Clinical Data Quality in Mozambique: A Comparative Exercise

CLINICAL DATA QUALITY IN MOZAMBIQUE

A COMPARATIVE EXERCISE AFTER FOUR ROUNDS

Mozambique Strategic Information Project (MSIP)

JSI Research & Training Institute, Inc. (JSI)

Prepared by:

Dália Monteiro Traça,

Chief of Party

[email protected]

November 7, 2017

No relationships to disclose.

Assessing the quality of

reported data

Use results to inform

quality improvement

Build capacity of

national health

information systems

Objectives of the DQA strategy

Strategic Approach

Create a sustainable Data Quality Assessment system that is

affordable, accepted, owned and scalable by the MOH

Prioritize the inclusion of MOH staff in all steps of

the development, piloting and implementation

of the DQA strategy

Promote the alignment of the existing reporting systems

(PEPFAR and DHIS2)

DQA Objectives

• To assess the quality of data registered in primary sources

and data reported to the upper levels, verifying the

following sources:

– Daily registers vs. Monthly reports (Health Facility),

– National Database DHIS2 (District),

– DHIS2 (Province),

– DHIS2 (Central level)

• To assess the data management and reporting systems at

the HF and District level.

Assessed Indicators Area Indicator Abbre-

viation

Treatment and Care Number of HIV+ positive individuals active on ART TARV

Number of HIV + individuals who are eligible for

Cotrimoxazole (CTX) and receive CTX

CTX

Prevention of Mother to

Child Transmission

Number of HIV+ pregnant women who received

medication/prophylaxis ARV to reduce the risk of

mother to child transmission during prenatal consult

CPN

Number of HIV+ pregnant women who received

medication/prophylaxis ARV to reduce the risk of

mother to child transmission during labor and delivery

MAT

Number of children exposed to HIV who received a

PCR test at <8 weeks

PCR

Counseling and Testing Number of people who were tested for HIV and

received their results in a clinical environment

UATS

Voluntary Medical Male

Circumcision

Number of men circumcised as part of the voluntary

package of male circumcision for HIV prevention

CM

Overall DQA Implementation Methodology

1. Calendar of DQA implementation with MOH (including site

selection)

2. MOH informs Provinces Health Department (DPS) of DQA

implementation dates and facilities

3. DPS informs District Health Directorates (DDS) and Health

Facility (HF) of DQA implementation and dates

4. Training of MOH central staff (prior to departure to provinces)

5. Training for DPS and Implementing Partner (IP) staff at

province

6. DQA implementation (with debrief at HF level)

7. DQA debrief at province level for DPS and IP

8. National debrief at MOH central

DQA RESULTS Round 2014, 2015, 2016 & 2017

Deviation:

Good quality data = <10%

Moderate data quality = 10-20%

Poor Quality Data = >20%

Indicator ART: Deviation in Reporting

37%

28%

22%

20%

0%

5%

10%

15%

20%

25%

30%

35%

40%

2014 2015 2016 2017

Devi

atio

n

Deviation:

Good quality data = <10%

Moderate data quality = 10-20%

Poor Quality Data = >20%

Indicator ART: Deviation in Reporting (Repeat sites)

2016

Indicator ART: Systems Assessment Scores

Indicator ART: Registers

Indicator ART: Patient Files

Before After

Deviation:

Good quality data = <10%

Moderate data quality = 10-20%

Poor Quality Data = >20%

National Level Deviations by indicator, DQA 2014 -2017

Discussion

• Country-wide, annual reporting by province

• Effective MOH ownership, with actual involvement from the beginning:

Selection of indicators and Health Facilities, definition of calendars and

team composition, budget allocation to the activity.

• Methodological approach with immediate written feedback at the level

where most discrepancies occur (Health Facility) - the innovative factor

• No new technology – uses only technology already available in the public

system

• Sites that received more then one visit show improvements – confirming

that the inclusion of HF staff and the immediate feedback have a great

positive impact on future improvement actions.

Key Aspects

Key Findings

Key Findings Ownership of the activity by MOH and leadership at

province level are essential for real impact and change at HF

level

The regular, periodic nature of the activity and consistency of

feedback and recommendations had a very positive impact on

the results

“Non-punitive” nature of activity, made it more welcoming by

HF staff and more willing to implement changes

Moving Forward

Moving Forward

“From QA to QI” – Existence of a clear gap between the DQA

activity and the implementation of changes that need to happen;

Use the momentum created by the DQA to generate change;

TA delivery to MOH for DQA implementation;

Roll out of methodology to other program areas – DQA

methodology with Malaria, TB and MCH programs (2016/17);

Inclusion of DQA activity in the official MOH budget.

OBRIGADA!

Dália Monteiro Traça Chief of Party MSIP

Maputo, Mozambique

[email protected]