Strengthening Information Systems for Community Based HIV Programs


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  • Strengthening Information Systems for Community Based HIV Programs

    1. 1. Strengthening Information Systems for Community Based HIV Programs Heidi Reynolds and Florence Nyangara Global Health Mini University 9 October 2009
    2. 2. Community-based HIV programs <ul><li>Non-facility based </li></ul><ul><li>Include services for: </li></ul><ul><ul><li>Orphans and vulnerable children (OVCs) </li></ul></ul><ul><ul><li>Home based care and support services for people living with HIV (HBC or C&S) </li></ul></ul><ul><ul><li>Prevention programs for the general population such as youth or high risk populations such as sex workers </li></ul></ul>
    3. 3. Information systems <ul><li>Facilitate </li></ul><ul><ul><li>Monitoring </li></ul></ul><ul><ul><ul><li>Process of collecting and analyzing information to track efficiency </li></ul></ul></ul><ul><ul><li>Evaluation </li></ul></ul><ul><ul><ul><li>Process of collecting and analyzing information to track effectiveness </li></ul></ul></ul><ul><ul><li>Reporting </li></ul></ul><ul><ul><ul><li>Systematic, timely, and periodic information provision of information </li></ul></ul></ul>Source: Building Monitoring Evaluation and Reporting Systems for HIV/AIDS Programs. Pact. 2005
    4. 4. Six components of a health information system (HIS) <ul><li>Inputs </li></ul><ul><ul><li>Resources </li></ul></ul><ul><li>Processes </li></ul><ul><ul><li>Indicators </li></ul></ul><ul><ul><li>Data sources </li></ul></ul><ul><ul><li>Data management </li></ul></ul><ul><li>Outputs </li></ul><ul><ul><li>Information products </li></ul></ul><ul><ul><li>Dissemination and use </li></ul></ul>Source: Health Metrics Network
    5. 5. Example of a typical reporting system
    6. 6. State of HIV HIS under PEPFAR <ul><li>Strengthened health facility systems and capacity </li></ul><ul><li>Facilitate reporting to managers, implementing partners, and donors </li></ul><ul><li>Parallel systems (lack of integration or interoperability) </li></ul><ul><li>Concerns with data quality, double counting, and capacity and systems for analysis and use </li></ul>
    7. 7. Challenges to community-based information systems <ul><li>Diverse capacity and resources of implementing organizations </li></ul><ul><li>Integration/interoperability with other Ministries (e.g., health and social affairs) </li></ul><ul><li>Lack of Ministry mandate to coordinate HIV community-based information systems </li></ul><ul><li>Lack of harmonized indicators </li></ul><ul><li>Burden on front line providers and volunteers </li></ul>
    8. 8. Tensions in community-based information systems <ul><li>Bottom up vs. top down </li></ul><ul><li>Parallel vs. national systems </li></ul><ul><li>Data use vs. data user </li></ul>
    9. 9. Technical consultation on information systems for community-based HIV programs <ul><li>July, 2009 </li></ul><ul><li>Objectives </li></ul><ul><ul><li>Present tools, resources and experiences </li></ul></ul><ul><ul><li>Propose way forward to fill gaps </li></ul></ul><ul><li>Vision </li></ul><ul><ul><li>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 </li></ul></ul>Information and report available through
    10. 10. Tools and Methods <ul><li>Community-level Program Information Reporting (CLPIR) Toolkit </li></ul><ul><li>OVC monitoring wellbeing tool (OWT) </li></ul><ul><li>Guidelines for monitoring and evaluating HIV programs for most-at-risk populations (MARPs) (forthcoming) </li></ul><ul><li>Excel to Google Earth (E2G) Tool </li></ul><ul><li>Sample Vital Registration with Verbal Autopsy (SAVVY) </li></ul>
    11. 11. Tools and methods con’t <ul><li>Non-HIV specific: </li></ul><ul><ul><li>Care Group method </li></ul></ul><ul><ul><li>Barrier analysis </li></ul></ul><ul><ul><li>Reaching Every District (RED) </li></ul></ul><ul><li>Care group in MZ ,from “Community Case Management Essentials “ document </li></ul>
    12. 12. Example of Community-focused Tool “text box”: Child Status Index (CSI)
    13. 13. What is the Child Status Index (CSI)? <ul><li>A community-based tool to assess and monitor child outcomes of OVC </li></ul><ul><li>Developed in 2006 by MEASURE Evaluation through a participatory community approach in Kenya and Tanzania </li></ul><ul><li>It has 12 domains that are broad enough to reflect and capture most critical dimensions of child well-being status. </li></ul><ul><li>Field-tested in Kenya and Tanzania (inter-rater reliability and validity) </li></ul>
    14. 14. Rationale for developing the CSI tool <ul><li>To assess and monitor child outcomes </li></ul><ul><li>To capture holistically the multiple dimensions of child well-being </li></ul><ul><li>To generate frequent and timely information for program decisions </li></ul><ul><li>To harmonize the data collection process across OVC program partners </li></ul><ul><li>To incorporate local perspectives of child well-being </li></ul>
    15. 15. CSI Content & Rating Scale <ul><li>Twelve outcome areas </li></ul><ul><ul><ul><li>Food and Nutrition - (Food Security; Nutrition & Growth) </li></ul></ul></ul><ul><ul><ul><li>Shelter and Care - (Shelter and Care) </li></ul></ul></ul><ul><ul><ul><li>Protection - (Abuse & Exploitation; Legal Protection) </li></ul></ul></ul><ul><ul><ul><li>Health - (Wellness; Health Care Services) </li></ul></ul></ul><ul><ul><ul><li>Psychosocial - (Emotional Health; Social Behavior), </li></ul></ul></ul><ul><ul><ul><li>Education and Training - (Performance; Education/Work) </li></ul></ul></ul><ul><li>Rating </li></ul><ul><ul><li>4= No problem; 3=A little problem; 2= Bad problem; 1=Emergency situation </li></ul></ul>
