i
MAKERERE UNIVERSITY COLLEGE OF HEALTH
SCIENCES/ SCHOOL OF PUBLIC HEALTH
CQI MEDIUM TERM FELLOWSHIP
PROJECT: IMPROVING TIMELINESS IN HMIS 108 REPORTING
FROM HEALTH UNITS TO THE DISTRICT IN KYENJOJO DISTRICT.
By:
1. MUGABI SIMON PETER
(BACHELOR OF QUANTITAIVE ECONOMICS)
2. RUHWEZA FRANCIS
(BACHELOR OF HEALTH ADMINISTRATION)
MEDIUM TERM FELLOWS
NOVEMBER 2013.
i
Table of Contents
List of Abbreviations .............................................................................................................................. iii
Declaration ............................................................................................................................................. iv
Acknowledgement ................................................................................................................................... v
Executive Summary ............................................................................................................................... vi
1. Introduction/ Back ground ............................................................................................................... 1
2. Literature Review ............................................................................................................................ 1
3. Statement of the problem ................................................................................................................. 3
Conceptual Frame Work: FISH BONE” describing the Problem Analysis: ............................................... 4
4. Project Objectives ................................................................................................................................ 5
4.1 General Objectives ..................................................................................................................... 5
4.2. Specific Objectives. ...................................................................................................................... 5
5. Methodology ................................................................................................................................... 5
5.1. The outcome of multi voting by the District QI team ..................................................................... 6
5.2 Planned Activities .......................................................................................................................... 7
6. Project Outcomes/ Achievements. ...................................................................................................... 10
7. Lessons Learnt................................................................................................................................... 11
8. Challenges and how they were addressed ........................................................................................... 12
9. Recommendations/ Conclusions ........................................................................................................ 12
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Operational Definitions
Access: Easy reach to the next level of health services delivery in terms of distance/ transport costs.
Brainstorming: It is a group or individual creativity technique by which efforts are made to find a
conclusion for a specific problem by gathering a list of ideas spontaneously contributed by its member(s).
Efficiency: A level of performance that describes a process that uses the lowest amount of inputs to create
the greatest amount of outputs. Efficiency relates to the use of all inputs in producing any given output,
including personal time and energy.
Effectiveness: It is the capability of producing a desired result. When something is deemed effective, it
means it has an intended or expected outcome, or produces a deep, vivid impression
Feedback: Delivering information either forward to the next higher level or backward from higher to
lower level through written down journals, verbal, or through the media like radio stations, televisions or
through routine & non routine meetings.
HMIS 108: It’s a Ministry of Health monthly reporting tool for Health Facilities that offer Inpatient
Department Services/ Admissions.
Private for Profit Health Units: These are health units that are basically intended to generate profits
from the health services they render to the population and they do not benefit from the Primary Health
Care Funds from Ministry of Health.
Private not for Profit Health Units: These are health units that render health services to the population
at a subsidized fee and benefit from the Primary Health Care Funds.
Timeliness: Giving feedback in terms of reporting as in the stipulated required time; for HMIS 108
reports (In-patient Diagnostic Department monthly Reports), it’s by 7th of every month.
iii
List of Abbreviations:
ADHO- Assistant District Health Officer.
CQI- Continuous Quality Improvement.
DHO- District Health Officer.
HC- Health Centre.
HIA- Health Information Assistant.
HMIS- Health Management Information Systems.
HSSIP- Health Sector Strategic and Investment Plan.
MoH- Ministry of Health.
MRA’s- Medical Records Assistants.
MTRAC- Mobile/ Medicines Tracking System.
NMS- National Medical Stores.
Sms- Short Messaging System.
iv
Declaration:
I MUGABI Simon Peter and Ruhweza Francis do hereby declare that this end-of-project entitled
“Improving timeliness in reporting of HMIS 108 from Health Units to the District” has been prepared and
submitted in fulfillment of the requirements of the Continuous Quality Improvement Medium Term
Fellowship Program at Makerere University School of Public Health and has not been submitted for any
academic or non- academic qualifications.
Signed…………………………………………………………………..Date……………………………….
