Small Data Matter

1. Small Data Matter
Real-time data use on the front lines for
program improvement and impact
CORE Group Spring Meeting, 2015

2. Background
• In Kenya, there are gaps in documentation of
circumstances and numbers of maternal deaths.
• This information will be used to guide decision
making on, e.g; provider training and, resource
allocation, focus areas for supervision, and
mentoring.
• Pilot to inform collection of optimal routine data:
– to support program planning and monitoring
– to guide quality improvement efforts, and
– to advocate for the inclusion of MNH indicators in the
national HMIS.
A Maternal and Newborn Health Monitoring Pilot in Kenya
Mark Kabue; Barbara Rawlins; Megan Wysong; Rose Mulindi; Teresia Mutuku: Jhpiego

3. Key finding and data use
• The intervention:
– M&E training of clinical and other staff
– Distribution and routine use of MNH data tools
– Supervisory visits
• Key finding:
– Improved MNH recordkeeping that informs mentoring
and service delivery.
• Data use:
– The MOH registers were revised in 2013, and data on
some of the indicators piloted are now collected
routinely.
A Maternal and Newborn Health Monitoring Pilot in Kenya
Mark Kabue; Barbara Rawlins; Megan Wysong; Rose Mulindi; Teresia Mutuku: Jhpiego

4. Real Time Monitoring for Health
Programs using Care Groups
Henry Perry, Johns Hopkins University. April 2015

5. Real Time Monitoring for Health
Programs using Care Groups
Monitoring of Population Coverage of
Key Indicators
• Mini-KPC
• Data collected quarterly by Promoters at time
of Care Group meetings

6. Real Time Monitoring for Health
Programs using Care Groups
Mortality Monitoring
• Care Group volunteers report number of
births and number of under-deaths (among
live-born children) at each meeting, and this
information is passed up the chain
Henry Perry, JHU

7. Real-time data use at CARE
• SAFPAC - Family planning in conflict/fragile
settings (Clinical training, community
mobilization, supplies and logistics, data-driven
supervision)
• Metrics of record
– Number of new FP users and post-abortion care
– Contraceptive method mix
• No household surveys (or census)
so no prevalence,
mortality or fertility
• But no quality or coverage!
Dora Ward Curry, CARE: CORE Group Spring Meeting, April 2015

8. • % FP among
PAC
CARE’s approach to real-time data use
Dora Ward Curry, CARE: CORE Group Spring Meeting, April 2015
• % FLHWs
assessed
• Supervisory
checklist scores
• Data visualization • FLHW skills building
• Facilitated, periodic review of their own data

9. The CORE Group Polio Project (CGPP) India
– Partners : ADRA, PCI and CRS and 10 national
NGOs
– The CGPP secretariat works in close
collaboration with the Ministry of Health, WHO,
UNICEF, Rotary International and USAID.
– In 2003, UNICEF & CGPP started working
together as the ‘Social Mobilization Network’
(SM Net) to provide concentrated support in high
risk areas (for polio) of Uttar Pradesh state.
– CGPP reaches about 600,000 under 5 children in
12 districts of UP through 1300 + mobilizers

10. 01
42
741
559
874
676
66
134
225
268265
1126
0
300
600
900
1200
1500
1800
2100
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012*
P1 wild P3 wild* data as on 14 September 2012
P2 wild
Polio : Progress in India – A snapshot
• 1995: Polio SIAs (campaigns) launched
• 1997: Acute Flaccid Paralysis (AFP) Surveillance initiated
• 1999: Last case of Wild Polio Virus (WPV) type 2 – (U.P)
• 2010: Last case of WPV type 3 - (Jharkhand)
• 2011: Last case of WPV type 1 - ( West Bengal)
• 2012: India removed from list of endemic countries
1600
mOPV 1 bOPV 1 & 3

11. Location of poliovirus by type, 2011*
Wild Poliovirus
13 January, 2011
Howrah, West Bengal
Rukhsar : The Last
case of polio in Inida

12. Real-time data usage: A Framework of CORE Group Polio Project India
Robust MIS
• Tracking case
specific
(household/child)
inputs and
outcomes
• Tracking
defaulters in
vaccination – SIA
and RI
• Recording of
programmatic
inputs, outputs
and outcomes at
every level
(MPRs)
Assessment (M&E) of program though internal (MIS, surveys) and external investigations
(baseline, midline, endline)
Addition/modification
in interventions
• Introduction of RI
drives
• Tracking high risk
populations
• Intensive tracking of
pregnant mothers
and newborns to
improve OPV0
coverage
• Specific activities to
improve awareness
and coverage of RI
(e.g. RI card holder,
invitation slips)
• Inputs in training
Ensuring data quality though validity checks/data triangulation (e.g. data validation exercises - validating
reported outcomes through project MIS with other sources)
Ensuring quality of activities through
Supervisory checklists
Special studies for reach, quality
and programmatic inputs
(LQAS study 2011, BA study 2015)

13. Real-time data usage: Applications at Block (BMC) level
Areas with more missed children in
the latest SIA
Activity planning of a BMC

14. Real-time data usage: Example from the frontline (CMC level)
Situation analysis – Identification of issues/concerns CMC Monthly planning - IPC visits
A child due for next shot of
DPT/Hep.B/OPV but yet to be vaccinated

15. Examples: Analysis by frontline workers
Quarterly comparison of RI Coverage
SIA wise
Booth coverage
FY 15

16. Date
Original Project Area
Number of births reported
Number of under-five deaths
reported
March 2000 189 19
April 155 22
May 136 20
June 141 29
July 130 18
August 118 15
September 130 25
October 166 16
November 178 16
December 129 10
January 2001 not available not available
February 159 16
March 146 10
April 118 8
May 160 21
June 121 17
July 110 16
August 114 9
September 113 12
October 100 19
November 145 19
Monitoring using Care Groups

17. Under-Five Mortality, World Relief/Cambodia
Child Survival Project, 2000-2004
0
20
40
60
80
100
120
140
160
180
200
Jan
June
N
ov
A
pril
Sept
Feb
July
D
ec
M
ay
O
ct
M
ar
A
ug
Jan
Deathsper1,000livebirths
Kampong
Cham
Province
National DHS
Project Area
2000 2001 2002 2003 2004
Kampong Cham Province
National
Henry Perry, JHU
Monitoring using Care Groups

18. Under-5 Mortality in Cambodia Nationally (1990-2005) with
Projection to 2015 and in the Ponhea Kriek-Dombe
Operational Health District (1990-2008)
0
20
40
60
80
100
120
140
Deathsper1000livebirths
Year
National (UNICEF)
Ponhea Kriek-Dombe
Operational Health
District
MDG goal
for 2015: 39
Henry Perry, JHU
Monitoring using Care Groups

19. Henry Perry, JHU
Monitoring using Care Groups

20. Percentage of Children Who Received
All Immunizations
0
10
20
30
40
50
60
70
80
90
100
1998 1999 2000 2001 2002 2003 2004 2005
Percentagecoverage
Kampong
Cham
National
DHS
Original
Area
Extension
Area
Children 12-23 months of age completely vaccinated on day of survey

21. Handwashing Practices
Percentage of mothers who wash their hands before food preparation, before feeding their children
before eating, or after defecation
0
10
20
30
40
50
60
70
80
90
100
1998
1999
2000
2001
2002
2003
2004
2005
Percentageofmothers
OA before food
preparation
EA before food
preparation
OA before feeding
children
EA before feeding
children
OA after
defecation
EA after
defecation