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Bridging the Divide: Interdisciplinary Partnerships for HIV and Health Systems
Health Informatics - Leveraging HIV Scale-up for HIS/HM
Kenyan Case
Dr. Charles M. Nzioka, MD, MPHPublic Health Specialist
16 – 17th July 2010, Vienna, Austria
Ministry of Health
Outline
• Vision/mission/Goal• HIV Program overview• Data sources for HIV program• Initiatives to achieve one M and E system• Challenges• Way forward
Vision HIS
• Be a centre of excellence for quality health and health-related data and information for use by all
Mission
• To provide timely, reliable and accessible quality health service information for evidence-based decision making in order to maximize utilization of scarce resources
Goal
• Establish a functional, robust, effective and efficient Health Information System
HIV IN KENYA• Current prevalence is 6.3% among 15-49yr olds
(KDHS 2009)– Males 4.3%– Females 8.0%– Provincial prevalence range 0.9% -13.9%
Service Sites Achievements
HAART 1065 336,980
HTC 4,200 3,946,862
PMTCT (HIV Testing) 4000 1,072,468
HIV Service data by December 2009
Routine HIV Data Sources• Routine Health Information System (HMIS): monthly collection and reporting of
facility health data through file transfer protocol (FTP) system• National Tuberculosis Control Programme Reporting (NLTPR): quarterly cohort
reporting for tracking case finding and treatment outcomes for TB patients that receive HIV-related interventions
• National Blood Transfusion Services Reporting (NBTSR): monthly reports on blood collection/screening by regional & satellite blood transfusion centres
• Logistical Management Information System (LMIS): used for tracking commodities and supplies from the Kenya Medical Supplies Agency
• Essential Medicines and Medical Supplies System (EMMS): facilities use EMMS forms to procure drugs for (OI) and sexually transmitted infection (STI) drugs from KEMSA and reporting to NASCOP
• Early Infant Diagnosis for HIV Reporting (EIDR): independent database at Clinton Foundation for reporting by 3 DNA-PCR testing laboratories
• Kenya Programme Monitoring System (KePMS): MS-Access database capturing M&E data for PEPFAR-supported HIV/AIDS treatment and prevention programs. Managed by APHIA II Evaluation/ICF Macro
• Community Health Information System
Non-Routine HIV Data Sources• ANC Sentinel Surveillance (ANC SS): ANC-based HIV testing at designated sites to
monitor HIV seroprevalence among the general population• Kenya AIDS Indicator Survey (KAIS): national population-based survey that
collects information on HIV and STI prevalence and treatment, conducted every 5 years
• Kenya Demographic and Health Survey (KDHS): national population-based survey conducted every 5 years to generate information on HIV knowledge and sexual behavior
• Kenya Service Provision Assessment (KSPA): cross-sectional country-wide survey every 5 years to assess the capacity and quality of health services, including STI/HIV services
Information Flow for Routine and Non-Routine Data Sources for HIV and AIDS
Division HIS
PTLC
HRIO
NTPR
DTLC
CHAI
KAIS, KDHS
TB Clinic In-Charge
PHRIO
DHRIO
MFL HMIS-FTP
NASCOP
LMIS
District Pharmacist
Pharmacy In-Charge
District Stores
EMMS
USG-PEPFAR
DLTLD
KePMS NBTSR
NBTS
RBTC Data Clerks
BTC Data Clerks
EIDR
PCR Testing Labs
MCH & Laboratory In-charges
ANC SS
OTHERS:•KNBS•NCAPD
Field Data
Collectors
CENTRAL LEVEL
PROVINCIAL/ REGIONAL
LEVEL
DISTRICT LEVEL
FACILITY LEVEL
In-charges for MCH/FP, CCC, VCT, STI, OPD, IPD,
Blood Banks
NPHL
LIS
DMLT
Lab In-Charge
Towards one M and E system
- HIS strengthening ( HIS Policy, HIS SP)-Country picked to be one of the initial countries
to implement Global Health Initiative– All inclusive process of Indicator harmonization– Development of Master Facility List– Development of standards for EMR for Patient
level monitoring– Adoption of DHIS for aggregate facility level
reporting– Mechanisms for routine data quality checks and
assurance– Governance for the Health Sector
HIV Indicator harmonization
• Deliberate and concerted effort to review and harmonize HIV indicators includes; Global Fund, PEPFAR, UNGASS and others
• Use of a standardized and integrated reporting tool (MOH 711)from all health facilities
District MOH 711 Spreadsheet or Database
Facility 711
Integrated tool MOH 711 - Data Element – Number of HIV +ve
Tests
Facility711
Facility711
Facility711
Facility 711
Facility 711
Facility 711KPMS
USG Partner
Database
MOH FTP At District
MOH FTP National
NASCOP
SCMS
KEMSA
LMU
MAPPING ?