Simon Peter MUGABI, Medium Term Fellow
Signed…………………………………………………………………..Date………………………………
Francis Ruhweza, Medium Term Fellow
Signed…………………………………………………………………..Date………………………………
Dr. William Mucunguzi, Institutional Mentor
Signed…………………………………………………………………..Date………………………………
Dr. Godfrey Kayita, Academic Supervisor.
v
Acknowledgement
This is to thank the following who made the training in Continuous Quality improvement (CQI)
techniques, application of concepts in project identification, implementation monitoring and
disseminations of outcomes; without whom it wouldn’t be a success. These were:
Makerere School of Public Health / CDC Fellowship for Technical, Administrative, Financial/
logistical support
Kyenjojo district local government for time off station and support during implementation of the
CQI project.
District Health sector CQI Team and staff in the health facilities supporting the need for change.
CQI Medium term Fellows for team work/guidance.
In a special way we extend our heartfelt thanks go to Mr. Matovu Joseph and his unique team for
parental resilient guidance and support.
vi
Executive Summary
With support from Makerere College of Health Sciences School of Public Health under CDC
grant the District Health Management Team in Kyenjojo Local Government with the leadership
of the Continuous quality improvement Medium fellows was facilitated to identify a priority
health problem of improving HMIS 108 in timely reporting was identified; among many others
brain stormed below:
- Poor recording in the Unit TB registers in health units.
- Incomplete and untimely reporting of HMIS reports.
- Not using the standard national treatment guidelines.
- Lack of reporting tools especially HMIS 108.
- Monthly physical counts of medicines not done like updating of stock cards.
- Lack of HMIS 054 (Inpatient registers) tools in health units.
- Intended absenteeism of health workers from duty.
- Lack of feedback from health workers who move out for trainings/ meetings/ workshops.
- Lack of using data/ health facility performance when in routine meetings at health facility
level with the VHT’S, Health Units Management Committees.
Problem analysis using the why, why problem fish analysis to identify the causes to of late
reporting as (Flow diagram below)
A review of the existing HMIS 108 data from October 2012 to March 2013 ;34% was taken
as an average(Baseline) of these 6 months in addition to review of the other supporting
resources to facilitate improvement.
A proposal with a General project objective to Improve HMIS 108 timely reporting from
34%in April 2013 to 90% by the end of September 2013 and the Specific objectives to:
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Improve the capacity of health facilities staff through training and provision of logistics
to develop and submit their HMIS 108 in time to the district.
Develop HMIS monthly tracking system at District and health facility level to easily
track any reports submitted/ not submitted from 0-90% by August 2013.
Strengthen quarterly timely feedback to 30 health facilities to enhance data utilization
and timely reporting at health facility to the district level by August 2013 was
developed.
Some of the immediate outputs/comes included the following:
After meetings with and training of 30 DHT members incharges of health facilities and
Medical Records Assistants, sending sms reminder messages every 3rd
and 4th of every
month for timely reporting, support supervision where data validation, mentorship, coaching,
distribution of HMIS 108 reporting tools, reporting checklists, daily Inpatient Census Sheets
was done. 2 review meetings were also held and as a result, HMIS timeliness improved from
34% in April to 90% in September 2013.
Despite these, the following challenges remained:
Low prioritization of HMIS 108 and untimely reporting of some Health Facilities, network
challenges of some mobile phone numbers, Institutional mentor went for further studies.
• However the strong team work in the district, use of HMIS 108 report tracking checklist
held every body accountable both at facility level and district level which has improved
timely submission, improved capacity for data management and timely submission of
other reports like HMIS 105 and ARV’s Reports/ Orders.
• Continuous feedback on timeliness in reporting during routine review meetings,
integrated support supervision by HSD’s and DHT and inclusion of HMIS reporting tools
viii
in Health Facility plans by the Incharges are needed to sustain and improve the results
made.
• The CQI fellows together with the other district health team members will continue
supporting these gain.
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1. Introduction/ Back ground.
Kyenjojo district has a population of 398,200 (UBOS 2012), an area of 2500KM2, with 2
constituencies of Mwenge North and Mwenge south, 2 HSDs (Kyenjojo and Kyarusozi), 16 sub
counties of which 4 are town councils, 36 health facilities (01 is a District General hospital, 01
HCIV; Out of these 30 health facilities, 16 are public, 9 PNFP and11 PFP (Kyenjojo Health
Facility Inventory 2012).
