cohort Hospitals)
– Number of patients under care 12652 (1202 when we start)
– Patient information capturing was performed using unstructured plain hospital cards
– Patients are registered (if they are) using plain unstructured logbooks
– National standard forms were under development
– No M&E Training
Data use Started slowly
Early Phase Data use Activities; Helping the M&E System to
Keck off – Printing and Distribution of M&E form– Recruitment of data clerks- Training of care providers and data clerks on M&E
forms
- Furnishing the record room- Improving paper based record keeping- Cleaning of back log data - Transcription of Cards intake and follow up register report
NB :Data was primarily compiled for reporting purpose : M&E was every body's’ job and there was one M&E advisor
Improving Paper Based Medical RecordsEg Hiwot Fana Hospital
Assisted sites to move from unstructured to structured data capturing
Improving Paper Based Medical Record Keeping
Data u
se fo
r Co
ntin
uo
us S
ervice & P
rog
ram Im
pro
vem
ent at P
oin
t of G
ene
ratio
n M
& E
, Tr
ain
ing
, D
ata
abst
ract
ion
, R
epo
rt c
om
pil
atio
n
M & E, Data use and data analysis Training and Mentorship, DQA & Feedback
M&E STAFFING: 2005 01 June 2010 = 13
Addis officeM&E Director
4 M&E Officers2 DB Managers
1 Program Evaluation Officer
Eastern 2Regional M&E Officers
(40 facilities)
South-West1Regional M&E Officer
(11 facilities)
Southern1Regional M&E Officer
(09 facilities)
Dil Chora H.Hiwot Fana H.Bisidimo H.
Chiro H.Karamara H.
Misrak. Arb. H.
AiraGimbi
Jimma H.Nekempt H.Metu Karl H.
Dembi Dolo H.
AbomsaAssela H.Goba H.
HageremariamNegelle H.
Shashemene H.
Central 1 Regional M&E Officer
(9 facilities)
Adama H.Ambo H.
Bishoftu H.Fitche H.
Wonji
Current ICAP-E M & E Activity & Support Level
Regional Support• Development of analysis template for achievement assessment• Compilation of data to be used for regional planning• Development & Role out of Patient level database
Site Level Support 65 (43 hospital & 22 HC• Over 87,500 Patients Capability Building/TA• Training & mentorship• Strengthen documentation• Site level data use• Renovate furnish, & equip data room
Internal M&E support Compile and submit Funder report Compile and share data regularly Plot performance graph in key areas & share Developed & Implemented database to organize report, training , SOCS and CSSCL information
Site Census: service provided and site GIS coordinated & is currently used as an input for goggle map of URS-NY in site map preparation
Current ICAP–E Site level data use Supports
• Training & Mentoring of providers and data clerks on nationally standardized M&E Tools
• Development data analysis and data use providers support tools
• Training and mentoring of clinical care providers and program managers on Data Analysis and Data use
• Conducting Regular data quality check; immediate feed back & follow up DQA issues identified
Capacity Building: Human Resources (Training and Mentoring)
Target achievement self Assessment form
Mes-01 Tik-01 Hidar-01 Tah-01 Tire-01 Yek-01 Meg-01 Miaz-01 Gin-01 Sene-01 Hamle-01 Nehase-01
PRE-ART Target 110 220 330 440 550 660 770 880 990 1100 1205 1310
PRE-ART Ach 105 220 311 407 500 593 697 769 869 956 1047 1161
ART Target 37 74 111 148 185 222 259 296 333 370 421 472
ART Ach 154 351 489 635 738 881 1081 1235 1392 1538 1630 1732
100
300
500
700
900
1100
1300
1500
1700
1900
110
220
330
440
550
660
770
880
990
1100
1205
1310
105
220311
407500
593
697769
869956
1047
1161
37 74 111 148 185 222 259 296 333 370421
472
154
351
489
635
738
881
1081
1235
1392
15381630
1732
Bishoftu Hospital Target Achievement in Care and RX between Meskem-01- Nehase-01
Quarters
# o
f p
ers
on
s
Follow up card completeness trends,
ART clinic Bishoftu Hospital; 2009-2010
Follow
up
date
Weig
ht
Pregn
ancy
Funct
ional
stat
us
WHO s
tage
TB scr
eenin
gOIs
Cotrim
oxaz
ole
ARV dru
g
Next v
isit d
ate
0%
20%
40%
60%
80%
100%
120%
100%
95%
60%
95%
100% 100% 100%
74%
90%
100%100% 100% 100% 100%
95%
100% 100%
93%
100% 100%
Bishoftu Hospital Feb -09
Bishoftu Hospital Apr-10
Key follow up variables
Per
cen
tag
e o
f co
mp
letn
ess
Regional Level Data Use
• Supported the development & rollout of Facility based ART Monitoring SystemBased on the two basic data capturing forms (intake
& follow up form)
Easy data processing and report compilation
Facilitate defaulter tracing
