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 (1 st and second cohort Hospitals) –Number of patients under care (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 Records Eg Hiwot Fana Hospital Assisted sites to move from unstructured to structured data capturing

Improving Paper Based Medical Record Keeping

Data use for Continuous Service & Program Improvement at Point of Generation M & E, Training, Data abstraction, Report compilation M & E, Data use and data analysis Training and Mentorship, DQA & Feedback M&E STAFFING: June 2010 = 13 Addis office M&E Director 4 M&E Officers 2 DB Managers 1 Program Evaluation Officer Eastern 2Regional M&E Officers (40 facilities) South-West 1Regional M&E Officer (11 facilities) Southern 1Regional M&E Officer (09 facilities) Dil Chora H. Hiwot Fana H. Bisidimo H. Chiro H. Karamara H. Misrak. Arb. H. Aira Gimbi Jimma H. Nekempt H. Metu Karl H. Dembi Dolo H. Abomsa Assela H. Goba H. Hageremariam Negelle 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

Follow up card completeness trends, ART clinic Bishoftu Hospital;

Regional Level Data Use Supported the development & rollout of Facility based ART Monitoring System  Based 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 action  Facilitate timely feed back during supervisors  Evidence based planning  Acknowledging 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)

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

Comparison of site Pediatrics IPD PICHT performing 3 rd and 4 th quarter; COP 09 Remark: 8 sites reported % PIPD testing rate; 1CRO,1 ERO, 4 SRO & 2 SW sites. RO Name of facility % Tested 3 rd Q % Tested 4 th Q Possible reason Recomm endation CRO Adama454/621 (73%) 457/490 (93%) ERO Hiwot Fana202/202 (98%) 147/197 (91%) SRO Abomsa39/60 (65%)48/57(84%) Goba153/176 (87%) 112/119(94%) Bullehura211/232 (91%) 149/198(75%) Negelle129/145 (89%) 72/93(77%) SW Gimbi120/133 (90%) 208/252(83%) Jimma497/507(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