Presented by Dalia Traca (Mozambique Strategic Information Project) at the 2015 American Public Health Association (APHA) Meeting on November 4, 2015.

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

2. No relationships to disclose.

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

4. StrategicApproach
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)

5. 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.

6. Assessed Indicators
Area Indicator Abbre-
viation
Treatment and Care Number of HIV+ positive individuals active on ART TARV
Number of HIV + individuals who are eligible for
Cotrimoxazole (CTX) and receive CTX
CTX
Prevention of Mother to
ChildTransmission
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 andTesting 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

7. 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

8. 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

9. TARV
CTX
CPN, MAT, PCR , UATS e CM
DataAnalysis – Calculation of the deviation
Deviation: <10% Good quality data; 10 to 20%: Moderate data quality; >20% Poor Quality Data

10. DQA RESULTS
Round 2014

11. IndicatorART:Deviation in Reporting
42%
20% 22%
35%
40%
45% 43%
47%
29%
38% 38%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Maputocity
Maputo
Province
Gaza
Inhambane
Sofala
Manica
Tete
Zambezia
Nampula
CaboDelgado
Niassa
Deviation
Deviation:
Good quality data = <10%
Moderate data quality = 10-20%
Poor Quality Data = >20%

12. Participatory
Approach to
DQA activity
Lessons Learned

13. DQA Lessons Learned (1)
Lessons Learned Impact
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; increased sustainability
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

14. DQA Lessons Learned (2)
Lessons Learned Impact
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

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

16. Comparison between Round 2014 and 2015
%Deviation
Indicator

17. Quality
Improvement
during eDQA

18. 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

19. 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.
Key Findings (cont.)

20. 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

21. 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”

22. OBRIGADA!
Dália MonteiroTraça
Chief of Party MSIP
Maputo, Mozambique
dtraca@mz.jsi.com