Option B+ Weekly SMS reporting; data Use to improve service delivery Zikulah Namukwaya, MD, MPH

1. Option B+ Weekly SMS reporting; data Use to improve service delivery Zikulah Namukwaya, MD, MPH MU-JHU Care /Mulago Hospital

2. Background • Dec 2012 Option B+ Rollout Evaluation Recommendation No.3: “Need For Systems to Aggregate and Report Summary of Progress Frequently” • Develop a real time monitoring system to inform ongoing rollout and the implementation of Option B+ • A monitoring system and online dashboard considered central in the PMTCT programme until B+ is well established • A team comprised of members from MOH, CDC, USAID and other stakeholders recommended nine indicators to be used for weekly reporting • IPs were asked to train at least one health worker for each facility supported in weekly reporting

3. Emergency Operations Centre (EOC) • MOH recently established an Emergency Operations Centre, and MOH declared eMTCT a public health emergency • It was agreed to channel efforts concerning eMTCT through the EOC, specifically: • Receive and disseminate real time data on eMTCTprogramme implementation • Monitor progress and track against targets • Carry out real-time monitoring, and remove bottlenecks as much and as soon as possible • Ask Implementing Partners(IPs) to present and interpret their data on a rotating schedule • The eMTCT team meets weekly at the EOC to discuss progress

4. The online dashboard • MOH, Districts, USG, HDPs and IPs have access to real-time online dashboard • Dashboards provide detailed access to reports, and datasets that may be downloaded and further analysed • Proportion of women tested and initiated • Stock-outs • EID data

5. The weekly reporting system • Each week, a health worker from a facility providing Option B+ sends a report with nine indicators via SMS through their phone • Data arecollected, collated and analyzed every week, and a report is distributed to stakeholders • Data arealso available realtime through a web-based dashboard accessible to stakeholders • No. of 1st ANC visits • No. of women having HIV test during 1st ANC Visit • No. of women testing positive for HIV • No. of women with known HIV+ status during 1st ANC visit • No. of women initiating Option B+ (ART) during 1st ANC visit • No of womenalready on ART treatment by 1st ANC visit • No. of women who missed any ANC appointment • Availability of test kits • Availability of HIV ARVs

6. New ANC Attendance (Indicator 1) • Daily summaries are compiled in time, from which weekly summaries are made • Total Number tested • Difference indicates increased access to HIV testing services • More accurate projection of the logistics needed • Total HIV positives • Identification of New positives/ Number smaller that previous numbers • Total ANC 1 known positives • Increasing numbers as seen from our previous reports

7. Weekly reporting • Reporting started initially below 30%, and is now consistently above 85% • 1677 facilities registered for Option B+

8. Proportion testing _Mulago Hospital • Average testing is 85% among new ANC. 15% report with documented HIV results (<3mo for HIV neg)

9. Reporting Clean reports at end of month due to on-going cleaning and checks (Earlier submission) Data Accountability; Easy to summarize weekly reports and see discrepancies

10. Reducing stock-outs • Weekly reporting can identify stock-outs at individual facilities each week • Through collaborative efforts, the major causes for these stock-outs were identified, and most were resolved • EOC monitors the stock levels on a weekly basis

11. Logistics • HIV kits and ARVs availability • 100% for Mulago (26 weeks in the 6-months) • Reflection of timely reporting and follow up of our supplies with NMS

13. EID data also included in the weekly report • EID data provided by the Central Public Health Laboratory has been included in the weekly report since March 2014 • Facilities with high MTCT rates can be identified immediately, so that action can be taken

14. Client Follow up • At the end of each clinic day, the health worker identifies clients who have missed their appointments by identifying all those without a tick () • For clients with phone contact, the health worker will call immediately and document the response in the appointment Book • For clients without phone contact / failure to contact through phone, a list is forwarded to the Health visitor for follow up • Using the Referral form for locator Information

15. Summary • There is more involvement by staff in reporting, DHOs and implementers embraced the system • It provided an opportunity to receive updates from sites in real-time without district staff having to physically go there • We have observed improvement in data capture, (timely and more accurate) • Client follow up is immediate (phone call same day) or weekly for home visits • More accurate documentation of HIV testing (New Vs repeats..) • Gaps are identified early and staff are taking more responsibility • Translating weekly reports to monthly/quarterly reports has improved general reporting

16. MAKERERE • UNIVERSITY • Ministry of Health • Partners in Weekly Reporting