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Strengthening Data Management under National AIDS Control Programme

in India through Web-based Strategic Information Management System

Abstract : THAE0105LB

Presenting Author:Dr S.Venkatesh

Deputy Director General

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Outline

1• Background

2• Overview of SIMS – Features &

Advantages

3• Management of SIMS

4• Challenges & Lessons Learnt

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India’s NACP: An Evidence-led Approach

Operational Research;

Special Studies;

Periodic Evaluations

• Migration studies

• Epidemic Profiling

• Operational Research

• Census/NFHS/DLHS

Programme

Monitoring

• Positivity rates

• Service delivery stats.

• Vulnerability indicators

• Programme gaps

Surveillance &

Estimations

• Prevalence levels &

trends• Risk Behaviours

• Incidence & Mortality

Estimation New Strategies

Geographic Prioritisation

Annual Action Plans

Mid-Course Corrections

Flexible Modeling

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Spectrum of Activities

Data Generation

HIV Sentinel Surveillance

Behavioural Surveillance

Programme Monitoring

HIV/AIDS Research

Evaluation & Impact

Assessment

Data Analysis- Dissemination

Epidemiological Analysis

HIV Estimations & Projections

Technical Reports &

Workshops

Website & Data Sharing

Data Use

Policy/ Strategy

Epidemiological Profiling

District Categorisation

Annual Action Plans

Capacity Building

Epidemiological Analysis

Modeling

HIV/AIDS Research &

Ethics

Tools – MS Office, SPSS,

SAS...

Institutional Collaboration & Cross-learning

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Issues with Earlier System

• Fragmented data collection tools• Inadequate quality control measures• Difficulty in undertaking integrated analysis• Limited data use at lower levels of

programme management• Limited options for advanced data analysis• No data visualisation options

SIMS developed as a solution to improve data management, analysis & use

M&E F

eeds

into Products of M

&E

Sources of M & E

Reports thru SIMS

Surveillance Evaluations / Assessments

Research and Studies

Dashboard & Key Indicator Update

Programme Progress Reports

External Evaluation Reports

Published Research Reports

State of Epidemic and Response

Outcome / Impact Assessment

Learning Forums

Programme Management

Planning, Policy Making

Source: Operations Manual for SIMU, August 2007

SAS Data Integration

SAS Analytics &

SAS Business

Intelligence

Monitoring and Evaluation SystemMonitoring & Evaluation System

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Framework for Strategic Information

•Program monitoring (inputs and outputs)•Measuring program outcomes•Research related to program implementation

• Impact assessments• Cost-effectiveness

Analyses• Concurrent Evaluation

• Surveillance & Estimations• Mapping & size estimation

of HRGs• Epidemiological profiling

and categorization• Research for Piloting new/

innovative intervention

models

• Knowledge products• Knowledge sharing• Knowledge translation

Knowledge Management & Translation

Pre-programme Assessments

In-programme Assessments

Programme Evaluation

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Strategic Information Management System

A web-based application with sophisticated tools for data analysis & integration from data sources/platforms for data entering, monitoring, analyses & reports generation

Has provision for offline data entry using MS-Excel

Has enhanced transparency – One version of data available for NACO/ SACS/DAPCU /RU

Launched in August 2010Personnel trained in 4 phases All India rollout in a phased manner

from 1st August to 1st Dec, 2011

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Key Features of SIMS An Integrated Web-based

Reporting, Data Management &

Decision Support System

Reporting Unit based data

capturing - Monthly reporting

from over 20,000 reporting units

across the country (includes

15,538 ICTCs/FICTC, 1,137 DAC

supported Blood Banks, 1,136

STI, 1,825 TI, 162 LWS, 1,295

ART & Link ART Centres)

Automatic aggregation of key

indicators

Integrated with all other

databases such as Surveillance,

PLHA database, survey data, etc

Individual level reporting from

ICTCs & ART Centres Moving

towards HIV Case Reporting

Modular, Expandable & Scalable

with Slice & Dice capabilities

Intelligent analysis for data use

at all levels

Standard & Custom Reports

Options for advanced analysis

using SAS

Linked to GIS System for spatial

analysis

Has options for dissemination

of standard outputs through

Share Point Portal

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Advantages of SIMS (1)• Enhances transparency & credibility of data, as only one version of

centralised validated data is available from Reporting Unit (RU) to

National level level at any given point in time.

• Provides real time access to data at all levels. Can be used for real

time monitoring of field activities.

• Though design is web-based, entry can be done both in online &

offline formats. No need for continuous internet connection at RU.

