1. Data Collection/Cleaning/Quality Processes MISAU Experience in Mozambique
September 2017

2. Background
Ensuring that quality data is collected and reported to the Ministry of Health (MOH) is a priority in Mozambique, as it is the foundation for quality health services.
Following the foundation of the MoH - HIS National Strategic Plan and the National Acceleration Plan for HIV/AIDS 2013 – 2017, the MoH in colaboration with partners developed National Health DQA Strategy.
7 indicators were selected as part of the national HIV DQA strategy
In 2017 the MOH proposed to add 7 indicator as part of Integrated DQA which include other non HIV program.
Each DQA had a quantitative and a system assessment component.
The quantitative component includes tracing and verification of reported data where recounted data reported and compared at three levels:
Health Facility (HF),
District, and province.
All DQAs were conducted using the same methodology, making the results comparable.

3. Strategic Approach 1
Promote the alignment of existing reporting systems DHIS2/SIS-MA 2
Create a sustainable Data Quality Assessment System that is affordable, accepted, owned and scalable by the MoH 3
Prioritize the inclusion of MoH staff in all steps of the development, piloting and implementation of the DQA strategy

4. Process
Definition and approval of program areas for DQA methodology and strategy.
Priority indicators per program (malaria, TB, HIV, and MCH) were identified for inclusion in the DQA activity.
Relevant programs at the MOH fully participated in developing the indicators and definition of SOP ready and approved by MOH
As part of institutionalizing the DQA activity within the MOH, specifically within the HIV program and the National Directorate for Planning and Cooperation (DPC), both departments assigned 21 people to participate in the first round of Integrated DQAs from MoH’s side;
MOH staff lead all DQAs. The partner provided support, orientation and clarifications when needed. MOH staff conducted all presentations during the training and debriefs at health facility and provincial levels.
Summary of activities and achievements

5. Indicators assessed under the Integrated DQA (first year ongoing pilot)
Sub Program Area
Indicator name
TUBERCULOSIS
Number of patients with TB/HIV who are on ART treatment
Number of TB patients cured + completed treatment
MALARIA
Number of malaria cases (confirmed and unconfirmed)
Number of patients treated with first-line medicines following national norms
MATERNAL AND CHILD HEALTH
Number of women with 4 or more pre-natal consultations
Number of stillbirths with positive vital signs upon arrival at the delivery ward
HIV
Number of patients in care and treatment with treatment adherence follow-up session

6. Indicators assessed under HIV Program (4th round of implementation since 2014 - 2017)
Sub Program Area
Indicator name
ART
Number of patients currently on ART (TX_CURR)
Retention in treatment at 12 months*
MCH
Prevalence of HIV at ANC setting*
Number of HIV+ pregnant women that received prophylaxis at ANC, to reduce mother to child transmission
Number of exposed children tested for PCR (EID) <2 months old
HTC
Number of patients counselled, tested for HIV and receiving the test results at VCT setting
VMMC
Number of men circumcised as part of the package for HIV prevention
* Replaced indicators in 2017 due relevant for program

7. Clinical Data Quality Results

8. Districts conducted eDQA for HIV Indicators in 2016
Site selection follow the criteria:
Each year 5 sites per Provinces need to be assessed based on TX_CURR site volume:
3 High volume sites with TX_CURR > patients;
2 Medium volume sites with TX_CURR patients;
1 Low volume sites with TX_CURR < 500 patients.

9. Site level deviation distribution of TX_CURR since 2014 – 2016 tend to increase in sites with < 10 percent deviation

10. The overall national deviation of the “patients active in ART” indicator has decreased from 37% to 22% over the three-year period

11. Number of HIV+ pregnant women that received prophylaxis at ANC, to reduce mother to child transmission.

12. Number of exposed children tested for PCR <2 months old

13. Health Facility selected and implemented Pilot Integrated DQA to date

14. Challenges:
DQA
Change in indicator disaggregation and reporting requirements;
Need to have BUDGET to support these activities
Human Resources with capacity to continue the activities upon partner transfer the capacity building to MOH
DHIS 2
General technical challenges related to internet connectivity, bandwidth.
Change in indicator reporting requirements (disaggregation).
Data cleaning process guidance

15. Recommendation to be follow up at all level
Elaboret and implement action plan to improve da data quality
Ensure the availability of register tools
Elaborate in-service training plan based on gap and provide training related with register, data collection, aggregation, data quality review check and validation process and data discussion before the submission;
Conduct site and district supervision for technical support to ensure that the Indicator reference guidance;
Regular monitoring of data entry process in the DHIS2 / SIS-MA;
Monitor the data cleaning process from primary source up to subsequent level
Revise the upcoming Indicator from MoH and Parners to anticipate how will this afect the changes in DHIS2 / SIS-MA

16. Thank you kanimambo Obrigado