1. Use of SOC data by ICAP-Ethiopia for quality improvement Tsigereda Gadisa MD,MPH M&E Director, ICAP-Ethiopia July, 2010

2. Using data for program improvement Three key interlinked factors affecting data use 1.Effective Reports compilation; relevance, validity, completeness, timeliness, simplicity & big picture demonstration 2.Skilled Managers; result oriented, curios and good data use aptitude and committed in building result orient management culture 3.Organizational culture for evidence based learning and improvement; setting simple but informative performance measures & creating regular forum to follow though the results

3. Effective Reports compilation Relevant to person in charge for the program Focuses attention on outcomes/result Use the best measures –Multi pronged, informative, understandable, valid, reliable Presented in easy to use format –Simple to interpret Provide the big picture of performance –tells the story Informs program improvement –Enables more detailed analysis making hypothesis testing possible

4. Manager Skills Creating a Results Oriented Culture Use Data routinely; Start slow; be non-judgmental Lead Program improvement efforts ; follow-through & support the team Involve all concerned ; Arrange mentoring, invite staff to be experts, ask input from beneficiaries Take responsibility; no blaming; focus on what can be done Stimulate positive action; encourage innovation Encourage learning; review & learn from success & failure Reward and reinforce; use rewards & recognition timely

5. Results Oriented Culture R eward and recognize E ncourage learning S eek involvement U se data routinely L ead improvement efforts T ake responsibility S timulate positive action

6. Site Start-up Assess and improve implementation Site support team Onsite team Assess and improve quality Assess and Build Capacity Site Independence Goal 1: Implement a chronic care model of HIV care and treatment (comprehensive, family focused) Goal 2: Build capacity to promote program sustainability and independence ICAP Standards of Care

7. Define standards of care (SOCs) and measures of quality Measure Standards of Care Identify Problems Prioritize problem areas Design and implement intervention SOC Data use for quality improvement Cycle

8. SOC Indicator setting and data compilation in ICAP Ethiopia With the TA from ICAP NY clinical team ICAP-E clinical Service department adopted the Care and treatment (adult and Ped); PMTCT, and TB HIV SOC Indicators were modified to our context Manual data collection instrument and SOP drafted The instruments were pilot tested in one regional office for feasibility and user friendliness

9. Lesson learned during pilot testing the SOC instrument –The process was cumbersome and time consuming; it required Manual tally and compile the tally Entering the compiled data in to excel sheet Make the calculation for each indicator Compile the report and Provide feed back to site provider by next visit

10. Action taken to make the instrument user friendly and provide immediate feed back –Clinical service and M&E department discussed to automate SOC data collection instrument –SOC database developed for the five SOC instrument in use (adult C&T, Ped C&T, HEI, PMTCT and TB HIV)

11. Major objectives of SOC database Reduce work load on the site support team in data compilation Facilitate the data capturing and analysis –No manual tallying Facilitate instant feedback to the site staff on strength and areas for improvement Facilitate easily follow up of action points

12. Standard of Care Database ( SOC DB )

13. Measure Standards of Care Routine Report Data quality SOC SOC Data use for quality improvement matrix PMTCTC &THCT TB/HIV Simple count Gross performance More closer look in to Service quality Ask why? More closer look in to data quality Ask why? Common Data Source for SOC, Data Quality Assessment & Routine report

14. ARV Prophylaxis, at ANC PMTCT SOC VS routine report at Selected ICAP-Ethiopia supported sites; Dec-9 toApril-10

15. Summary follow –Up PSOC assessment as compared to the baseline for HIV infected children in 8 ICAP supported Hospitals Site Proportion of HIV+ children with accurately plotted growth measurements Proportion of HIV+ children accurately documented neurodevelopment assessment in past 6 months Proportion of HIV+- children who have CD4 done in the past 6 months Proportion of HIV+ children who have had 2 clinical encounters in the past 6 months Proportion of HIV+ children eligible for who are on HAART based on CD4 and/or clinical criteria Proportion of HIV+ children on HAART with appropriate ARV dose prescribed BaselineFollow-up Baselin e Follow-up Baselin e Follow-upBaselineFollow-upBaselineFollow-up Baselin e Follow-up Dilchora 95100701007067100 951000 Hiwot fana 296901005769100 5069 Chiro 405407560751008210094013 Karamara 238301007250100 067 Jugol 02589 100 225089100 88 Ambo 85429 68 64711007610093815 Fitche 12800 97 78 1009284 093 Metehara 202743 60 825010087100 23100

16. TB Screening among newly enrolled in care, Ginbot,01 (May-09) and Ginbot,02 (May-10)

17. Added advantage of SOC data as measure of quality of Services Provide an in-depth look in to a program by looking in two the practice (not aggregate) Facilitate live discussion between the site support team and site level providers on the identified success or problem areas & draw action points Guide the site support team to prioritize and focus areas for intense mentoring

18. Added advantage of SOC data as measure of quality of Services Captures key quality indicators not included in routine report (eg. Follow up CD4 for Pre- ART Pt; Compliment CQI effort by breaching the gap created due to timing of routine report compilation (ARV prophylaxis at ANC)

19. Future Direction Expand the SOC assessment to capture soft but important quality indicators in all technical areas we support and automate them Fully integrate the priory SOCs as part of routine SOC Enhanced use of SOC data for CQI Build the capacity of site providers to complete, interpret and act on SOC data

20. Thank You † Amesegnalehu