Mainstreaming MIYCN indicators into Health Management Information System: Sharing the Ugandan experience Tim Mateeba- S/Nutritionist Ministry of Health (U) 1 st March 2016 Background Health Management Information System (HMIS) is the official reporting system on Health related indicators for the Ministry of Health Uganda. National framework to collate health information from multiple sources in order to inform multi-sectoral responses. In order to track progress of performance nutrition interventions and efforts, MIYCN indicators need be collected and analysed for use. Background cont. Unfortunately, HMIS manual 2010 version collected limited nutritional indicators in the system and these included: vitamin A supplementation and de-worming coverage by district low birth weight rates the number of Severe Acute Malnutrition (Marasmus, Kwashiorkor, Marasmic-kwash) cases of anemia (0 -4 years, 5 and above years). How nutrition data was managed Efforts to collect some of nutrition information and indicators resulted in silo management of these indictors by different stakeholders e.g. MOH, UNICEF, WFP, NGO, etc. SILO for WHO SILO for UNICEF SILO for MOH SILO for WFP SILO for USAID SILO for Others Background cont Flow of HMIS data Yet a lot of Nutrition data has been and continues to be generated at the different levels. The existing recommendat ion is that all nutrition and health indicators should be collected and managed by the recognized HMIS. Background cont. There were challenges and barriers in having all key Maternal Infant and Young child Nutrition (MIYCN) indicators reported in HMIS. There was need to streamline management of (MIYCN) indicators into the HMIS. Highlights of the Process to mainstream indicators into HMIS HMIS A multi-sectoral and multidisciplinary team led by MOH resource centre and chaired by Nutrition Unit Consensus reached on the number and types of nutrition indicators to include in the revised HMIS Existing HMIS manual 2010 version was the working document for review. A number of Nutrition indicators were identified for review and inclusion in HMIS as data elements after appropriate justification. Outcomes of the HMIS review 1.Some key indicators were integrated as data elements in other health data collection tools; OPD register, IPD register, ANC register, Maternity register, PNC register, ART register, child Health register, TB register etc. Outcomes of the HMIS review 2.Nutrition services section was included in the Technical module on Preventive and curative activities (Originally missing in HMIS 2010 Version). This led to inclusion of HMIS 077 the Integrated Nutrition Register (INR) and corresponding Tally sheet (HMIS 077a) 3.Nineteen (19) data elements generated from the INR for quarterly reporting and these included the following: Outcomes of the HMIS review Single stop centre to collect wide range of nutrition data elements and analysis at data bank Reduced time wastage in search of nutrition data Summery of Nutrition Data elements for Quarterly reporting 1.Number of clients who received nutrition assessment on each clinic visit using color coded MUAC tapes/Z score chart 2.Total No. of clients who received nutrition assessment using Height/Length for Age Z- scores 3.No. of clients who received nutrition assessment using Height/Length for Age Z- scores who were found to be stunted Nutrition Data elements for Quarterly reporting 4.Number of clients who received nutritional assessment and had Moderate Acute Malnutrition (MAM) 5.Number of clients who received nutritional assessment and had Severe Acute Malnutrition (SAM) without oedema 6.Number of clients who received nutritional assessment and had Severe Acute Malnutrition (SAM) with oedema 7.Number of newly identified malnourished cases Nutrition Data elements for Quarterly reporting 8.Number of total clients who received nutrition supplementary/therapeutic feeds 9.Number of HIV positive clients who received nutrition supplementary/therapeutic feeds 10.Number of total pregnant women who received maternal nutrition counseling 11.Number of HIV positive pregnant women who received maternal nutrition counseling 12.Number of total pregnant women who received infant feeding counseling Nutrition Data elements for Quarterly reporting 13.Number of HIV positive pregnant women who received infant feeding counseling 14.Number of total mothers who initiate breastfeeding within the first hour after delivery 15.Number of total mothers who initiate breastfeeding within the first hour after delivery 16.Number of HIV exposed infants who reported to be exclusively breastfed for the first 6 completed months during the reporting period Nutrition Data elements for Quarterly reporting 17.Number of HIV exposed infants who reported to be breastfed up-to 1 year 18.Total No. of treated malnourished clients who attained target exit criteria at the end of the quarter 19.Number of treated malnourished HIV+ clients who attained target exit criteria at the end of the quarter Use of Nutrition data elements From data bank, nutrition data can be analysed and reported in table, graphical or other format as need may determine. Examples of current nutrition indicators in HMIS as computed from reviewed data elements : National: No of mothers who initiate B/feeding within 1hour (HIV+) Before reviewed data in HMIS After reviewed data in HMIS SAM with and without oedema Attending 1 st ANC and receiving Iron /Folic acid Percentage who receive iron/folic acid on 1 st ANC visit National: RUTF used (sachets) National: F 100 used National: BMI Severe underweight in OPD National: Cases of Obesity Challenges HMIS still has a limit for which data elements for nutrition and other health services can be posted. Some data elements are not being collected in the tools (Reasons: Logistical, HR, Training or other) Data from special nutrition surveys may be found in the data bank but not in HMIS. Some nutrition data elements still in addendum yet to posted into the HMIS Conclusion The cross cutting nature of nutrition indicators require Integration of data elements in existing HMIS tools. Direct specific nutrition indicators can be addressed with existence of an integrated nutrition register as an HMIS tool. Harmonization and central command of the nutrition data can be achieved if all stake holders use the officially recognized HMIS. Way forward Plan to ensure all data elements are collected and reported on in HMIS. Making use of Nutrition indicators in HMIS for performance improvement at all levels. (May require training) Maternal Infant and Young Child Nutrition Roadmap to support institutionalization and scaling up mainstreaming of nutrition indicators in HMIS. THANK YOU