Development of Master Facility List (MFL)
• List of all existing facilities and services offered• Each facility assigned a Unique identifier(code)• Helps accurately determine number of
expected reports hence computation of Reporting rates and completeness of reports
• In-built mechanism for regular updates• Can be found at : www.ehealth.go.ke
The ultimate goal –integrated HIS
Human Resources
Drugs & Supplies
Financial and
Expenditure Systems
H.I.V. Malaria / Other
Programmes
G.I.S. / MAPPING
Infrastructure / Equipment
SURVEYS / RESEARCH/
HDSS/ VR
Disease Surveillance
Annual Operational
Plans
Morbidity / Mortality /
HMIS
Master Facility
List
EMR: Electronic Medical Records
• Up to now the country had been relying on using paper based systems expect in a few donor run facilities
• Steps in adapting EMR– Assessment of all existing EMRs: Done– Development of standards for EMR: Done– Identification of an appropriate EMR– Upgrading Existing EMRs– Identification of Model sites for use of EMRs
Adopting of DHIS for aggregate facility level reporting
• DHIS: District Health Information systemsUsed in South Africa and Botswana• Open source software that allows sending of
facility reports into a National Database (Web• Has inbuilt decision support systems hence
allowing data use at the District level• Customized to generate automatic reports for:
UNGASS, UA, PEPFAR, AOP, etc.
Data Quality
• National TWG on data quality formed• Have developed standard tools and
methodologies to conduct Routine DQA• Configured DHIS to have internal checks• Regular supervisions, review meetings and
feedback
Governance in the Health sector
• Joint planning and priority setting
• Joint monitoring
• Common management arrangements
• Mutual accountability
• Stewardship
• Public-private partnerships
Governance-achievements
• Joint planning, M&E cycle established (JPW).• Code of Conduct signed, JFA development in
progress.• Coordination Framework (HSCC,ICCs) in place.• Coordination network for implementing partners
established (HENNET)• Coordinating structure for private practitioners
in place
Challenges and constraints
• Timeliness of reporting for service delivery at health facility level
• Limited data use/utilization and mechanisms to inform decision making process
• Data quality – lack of systematic validation process to ascertain the accuracy
Challenges
Inadequate resources• Human resource
– Inadequate numbers– Limited skills
• Limited financial allocation
MOH MOEC
MOF
PMO
PRIVATE SECTORCIVIL SOCIETYLOCALGVT
NACP
CTU
CCAIDS
INT NGO
PEPFAR
Norad
CIDA
RNE
GTZ
SidaWB
UNICEF
UNAIDSWHO
CF
GFATM
USAID
NCTP
NCTP
HSSP
HSSP
GFCCPGFCCPDAC
CCM
T-MAP
3/5
SWAPSWAP
UNTG
PRSP PRSP
Donor Collaboration and alignment, a Donor Collaboration and alignment, a challenge we are overcomingchallenge we are overcoming
Source: WHO: Mbewe
Way forward [1]
• Implementation of HIS strategic plan– Resource Mobilisation & Collaboration for
development - integrated system
• Enforcement of the HIS policy especially– Mandatory reporting by all service delivery points
Way forward [2]
• Utilization of ICT in health information System– Creation of district, provincial and national
databases
• Continuous capacity development• Strengthening & advocacy for data demand
and information use at all levels
Thank you…