A health facility was considered to have reported timely for HMIS 108 if submission to the
District of the reports for the preceding month was within 7 days of the following Month. A
number of factors were responsible for untimely reporting from the Health Facilities to the
District which included: lack of prioritization of HMIS 108 reporting, lack of reporting tools,
lack of the report tracking checklist, inadequate knowledge/ skills in compiling and reporting,
and lack of reminder messages to health staff on reporting.
As of April 2013, HMIS 108 timeliness in reporting from Health Facilities to the District had
stood at 34%; which meant late submission/entry of the reports into District Health Information
Software 2 (DHIS2), late reporting to MoH and untimely utilization of representative HMIS Data
for Health Service Delivery.
2. Literature Review
According to the M&E plan for Health Sector 2010/2011-2014/2015, the HMIS was noted
during the HSSP I & II to have various weaknesses. The low and declining trends of timeliness
of monthly reporting by districts (68% end of HSSP II) were worrying. Factors associated to
cause the none timeliness in reporting to the district level included: Insufficient funds,
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inadequate staff at all levels, inadequate numbers of HMIS tools and the inadequate trainings of
Health Information Assistants, prioritization of HMIS at all levels, and inadequate utilizations of
data were causes of concern. According to the HMIS Manual developed by MoH Resource
Centre, timeliness and completeness in reporting is mandatory for early informed decisions.
Timeliness has different levels; epidemic prone morbidities MUST be reported within 24 hours
of encountering a case, weekly surveillance reports MUST be reported by every Monday of the
following week, monthly reports (HMIS 105, HMIS 108, PMTCT) MUST be reported every 7th
of the following week, quarterly reports (HMIS 106a) MUST be reported every 21st of the 2
nd
month after the end of the quarter and the annual report MUST be reported every 7th
of the
August. All these timeliness and completeness is to the district level.
Timeliness in reporting is mandatory for early informed decisions to the HMIS (MoH/August
2010),. It is important for timely decision making at MoH, District and Health facility level to
direct planning and mobilization for resources, implementation and monitoring and evaluation
of health services including Inpatient services , failure of which can result in to patients having
poor quality services, delay them in seeking care, develop complications or even die from acute
conditions.
HMIS 108 reports are also used to portray the picture of the severity of health conditions in the
catchment area of a health facility and the overall proportion of clients that utilize these services
of which failure to report gives an unclear situation quite disadvantageous to both service
providers and users.
Like many health facilities in Uganda, Mpumude Health centre reported related similar
challenges (CQI Medium Report 2011).
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3. Statement of the problem
As of March 2013 only 66% of all health facilities proving these services reporting late with
majorly from Public Health Facilities (72%) contrary to the expectation of 100% from both the
Private and Public Health Facilities as required by Ministry of Health to improve evidence based
decision making and health service delivery in the district in general , allocation of resources
like equipment, equitable essential medicines and supplies currently relying on crude allocation
of these supplies by level of health care delivery, with the result of over and under stocking of
supplies and wastage and expiry of these essential items and denied access to safe efficacious
good quality supplies and build community confidence in the quality of health services.
This was not possible because many Health Workers had not been trained in data management
and reporting, lacked reporting tools especially inpatient summery sheets and registers in
addition to the district not sharing this information and providing timely feedback may not even
access them from other private facilities where the quality might also be below, hence
compromised the satisfaction of the reasonable expectations and needs of patients/ clients.
4
Conceptual Frame Work: FISH BONE” describing the Problem Analysis:
Inadequate Skills and Knowledge
Staff not trained/ mentored
Limited CME’s done in Facilities
No Focal Persons & not prioritized.
No tracking mechanism for reporting
Inadequate Collection & Reporting tools Tracking mechanism not developed
Not supplied by NMS/ District Not prioritized at District/ Health Unit level
No need identified
Daily Inpatient census not done.
No need identified
No follow up & feedback
Inadequate Supervision
Many HMIS reports to fill
Many activities implemented
Systems
Late
Reporting
of HMIS
108
reports
Skills
Supplies
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4. Project Objectives
4.1 General Objectives
Improve HMIS 108 timely reporting from 34% to 90% by the end of September 2013.
4.2. Specific Objectives.
Improve the capacity of health facilities staff through training and provision of logistics
to develop and submit their HMIS 108 in time to the district.
Develop HMIS monthly tracking system at District and health facility level to easily
track any reports submitted/ not submitted from 0-90% by August 2013.
