Presentation given at the USAID SQALE Symposium, Bridging the Quality Gap - Strengthening Quality Improvement in Community Health Services, by Charles Mito on behalf of MEASURE Evaluation PIMA. http://usaidsqale.reachoutconsortium.org/

1. Community Health Information
System Improvement
Charles Mito
MEASURE Evaluation PIMA
September 29th, 2016
SQALE Symposium, Kenya School of Monetary Studies

2. Presentation outline
Introduction
 PIMA Project
 CHIS Improvement
CHIS Status in 4 counties
 Rapid Assessment
 Methodology
 Findings
CHS Partners at the county
Action Plans
Responsive support
Next steps

3. PIMA Project
Who we are:
MEASURE Evaluation PIMA is a five year
USAID-funded project designed to support
the Government of Kenya to build
sustainable Monitoring and Evaluation
capacity in using evidence-based decision
making to improve the effectiveness of the
Kenya Health System. Currently in year 4.

4. PIMA Project objectives
What we do (IR):
• Improved M&E capacity of the MOH programs (DRH,
NMCP, CRS) and CHMTs to identify and respond to
information needs
• Improved availability and use of quality health
information by strengthening the RSS, CHIS, CRVS and
CPIMS systems
Where we work
Currently working in 10 counties: Nairobi, Machakos,
Nakuru, Muranga, Kakamega, Kisumu, Siaya Kilifi,
Homabay and Migori

5. CHS Improvement
MEval-PIMA's M&E support to the CHIS is focused on
increased operationalization and use of an improved
community health information system
Technical Strategy:
1. Strengthen the M&E capacity at national and
subnational levels
2. Ensure data availability for use and decision making
at community level
3. Enhanced community data quality and reporting in
DHIS
Geographic Focus: Homa Bay, Migori, Kisumu, Nairobi
and Siaya Counties

6. Purpose of Rapid Assessment
• Determining use of CHIS revised tools
• Ascertaining the sub counties reporting rates
• Understanding data use by the communities for
decision making
• Identifying challenges encountered by the sub
counties in improving the CHIS
• Identifying partners involved in CHIS strengthening
to enable coordination and enhance stakeholder
engagement and partnerships

7. Methodology
• A self-administered questionnaire developed in consultation
with the CHSDU with contribution from the county
community health services coordinators
• The tool sent to the sub county community services focal
persons who shared with the relevant CHEWs for
completion based on their knowledge of community unit(s)
• The tool was completed by the CHEWs and community focal
persons for their respective community units, analysis done
with support of PIMA
• The sub counties assessed were those currently getting CHIS
support which are also PIMA intervention sites

8. Assessment Findings

9. Availability of old tools
County
No of
CUs
MOH
513
MOH
514
MOH
515
MOH
516
MOH
100
Treatment
register
Indicator
matrix
Supervision
checklist
Nairobi
34 4 5 5 0 6 9 1 3
Siaya
64 12 42 5 5 2 0 1 2
Migori
52 7 41 7 8 4 5 6 5
Kisumu
10 6 8 9 7 5 1 0 5
Total
160 29 96 26 20 17 15 8 15
%
18% 60% 16% 13% 11% 9% 5% 9%

10. Availability of revised tools
County
No of
CUs
MOH 513 MOH51
4
MOH
515
MOH
516
MOH
100
Treatment
register
Indicator
matrix
Supervision
checklist
Nairobi
34 2 2 4 2 2 2 0 0
Siaya
64 16 19 45 8 46 47 5 9
Migori
52 6 12 12 4 1 0 0 6
Kisumu
10 2 2 1 0 1 1 0 1
Total
160 26 35 62 14 50 50 5 16
%
16% 22% 39% 9% 31% 31% 3% 10%

11. CU with SOPs
34
64
52
10
6
22
0
5
0
10
20
30
40
50
60
70
Nairobi Siaya Migori Kisumu
Standard Operating Procedures
# of CUs Assesed
# of CUs With SOPs

12. Reporting
0%
20%
40%
60%
80%
100%
120%
0
10
20
30
40
50
60
70
Nairobi Siaya Migori Kisumu
Timely Reporting
CHVs %
CHEWs %
# of CUs Assesed

13. Completeness
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
10
20
30
40
50
60
70
Nairobi Siaya Migori Kisumu
Report Completeness
Complete %
Partial %
Incomplete %
# of CUs Assesed

