Building Sustainable Strategic Information Systems in Low-Resource Countries

Bobby JeffersonSenior HMIS Advisor

AIDSRelief projectFutures Group International LLC

Presenting on behalf of Lanette Burrows, Pat Bass, Ian Wanyeki

AIDSRelief Overview• PEPFAR Track 1.0 Initiative

– Catholic Relief Services – Prime (CRS)– University of Maryland Institute of Human

Virology (IHV)– Futures Group– Catholic Medical Mission Board (CMMB)– Interchurch Medical Association (IMA)

• 5-year project focused on increasing access to high quality HIV care and treatment

AIDSRelief Overview• Implemented in 9 countries:

– Guyana, Haiti, Kenya, Nigeria, Rwanda, South Africa, Uganda, Tanzania, Zambia, Ethiopia (April 2009)

• Focus on building capacity for quality HIV care and treatment– lab, pharmacy, clinical services, M&E

• More than 212 local partner treatment facilities (LPTF)– Small Rural Health Centers– Rural Health Clinics – District Hospitals– Mission Hospitals– Urban High Volume hospitals

212 ART Treatment

Facilities (Clinics) + 122 satellite

Sites + 288 PMTCT sites

3

7

29

18

2510

78

18

24

Where we work

Futures Group Overview• Futures Group provides strategic information (SI)

capacity building and focuses on:– Improved data demand and information use (DDIU)– Enhancing/implementing patient monitoring and

management (PMM) systems that meet local requirements

– Enhancing Data quality for better services and clinical outcomes

– Using local experts to build capacity at partner sites

Regional Software development teamsin Kenya, Rwanda, South Africa, India

Strategic Information• Committed to collecting only information essential for

clinical management and quality improvement • Capacity building (local ownership)• Committed to feeding back information to the local partner

treatment facility (Clinic) to address gaps in program and services

• To offer a library of tools and solutions built around adaptive management, high quality data, and sustainability

• Freely available software, no licensing fees • User , Admin Training, and In-country Programmer

or Database Training available• To develop requirements through practical field

experience and lessons learned• To take a collaborative approach using local experts

throughout the development process

Patient Management and Monitoring

Typical Hospital Records Center

Finding patient information in the past

Key Features

• Stability and ease of use – A browser-based, easy-to-use software tool with

robust underlying SQL database– No Internet access required to use system

• Facility and Patient Dashboards• Real Time data entry and reporting• Custom reports

Monitoring our programs through IQSolutions

Demonstrate outputs and outcomes– Clinics ability to hit set targets– Trend analysis– CD4 count changes– Mortality & Lost-to-follow-up rates

Case studies demonstrating outcomesUsing data collected on a routine basis for:

– Life table analysis– Defaulter tracking– Quality of life analysis

“After successful assessment, the IQ Care system developed and supported by the Constella Futures Group and Catholic Relief Services came up top in terms of overall features (technical and non technical) and also in terms of largest number of installations “

“From the above data, IQ Care comes out strongly ….recommended for medium to large ART centres.”

WHO and CDC sponsored EMR Assessment Report , Kenya May 2009

Implementing IQCare

Number of Sites

Number ofPatients

Kenya 28 65,500

Uganda 20 63,000

Nigeria 27 60,000

Total 75 188,500

Missed ART > 20 days in August- December 2008 per LPTF

Local Partner August September October November December

Hospital # 1 78 21 12 4 3

Hospital # 2 51 23 5 0 0

Hospital # 3 25 22 7 5 5

Hospital # 4 17 19 13 1 1

Hospital # 5 5 0 0 0 0

Hospital # 6 5 1 0 0 0

Hospital # 7 2 0 1 1 2

Hospital # 8 1 1 0 0 0

Hospital # 9 0 0 0 0 0

Hospital # 10 0 0 0 0 0

Hospital # 11 0 0 1 0 0

TOTAL 184 87 39 11 11

What does it provide us with? ARV Pickup Report

Close monitoring of the ART pick up habits over time at LPTFs has helped ensure that fewer patients miss collecting their ARTs on time

What does it provide us with?

August September October November December0

20

40

60

80

100

120

140

160

180

200184

87

39

11

11

All sites

Reporting

• ARV Pickup Report• CDC Track 1.0 Quarterly Report• Monthly TRAC MOH reports• Custom user and Data quality reports• Cohort mortality report• Display on screen or export to Excel

Three sites showing the sub-districts they service

# Defaulters per village – Green <5, Yellow 5-10, Red >10

Capacity Building and decision making

• Identify defaulters per village or sub-district– Deploy adherence counselors to follow-up

• Identify trends– Link defaulter data to average distance travelled or

average time taken reach the site• Provide supplemental services (transport)• Open field service centers

Select a village to see the defaulter list and HCW assigned

Other Developments• Electronic first (E-First) data entry• Paperless Clinics

– Pilot in Kenya– Pilot in Nigeria Clinic

• Wireless at Clinics– Security, Use of HTTPS, – OpenSSL

# Defaulters (red) vs avg distance travelled to reach site (blue)

Thank youThank you