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Utilizing Facility Data for Program Monitoring Valerie Koscelnik Track 1 ART Program Meeting

Utilizing Facility Data for Program Monitoring Valerie Koscelnik Track 1 ART Program Meeting Maputo, August 12, 2010. Outline. Framework for health system components and outcomes Transition short & long term goal/objective Transition Logic model Measurements: Site and Regional readiness

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Utilizing Facility Data for Program Monitoring Valerie Koscelnik Track 1 ART Program Meeting

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  1. Utilizing Facility Data for Program Monitoring Valerie KoscelnikTrack 1 ART Program Meeting Maputo, August 12, 2010

  2. Outline • Framework for health system components and outcomes • Transition short & long term goal/objective • Transition Logic model • Measurements: • Site and Regional readiness • Outcome indicators • Data quality assessments • Summary and conclusions

  3. Health Systems Building Blocks and Key Health Outcomes Overall Health Outcomes

  4. Transition monitoring: What are we looking for? Long term goal & shorter-term objective • Long term goal: sustained local ownership with maintenance of excellent patient care and good patient outcomes. Ultimately, a vision of an effective strengthened health systems. • Shorter term objective: Sites and local partners (governmental and/or NGO) able to accept/absorb and grow the program with delivery of high quality care Source: Transition Logic Model Working Group

  5. The Transition Logic Model: Inputs &Outputs individualized per partner Transition Logic Model Inputs and outputs individualized per partner

  6. Process/Health System Measurements • Site maturity: SCA-like tools • Technical and organizational competency of local government and NGO partners • Ownership – Performance & accountability documentation TBD Source: Transition Logic Model Working Group

  7. Site readinessKenya • Locally developed site readiness tools assessing key domains ICAP-Kenya Track I Rapid Maturity Assessment Tool for Health Facility Transition: • Assessed (1) services offered, (2) HR, (3) general management, (4) financial management, (5) quality management (6) procurement/supply chain management and (7) performance indicator: retention of patients in last 12 month • Facility is ready for transition if scores 90% or greater • Facilities below 90% require continued capacity building for transition

  8. State and site readiness:Nigeria • Structured assessment of state institutions and sites by (1) governance/leadership, (2) organizational structure, (3 & 4) HR & fin management, (5) external relationships, (6) service delivery, (7) pharmacy and (8) laboratory • Scale used to determine priority states for transition

  9. State Y

  10. State X

  11. Clinical Quality of CareOutcome indicators • Adult care and treatment • Pediatric care and treatment • PMTCT • TB/HIV • Laboratory • Counseling & Testing • Adherence and Psychosocial support Need to focus on priority set of key Quality of Care indicators

  12. ICAP priority quality indicators: Standards of Care (SOC) Rationale: • Five priority quality indicators selected to allow for comparisons across sites, programs and countries* • Creates a limited, manageable core set of indicators for program monitoring and review of quality Data sources: • Routinely-collected site-level indicator data reported every quarter for HIV care and treatment (Track 1 reporting indicators), TB/HIV, and PMTCT programs • Data imported from country aggregate databases or hand-entered on on-line indicator database • Data checks are run on the data to ensure internal and cross-quarter consistency * Countries and site can select specific SOCs for monitoring & CQIactivities

  13. Priority Quality Indicators

  14. Priority Indicator 1 Target: 95% of eligible patients in care and treatment receive cotrimoxazole • To start centrally collecting in fall 2010

  15. Priority Indicator 2 Target: 95% of HIV infected children under one year of age receive ART

  16. Priority Indicator 3 Target: 90% of patients enrolled into treatment remain in care for at least 12 months

  17. Priority Indicator 4 Target: 95% of all patients in care and treatment receive TB screening at enrollment

  18. Priority Indicator 5 Target: 95% of HIV-infected pregnant women in PMTCT services receive multi-drug ARV prophylaxis

  19. Indicators across country programs

  20. Site specific trends in priority quality (SOC)indicators Mozambique

  21. Site-specific trends in priority quality (SOC) indicators by siteRwanda

  22. DQA Indicators * Quality Indicator

  23. DQA Indicators (con’t)

  24. Summary • Readiness assessments critical to determine status of health system components and provide important information for transition preparation and monitoring • Quality indicator data at site and country levels provide critical outcome data on quality of health system outcomes before, during and after transition • Data quality audits are important and can serve to monitor performance and could inform continued funding and accountability

  25. Conclusions Data must always inform programs Data must continue to inform all aspects of transition efforts

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