Strengthening Information Systems for Community Based HIV Programs Heidi Reynolds and Florence Nyangara Global Health Mini University 9 October 2009

Community-based HIV programs Non-facility based Include services for: Orphans and vulnerable children (OVCs) Home based care and support services for people living with HIV (HBC or C&S) Prevention programs for the general population such as youth or high risk populations such as sex workers

Non-facility based

Include services for:

Orphans and vulnerable children (OVCs)

Home based care and support services for people living with HIV (HBC or C&S)

Prevention programs for the general population such as youth or high risk populations such as sex workers

Information systems Facilitate Monitoring Process of collecting and analyzing information to track efficiency Evaluation Process of collecting and analyzing information to track effectiveness Reporting Systematic, timely, and periodic information provision of information Source: Building Monitoring Evaluation and Reporting Systems for HIV/AIDS Programs. Pact. 2005

Facilitate

Monitoring

Process of collecting and analyzing information to track efficiency

Evaluation

Process of collecting and analyzing information to track effectiveness

Reporting

Systematic, timely, and periodic information provision of information

Six components of a health information system (HIS) Inputs Resources Processes Indicators Data sources Data management Outputs Information products Dissemination and use Source: Health Metrics Network

Inputs

Resources

Processes

Indicators

Data sources

Data management

Outputs

Information products

Dissemination and use

Example of a typical reporting system

State of HIV HIS under PEPFAR Strengthened health facility systems and capacity Facilitate reporting to managers, implementing partners, and donors Parallel systems (lack of integration or interoperability) Concerns with data quality, double counting, and capacity and systems for analysis and use

Strengthened health facility systems and capacity

Facilitate reporting to managers, implementing partners, and donors

Parallel systems (lack of integration or interoperability)

Concerns with data quality, double counting, and capacity and systems for analysis and use

Challenges to community-based information systems Diverse capacity and resources of implementing organizations Integration/interoperability with other Ministries (e.g., health and social affairs) Lack of Ministry mandate to coordinate HIV community-based information systems Lack of harmonized indicators Burden on front line providers and volunteers

Diverse capacity and resources of implementing organizations

Integration/interoperability with other Ministries (e.g., health and social affairs)

Lack of Ministry mandate to coordinate HIV community-based information systems

Lack of harmonized indicators

Burden on front line providers and volunteers

Tensions in community-based information systems Bottom up vs. top down Parallel vs. national systems Data use vs. data user

Bottom up vs. top down

Parallel vs. national systems

Data use vs. data user

Technical consultation on information systems for community-based HIV programs July, 2009 Objectives Present tools, resources and experiences Propose way forward to fill gaps Vision Information systems for community-based HIV programs provide high quality data that are used to improve programs and facilitate reporting and use throughout the health system Information and report available through www.cpc.unc.edu/measure

July, 2009

Objectives

Present tools, resources and experiences

Propose way forward to fill gaps

Vision

Information systems for community-based HIV programs provide high quality data that are used to improve programs and facilitate reporting and use throughout the health system

Tools and Methods Community-level Program Information Reporting (CLPIR) Toolkit OVC monitoring wellbeing tool (OWT) Guidelines for monitoring and evaluating HIV programs for most-at-risk populations (MARPs) (forthcoming) Excel to Google Earth (E2G) Tool Sample Vital Registration with Verbal Autopsy (SAVVY)

Community-level Program Information Reporting (CLPIR) Toolkit

OVC monitoring wellbeing tool (OWT)

Guidelines for monitoring and evaluating HIV programs for most-at-risk populations (MARPs) (forthcoming)

Excel to Google Earth (E2G) Tool

Sample Vital Registration with Verbal Autopsy (SAVVY)

Tools and methods con’t Non-HIV specific: Care Group method Barrier analysis Reaching Every District (RED) Care group in MZ ,from “Community Case Management Essentials “ document

Non-HIV specific:

Care Group method

Barrier analysis

Reaching Every District (RED)

Care group in MZ ,from “Community Case Management Essentials “ document

Example of Community-focused Tool “text box”: Child Status Index (CSI)

What is the Child Status Index (CSI)? A community-based tool to assess and monitor child outcomes of OVC Developed in 2006 by MEASURE Evaluation through a participatory community approach in Kenya and Tanzania It has 12 domains that are broad enough to reflect and capture most critical dimensions of child well-being status. Field-tested in Kenya and Tanzania (inter-rater reliability and validity)

A community-based tool to assess and monitor child outcomes of OVC

Developed in 2006 by MEASURE Evaluation through a participatory community approach in Kenya and Tanzania

It has 12 domains that are broad enough to reflect and capture most critical dimensions of child well-being status.

