Overview of system for immunization reporting and analysis CAMEROON By: Mariette DIA Head of Unit responsible for validation and data management CTG-EPI

Outline 1- Context 2- National Health Information System actors 3- Organogram of the EPI in Cameroon 4- Tools for reporting and analysis of immunization data 5- National Health Informations System procédures 6- National system of data transmission and feed-back information 7- Strengths & weaknesses 8- Challenges and perspectives 9- Conclusion

Context Population totale 2013 : 20 896 469 Border with Nigeria to west, Chad and CAR to East, Equatorial Guinea, Gabon, Congo to south Population 2014: 21 418 881 (census 2005) Superficie: 475 650 Km2; 2 official languages (french and english) Climate: Equatorial and Tropical; 4 ecological areas: coastal (LT, SU, SW); sub-saharan (AD, NO, FN); forest (CE, SU, ES); highlands(WE, NW); 10 administrative and Health regions; 189 Health districts; 1 707 Health areas;

National Health Information System actors (1/3) They are found at all levels of the pyramid: Central Level: Health Informations Unit National Observatory of Public Health Department of family health Technical Departments Central Technical Groups of Programs (eg: CTG-EPI, CTC- NC/AIDS, …) General Hospitals / Central Hospitals

National Health Information System actors (2/3) Intermediate Level: Regional Delegations of Public Health Service of Planning and Health Information Regional Unit (EPI, Malaria,…) Technical services Regional Hospitals

National Health Information System actors (3/3)  Operational Level: Health Districts Districts Hospitals 1st and 2nd class Health Facilities (CMA, IHC (Integrated Health Centers), Private Health Centers, Clinics…) Community Level: Community Relay Workers

Organogram of the EPI Programme in Cameroon Execution’s level Regional Unit-EPI Health District Health Area Regional Delegation for Public Health District Team Area Team Decision’s level Interagency Coordinating Committee Central level intermediate level Central Technical Group-EPI Operationnal level

National Health Information System tools

National Health Information System tools (1/2) There are several tools Collection Tools: Health Facilities Registers. They provide primary data collection and are the source of data verification for the sake of quality assurance. Harmonized registers exist for different services and domains. (e.g.: vaccination, outpatient, hospitalizations, ANC, Laboratories, mother CPON, CPON Child, medical imaging...)

National Health Information System tools (2/2) Transmissions Tools: Reports and Monthly Activities Sheets MAR (Monthly Activities Report) from Health Facilities, The monthly data sheet from programs; The weekly Summary Report of DEP (Diseases with Epidemic Potential); Analysis Tools: data Synthesis/Analysis software for every levels.

Tools for reporting and analysis of immunization data

Tools for collecting, reporting and analysis of immunization data LEVEL OBSERVATIONS TOOLS FOR COLLECTING OF IMMUNIZATION DATA Tally sheet Health facility used to count the number of persons vaccinated Vaccination registers used to record information about persons vaccinated TOOLS FOR REPORTING OF IMMUNIZATION DATA Monthly report for activities Health facility, health area, health district used to transmit data to the next level

Tools for collecting, reporting and analysis of immunization data LEVEL OBSERVATIONS TOOLS FOR ANALYSIS OF IMMUNIZATION DATA Monthly monitoring curves Health Facility, Health Area, Health District used for monthly monitoring of vaccination coverage at all levels Defaulter register Health Facility used to search children defaulter District Vaccine Data Management Tool (DVDMT) Health District, Regional and Central level To analyse data from Health facilities and Health Districts Routine Immunization (RIM) Central level Epi Info application for encoding and analysis of immunization data Data review template Review data monthly Data Quality Self assessment (DQS) to ensure there is no under or over-estimate data from operational level

Reporting and analysis tools for immunization data : DVDMT Version 2013,

Reporting and analysis tools for immunization data : DVDMT to collect data from Health areas by the district

Reporting and analysis tools for immunization data : DVDMT to analyse data from Health areas by the district

Reporting and analysis tools for immunization data : RIM to collect and analyse data from Health districts by central level

National Health Information System procédures

National Health Information System procédures (1/2) At the operational level: Health Facilities To collect health information and fill transmission forms (MAR, weekly reporting, ...); To transmit no later than the 5th of the month to Health District the monthly activity report; To archive physical reports submitted to Health District Health District To collect, analyze and use health information of health facilities, enter data received from health facilities in the existing application program (DVDMT for EPI); To forward to the RDPH, synthesis of data received from health facilities no later than the 10 of the month for EPI; To transmit to Health Facilities the synthesis of District’s statistics (feedback); To archive received and transmitted report

National Health Information System procédures (2/2) Regional Level Regional Unit of Programs: do the monthly District’s data summary and transmit to the Planning and Health Information Service, and to the CTG of programs ; Central Technical Groups To make a monthly summary of data from the regions and transmission to the Health Information Unit; To contribute to the production of annual report; Health information unit and National Observatory of Public Health) To participate in the publication of health data; To transmit validated data to partners

National system of data transmission and feed-back information HA HD Region Report HF Tally sheet Report District Report (compilation) district District report Compilation (region) NHIS NOPH Central level - Vaccination register - monitoring curves Partners -WHO -UNICEF -AMP RIM (CTG-EPI) Transmission Feed-back

Strengths & weaknesses in the use of RIM data from several years (2009-2014) are in the same .mdb file allows for comparative analysis of several years generate analysis as cumulative monthly and covers Weaknesses Data are agregated: vaccine acts are not presented by strategy (outreach, mobile and fixed) and Sex; Vaccine management data are not included; used only at the central level Some analysis produce wrong results; The new vaccines are not taken into account,

Strengths & weaknesses in the use of DVDMT used by all regions for the analysis of district data immunization data analysis with indicators of the RED Logistic data analysis with global and specific wastage rates; Weaknesses Data are agregated: vaccine acts are not presented by strategy (advanced, mobile and fixed) and gender This version is heavy and require high performance equipment; District team are not trained; used in less than 50% of the district, Incomplete filling

Strengths & weaknesses of National Health Information System Phone fleet for the transmission of data in real time; Internet connection in the RDPH existence of procedures for the collection and transmission of data Weaknesses insufficient staff in the districts and health facilities; insufficient computer equipment and poorly maintained; inadequacy of supervision by the higher level

Challenges and perspectives To ensure a maintenance system of computers at all levels. Deploy the RIM tool at the regional level To monitore immunization activities using a dashboard in all districts Elaborate a plan to improve data quality by 2015 Perspectives To shift from DVDMT version 2013 to version 2009 in all district of the country; To organize a training on DVDMT and dashboard; Expansion of internet connection in Health Districts; to use DQS for all supervisions

CONCLUSION "It is not because countries are poor that they cannot afford good health information system. It is precisely because they are poor that they cannot afford to do without. "

Thanks for your Kind Attention