1. Research & Evaluation Improving measurement for improvement
Thursday, 6 April 2016
Primary Health Care Improvement Global Stakeholders Meeting
Geneva, Switzerland
Rhea Bright, MPH
Quality Improvement & HRH Advisor
Office of Health Systems
Bureau for Global Health
USAID

2. At what scale are we working in Research and Evaluation?
Multi-country: 4
Ukraine: 1
Ecuador: 1
Uganda: 8
Burundi: 2
Kenya: 1
Tanzania: 3
Malawi: 2
South Africa: 1
Swaziland: 3 20
India: 3
Mali: 3
Cote d’Ivoire: 1
Dem. Rep. Congo: 2 6

3. R&E: What are we trying to accomplish?
Activity
Scale
1. Validation of 25% of improvement indicators
No less than 25% of total number of country reported indicators with completed validity assessment
2. Collecting data from control groups for 10% of indicators
Comparison reports on no less than 10% of country-reported indicators
3. Evaluating design of improvement activities for lower- and middle-income countries
Every ASSIST country program
4. Evaluation of methods and approaches for effective design and implementation of scale-up
Selected ASSIST country programs with scale up activities

4. Teams independently monitor indicators

5. Indicator Validation: Tanzania
Methods
Retrospective, cross-sectional, cohort assessment was conducted in August 2015
3 facilities in Morogoro Urban District
Data collected from patient record and facility registers to determine consistency, accuracy, and completeness of patient- and facility-level data
Conducted interviews with staff who manage data

6. Findings: Facility data likely to be inaccurate
Indicator Validation: Tanzania
Findings: Facility data likely to be inaccurate
Inconsistencies transferring patient data from care and treatment cards to facility registers
High proportion of incomplete care and treatment cards
Not enough data in patient files and records to report on some indicators

7. Recommendations to improve clinical effectiveness, data validity, and quality improvement processes at health facilities:
Expand use of Open Medical Records System (OpenMRS) software (used at Regional Hospital)
Train health workers to consistently and regularly update care and treatment cards and medical records
Standardize symbols and abbreviations used by clinicians when entering patient data into the medical records, and denoting missing data

8. Recommendations
Improve training for data clerks on national databases, search criteria and queries
Expand health workers’ understanding of capabilities of database to perform searches and determine medication effectiveness
Improve storage and security of files/records to facilitate rapid retrieval