5. Methodology
With support from Makerere School of Public Health under the CDC grants as requirement for
fulfillment of award of a CQI Certificate of Attendance, the identified medium fellows led the
DHMT to identify and implement a project on Improving HMIS 108 timeliness in reporting
from Health Facilities to the District since April 2013.
The District Health Sub District QI Members identified a problem and the causes to the
problem to work on and made a proposal for funding interventions following the training in
CQI and as a requirement from the training institution.
The District team underwent brainstorming, generated ideas / problems affecting the health
sector. This was guided by stimulating idea generation and increasing overall creativity and
consensus in problem and cost effective solutions and principles of “Focusing on Quality”,
“Withholding disapprovals” and “Welcoming unusual ideas”.
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Below is a summary of issues raised:
- Poor recording in the Unit TB registers in health units. (AA)
- Untimely reporting of HMIS 108 reports from health units to the district(AB)
- Not using the standard national treatment guidelines (AC)
- Lack of reporting tools especially HMIS 108 (AD)
- Monthly physical counts of medicines not done like updating of stock cards (AE)
- Lack of HMIS 054 (Inpatient registers) tools in health units (AF).
- Intended absenteeism of health workers from duty (AG).
- Lack of feedback from health workers who move out for trainings/ meetings/ workshops
(AH).
- Lack of using data/ health facility performance when in routine meetings at health facility
level with the VHT’S, Health Units Management Committee’s (AI).
5.1. The outcome of multi voting by the District QI team:
ITEM LETTER 1ST
VOTE 2ND
VOTE 3RD
VOTE
AA 5 4 1
AB 6 6 4
AC 3 2 1
AD 4 4 2
AE 3 2 2
AF 3 1
AG 5 3 2
AH 4 2
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AI 6 4 1
Untimely reporting of HMIS 108 reports from the health units to the district was prioritized.
The team having identified and prioritized the problem to work on made a proposal with work
plan and budget that was presented to Makerere College of health sciences, School of public
health Fellowship programme for approval and funding under the CDC grant.
Integrated support supervision and meetings with DHT and sending sms went on prior
implementation of other activities that needed financial support as the project was not a new idea
but building and improving on the existing practices using available resources to foster
ownership, team work, motivation for improvement and sustainability of the achieved results.
The flow diagram in ANNEX 1 below shows the reporting process from the health facilities to
District.
5.2 Planned Activities
Annex 3 is a summary of counter measures developed to solve the problem.
Refresher training of 30 Health Facility In charges and Medical Records Assistant on
HMIS 108.
Supply of HMIS tools (HMIS 108 reporting forms, Daily Inpatient Census Forms and
Report Tracking Checklist) to 30Health Facilities.
Conduct integrated support supervision to all Health Facilities.
Conduct 2 District Level HMIS 108 review meetings with Incharges and Medical
Records Assistants on timely reporting.
Send sms reminders to all mTRAC registered health workers every 3rd
of the following
month to adhere to timely reporting.
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The review meetings in addition to support supervision both from the district and MakSPH were
part of the monitoring system to track activity implementation and address/ correct challenges in
time. The final dissemination at national level was to report the project results and how the
district planned to sustain these as way of improving the quality service delivery in the district.
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6. Project Outcomes/ Achievements.
29 In charges, Medical Records Assistants and 1 DHT members were trained in HMIS
108 of which all the 29 were subjected to a Pre/Post Test where 72.4% improve in
Knowledge.
30 Health Facilities were supplied with HMIS 108 reporting tools, reporting checklist,
daily Inpatient Census Sheets which would run them for a complete Financial Year
2013/2014. This drastically improved on non-availability of the HMIS tools.
152 monthly sms reminders on timely reporting were sent to 152 registered health
workers using mTRAC system. This was done every 3rd
or 4th of every following month.
.
Support supervision was conducted in 30 Health Facilities offering Inpatient/ Maternity
services. Data validation/ auditing, mentorship, coaching and sharing any challenges that
were experienced in the quality of timely reporting.
2 review meetings were conducted with 76 District Health Team members, Incharges of
Health Facilities and Medical Records Assistants.
As a result of the above interventions implemented by the team, there was improvement
from 34% in April 2013 to 90% in September 2013 in HMIS 108 timely reporting from
Health Units to the District which is also improved other HMIS routine reports like the
ARV reports and orders
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0
10
20
30
40
50
60
70
80
90
100
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13
% T
imel
y Re
port
s
KYENJOJO DISTRICT HMIS 108 TIMELINESS IN REPORTING TO THE DISTRICT LEVEL.
