Small Data Matter Real-time data use on the front lines for

program improvement and impact

CORE Group Spring Meeting, 2015

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

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

Real Time Monitoring for Health Programs using Care Groups

Henry Perry, Johns Hopkins University. April 2015

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

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

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

• % 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

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

0142

741

559

874

676

66134

225268265

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

Location of poliovirus by type, 2011*

Wild Poliovirus 13 January, 2011

Howrah, West Bengal

Rukhsar : The Last case of polio in Inida

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)

Real-time data usage: Applications at Block (BMC) level

Areas with more missed children in the latest SIA

Activity planning of a BMC

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

Examples: Analysis by frontline workers

Quarterly comparison of RI Coverage SIA wise

Booth coverage FY 15

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 December 146 10 Monitoring using Care Groups

Under-Five Mortality, World Relief/Cambodia Child Survival Project, 2000-2004

020406080

100120140160180200

Jan

June

NovApril

Sept

Feb July Dec May Oct Mar

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Dea

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KampongChamProvince

National DHS

Project Area

2000 2001 2002 2003 2004

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National

Henry Perry, JHU

Monitoring using Care Groups

Under-5 Mortality in Cambodia Nationally (1990-2005) with Projection to 2015 and in the Ponhea Kriek-Dombe

Operational Health District (1990-2008)

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MDG goal for 2015: 39

Henry Perry, JHU

Monitoring using Care Groups

Henry Perry, JHU

Monitoring using Care Groups

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

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Children 12-23 months of age completely vaccinated on day of survey

Handwashing Practices

Percentage of mothers who wash their hands before food preparation, before feeding their children before eating, or after defecation

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