Facilitate continuous service and data quality improvement through data use
Regional Level Data Use-2 Developed a Regional Data Analysis template (Target
achievement self assessment form )
Training of regional HIV coordinators and data managers on data analysis and data use
Supported the development and implementation of Patient level database
Support in data aggregation for evidence based actionFacilitate timely feed back during supervisors Evidence based planningAcknowledging best performing sites
Facility Based ART Monitoring System
Examples of data Analysis Job Aid
Evidence Based Regional Review & Planning Meeting
Evidence Based Recognition of Best Performing Sites
ICAP –Ethiopia Internal data use for CQI
Developed & Implemented database to timely organize the different aggregate data,
- DSS, TrainSoft, SOCS and CSSCL Databases– DSS: Organize service delivery performance aggregate data; produce
report and graph
– TrainSoft: Organize training data by all technical areas
– SOCS: Organize data from SOC exercise & facilitate immediate feedback and see trends in the SOC indicators
– CSSCL: Organize data from CSSCL exercise & facilitate immediate feedback and see trends in the SOC indicators
ICAP –Ethiopia Internal data use for CQI
Selected and developed key performance indicators with the clinical units
Regularly analyze aggregate data and prepare graph on the key indicators for performance review meeting
Regularly meet to review performance design actions
Share results and action points with clinical unit & RO to guide mentorship
Decision Support System (DSS)
TrainSoft
Standard of Care Database (SOC
DB)
Comprehensive Check List database
(CSCLBD)
TB Screening among newly enrolled in care, Ginbot,01 (May-09) and Ginbot,02 (May-10)
Central East South SW all ICAP0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
596
327367
294
1,584
535(90%)
288(88%) 306 (83%)247 (84%)
1376 (87%)
380
263 289
208
1,140
346(91%)252 (96%) 279(97%)
195(94%)
1,072 (94%)
Newly Enrolled Ginbot,01 Screened for TB Ginbot,01 Newly Enrolled Ginbot,02 Screened for TB Ginbot,02
ICAP Centeral East South SW0
1000
2000
3000
4000
5000
6000
7000
8000
5885
1380 12511042
2212
4708(80%)
1200(87%) 900(72%)802(77%)
1858(84%)
7129
1238
2097
1067
2727
5988(84%)
1102 (89%)
1598 (76%)
939(88%)
2349(86%)
MIPD Unknown status Tir 2001 MIPD tested Tir 2001 MIPD Unknown status Tir 2002 MIPD tested Tir 2002
Medical IPD testingPerformance , Ginbot,01
(May-09) and Ginbot,02 (May-10)
Transition from SdNVP to multiple ARV prophylaxis:
April-07- March-10 ; All ICAP supported sites
April June July- Sept-07
Oct- Dece-07
Jan- March-08
April June-08
July- Sept-08
Oct- Dece-08
Jan- March-09
April-June-09
July- Sept-09
Oct- Dece-09
Jan- March-10
0%
20%
40%
60%
80%
100%
120%
100% 100%
81%
22%
15%
4% 3% 2% 2% 0% 1% 0%
0% 0%
19%
78%
85%
96% 97% 98% 98% 100% 99% 100%
sdNVP% NVP+AZT+3TC%
Comparison of site Pediatrics IPD PICHT performing 3rd and 4th quarter; COP 09
Remark: 8 sites reported 75- 94% PIPD testing rate;
1CRO,1 ERO, 4 SRO & 2 SW sites.
RO Name of facility
% Tested 3rd Q
% Tested 4th Q
Possible reason
Recommendation
CRO Adama 454/621 (73%)
457/490 (93%)
ERO Hiwot Fana 202/202 (98%)
147/197 (91%)
SRO
Abomsa 39/60 (65%) 48/57(84%)
Goba 153/176 (87%)
112/119(94%)
Bullehura 211/232 (91%)
149/198(75%)
Negelle 129/145 (89%)
72/93(77%)
SW Gimbi 120/133 (90%)
208/252(83%)
Jimma 497/507(98%) 265/297(89%)
Lesson learned
• Training of site & RHB staffs on data analysis and use provided opportunity to look at the data , beyond individual patient care in terms of
Service quality (linkage, prophylaxis), Treatment outcome (lost, death, on treatment cure rate) Target setting & target achievement monitoring
• Site staff will be more concerned for the quality of data when they know how to analyze, interpreted and use
• Training, Mentoring and regular DQA with feedback, coupled with data analysis and interpretation enhance data quality and data use
Challenges
• Building result oriented culture on fragile system
• Overburdened & de-motivated site staffs vs huge demand on complete documentation and use of data remained an overarching challenge?
Next Steps
– Especial focus will be made to support the rollout of HMIS and smooth Integration of HIV information
– Support DQA with the new HMIS tools and HMIS and NGI indicators,
– Enhance the use of data collected though HMIS for CQI at a point of generation
Thank You
ICAP-E Family May 2009