community health information system improvement in kenya

Community Health Information System

Improvement

Charles MitoMEASURE Evaluation PIMA

September 29th, 2016

SQALE Symposium, Kenya School of Monetary Studies

Presentation outline

Introduction PIMA Project CHIS Improvement

CHIS Status in 4 counties Rapid Assessment Methodology Findings

CHS Partners at the countyAction PlansResponsive supportNext steps

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.

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

CHS Improvement

MEval-PIMA's M&E support to the CHIS is focused on increased operationalization and use of an improved community health information systemTechnical 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

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

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

Assessment Findings

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%

Availability of revised tools

County

No of CUs

MOH 513 MOH514

MOH 515

MOH 516

MOH 100

Treatment register

Indicator matrix

Supervision checklist

Nairobi

34 2 2 4 2 2 2 0 0Siaya

64 16 19 45 8 46 47 5 9Migori

52 6 12 12 4 1 0 0 6Kisumu

10 2 2 1 0 1 1 0 1Total

160 26 35 62 14 50 50 5 16%

16% 22% 39% 9% 31% 31% 3% 10%

CU with SOPs

Nairobi Siaya Migori Kisumu0

10

20

30

40

50

60

70

34

64

52

10

6

22

0

5

Standard Operating Procedures

# of CUs Assesed# of CUs With SOPs

Reporting

Nairobi Siaya Migori Kisumu0

10

20

30

40

50

60

70

0%

20%

40%

60%

80%

100%

120%

Timely Reporting

CHVs % CHEWs %

# of CUs Assesed

Completeness

Nairobi Siaya Migori Kisumu0

10

20

30

40

50

60

70

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Report Completeness

Complete %

Partial %

Incomplete %

# of CUs Assesed

Data analysis

Nairobi Siaya Migori Kisumu0

10

20

30

40

50

60

70

Data Analysis and Use

# of CUs Assesed

Data Analysis #

Data Use #

Community Data Use Forums

Nairobi Siaya Migori Kisumu0

10

20

30

40

50

60

70

Data Use Forums at the Sub-Counties

# of CUs Assesed

Dialogue Days

Stakeholder Forums

Facility Meetings

Chief Barazas

Monthly Meetings

CHV capacity to conduct VA

Nairobi Siaya Migori Kisumu0

20

40

60

80

100

120

140

160

180

Capacity on Verbal Autopsy

No. of CU s Assessed

No. of CU s Trained

No. of CU s Conducting

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

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

Partnerships and collaboration

Partner name Type of supportMACEPA 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

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

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

Relevant Evidence – tools transition & improved reporting rates – Siaya County

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun2015 2016

0

20

40

60

80

100

47

32 34

20 18 15 16 17 16 1623

17

43

2934

2

16 15 15

1 1

1623

15

Reporting rates - old MOH 515

Completeness Timeliness

Perc

ent

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun2015 2016

0

20

40

60

80

100

31

58

4354 53 54

72 7059

76

50

79

14

31

13

28 32

49

67

4148

75

39

73

Reporting rates - revised MOH 515

Completeness Timeliness

Perc

ent

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

MEASURE Evaluation PIMA is funded by the U. S. Agency for International Development (USAID) through associate award AID-623-LA-12-00001 and 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