1. 1 Strengthening PMTCT Data Reporting and Use through Supportive Supervision and Routine Performance Evaluation: Experiences from Dedza and Ntcheu Districts, Malawi A.Yemaneberhan, Sue Willard, P. Mbetu, C. Chitsulo, S. Nyirenda, M. Phiri, M. Gordon, F. Chimbwandira, M. Eliya Abstract Number : WEAE701 Date: December 7, 2011; Time: 14:00-15:00; B1:Awash

2. Background Malawi data, as of June 2011: – population of 13 million; HIV prevalence 10% – 750 health facilities: 560 PMTCT, 370 ART and 1000 HTC sites – 95% of pregnant women engage in ANC at least once – Uptake of HTC in ANC is 76% – 40% coverage of ARV prophylaxis – 18% coverage of maternal ART for treatment – 32% Infant ARV uptake Current EGPAF-supported districts New districts to be supported by EGPAF in FY10

3. EGPAF Program in Malawi Background: EGPAF began PMTCT support in Malawi in 2001 through partner organizations and, in 2008, opened an office upon MOH request to scale-up PMTCT Work closely with the national technical working group in development of guidelines, training manuals, and zonal mentorship program Expanded PMTCT technical assistance program to additional districts: currently 97 sites receive technical assistance from EGPAF The EGPAF program focuses its efforts on: – Improving access to comprehensive PMTCT and pediatric HIV care services – Building facility and staff capacity for PMTCT, through training, mentorship, supportive supervision and performance review – Increasing efficacy of programs through collaboration with MOH and implementing partners – Strengthening M&E systems, including data quality – Increasing access to psychosocial support of HIV-positive children – Building capacity of CBOs to manage community-level PMTCT projects

4. Issues EGPAF was requested by the MOH to strengthen PMTCT services in Dedza and Ntcheu Districts. A baseline assessment was conducted in August 2009 in 50 sites in the two districts. One area of weakness revealed was inconsistency in data collection, reporting, and use: - many sites were not reporting data, such as HIV counseling and testing and maternal ARV uptake (e.g., only 29 out of 50 sites provided data to the MOH) - 21 of the 50 sites were reporting incomplete data - All sites were not effectively using data for program evaluation and enhancement.

5. Description EGPAF began conducting quarterly supportive supervision visits to all 50 sites in October 2009 using a revised national MOH supervision checklist with the objectives of identifying and addressing weaknesses in clinical service provision, data recording, reporting, and data use. During these visits, EGPAF, in close collaboration with district PMTCT coordinators and site level staff, reviewed site-level data to ensure the quality of data, assess and support report compilation, identify areas of weaknesses and develop improvement plan EGPAF also provided a training to health care providers on proper data collection processes and reporting.

6. Description Cont’d Each supportive supervision visit was followed by a “ Feedback review meetings” where EGPAF technical team, MOH staff, district health management teams, program coordinators and service providers were actively involved in collectively reviewing site and district level performance using their data. Improvement plans were re- designed by the sites’ health-care providers under the leadership of district health management team and MOH to address issues uncovered in the baseline assessment and during the supportive supervision. EGPAF continued working in close collaboration with district coordinators to further strengthen data collection processes and data use for performance assessment.

7. Lessons Learned Currently all 50 sites are reporting quality and complete data in a timely manner to the MOH on a quarterly basis. Improvements in data use have been noted in most areas. There is improved ownership of data, commitment for data collection and reporting among district health teams. Service providers are motivated to share lessons and discover effective ways of collecting and analyzing their data. Feedback review meetings that follow supportive supervision visits have assisted service providers in evaluating their site performance in comparison with other nearby sites. Service providers coming from poor performing sites were given a chance to learn from other providers on how to improve services and service providers from high performing sites are acknowledged and encouraged to share their experiences.

8. Next Steps There is a need to continue supporting the health facilities in the collection of accurate data, timely reporting, and data use. This experience should be shared with other partners to scale-up this promising initiative in the country. In addition to increasing human resources for data recording and reporting, electronic data systems should be scaled up. National data quality control system should be established to assist in improving quality data and data use

9. 9 THANK YOU TATOKOSA