Trend (%) Target
Review Meetings & Supervision Conducted
Sms’ sent, Support Supervision conducted
Training done, logistics supplied, sms’
sent
7. Lessons Learnt.
The use of report tracking checklist held each and every body accountable both at facility
level and district level.
Team work was key in identification, implementation and review of the interventions for
ownership and sustainability.
Health facilities having realized the need for timely reporting are now committed,
enthusiastic and reporting in time.
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8. Challenges and how they were addressed.
S/N Challenge Addressed
1 Prioritization of HMIS 108 Timely
Reporting of some Health
Facilities.
- Sharing of reports during the review meetings
and support supervision
- Development of Standard Operating
procedure on Reporting.
2 Network challenges of some
mobile phone numbers.
- Encouraging other registered staff to inform
the concerned after getting the reminder sms’
since more than one member from the health
facilities are registered.
3 Busy schedules Integration of CQI activities into the routine work.
9. Recommendations/ Conclusions.
Train new staff and reorient existing staff in HMIS reporting and use including new
reporting formats/ MoH guidelines.
Feedback on timely reporting.
Integrate HMIS 108 into support supervision activities to the health facilities.
Sustain the District HMIS and health facility tracking tools to monitor performance.
Inclusion of HMIS reporting tools in Health Facility and District Health Plans and
budgets.
Lobby for more support for data management from stakeholders.
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Include timeliness in reporting in the Health Facilities Quarterly League Tables so
that the district remains in the know of which facilities are doing well or have
challenges.
As a result of implementation of this project through training of health workers, quarterly
data reviews, logistical support and sending sms reminders the HMIS 108 from 34% to
90% with more team work, health workers are now motivated to routinely report,
manage data and improve planning, decision making and health service delivery in the
district.
The CQI medium term fellows will work with the district to sustain/ improve gains
made.
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References
Kyenjojo District local government health sector inventory (2012).
Ministry of Health (2010) Health Sector Strategic Plan III 2010/11- 2013/14 page 94.
Nankanja R and Kayizzi J B (2012) Improving records and data management in the ART clinic
at Mpumudde HCIV: Makerere School of Public Health page 3
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Appendices
Annex 1. Flow of reports from Health Unit to the District.
No No
Yes
No
Yes
Should report
be delivered
to District or
HSD
In charge-
endorses the
report for
submission
Is the report
Timely?
Compile
HMIS 108
report.
HMIS Report submitted to
District
Report submitted
at HSD level.
Submit report to
the District.
Enter the
report in
DHIS2
Enter the
report in
DHIS2
Fill the reporting
checklist, Advice &
File the report in
database.
Fill the monthly monitoring
checklist. Maintain good
practice & File the report in
database.
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Annex 2. Continuous Quality Improvement District Team.
i. Dr. Mucunguzi William- Ag DHO
ii. Babukika Anita- ADHO (MCH)
iii. Bwerere G.W.- District Health Educator
iv. Mwesige David- MRA/ DHO’s Office
v. Birungi Margie- Health Information Assistant/ Kyenjojo Hospital
vi. Mugabi Simon Peter- Bio-statistician
vii. Ruhweza Francis- District TB and Leprosy Supervisor.
viii. Kabajuma Felister- Office Attendant/ DHO’s Office
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ANNEX 3: Counter measures matrix
Staff not trained/
mentored
Lack of Data
Collection Tools Untimely reporting
of HMIS 108
Reporting
No tracking
system at all levels
No feedback on
Reporting to
Health Units
Procurement
of HMIS
Tools
- Training
- Supervision
Develop a
Tracking
System
Provide
Feedback
- Sms’ using mTRAC
saying “Thank You
for Reporting”
PROBLEM ROOT CAUSES COUNTER MEASURES PRACTICAL METHODS
Photocopying
Training of I/C’s & HIA’s
On Job Mentorships
Support supervision
Follow up from NMS
Ordering from NMS
Sms reminders (mTRAC)
Reporting trends
4 4 16 Y
5 4 20 Y
4 5 20 Y
4 4 16 Y
4 3 12 N
3 2 6 N
5 4 20 Y
4 4 16 Y
5 5 2
5
Y
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Annex 4 Work plan to improve HMIS reporting- Kyenjojo 2013.
