Building Information Systems for Community Programs

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Presented by Mary Freyder, Edward Kunyanga and Molly Cannon at the MEASURE Evaluation End-of-Phase-III Event.

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Building Information Systems for Community Programs

  1. 1. Building Information Systems for Community Programs Mary Freyder
  2. 2. Community Programs  Definitions of community  Geography, identity  Setting, target, agent, resource  Clinical and non-clinical health services  Community actors – volunteers, civil society orgs, government agencies  Evidence-based impact – community development, non-clinical services
  3. 3. MEASURE Evaluation Contributions  M&E framework – Kenya  Needs assessments – Kenya, Mozambique, Mali  Case studies – Kenya, Tanzania, Zambia  System design and training – Ethiopia, Kenya  Data quality assessments– Tanzania, Rwanda
  4. 4. MEASURE Evaluation Contributions  Indicator development  Routine data quality assessment (RDQA) tool  mhealth technologies for data quality improvement  Child Status Index (CSI)  Priorities for Local AIDS Control Efforts (PLACE)  Survey tool for OVC programs
  5. 5. Lessons Learned  Community volunteers and CBOs are collecting and using data – Kenya dialogue days, local CBOs serving vulnerable children  Information systems often focus on reporting to higher levels – not useful or sustainable at the community level.  M&E tools are only useful when they fit the purpose – room for capacity building
  6. 6. Interventions for Empowering Communities-Strengthening the Community Health Information System (CHIS) in Kenya Edward Kunyanga MEASURE Evaluation End-of-Phase-III Event, May 22, 2014
  7. 7. Outline  Background  Overview of Community Health Strategy (CHS) in Kenya  Progress and outcomes in CHIS strengthening  Lessons Learned
  8. 8. Background  Community Health Strategy (CHS) rolled out in 2006 as part of the National Health Sector Strategic Plan (NHSSP II) 2005-2010  NHSSP II refocuses national efforts on health promotion of individuals and communities, formally recognizing tier 1 services  Tier 1 services are aimed at empowering communities and households to take charge of improving their health
  9. 9. Structure for Community Health Service Delivery
  10. 10. Community Health Committee (CHC)  Health activities taking place in the community unit (CU) are coordinated by the CHC:  Dialogue days: key health indicators are reviewedin orderto identify communityneedsto improvehealth and developactions  Actiondays: keyactions as determinedduring the dialogue days are implemented
  11. 11. Typical Monthly CU Dialogue Day  Improvingtheperformance(availability,access,qualityandutilization)ofCHISwill beagradualprocess(lowliteracylevelsofCHWs,volunteerism,sizeofthe coverage,stakeholderconsensusbuilding)  Utilizationofover80%ofthecollectedcommunitydatainCUsdialogueandaction dayshasimprovedhealthoutcomes
  12. 12. Objectives of CHIS Strengthening  To strengthen CHIS in providing quality data from tier 1 for use at both community level and within the formal health sector  Prepare CHIS for linkage with the unified system for national health information management (District Health Information System – DHIS2)
  13. 13. CHIS Strengthening
  14. 14. Examples of CHIS Indicators  # of deliveries by a skilled attendant  # of pregnant mothers who attend at least 4 ANC visits  # of children fully immunized  # of fever cases managed  # of case referred  # of births, # of deaths by age  # of diarrhea cases managed
  15. 15. Community Health Information System (CHIS) – Assessment  Case Study of the CHIS in 5 CUs conducted in April 2011  M&E capacity assessment of national CHS M&E unit conducted in June 2013  CHIS functionality assessment of 31 CUs conducted in July 2013
  16. 16. Findings  CHISrequirescoordinatedstrengtheningeffortsaround priorityareasin orderforittobea morecompleteand functional systemservingbothcommunityand national-level programmonitoring anddecisionmaking, asintended.(Case Study, 2011)  Capacity oftheM&E teamtoimplementCHIS requires supportwithineachofthe12 componentsofafunctional M&Esystemtoimprovethequality, technical, and financial autonomy in implementingCHIS (M&ECBAssessment,2013)
  17. 17. CHIS Functionality Assessment Key Finding: Only half of the CUs that were sampled were fully functional as per national guidelines. Issues include:  lack of infrastructure  training gaps among CU staff  poor reporting rates and data quality