• Can manage multiple types of users at all levels through rights-based

user management. Facilitates stakeholder involvement in SIMS

management.

• Provides options to build in robust validation checks to improve data

quality.

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Advantages of SIMS (2)• Allows for generation of customised dashboard reports on key

indicators for each programme component at any level• Provides multiple options to carry out different types of

analyses of data, from simple aggregations to advanced statistics, all through one platform

• Facilitates effective presentation of key outputs, including tables, graphs, maps etc. & wider dissemination through portal

• Improves decision making by enhancing ease with which data across different sources can be triangulated, due to its integrated model

• Has built-in consistency checks & alerts to programme managers when data goes beyond (above/below) acceptable thresholds

• Has huge potential to become a customised Decision Support System for programme managers at different levels

Reporting Unit (Sub-District

Level)

DAPCU(District Level)

SACS(State Level)

NACO(National Level)

Monitoring and Data Quality Feedback to

RU

Use datato assess district-

level trends

Use data to assess state-level trends and high priority

districts

Use data to inform resource allocations

Monitoring and Data Quality Feedback to

DAPCU and/or RU

Monitoring and Data Quality Feedback to

SACS

Use data to evaluate

performance against targets

Direct reporting if no DAPCU

Data Flow

Feedback

Data Flow, Feedback & Data Use in SIMS

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Three Modules in SIMSModule FunctionsAdmin Reporting Unit creation & management (activate,

deactivate, edit, delete)User creation & management (activate, deactivate, edit, delete)User access rights management

Unlocking accounts/ Resetting passwords

MIS Data entry formats

Validation checks on data entry

Searching, viewing, modifying & exporting data

Reports and Analytics using SAS

Captures input data into customised tabular outputs

Summarizing & viewing key indicators (Dashboards)

Monitoring data entry, reporting & forwarding

Analysis including triangulation & spatial analysis

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Scale up-Service facilities

4,132

1,825 1,136

15,538

1,295

2013

2007

TI LWS STI CSMP ICTC ARTCNo. of

TINo. of Dists.

No. of Dists.

No. of Clinics

No. of Centres

No. of Centres

TI: Targeted Intervention (Urban MARPs)LWS: Link Worker Scheme (Rural MARPs)STI: Sexually Transmitted InfectionsCSMP: Condom Social Marketing ProgrammeICTC: Integrated Counseling & Testing CentreART: Anti Retroviral Treatment

Strategic Information Management System

NGO’s for Targeted Interventions

ICTC F-ICTC (CHC/PHC)

Community Support Centre

ART Centres

STI Clinics

Blood Banks

• Outreach coverage• Facility linkage• Commodity Distribution• Staffing & Training • Patient Volume

• Patient Symptoms

• Enrolment• Treatment• Adherence• Inventory Mgmt• Staffing

• Volume & Profile• Testing Results• Inventory Mgmt

Gynecology OPDs

• Service volume• Profile of Positives• In & Out Referrals

• Clinic volume• Syndromatic Diagnosis• Coverage of ANC

syphilis screening• Laboratory Procedure• Inventory Management

• Pregnancy Information• Women Health issues

• General Health data

SIMS Users

• AIDS demographics

• Opportunistic Infections

NACO SACS DAPCU

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Management of SIMS at NACO Level• Stabilizing Active Reporting Units (RU) in SIMS

– Defining ‘active’ & ‘de-active’ RU– Developing guidelines for creating, activating & de-activating RUs under

different components

• Managing Unique Centre Code System in SIMS to ensure error-free reporting

• Monitoring & addressing issues reported from RU/ DAPCU/ SACS• Analysis of Bugs reported/ identified & coordination with Software

team for timely resolution• Streamlining User Access Rights for smoother & efficient data

management• Development of responsibility matrix & guidelines for data

management at different levels• Development, printing & distribution of user manuals, data

definitions, wall charts etc. for SIMS formats under all programme components

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State AIDS Control Socities(SACS): Roles & Responsibilities

• Ensure availability of required Computer & Internet connectivity in reporting units, District AIDS Prevention Control Units & SACS

• Actively monitor SIMS training programme & progress of SIMS rollout

• Include SIMS review as a part of all the review meetings & tours/visits

• Handhold concerned SACS officers in rolling out SIMS

• State M& E Officer - nodal person for SIMS, supports & supervises SIMS training activities & takes the lead as resource person

• Respective programme component division Officer deputed for SIMS Reporting Unit training for supervision & to clarify doubts regarding respective formats

• Technical Support Unit actively involved in all activities - SIMS roll out

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Roles & ResponsibilitiesAt Primary Reporting Units• Data is entered