ACTIVITY LOCATION TAR
GET
TIME FRAME INDICATORS MEANS OF
VERIFICATIO
N
RESP
ONSI
BLE
PERS
ON
COMMENTS
M A M J J A S
1. District feedback
meeting
District 1 No. of
participants
attending.
Report and
attendance lists
CQI
Fellow
s
Done in late
March 2013
2. Selection of CQI
team
District 8 No. CQI team
members active.
DHT Done in late
March 2013
3. Proposal presentation Kampala 1 Developed and
approved
proposal.
CQI
Fellow
s
4. Meeting DHT and
Incharges
District 40 No. of
participants
Report and
attendance lists
CQI
Fellow
19
attending. s
5. Training of health
workers on HMIS 108
District 30 No. of
participants
trained, No of
participants
reporting on
time.
Training reports CQI
Fellow
s
6. Provision of HMIS
tools
Health Units No. of health
facilities
receiving HMIS
tools.
Receipts CQI
Fellow
s
7. Development of
tracking checklist
District HMIS 108
monitoring tool
in use.
CQI
Team
8. Bimonthly feedback
meetings
District No. of
participants
Minutes/ reports CQI
Fellow
20
attending. s
9. Quarterly review
meeting
District 1 No. of
participants
attending.
Minutes/ reports CQI
Fellow
s
10. Feedback using
mTRACsms'
District No. of sms' sent
using mTRAC.
Bio-
statistic
ian
21
Annex 6
KYENJOJO DISTRICT HEALTH FACILITY REPORTING CHECKLIST (FY 2013/2014)
HEALTH UNIT NAME:………………………………………………………… LEVEL……..
ROUTINE REPORT
DATE SUBMITTED TO THE DISTRICT (Fill in for the different reports & Respective Month)
AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN JUL
HMIS 009a
HMIS 105
HMIS 108
HMIS 106a
ARV'S/PMTCT Orders
Reports Not Submitted to the HSD/District:………………………………………………………………………………………..
Reason for Not Submitting:………………………………………………………………………………………………………….
Verified by Incharge/ Name:………………………..……………………………Date:………………..Sign:………………………
Delivered to HSD/District By:………………………………………………..…..Date:………...…..Sign:…………………………..
Received at HSD/District By:…………………………………………………….Date:………….….Sign:…………………………
Note: Timeliness for Reporting to HSD/District is by 7th of the following month except HMIS 106a which is by 14th of the following month.
22
Annex 7
KYENJOJO DISTRICT HMIS 108 REPORT TRACKING CHECKLIST.
S/N HEALTH UNIT BY
MONTH
REPORT SUBMITTED ON TIME – Y for Yes/N for No
i.e. (7th
of Following Month 2013/2014)
Aug. Sept Oct. Nov. Dec. Jan Feb. Mar. Apr.
1 Kyenjojo Hospital
2 Butiiti HCIII
3 St. Adolf HCII
4 Villa Maria-Kaihura HCII
5 Nyakarongo HCII
6 Mbale HCII
7 Kigarale HCII
8 Butunduzi HCIII
9 Rwibaale HCII
10 Kisojo HCIII
11 Rwaitengya HCII
12 Kyankaramata HCII
13 St. Edwards HCII
14 McFarland MC
15 Katooke HCIII
16 Myeri HCII
17 Bufunjo HCIII
18 MukamaAsiimweCl
19 Midas Torch Clinic
20 Kyarusozi KCIV
21 Kyembogo Holy Cross
22 Mwenge Clinic HCIII
23 Kigoyera HCII
24 Nyamabuga HCIII
25 Kyakatara HCIII
26 Nyankwanzi HCIII
27 St. Martins-Mabiira
28 Kagorogoro SDA HCII
29 Mabale Clinic HCII
30 Katooke Clinic Centre
23
Annex 8:
A CQI Fellow Discussing during a Review Meeting
24
Annex 9:
MAKERERE SCHOOL OF PUBLIC HEALTH CDC FELLOWSHIP SUPERVISORS WITH
MEDIUM TERM CQI FELLOWS AND DHT AT KYENJOJO
DISTRICT
Supervisors Visit
25
Annex 9
2 Review Meetings with (76)-DHT, Incharges of HU’s, Medical
Records Assistants were held, shared Best Practices and Challenges