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Strengthening Information Systems for Community Based
HIV Programs
Heidi Reynolds and Florence Nyangara
Global Health Mini University9 October 2009
Community-based HIV programs
Non-facility based
Include services for:
Orphans and vulnerable children (OVCs)
Home based care and support services for people living with HIV (HBC or C&S)
Prevention programs for the general population such as youth or high risk populations such as sex workers
Information systems Facilitate
Monitoring
Process of collecting and analyzing information to track efficiency
Evaluation
Process of collecting and analyzing information to track effectiveness
Reporting
Systematic, timely, and periodic information provision of information
Source: Building Monitoring Evaluation and Reporting Systems for HIV/AIDS Programs. Pact. 2005
Six components of a health information system (HIS) Inputs
1. Resources Processes
2. Indicators
3. Data sources
4. Data management Outputs
5. Information products
6. Dissemination and use
Source: Health Metrics Network
State of HIV HIS under PEPFAR
Strengthened health facility systems and capacity
Facilitate reporting to managers, implementing partners, and donors
Parallel systems (lack of integration or interoperability)
Concerns with data quality, double counting, and capacity and systems for analysis and use
Challenges to community-based information systems Diverse capacity and resources of implementing
organizations
Integration/interoperability with other Ministries (e.g., health and social affairs)
Lack of Ministry mandate to coordinate HIV community-based information systems
Lack of harmonized indicators
Burden on front line providers and volunteers
Tensions in community-based information systems Bottom up vs. top down
Parallel vs. national systems
Data use vs. data user
Technical consultation on information systems for community-based HIV programs
July, 2009 Objectives
Present tools, resources and experiences Propose way forward to fill gaps
Vision Information systems for community-based HIV
programs provide high quality data that are used to improve programs and facilitate reporting and use throughout the health system
Information and report available through www.cpc.unc.edu/measure
Tools and Methods
Community-level Program Information Reporting (CLPIR) Toolkit
OVC monitoring wellbeing tool (OWT)
Guidelines for monitoring and evaluating HIV programs for most-at-risk populations (MARPs) (forthcoming)
Excel to Google Earth (E2G) Tool
Sample Vital Registration with Verbal Autopsy (SAVVY)
Tools and methods con’t
Non-HIV specific:
Care Group method
Barrier analysis
Reaching Every District (RED)
Care group in MZ ,from “Community Case Management Essentials “ document
What is the Child Status Index (CSI)?
A community-based tool to assess and monitor child outcomes of OVC
Developed in 2006 by MEASURE Evaluation through a participatory community approach in Kenya and Tanzania
It has 12 domains that are broad enough to reflect and capture most critical dimensions of child well-being status.
Field-tested in Kenya and Tanzania (inter-rater reliability and validity)
Rationale for developing the CSI tool
To assess and monitor child outcomes To capture holistically the multiple dimensions of
child well-being To generate frequent and timely information for
program decisions To harmonize the data collection process across
OVC program partners
• To incorporate local perspectives of child well-being
CSI Content & Rating Scale Twelve outcome areas
Food and Nutrition - (Food Security; Nutrition & Growth)
Shelter and Care - (Shelter and Care)
Protection - (Abuse & Exploitation; Legal Protection)
Health - (Wellness; Health Care Services)
Psychosocial - (Emotional Health; Social Behavior),
Education and Training - (Performance; Education/Work)
Rating 4= No problem; 3=A little problem; 2= Bad problem;
1=Emergency situation
Decision-making levels and the use of the CSI?
Individual child level –The CSI data enables service providers to make several decisions about each child so as to serve them better.
Program Level Assessments - it can also be used at program level through a carefully designed assessment process. So as…
To provide information for program improvement
To document program effectiveness - achieving the intended outcomes
To align program practices with program quality standards, e.g., Ethiopia Case study
Analyzing and using CSI data
Integrate the CSI tool within the overall M&E for OVC database system
For Example:
CCF has developed database for keeping, updating, analyzing and reporting information on OVC.
The database is linked with other program data and generates automatic reports (see next slide).
About CCF Database System
The database is secured by a password
Both baseline information (during OVC Enrollment) and information gathered during follow-up/home visits is entered to database;
In Kenya, a baseline data for 8,853 OVC have been entered so far through New OVC Enrollment (from October 2007)
Reducing data collection burden – if CSI used----
• As part of a home visit conducted by volunteers & frontline staff (monthly in some areas)
• Periodically as determined by program or service providers and purposes (e.g. 6 months – see PC3/Ethiopia example)
PC3 - Aggregate scores by domainDomain Good
(4)Fair (3)
Bad (2)
V/bad (1)
Total n
Food and Nutrition 25.8% 40.4% 27.1% 6.6% 9918
Shelter and Care 29.2% 39.3% 22.4% 9.1% 9918
Protection 46.2% 33.3% 15.6% 3.8% 9918
Health 41.3% 33.1% 10.4% 7.2% 9918
Psychosocial Care
38.8% 40.1% 16.9% 4.1% 9918
Education and work
37.0% 35.7% 20.4% 6.3% 9858
CSI users’ responses from field
• Provides a consistent way to assess outcomes • Puts focus on outcomes rather than on outputs• Helps ensure appropriate responses to child needs• Provides data for program managers and
improvements• Supports advocacy • Raises awareness about all areas of a child
wellbeing that need monitoring• Accountability - demonstrate program progress
CSI looking forward
Provide guidelines for CSI use at program & national levels (systems)
Web-based access for CSI documents
Surveillance tool to identify OVC in population and help define vulnerability beyond orphans in-country.
Integrate it within the existing data management systems (in program, country, Organization)
Mapping of the information
CSI conclusions
CSI tool is one of the methods/M&E activities to collect data that can inform on the effects of an OVC program
CSI assessment - has to be planned and coordinated with other M&E activities (for better scheduling, staffing, funding, and use of existing resources)
Consolidating CSI data with other M&E data strengthens the case and advocacy efforts for OVC
Vision for the field Harmonize indicators at the global level Generate evidence base Make tools, guides, and indicators available but
adaptable Harmonize systems at country level Strengthening information linkages throughout the
system Communities determine their needs Strengthen community-based HIV program capacity
Challenges “Community” lacks definition The purpose is not always articulated Information gathering requirements pose a burden for
front line providers Volunteer expectations are not defined Linkages are weak Data use is weak Data quality is weak National systems are weak Double counting is a problem
Recommendations
Foster data use at the community-based program and community level
Develop a bibliography of resources
Develop a framework for information systems for community-based HIV programs
Promote available resources and experiences related to information systems for community-based HIV programs
Other recommendations
Global fund work on community systems
World Bank developing plan to evaluate community response to HIV
Document or evaluate existing experiences
Apply lessons learned from non-HIV experiences
Seek creative solutions to shift burden from front line, e.g., Review population based surveys
MEASURE Evaluation is funded by the U.S. Agency for
International Development and is implemented by the
Carolina Population Center at the University of North
Carolina at Chapel Hill in partnership with Futures Group
International, ICF Macro, John Snow, Inc., Management
Sciences for Health, and Tulane University. The views
expressed in this presentation do not necessarily reflect
the views of USAID or the United States Government.