EXTERNAL DQA METHODOLOGY AND IMPLEMENTATIONMozambique Strategic Information Project (MSIP)

JSI Research & Training Institute, Inc. (JSI)in collaboration with UCSF, I-Tech

Prepared by: Dália Traça

November 4, 2015

Objectives of the eDQA 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 eDQA strategy

Promote the alignment of the existing reporting systems (PEPFAR and SIS—MA/Módulo Basico)

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 “Módulo Básico” (District/NED), – “Módulo Básico” (Province/NEP), – “Módulo Básico” (Central level)

• To assess the data management and reporting systems at the HF and NEDs level.

Assessed IndicatorsArea Indicator Abbr

e-viatio

nTreatment 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

7

ART IndicatorRandom selection of 30 active patients on ART

• Confirmation of patient status, within the revision period, based on:• Drug pick-up date in the Pharmacy Register Book and

Individual Drug Prick-up form (FILA)• Last medical consultation, based on individual patient file

CTX IndicatorRandom selection of 30 active patients eligible for CTX

• Confirmation of reception of CTX for eligible patients using individual patient files

ANC, MAT, PCR CT & VMMC Indicators Comparison of recounts from source documents with reported data at the various levels

Methodology for data collection

TARV

CTX

CPN, MAT, PCR , UATS e CM

Data Analysis – Calculation of the deviation

Deviation: <10% Good quality data; 10 to 20%: Moderate data quality; >20% Poor Quality Data

DQA RESULTSRound 2014

Indicator ART

Participatory Approach to DQA activity

Lessons Learned

DQA Lessons Learned (1)Lessons Learned Impact

Participatory development of SOP for each indicator

Clear understanding of the indicator and data to be collected

Involvement of MoH from project inception

Strong ownership of activities and DQA results

Understanding the logistical and time challenges of the Mozambican context

Compliance with DQA planned activities and timeline

Conducting of DQA training before field implementation

All the DQA participants – MoH staff, DPS staff have theoretical knowledge of the DQA process before field implementation

Determining the role of each DQA participant

Efficient use of time during HF visits

DQA Lessons Learned (2)Lessons Learned Impact

Active participation of MoH staff during DQA training

Ownership by the MoH of DQA activity

Presentation and introduction of DQA team by DPS focal point at HF/District level

Ownership of DQA activity by DPS and giving the face of MoH/DPS

Capacity building of HF staff and promotion of Quality Improvement of HF data during DQA

Improved capacity among HF staff on data registering and aggregation

Leaving written preliminary observations at HF after DQA visit

HF management uses preliminary observations to address challenges

Presentation of Provincial DQA results to the DPS at the end of each DQA activity

Endorsement of DQA results by the DPS and focus on solutions for the identified challenges

On the right track?

Cabo Delgado Province

Comparison between round 2014 and round 2015

Comparison between Round 2014 and 2015

Quality Improvement during eDQA

Key Findings

eDQA Preparatory phase:1. Training with MoH central – training with central level MoH staff prior to departure to the DQA, to accompany the team in the field

2. Training with DPS – Training all DPS staff and IP on the DQA implementation

Key Findings (cont.)At Health Facility:

During Data Collection

Clarification on the filling in of registers (missing data, misplaced data, etc)

Poorly kept registers Counting clarification during recounting by eDQA team Clarification of indicator definition and data collection

During Debriefing (technical and management)

Highlight and discussion of specific HF strong and weak points observed during DQA activity

Leaving observations and recommendations in writing, including preliminary deviations for each indicator

Reinforce the importance of Data Use for better management.

Key Findings (cont.)

Debrief at Province Level with DPS and IP:

1. Discussion of strong and weak points observed during DQA activity, highlighting more problematic indicators.

2. Clarification of calculated deviations per indicator

3. Leaving observations and recommendations in writing in the form of a detailed Power Point presentation

Conclusion

Even though the DQA had a specific purpose, we realized that the participatory methodology used creates the possibility to introduce to Quality Improvement elements along the process, as well as capacity building and empowerment of the MoH staff to pursue better quality data, at all levels of the hierarchy.

“You cannot do DQA without doing QI”

OBRIGADA!

Dália Monteiro TraçaChief of Party MSIP

Maputo, Mozambique

dtraca@mz.jsi.com