Preventing Cervical Cancer Through

Effective Data Use: Practical Tools

Jenn Drummond, MPH

IDCCP Lead Technical Advisor

Megan Wysong, MPH

M&E Team Lead, Jhpiego/USA

John E. Varallo, MD, MPH

Senior Technical Advisor, Jhpiego/USA

Global Health Mini University 2016

ACKNOWLEDGEMENTS

• Collaboration among countries and international agencies

• WHO, CDC Foundation, CDC, Gates Foundation, George W.

Bush Institute, and Jhpiego

• Field testing with Ministries of Health in Botswana and

Tanzania

• Draws upon previous WHO publications and cervical cancer

project documents

• Originally developed by Jhpiego

OUTLINE OF PRESENTATION

General overview of the IDCCP Project

Patient and Program Monitoring Toolkit: Overview

Facility-based Surveillance Toolkit: Overview

Speed Dating

Summarize learning and next steps for the initiative

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The NeedA global absence ofstandardized tools andguidance, technical expertise,and implementation supportfor countries that are seekingto collect and use high-quality data to monitor,evaluate, and improve theirscreening and treatmentprograms.

The Grant• Goal: To improve and accelerate

the availability of data forplanning and improving globalcervical cancer programs bygathering information on datasystems in select country contexts,and by developing global standards, tools, and guiding information

• Timeframe: January 2014 toJune 2016

• Donor: Bill & Melinda GatesFoundation’s NeglectedInfectious Disease (NID) programstrategy area

Improving Data for Decision-Making in Cervical Cancer

Programmes (IDCCP) Project

Improving Data for Decision-making in Global

Cervical Cancer Programs (IDCCP) Project

4. Coordination

Bush Institute WHO

1. Data Systems

Assessments

CDC/DGHT

Indiana

University

Bill and Melinda Gates Foundation Grant ActivitiesImproving Data for Decision-Making in Cervical Cancer Programs

3. Web-based

Knowledge

Management

Bush Institute

Johns Hopkins University –Center for Communication

Programs

2. Standardized Toolkit

Program Costing

Bush Institute WHOLevin & Morgan

Outcomes Evaluation

CDC/DGHT WHOInternational Agency

for Research on Cancer

Population-based Survey Modules

CDC/DCPC John Snow International

Patient and Program Monitoring

CDC/DGHT Jhpiego

Facility-based Surveys

JhpiegoCDC/DGHT

CDC Foundation

5

Southern Methodist University

Pink Ribbon Red Ribbon

IDCCP Toolkit Components

How to identify opportunities for strengthening country data and data systems?

How to estimate costs of cervical cancer screening & treatment programs?

How to estimate outcomes of cervical cancer screening and treatment programs?

How to measure population

coverage of cervical cancer screening

and secondary prevention?

How to survey facilities for service readiness, service availability, service quality?

How to routinely monitor patients and programs?

Part 1: Rapid Situational Assessment

of Cervical Cancer Data and Data Systems

Part 5: Cervical Cancer Prevention and

Control Costing – Screening and Treatment

Module

Protocol for the Evaluation of Patient

Outcomes

Part 2: Population-based Survey Modules

for Cervical Cancer

Part 4: Facility-based Surveys for Cervical

Cancer

Part 3: Patient & Program Monitoring for

Cervical Cancer

PATIENT AND

PROGRAM

MONITORING

TOOLKIT

INTRODUCTION TO PPM TOOLKIT

• System of key indicators, data

collection, and data

management and use tools to

monitor national programs and

improve cervical cancer

programs

FOCUSES ON DOES NOT FOCUS ON

• Pre-cancer screening

methodologies:

• VIA

• Cryotherapy

• LEEP

• Aggregate systems

• Methodologies

• HPV vaccine

• Colposcopy

• Biopsy

• Sentinel site surveillance

or electronic medical

record system

PURPOSE OF PPM AND THIS TOOLKIT

Systematic

means of

capturing

client-level

data…

Summarizing

it with

appropriate

aggregation…

Providing guidance

on how info can be

strategically used at

the facility,

subnational, and

national levels

PURPOSE

THIS TOOLKIT CONTAINS

• Fundamental tools and info to

develop and improve existing

M&E systems

• Data elements and indicators that are

derived from and feed into WHO global

cervical cancer indicators1

1 Comprehensive Cervical Cancer Control: Guide to Essential

Practice, 2nd Edition, 2014

INTENDED AUDIENCE

Consensus building on data recording in

Guyana

National health sector staff engaged in designing, adapting or

maintaining M&E systems

Decision-makerswho use data to improve programs

NGOs, private-sector providers,

CSOs, donors and academic

groups to ensure their systems are aligned with

the global guidance and national

system

TOOLKIT BASICS

“Instruction on how to build the engine – not drive the car”