Field-tested in Kenya and Tanzania (inter-rater reliability and validity)

Rationale for developing the CSI tool To assess and monitor child outcomes To capture holistically the multiple dimensions of child well-being To generate frequent and timely information for program decisions To harmonize the data collection process across OVC program partners To incorporate local perspectives of child well-being

To assess and monitor child outcomes

To capture holistically the multiple dimensions of child well-being

To generate frequent and timely information for program decisions

To harmonize the data collection process across OVC program partners

To incorporate local perspectives of child well-being

CSI Content & Rating Scale Twelve outcome areas Food and Nutrition - (Food Security; Nutrition & Growth) Shelter and Care - (Shelter and Care) Protection - (Abuse & Exploitation; Legal Protection) Health - (Wellness; Health Care Services) Psychosocial - (Emotional Health; Social Behavior), Education and Training - (Performance; Education/Work) Rating 4= No problem; 3=A little problem; 2= Bad problem; 1=Emergency situation

Twelve outcome areas

Food and Nutrition - (Food Security; Nutrition & Growth)

Shelter and Care - (Shelter and Care)

Protection - (Abuse & Exploitation; Legal Protection)

Health - (Wellness; Health Care Services)

Psychosocial - (Emotional Health; Social Behavior),

Education and Training - (Performance; Education/Work)

Rating

4= No problem; 3=A little problem; 2= Bad problem; 1=Emergency situation

Sources of CSI Information Community Caregivers Children Youth

Decision-making levels and the use of the CSI? Individual child level – The CSI data enables service providers to make several decisions about each child so as to serve them better. Program Level Assessments - it can also be used at program level through a carefully designed assessment process. So as… To provide information for program improvement To document program effectiveness - achieving the intended outcomes To align program practices with program quality standards, e.g., Ethiopia Case study

Individual child level – The CSI data enables service providers to make several decisions about each child so as to serve them better.

Program Level Assessments - it can also be used at program level through a carefully designed assessment process. So as…

To provide information for program improvement

To document program effectiveness - achieving the intended outcomes

To align program practices with program quality standards, e.g., Ethiopia Case study

Analyzing and using CSI data Integrate the CSI tool within the overall M&E for OVC database system For Example: CCF has developed database for keeping, updating, analyzing and reporting information on OVC. The database is linked with other program data and generates automatic reports (see next slide).

Integrate the CSI tool within the overall M&E for OVC database system

For Example:

CCF has developed database for keeping, updating, analyzing and reporting information on OVC.

The database is linked with other program data and generates automatic reports (see next slide).

About CCF Database System The database is secured by a password Both baseline information (during OVC Enrollment) and information gathered during follow-up/home visits is entered to database; In Kenya, a baseline data for 8,853 OVC have been entered so far through New OVC Enrollment (from October 2007)

The database is secured by a password

Both baseline information (during OVC Enrollment) and information gathered during follow-up/home visits is entered to database;

In Kenya, a baseline data for 8,853 OVC have been entered so far through New OVC Enrollment (from October 2007)

Reducing data collection burden – if CSI used---- As part of a home visit conducted by volunteers & frontline staff (monthly in some areas) Periodically as determined by program or service providers and purposes (e.g. 6 months – see PC3/Ethiopia example)

As part of a home visit conducted by volunteers & frontline staff (monthly in some areas)

Periodically as determined by program or service providers and purposes (e.g. 6 months – see PC3/Ethiopia example)

PC3 - Aggregate scores by domain Domain Good (4) Fair (3) Bad (2) V/bad (1) Total n Food and Nutrition 25.8% 40.4% 27.1% 6.6% 9918 Shelter and Care 29.2% 39.3% 22.4% 9.1% 9918 Protection 46.2% 33.3% 15.6% 3.8% 9918 Health 41.3% 33.1% 10.4% 7.2% 9918 Psychosocial Care 38.8% 40.1% 16.9% 4.1% 9918 Education and work 37.0% 35.7% 20.4% 6.3% 9858