  18. 18. Where Are We Now?  Monitoring the collectionanduseofquality datain8CUsthat havebeentargeted with apackageofinterventions todevelop themas“Centers ofExcellence” forCHIS  Currentreportingrates insupportedCUsreceiving apackage ofinterventions hasincreasedfrom69%inJune,2013to100% asofMarch2014  New data collectiontoolshavebeenrolled-outtobetterfacilitate thecollection, management, anduseofcommunityhealth data  TheCHISM&Eteamisimplementing acapacitybuilding action plan  AnmHealthplatformhasbeendeveloped toincreasethe collection ,quality, anduseofcommunityhealth data  Structuredlearning visits have beenorganizedtosharelessons andbestpractices inCHSprogramming.
  19. 19. Lessons Learned 1. System strengthening takes timeandlong-term commitment andresourcesinordertoensureboth successandsustainability 2. SuccessfulCHISstrengthening isreliant uponunderstanding localdataneeds 3. Continuousengagement with DCHSiscritical incoordinatinga countryownedprocessforsystem strengthening 4. Synergyamongallpartners isessential inordertoaddress allof theneeds forstrengthening CHIS 5. Using CHWstoanswerdonor,national, andsubnational questions abouthealth service delivery andoutcomesoften over-burdensstaff,andresults inmissing reportsandpoor quality data
  20. 20. Community Based Information Systems Through an OVC Lens Molly Cannon End-of-Project Event May 22, 2014
  21. 21. Volunteer CBO
  22. 22. Types of OVC Information Gathered Information Types Illustrative Tools Situation Analysis PEPFAR OVC program evaluation tools Targeting Nigeria’s Child Vulnerability Index, VAT, VI Information to support and monitor case management Child Status Index, Orphan Wellbeing Tool Parenting Map, Child Support Index, Household Assessment Monitoring Registration, Visitation/Service, Referral, Training forms Program Evaluation PEPFAR OVC program evaluation tools
  23. 23. MEASURE Evaluation Contributions  Global Leadership  National Systems  Assessments  Quantitative  Qualitative  Mixed Methods
  24. 24. MEASURE Evaluation Contributions  Global Leadership  National Systems  Assessments  Quantitative  Qualitative  Mixed Methods
  25. 25. MEASURE Evaluation Contributions  Global Leadership  National Systems  Assessments  Quantitative  Qualitative  Mixed Methods
  26. 26. MEASURE Evaluation Contributions  Global Leadership  National Systems  Assessments  Quantitative  Qualitative  Mixed Methods
  27. 27. OVC M&E Lessons Learned 1. Advances in OVC M&E systems 2. Data collection systems are organized for reporting purposes 3. Design of M&E systems effects data flow 4. Ensure tools are fit for purpose
  28. 28. 1. Advances in OVC M&E Systems  Strong M&E systems  Emphasis on data quality and availability  Use of information for decision making
  29. 29. OVC Tools Database Canned Reports Review Data Queries Framework for Decision Making
  30. 30. 2. Data Collection Systems Are Organized for Reporting Purposes
  31. 31. Consequences  Disconnect  Collecting information on every child at every encounter  Ethics  Burden  Data quality I’m sorry, didn’tyou already ask me about that last time you were here?
  32. 32. 3. Design Of M&E Systems Effects Data Flow Village 1 X40 Village 2 X40 SIGNATURES 80 forms per ward X 20 wards =1,600 forms WEO 1 CBO2 CBO3 CBO4 CBO5 CBO6 CBO7 CBO8 80 forms CBO 1
  33. 33. X4 X4 X4 Station 1 Station 2 Station 3 11 volunteers per station x 4 forms = 44 per station tation 11 vol * 4 forms District 1 OVC Focal Person CBO 1 44 forms X 3 stations = 132 forms for a District 2 districts X 66 volunteers = 252 forms District 2 1 volunteer completes 40 forms per month. 40 stay with him/her CBO 2 CBO 3 11 vol * 4 forms 11 vol * 4 forms
  34. 34. Consequences Volunteer CBO Increased burden More forms, more labor Need capacity for tallying Need capacity for entry, analysis, IT More challenging to assess data quality Is it sustainable?  Signatures can impede flow and create burden  Aggregation task shifting has consequences
  35. 35. 4. Ensure Tools Are Fit for Purpose  Consequence  May make decisions on incorrect information
  36. 36. The Way Forward Prioritize information needs Streamline guidance and tools Ensureinformationsupportsvolunteers Identify sustainable solutions
  37. 37. www.measureevaluation.org/eop

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