• How to apply the tools to the development

and improvement of the M&E system

• Does NOT include instruction on how to

complete tools or train providers

Provides standard

indicators and tools to

be used across and

within countries

Builds on systems

already in place;

does not replace

existing systems

ESSENTIAL COMPONENTS

Core and optional indicators

Data collection, collation and analysis

tool samples

Electronic data capture and visualization system: DHIS 2

Data quality and training guidance

CERVICAL CANCER CONTROL CORE INDICATORS (WHO, 2014)

Screening Coverage of the Target Population:

Percentage of women aged 30 – 49 years who have been screened at least once since age 30

Data Source: Population Survey

Screening Rate of the Target Population:

Percentage of women aged 30 – 49 years who have been screened over a 12 month period,

disaggregate first screen from repeat screen

Data Source: Routine Service Delivery Registers / Summaries

Screening Test Positivity:

Percentage of [first time] screened women aged 30 – 49 years with a positive result in the previous

12-month period

Data Source: Data Source: Routine Service Delivery Registers / Summaries

Treatment Rate:

Percentage of [first-time] screen-positive women completing appropriate treatment for pre-cancer

and treatment for invasive cancer in the previous 12-month period

Data Source: Data Source: Routine Service Delivery Registers / Summaries + Cancer Registries

Impact Indicator:

Cervical cancer age – specific incidence and mortality

Data Source: Population-based or sentinel hospital-based cancer registries

INDICATORS

TOOLS

STANDARD CERVICAL CANCER DATA COLLECTION TOOL SAMPLES AND

DATA ELEMENT CHECKLISTS

Additional facility forms include: referral form, client card, referral follow-up listing,

etc.

Sample Client Form

Screening / Treatment

Register

Monthly Summary

DATA CAPTURE USING DHIS2

DATA USE POSTER AT FACILITY-LEVEL

Those that document

data can use their data

to identify trends /

patterns, gaps, and

progress toward targets

and standards.

PROVIDER TRAINING WITH INTEGRATED M&E SESSIONS

FACILITY-BASED

SURVEILLANCE

TOOLS

FACILITY-BASED SURVEILLANCE TOOLS

• Service Availability

• Facility Readiness Assessment

• Supportive Supervision

SERVICE AVAILABILITY

PURPOSE

• Mapping:

• Identify existence or physical presence of facilities and

mobile clinics

• Systematic survey at the national or subnational level

• Used to improve cervical services by assessing the

equitable distribution of facilities and mobile clinics

INTENDED USERS

• MoH, national planners, health administrators, partner

organizations

FACILITY READINESS ASSESSMENT

PURPOSE

• Assess facility capacity to deliver cervical cancer screening

and treatment services; level of readiness

• Ensure that the facility has the necessary inputs or core

elements required for services

• A precondition for service quality, it does not ensure

quality

• Done as Baseline and as Periodic assessment of level of

readiness

INTENDED USERS

• MoH, facility supervisors, program managers,

internal/external evaluators, partner organizations

FACILITY READINESS ASSESSMENT

FACILITY LEVEL OF READINESS AND SUMMARY SCORE

SUPPORTIVE SUPERVISION

PURPOSE

• Focus on quality: 1) provider performance; 2) data quality

and meeting key indicator benchmarks

• Also assesses level of facility readiness

INTENDED USERS

• Clinical trainers/supervisors, M&E advisors, program

managers, supervisors, and providers (peer and self-

assessment)

FACILITY READINESS ASSESSMENT

PROVIDER PERFORMANCE

PROVIDER PERFORMANCE

DATA MANAGEMENT AND MEETING KEY INDICATOR BENCHMARKS

PERFORMANCE AND FACILITY READINESS SUMMARY SCORE

REVIEW TOOLKITS

Divide into 2 groups

1 group review the PPM Toolkit and the other group

review the FBS Toolkit (20 min)

Switch (20 min)

Summarize next steps

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2.

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4.