CSI users’ responses from field Provides a consistent way to assess outcomes Puts focus on outcomes rather than on outputs Helps ensure appropriate responses to child needs Provides data for program managers and improvements Supports advocacy Raises awareness about all areas of a child wellbeing that need monitoring Accountability - demonstrate program progress

Provides a consistent way to assess outcomes

Puts focus on outcomes rather than on outputs

Helps ensure appropriate responses to child needs

Provides data for program managers and improvements

Supports advocacy

Raises awareness about all areas of a child wellbeing that need monitoring

Accountability - demonstrate program progress

CSI looking forward Provide guidelines for CSI use at program & national levels (systems) Web-based access for CSI documents Surveillance tool to identify OVC in population and help define vulnerability beyond orphans in-country. Integrate it within the existing data management systems (in program, country, Organization) Mapping of the information

Provide guidelines for CSI use at program & national levels (systems)

Web-based access for CSI documents

Surveillance tool to identify OVC in population and help define vulnerability beyond orphans in-country.

Integrate it within the existing data management systems (in program, country, Organization)

Mapping of the information

CSI conclusions CSI tool is one of the methods/M&E activities to collect data that can inform on the effects of an OVC program CSI assessment - has to be planned and coordinated with other M&E activities (for better scheduling, staffing, funding, and use of existing resources) Consolidating CSI data with other M&E data strengthens the case and advocacy efforts for OVC

CSI tool is one of the methods/M&E activities to collect data that can inform on the effects of an OVC program

CSI assessment - has to be planned and coordinated with other M&E activities (for better scheduling, staffing, funding, and use of existing resources)

Consolidating CSI data with other M&E data strengthens the case and advocacy efforts for OVC

Technical consultation outputs

Vision for the field Harmonize indicators at the global level Generate evidence base Make tools, guides, and indicators available but adaptable Harmonize systems at country level Strengthening information linkages throughout the system Communities determine their needs Strengthen community-based HIV program capacity

Harmonize indicators at the global level

Generate evidence base

Make tools, guides, and indicators available but adaptable

Harmonize systems at country level

Strengthening information linkages throughout the system

Communities determine their needs

Strengthen community-based HIV program capacity

Challenges “ Community” lacks definition The purpose is not always articulated Information gathering requirements pose a burden for front line providers Volunteer expectations are not defined Linkages are weak Data use is weak Data quality is weak National systems are weak Double counting is a problem

“ Community” lacks definition

The purpose is not always articulated

Information gathering requirements pose a burden for front line providers

Volunteer expectations are not defined

Linkages are weak

Data use is weak

Data quality is weak

National systems are weak

Double counting is a problem

Recommendations Foster data use at the community-based program and community level Develop a bibliography of resources Develop a framework for information systems for community-based HIV programs Promote available resources and experiences related to information systems for community-based HIV programs

Foster data use at the community-based program and community level

Develop a bibliography of resources

Develop a framework for information systems for community-based HIV programs

Promote available resources and experiences related to information systems for community-based HIV programs

Other recommendations Link in with Global Fund work on community systems Link in with World Bank plan to evaluate community response to HIV Document or evaluate existing experiences Apply lessons learned from non-HIV experiences Seek creative solutions to shift burden from front line, e.g., Review population based surveys

Link in with Global Fund work on community systems

Link in with World Bank plan to evaluate community response to HIV

Document or evaluate existing experiences

Apply lessons learned from non-HIV experiences

Seek creative solutions to shift burden from front line, e.g., Review population based surveys

MEASURE Evaluation is funded by the U.S. Agency for International Development and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group International, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States Government.

MEASURE Evaluation is funded by the U.S. Agency for

International Development and is implemented by the

Carolina Population Center at the University of North

Carolina at Chapel Hill in partnership with Futures Group

International, ICF Macro, John Snow, Inc., Management

Sciences for Health, and Tulane University. The views

expressed in this presentation do not necessarily reflect

the views of USAID or the United States Government.