community health information system improvement in kenya
TRANSCRIPT
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