• Individual (ICTC/ART)• Monthly (STI/BB/TI etc)

• Entered data is validated & sent(forward) to DAPCU

At DAPCU level

• Receive data sent by Primary Reporting Units

• Scrutinize data for:• Completeness of reporting• Correctness of reporting

• After validation, send (forward) the data to next level (SACS)

• If errors/incomplete data/queries are found, would revert the data to the reporting unit level, ask them to correct and resend

• Enter the data required to be entered at DAPCU level, validate & forward to SACS

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Structured Trainings on SIMS- Induction & Refresher

• Detailed induction training to new recruits at reporting unit level, using standard training schedules & material

• Includes hands-on practice• Annual Refresher trainings to all Reporting Unit staff on

respective modules in SIMS• Trainings include basic computer skills for users who are

not well versed with IT• Focussed repeat trainings & Orientation sessions for poor

reporting RUs• Mandated SACS to develop quarterly training plans &

share with NACO• Focus on close monitoring of trainings & timely submission

of training reports

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Data definitions developed to standardise reporting

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Data Quality Monitoring System

• Framework & Guidelines developed for a comprehensive,

systematic data quality monitoring system:

– Validation checks within SIMS

– Consistency checks & Alerts

– Checklists for periodic quality review of data

– Plan for periodic field visits to monitor data quality

– Checklists for spot checks, register verifications & random

checks

– All review meetings to include SIMS data quality review

– Periodic Data quality reports with identified quality indicators

– Clear Responsibility Matrix

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National & State Helpdesks• National Helpdesk with 2 persons functional since March 2012

• Dedicated mobile numbers for direct contact from across the

country

• Provides real time support by telephone & email

• Immediate resolution of issues through remote access to users’

computers

• Maintenance of detailed log of all issues reported

• Act as liaison between users & software team for resolution of

issues

• State level Helpdesks set up in all states with 60 persons with

local language proficiency

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Steps to Improve SIMS Reporting (1)

• Project Directors & nodal persons at SACS instructed to focus on reporting thro’ SIMS:– Avoid parallel mechanisms of reporting & use

only SIMS– Closely monitor & handhold non-reporting units– Focus on SIMS reporting during field visits &

review meetings– Review SIMS implementation progress in each

component at SACS level review meetings– Regularly generate reports & monitor progress

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Steps to Improve SIMS Reporting (2)

• SACS to ensure computer availability– Sharing of computers at co-located facilities– Use of internet café or other closest internet points– Procure/Upgrade computers, where necessary

• SACS to ensure internet connectivity in RUs: – provide datacards – instruct sharing of co-located facilities – map nearest internet points; make provision for

travel & internet charges – identify back up mechanisms, such as paper-based

reporting to DAPCU

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Managing Data Outputs

1. Standardising reports & ensuring error & bug-free reports

2. Regular dissemination through Share Point Portal

3. Customised component-wise dashboards to capture key

indicators

4. Alert mechanisms for priority attention of programme

managers

5. Development of analytics module including triangulation,

advanced analysis using SAS

6. Operationalising GIS component for spatial analysis

7. Development into a fully functional Decision Support System

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Promoting SIMS Data Analysis & Use

• Capacity building of SACS personnel on data analysis & data use

• Quarterly SIMS bulletins at NACO & SACS • Two analytic reports/person in SIMU of SACS • Monthly SIMS Update from NACO M&E division

to other programme divisions, highlighting key indicators, issues & recommended actions

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Reporting Status 2013-14

0

10

20

30

40

50

60

70

80

90

100 100

100

100

100

100

100

100

99 98 98 98

95 95

93 92

90 89 88

85

80 79

75

69 69 68

56

90

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Key Challenges• Software developer related issues: delay in development

& resolution of bugs, frequent change of Project Staff • Frequent changes in formats due to evolving programme

needs• Computer & internet connectivity • Computer literacy of users at facilities in different levels• Change of SIMS users • Standardisation of SIMS management protocols at NACO

& SACS• Development of capacities at state level to manage SIMS

& manage data through SIMS• Ownership by programme divisions & SACS to improve

quality, utility & value of SIMS data

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Lessons learnt• A web-based integrated data management system

offers us an opportunity to improve programme reporting, data quality & data use at all levels of programme management.

• A strong system push needed from national level to Reporting Unit level to implement the system.

• Focus should be on building infrastructure & computer skills of users is critical.

• Standardised management protocols help promote stabilility & continuity of the system.

• Ownership of SIMS by programme divisions & SACS is essential to improve its functionality & utility.

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Thank You