1. EXTERNAL DQA METHODOLOGY AND IMPLEMENTATION ​ Mozambique Strategic Information Project (MSIP) ​ JSI Research & Training Institute, Inc. (JSI) in collaboration with UCSF, I-Tech Prepared by: Dália Traça November 4, 2015

2. Assessing the quality of reported data Use results to inform quality improvement Build capacity of national health information systems Objectives of the eDQA strategy

3. Strategic Approach Create a sustainable Data Quality Assessment system that is affordable, accepted, owned and scalable by the MoH Prioritize the inclusion of MoH staff in all steps of the development, piloting and Implementation of the eDQA strategy Promote the alignment of the existing reporting systems (PEPFAR and SIS—MA/Módulo Basico)

4. DQA Objectives To assess the quality of data registered in primary sources and data reported to the upper levels, verifying the following sources: – Daily registers vs. Monthly reports (Health Facility), – National Database “Módulo Básico” (District/NED), – “Módulo Básico” (Province/NEP), – “Módulo Básico” (Central level) To assess the data management and reporting systems at the HF and NEDs level.

5. Assessed Indicators AreaIndicator Abbre- viation Treatment and Care Number of HIV+ positive individuals active on ARTTARV Number of HIV + individuals who are eligible for Cotrimoxazole (CTX) and receive CTX CTX Prevention of Mother to Child Transmission Number of HIV+ pregnant women who received medication/prophylaxis ARV to reduce the risk of mother to child transmission during prenatal consult CPN Number of HIV+ pregnant women who received medication/prophylaxis ARV to reduce the risk of mother to child transmission during labor and delivery MAT Number of children exposed to HIV who received a PCR test at <8 weeks PCR Counseling and Testing Number of people who were tested for HIV and received their results in a clinical environment UATS Voluntary Medical Male Circumcision Number of men circumcised as part of the voluntary package of male circumcision for HIV prevention CM

6. Overall DQA Implementation Methodology 1.Calendar of DQA implementation with MoH (including site selection) 2.MoH informs Provinces Health Department (DPS) of DQA implementation dates and facilities 3.DPS informs District Health Directorates (DDS) and Health Facility (HF) of DQA implementation and dates 4.Training of MoH central staff (prior to departure to provinces) 5.Training for DPS and Implementing Partner (IP) staff at province 6.DQA implementation (with debrief at HF level) 7.DQA debrief at province level for DPS and IP 8.National debrief at MoH central

7. 7 ART Indicator Random selection of 30 active patients on ART Confirmation of patient status, within the revision period, based on: Drug pick-up date in the Pharmacy Register Book and Individual Drug Prick-up form (FILA) Last medical consultation, based on individual patient file CTX Indicator Random selection of 30 active patients eligible for CTX Confirmation of reception of CTX for eligible patients using individual patient files ANC, MAT, PCR CT & VMMC Indicators Comparison of recounts from source documents with reported data at the various levels Methodology for data collection

8. TARV CTX CPN, MAT, PCR, UATS e CM Data Analysis – Calculation of the deviation Deviation: 20% Poor Quality Data

9. DQA RESULTS Round 2014

10. Indicator ART

11. Participatory Approach to DQA activity Lessons Learned

12. DQA Lessons Learned (1) Lessons LearnedImpact Participatory development of SOP for each indicator Clear understanding of the indicator and data to be collected Involvement of MoH from project inception Strong ownership of activities and DQA results Understanding the logistical and time challenges of the Mozambican context Compliance with DQA planned activities and timeline Conducting of DQA training before field implementation All the DQA participants – MoH staff, DPS staff have theoretical knowledge of the DQA process before field implementation Determining the role of each DQA participant Efficient use of time during HF visits

13. DQA Lessons Learned (2) Lessons LearnedImpact Active participation of MoH staff during DQA training Ownership by the MoH of DQA activity Presentation and introduction of DQA team by DPS focal point at HF/District level Ownership of DQA activity by DPS and giving the face of MoH/DPS Capacity building of HF staff and promotion of Quality Improvement of HF data during DQA Improved capacity among HF staff on data registering and aggregation Leaving written preliminary observations at HF after DQA visit HF management uses preliminary observations to address challenges Presentation of Provincial DQA results to the DPS at the end of each DQA activity Endorsement of DQA results by the DPS and focus on solutions for the identified challenges

14. On the right track? Cabo Delgado Province Comparison between round 2014 and round 2015

15. Comparison between Round 2014 and 2015

16. Quality Improvement during eDQA

17. Key Findings eDQA Preparatory phase: 1. Training with MoH central – training with central level MoH staff prior to departure to the DQA, to accompany the team in the field 2. Training with DPS – Training all DPS staff and IP on the DQA implementation

18. Key Findings (cont.) At Health Facility: During Data Collection  Clarification on the filling in of registers (missing data, misplaced data, etc)  Poorly kept registers  Counting clarification during recounting by eDQA team  Clarification of indicator definition and data collection During Debriefing (technical and management)  Highlight and discussion of specific HF strong and weak points observed during DQA activity  Leaving observations and recommendations in writing, including preliminary deviations for each indicator  Reinforce the importance of Data Use for better management.

19. Key Findings (cont.) Debrief at Province Level with DPS and IP: 1. Discussion of strong and weak points observed during DQA activity, highlighting more problematic indicators. 2. Clarification of calculated deviations per indicator 3. Leaving observations and recommendations in writing in the form of a detailed Power Point presentation

20. Conclusion Even though the DQA had a specific purpose, we realized that the participatory methodology used creates the possibility to introduce to Quality Improvement elements along the process, as well as capacity building and empowerment of the MoH staff to pursue better quality data, at all levels of the hierarchy. “You cannot do DQA without doing QI”

21. OBRIGADA! Dália Monteiro Traça Chief of Party MSIP Maputo, Mozambique dtraca@mz.jsi.com