Tonny Odong - STAR-EC, Uganda

Strengthening TB and HIV&AIDSResponses in East Central Uganda

From data to action: Using Service Performance Assessment and Improvement (SPAI) process to promote utilization of HIV

& AIDS data generated through Lot Quality Assurance Sampling (LQAS) survey .

Experiences from East central Uganda

Presentation to the Capacity Building Summit,

Birchwood Conference Center,Johannesburg, South Africa.

21st March 2013

Authors:Odong Tonny, Denis [email protected]


A five years (2009-2014) program funded by USG through USAID

Implemented by JSI Research & Training Institute Inc.(JSI) in collaboration with Ministry of Health-Uganda

Serves about 9% of the country’s population (Approx. 3.1m people)

Works through district based structures and Civil Society Organizations (CSOs)

Operates in 9 Districts of East Central Uganda

Background to STAR- EC

The 9 districts served:Bugiri, Buyende, Namutumba, Namayingo, Mayuge, Iganga, Luuka, Kamuli & Kaliro

Program goal: To increase access to, coverage of, and utilization of quality and comprehensive HIV&AIDS and TB prevention, care and treatment services


Description of context Many community based HIV & AIDS and TB programs / projects often gathers a lot of data

These data are generated from multiple sources such as; - Routine disease surveillance - Health facility records - Surveys Annually, STAR – EC conducts survey using Lot Quality Assurance Sampling ( LQAS) technique

The first survey focusing on TB and HIV & AIDS indicators was conducted in 2009 and this generated a lot of data

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Description of context .

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However, most lay program implementers have limited capacity to make meaning out of the available data

Thus the use of data to influence key decisions is severely affected

In 2010, Management Sciences for Health (MSH) / STAR- E LQAS project introduced SPAI process in East Central Uganda as a technique to promote data utilization

STAR – EC applied this technique on 2010 LQAS survey results

Methodology


Key steps undertaken in SPAI process

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District based program implementers ( who formed SPAI team) were convened for 5 days residential workshop.

The list of all indicators that were investigated during 2010 LQAS survey was provided to the team

The team thoroughly reviewed the indicators and identified those that were poorly performed as well as the sub- counties affected

The affected indicators and sub- counties were later prioritized for performance improvement


Key steps cont…..

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Example of how indicators and sub- counties were prioritized

Priority sub- counties for intervention

Indicator Target Of all sub counties surveyed, Sub- counties scoring below target

1.Proportion of men who know a mother can transmit HIV to her infant during pregnancy

59% Bunya A, B and E

2. % of adults (15years and above) who have ever taken an HIV test

57% Bunya B and C

3. % of adults (15 + years ) who know a place where to get ARVs for HIV patients ( Bunya B and E

57%Bunya A, B and E


Key steps cont….

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The team later conducted constraint analysis by discussing the factors leading to poor uptake of HIV Testing and Counseling (HTC) services in the affected sub counties

The next step involved target and objective setting of the desired health situation that the district needs to achieve ( e.g. achieve 70% population tested for HIV)

Next, the team developed Performance Improvement ( PI) strategy by looking at critical activities and means to deliver them. E.g. training of health workers, creation of more out reaches for HTC services, effective mobilization for HTC services, supplies- timely requisition of HIV test kits, better records management, infrastructural development etc.

Lastly, the team developed performance improvement and monitoring plans


An extract of PI plan generated during SPAI process

Start Date

End Date

Training in HCT

1.1 Identification & training of trainers

1.2 Identification & invitation of Facilitators of the TOT1.3 Identification & invitation of trainee participants

1.4 Identification & hire of venue

1.5 Training of health workers in HCT

Training of health workers in comprehensive HIV/AIDS care

1.1 Identification & training of trainers

1.2 Identification & invitation of Facilitators of the TOT1.3 Identification & invitation of trainee participants

1.4 Identification & hire of venue

1.5 Training of health workers in HCT

1.Training

Time Frame

Dr. Muwanguzi

4 training sessions of 30 participants completed

2 trainings of 30 participants each

undertaken

One Vehicle,

Fuel , Venue,

Facilitators,

Stationery,Perdiem,fuel,Vehicle,

Venue,

STAR-EC, MOH, SDS

24th

January 2011

8th April 2011

11th

April 2011

13th May 2011

Strategy Element

for PI

PI Activities Planned Products

Responsible Perso

n

Critical PI

Resources Requirem

ents

Source of Critical

Resources


Results

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STAR-EC LQAS results: 2010-2012


Challenges

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SPAI process requires trained facilitators to guide the lay program implementers

SPAI can best be conducted in a workshop setting thus need for funds to run the workshop

Activities and strategies proposed needs to be implemented using the available resources in the district but program implementers tend to think of external funding


SPAI is a good approach that; - Enable lay program implementers to discuss and analyze data - Identify health service gaps & set priorities - Come up with action plans to address the gaps - Promotes service uptake through data utilization

Collaboration between implementing partners is critical to introduce good practices in HIV intervention

Lessons Learned

Conclusion Data generated through LQAS surveys and other means are relevant

only if the data can be used to effect change.

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Acknowledgement

Government of Uganda (GoU) USAID JSI / STAR- EC MSH/STAR- E LQAS EC district SPAI teams & Program implementers

Health & Medicine

Tonny Odong - STAR-EC, Uganda