They can do all this with the support of a robust management system. INFORMED BY DATA; CC+ system – mobile health platform is what helps to really drive the information flow in this program.It is widely acknowledged and emphasized in the literature that the success of CHW programs hinges on regular and reliable support and supervision. It is equally acknowledged, however, that supervision is often among the weakest links in CHW programs. The support network can also have multiple functions in programme operations:to select and hold the CHWs accountable; to offer incentives; to train and update skills; to provide clinical supervision and guidance; to serve as a communications and equipment link; and to collect, analyse and use health statistics.
Transition into how this information is collected: via mobile phone which sends information to a server, which then can transfer information to the OpenMRS standards-based medical record system for clinicians and managers (MGV-Net) and the district health information system. Automated rules feedback to the CHW guidelines to assist with treatment compliance and capacity building.Millennium Villages Project developed ‘ChildCount’ an mHealth application based on UNICEF’s RapidSMS3,4First developed to support Community-Based Management of Acute Malnutrition (CMAM) and Malaria case managementSony Ericsson (phones) and Zain Kenya (network) main partners‘Childcount+’ is an expanded application for pregnant women using an electronic interactive database designed to accommodate registration of user numbers, of clients and of specific health data integrated with an electronic medical record.
The 5 major goals for CC+ (taken from CC+ website)
IMPORTANT TO EMPHASIZE: everyone should have access to these reports, sms or not because all CHWs have been trained in A, B, C
Detailed report for each CHW on his/her patients and performanceBasic performance metricsList of every child without a MUAC in the last 90 daysList of children without 100% immunizationsList of referred patients not followed upGiven to CHWs and reviewed every monthCONFIDENTIAL DATA – NOT FOR DISTRIBUTION OUTSIDE SITE TEAM
Do in 30 seconds or less: Example of CHW management reports: how you can compare reports to validate the quality of the data
Is the denominator (sample size) appropriate? For example, are the CHWs doing enough HH visits or seeing enough children or recording enough births?Is the problem isolated to one (1) indicator or are there problems with related indicators?Are there particular CHWs with poor indicators or is it across all CHWs?How long does the problem last?Does the data available match your impression of the eHealth system’s strengths and weaknesses? If not, then where is the problem? Healthcare delivery, data collection, data entry, data transfer, data analysis…or other?----For example, you know CHW are regularly recording MUAC, but the report shows very low resultsWhere is the problem in the system? Healthcare delivery: personnel not doing their job Data collection: collecting data incorrectly (misunderstand q’s)Data entry: data not entered properly or untimelyData transfer: data not reaching the server Data analysis: indicator not calculating properly…or other?
Putting Tigers in CHWs Tanks_Liu_5.3.12
The Millennium Villages Project:Use of data to improve decision-making
MVP: Who are the Community Health Workers?Literate Locally-BasedMen and Women PaidAll Ages Nominated by Community
Millennium Villages CHW Program CHW visits a household at least once every 90 days Health Education Health Surveillance and Referrals Community Case Management and Commodities DistributionFeedback, Management, Prompts for Follow-up Health DataVisits D Collection by paper forms or phone
Supported by a Foundation of Management and Supervision Supervision / Inform Health Priorities Health Coordinator Operations Management,Community and Task-Setting, Performance ReviewsClinic Reports Performance Reports, Inform Health Priorities CHW Managerand Concerns Technical and Senior CHW Supportive Supervision CHW Activities: or Health Household Visits and Service Delivery Facilitator Raw Health Data Transfer “Social” Community Supervision Health Updates on Committee Community Health Prompts for Follow-Up Visit at Village Clinic Home Referral for Advanced Care
“The purpose of collecting and analyzing ChildCount+ data is to generate ‘real-time’ information to inform and guide health services delivery by identifying systemic problems and responding appropriately”“ChildCount+ data should be viewed along-side clinic-based data and other sources (surveys, verbal autopsy, etc.)”
PATIENT MANAGEMENT REPORTS • SMS Alerts to supervisors for at risk patients • Longitudinal patient records for health system assessmentsExample: Individual CHW Nutrition Surveillance Case Report
CHW MANAGEMENT REPORTS • CHW activity reports • Performance Monitoring • Data validation reports (see below) CHW No 86 CHW No 89Histograms showing frequency of MUACs for children as recorded by 2 CHWs with different levels of precision
eHEALTH MONTHLY DATA ASSESSMENT CC+ data inputted daily by CHWs and/or data entry clerks eHealth Specialist generates MVIS Indicators report, CHW manager report, and utilization report and puts in dropbox (or sends to Casey) by the 5th of each month NYC/MDG Centre Teams conduct preliminary analysis and feedback You Should Receive This Assessment By The 10th of EVERY MONTH
QUESTIONS TO ASK WHEN LOOKING AT DATA? Perhaps not all CHWs are doing(1) IS THE DATA REPRESENTATIVE? household visits. Errors, Data entry delay, SMS not working:(2) IS THE DATA ACCURATE? Not reflecting what CHWs are actually doing (and household health outcomes)(3) IS THERE A SYSTEMIC PROBLEM? Supply chain? Accident? Floods? CHW/Senior CHW protest? No SMS contract?(4) ARE THERE PARTICULAR POOR Some demotivated CHWs? Some CHWs PERFORMING CHWs? that need retraining? CHWs to replace?(5) ARE THERE TRENDS OVER TIME? Health risks and patterns? Decreasing quality with increasing workload?(6) DOES THE DATA MATCH YOUR IMPRESSION OF THE eHEALTH Not enough people? Server down? SMS SYSTEM’S STRENGTHS AND system down? WEAKNESSES?
DATA FEEDBACK SESSIONS WITH CHWS300250 Annociat Nabegyesa200 Christine Tumwijukye Eunice Musiimenta Felix Ahimbisibwe150 John Asimwe Museveni Kobusiigye V Daddy Lillian Kyokusiima Macklean Arinaitwe100 Narciscio Bazirake Rose Kyomukama50 0 Jan Feb March April May June July Aug Sept Oct Nov Dec
NEXT STEPS1. Explore alternative mHealth options to address current challenge of CC+2. Strengthen qualitative data collection to provide a more rounded view of programs (spot checks, supervision visits, client interviews)3. Build comprehensive training platforms for local managers to use data in decision- making