14. Data analysis
0
10
20
30
40
50
60
70
Nairobi Siaya Migori Kisumu
Data Analysis and Use
# of CUs Assesed
Data Analysis #
Data Use #

15. Community Data Use Forums
0
10
20
30
40
50
60
70
Nairobi Siaya Migori Kisumu
Data Use Forums at the Sub-Counties
# of CUs Assesed
Dialogue Days
Stakeholder
Forums
Facility Meetings
Chief Barazas
Monthly Meetings

16. CHV capacity to conduct VA
0
20
40
60
80
100
120
140
160
180
Nairobi Siaya Migori Kisumu
Capacity on Verbal Autopsy
No. of CU s Assessed
No. of CU s Trained
No. of CU s Conducting

17. Challenges
• Late reporting by community health assistants
due to lack of motivation such as stipend and
allowances
• Lack of reporting tools especially the MOH 514
and stationery, pens, note books and flip charts
• Some CHVs have many households to cover
hence reports are shared for only the
households reached which may not be
representative of the CU population
• Lack of capacity among the CHVs in completion
of tools and understanding of indicators

18. Challenges cont.
• Un-harmonized reporting tools- some of the
CUs are still using old tools while other use
both revised and old hence low reporting on
MOH 515 and MOH 516
• Tedious retrieval of data in manual in relation
to aggregation of the indicators from the
community daily registers
• Training of CHVs on Verbal Autopsy, CHIS
module and ICCM
• Drop outs of CHVs
• Lack of adequate forums for CHS discussions

19. Partnerships and collaboration
Partner name Type of support
MACEPA Capacity Building, Malaria Control, Reporting tools
AMREF Capacity building on m-learning
UNICEF ICCM Training, Commodity and tools provision,
ICAP Reproductive Health
KMET Reproductive Health
IRDO Tools provision (MOH 513)
JICA Data review Meetings
CMMB Dialogue days
Kenya Red Cross Capacity Building
Matibabu Family Planning
Mildmay Technical Support
SANNE LADIN HIV/AIDS
APHIA PLUS/Jijini Training on data analysis
North Gem Outreaches

20. Issues prioritized in the action
plans
• Sensitization of revised CHIS tools
• Support to conduct stakeholder forums
• Harmonization of community data in DHIS
• Collaboration with partners to avail revised tools and
or correction of the chalk boards to reflect the
revised chalk board.
• Collaboration with partners to conduct data quality
reviews
• Training on verbal autopsy and other relevant
trainings

21. PIMA responsive support
• Dissemination during stakeholder fora in respective counties
• Conducted orientation on CHIS revised tools in 5 target
counties
• Development of sub county specific Performance
Improvement Plans - action plans on google doc
• Data review meetings in Siaya and Nairobi counties
• DHIS2/MCUL harmonization for Migori and Siaya counties
• CHIS SOPs disseminated during the orientation on CHIS
revised tools
• County specific fora in Q2 for 5 target counties
• Regional stakeholder forum in Q3 in collaboration with APHIA
plus where the DHIME and CHSU discussed issues affecting
community reporting
• Support conducting county and sub county data quality
reviews

22. Relevant Evidence – tools transition &
improved reporting rates – Siaya County
47
32 34
20 18 15 16 17 16 16
23
17
43
29
34
2
16 15 15
1 1
16
23
15
0
20
40
60
80
100
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
2015 2016
Percent
Reporting rates - old MOH 515
Completeness Timeliness
31
58
43
54 53 54
72 70
59
76
50
79
14
31
13
28
32
49
67
41
48
75
39
73
0
20
40
60
80
100
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
2015 2016
Percent
Reporting rates - revised MOH 515
Completeness Timeliness

23. Next steps
• Continued support for national level M&E TWG
• Follow up implementation of action plans
including quarterly review of CHIS data
(availability of reporting tools, information flow,
feedback on data to advocate for use)
• Facilitate stakeholder coordination including
between DHIME and CHSU
• Review the mhealth community toolkit to ensure
use

24. MEASURE Evaluation PIMA is funded by the U. S. Agency for International
Development (USAID) through associate award AID-623-LA-12-00001and is
implemented by the Carolina Population Center at the University of North Carolina
at Chapel Hill, in partnership with ICF International; Management Sciences for
Health; Palladium; and Tulane University. The views expressed in this presentation
do not necessarily reflect the views of USAID or the United States government.
www.measureevaluation.org/pima