Monitoring HIV/AIDS using Sample Vital Registration with Verbal Autopsy

1. Monitoring HIV/AIDS using Sample Vital Registration with Verbal Autopsy Gregory Kabadi on behalf of SAVVY partners

2. Outline • SAVVY Overview • Technical aspects for SAVVY • Implementation plan • SAVVY’s facilitation with RITA

3. SAVVY Overview ‘SAVVY’=Sample Vital Registration with Verbal Autopsy • A sample demographic surveillance system built around vital events monitoring • Purpose is to provide improved monitoring and measurement of vital events • Not available from vital registration systems, household surveys, etc. • SAVVY will include cause of death ascertainment • Supplemental information from periodic surveys “nested” within system • SAVVY will consolidate and adapt “best practice” in • Sample and demographic surveillance techniques • Survey sampling methods • Validated ‘verbal autopsy’ methods

4. SAVVY’s ORGANISATIONAL STRUCTURE • National Level: • Technical Staff at MOHSW, Other Gov Depts, Development Partners. SAVVY’s Implementing Partners: IHI & NIMR Mza • District Level: • DMO and CHMT, SAVVY’s District Coordinator • Community Level • Census Supervisors, Enumerators and Key Informants

5. Sentinel Panel of Districts (SPD) SPD central District Medical Officer SAVVY District Coordinator FBIS District Coordinator KIs & Census Enumerators Facility I/C FBIS = Facility-Based Info System

6. Why SAVVY? • Several millennial commitments to ‘do better’ with investments in population health and development • Few reliable sources of information on mortality rates and causes of death- especially HIV/AIDS • Strengthen the capacity of the Ministry of Health & Social Welfare to collect and use surveillance data to manage programs

7. SAVVY Sample Selection - NBS • Probability Proportional to Size • Enumeration area and households from Tanzania Mainland • National estimates • Stratified by rural-urban & gender • Target population is adults 18-59

8. SAVVY Sampled Districts

9. What are the technical aspects? Censuses • Conduct baseline census followed by periodic updates • Deaths and births reported Mortality Surveillance System • Deaths followed-up with ‘verbal autopsy’ • Substantial and growing literature on the reliability and validity of this technique • Provides accurate cause of death data at community level by age and sex Nested studies • Behavioral, service satisfaction, health equity, SES

10. Implementation plan • Sensitization and Govt buy-in • Signing of MOU with NIMR • Signing of MOU with NBS • List of names of the sample districts including EAs from NBS Statistical Master Sample • Plan/set up Financial & A/C reporting • SAVVY staff recruitment • So far, 2 hired at IHI, 3 at NIMR Mwanza • Pending, 4 – 6 at IHI & NIMR Mwanza (all, fulltime) • Pending 23 District Coordinators (District-based, fulltime) • District-based, KIs + Census enumerators (abt 270, temp) • Office set up, procurement of utilities + cars

11. Implementation Plan… cont’d • Phased-in implementation of SAVVY • 4 Pilot districts – 2010: Kinondoni, Bagamoyo, Geita & Kahama • 12 districts by 2011; ALL by – 2012 • Identification of key members in selected districts to organize district work and VA interviews • Preparation of SAVVY field manuals, guidelines and SoPs • Develop and pilot test data for census and VA both on Tablet PCs • Training of field teams on data collection using Tablet PCs • Write and submit Feasibility Study

12. Implementation Plan…..cont’d • Establish vital events reporting system in pilot districts • Train community Key Informants on recording & reporting of vital events • Conduct baseline census in the first 4 SAVVY districts & Conduct verbal autopsy interviews • Conduct supervision and quality assurance of baseline census • Data management and analysis of baseline census, write report of baseline census • Identification and training of physicians for coding of Verbal Autopsy data • Set up of Steering Group (high level) & TWG

13. REGISTRATION OF BIRTHS & DEATHS, RITA - I RITA = Registration, Insolvency & Trusteeship Agency (Ministry of Justice and Constitutional Affairs) • To register a birth or death event (birth within 90 days, death within 30 days): • Birth or Death notification: • B1 or D1 for a birth or death at a health facility resp • B2 or D2 for a birth or death in communities resp • Certificate, TShs. 3,500/= (about US $ 3) • A birth/death event after the period recommended, more evidence will be needed, fee + penalty! • A birth certificate: Given a name, Citizenship, know own parents and to be cared for, Retirement, Higher education • A death certificate: Inheritance, Evidence to being an orphan, Sponsorship by Gov

14. REGISTRATION OF BIRTHS & DEATHS, RITA - II • SAVVY will monitor and register all live births and deaths in its communities (SAVVY districts) • RITA promised to issue SAVVY its notification registers (B1/B2 and D1/D2) that it will be distribute to Village Executive Officers (VEO) • SAVVY’s KIs inform the SAVVY District Coordinator of vital events in their communities • SAVVY Coordinator verifies events and collects data, registers them at the VEO (RITA’s registers) • SAVVY Coordinator / VEO send the notification registers to the RITA’s District Officer for issuance of certificates

15. SAVVY’s Key Informants, Attributes • A SAVVY’s KI should be appointed by community leadership (Ward or Village) for having the following attributes/qualifications to be able to report on vital events: - Be a resident of the community - Approved of by the community - Confidentiality - Of good rapport - Be able to read and write

16. WORKING TOOLS • Key Informant • A Bicycle • A Simple phone (within network coverage) • Incentive: for each birth or death reported • Census Enumerators/Supervisors • A Tablet PC • Transport during census • SAVVY District Coordinator • A Tablet PC • Transport

17. Conclusion • Very powerful information platform to generate population-based demographic, health & mortality data • NBS-endorsed, national sample; results stratified by residence & zone • Provides economical, quality platform for detailed programme Monitoring & Evaluation • Provides opportunity for fundamental & operational research • Comparability over time: trend analysis • Included in the MOHSW’s HMIS project for sustainability in the near future

18. ASANTENI