    16. 16. Sources of CSI Information Community Caregivers Children Youth
    17. 17. Decision-making levels and the use of the CSI? <ul><li>Individual child level – The CSI data enables service providers to make several decisions about each child so as to serve them better. </li></ul><ul><li>Program Level Assessments - it can also be used at program level through a carefully designed assessment process. So as… </li></ul><ul><ul><ul><li>To provide information for program improvement </li></ul></ul></ul><ul><ul><ul><li>To document program effectiveness - achieving the intended outcomes </li></ul></ul></ul><ul><ul><ul><li>To align program practices with program quality standards, e.g., Ethiopia Case study </li></ul></ul></ul>
    18. 18. Analyzing and using CSI data <ul><li>Integrate the CSI tool within the overall M&E for OVC database system </li></ul><ul><li>For Example: </li></ul><ul><ul><li>CCF has developed database for keeping, updating, analyzing and reporting information on OVC. </li></ul></ul><ul><ul><li>The database is linked with other program data and generates automatic reports (see next slide). </li></ul></ul>
    19. 20. About CCF Database System <ul><li>The database is secured by a password </li></ul><ul><li>Both baseline information (during OVC Enrollment) and information gathered during follow-up/home visits is entered to database; </li></ul><ul><li>In Kenya, a baseline data for 8,853 OVC have been entered so far through New OVC Enrollment (from October 2007) </li></ul>
    20. 21. Reducing data collection burden – if CSI used---- <ul><li>As part of a home visit conducted by volunteers & frontline staff (monthly in some areas) </li></ul><ul><li>Periodically as determined by program or service providers and purposes (e.g. 6 months – see PC3/Ethiopia example) </li></ul>
    21. 22. 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
    22. 23. CSI users’ responses from field <ul><li>Provides a consistent way to assess outcomes </li></ul><ul><li>Puts focus on outcomes rather than on outputs </li></ul><ul><li>Helps ensure appropriate responses to child needs </li></ul><ul><li>Provides data for program managers and improvements </li></ul><ul><li>Supports advocacy </li></ul><ul><li>Raises awareness about all areas of a child wellbeing that need monitoring </li></ul><ul><li>Accountability - demonstrate program progress </li></ul>
    23. 24. CSI looking forward <ul><li>Provide guidelines for CSI use at program & national levels (systems) </li></ul><ul><li>Web-based access for CSI documents </li></ul><ul><li>Surveillance tool to identify OVC in population and help define vulnerability beyond orphans in-country. </li></ul><ul><li>Integrate it within the existing data management systems (in program, country, Organization) </li></ul><ul><li>Mapping of the information </li></ul>
    24. 25. CSI conclusions <ul><ul><li>CSI tool is one of the methods/M&E activities to collect data that can inform on the effects of an OVC program </li></ul></ul><ul><ul><li>CSI assessment - has to be planned and coordinated with other M&E activities (for better scheduling, staffing, funding, and use of existing resources) </li></ul></ul><ul><ul><li>Consolidating CSI data with other M&E data strengthens the case and advocacy efforts for OVC </li></ul></ul>
    25. 26. Technical consultation outputs
    26. 27. Vision for the field <ul><li>Harmonize indicators at the global level </li></ul><ul><li>Generate evidence base </li></ul><ul><li>Make tools, guides, and indicators available but adaptable </li></ul><ul><li>Harmonize systems at country level </li></ul><ul><li>Strengthening information linkages throughout the system </li></ul><ul><li>Communities determine their needs </li></ul><ul><li>Strengthen community-based HIV program capacity </li></ul>
    27. 28. Challenges <ul><li>“ Community” lacks definition </li></ul><ul><li>The purpose is not always articulated </li></ul><ul><li>Information gathering requirements pose a burden for front line providers </li></ul><ul><li>Volunteer expectations are not defined </li></ul><ul><li>Linkages are weak </li></ul><ul><li>Data use is weak </li></ul><ul><li>Data quality is weak </li></ul><ul><li>National systems are weak </li></ul><ul><li>Double counting is a problem </li></ul>
    28. 29. Recommendations <ul><li>Foster data use at the community-based program and community level </li></ul><ul><ul><li>Develop a bibliography of resources </li></ul></ul><ul><li>Develop a framework for information systems for community-based HIV programs </li></ul><ul><li>Promote available resources and experiences related to information systems for community-based HIV programs </li></ul>
    29. 30. Other recommendations <ul><li>Link in with Global Fund work on community systems </li></ul><ul><li>Link in with World Bank plan to evaluate community response to HIV </li></ul><ul><li>Document or evaluate existing experiences </li></ul><ul><li>Apply lessons learned from non-HIV experiences </li></ul><ul><li>Seek creative solutions to shift burden from front line, e.g., Review population based surveys </li></ul>
    30. 31. <ul><li>MEASURE Evaluation is funded by the U.S. Agency for </li></ul><ul><li>International Development and is implemented by the </li></ul><ul><li>Carolina Population Center at the University of North </li></ul><ul><li>Carolina at Chapel Hill in partnership with Futures Group </li></ul><ul><li>International, ICF Macro, John Snow, Inc., Management </li></ul><ul><li>Sciences for Health, and Tulane University. The views </li></ul><ul><li>expressed in this presentation do not necessarily reflect </li></ul><ul><li>the views of USAID or the United States Government. </li></ul>