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…