Sustainable Innovation in Monitoring for Health Projects - DHIS2 and the Fistula Care Plus Project

1. Sustainable innovation in monitoring for health projects – DHIS2 and the Fistula Care Plus project Vandana Tripathi, Karen Levin, Chidimma Anyanwu July 2015 | ECOWAS-WAHO 1st Best Practices Forum

2. EngenderHealth Mali  Niger  Nigeria   Family Planning 16 countries, 9 projects Maternal Health13 countries, 6 projects HIV and AIDS7 countries, 6 projects Gender6 countries, 5 projects Burkina Faso  Bangladesh  USA  Guinea  India  Sierra Leone  Ethiopia  Cote d'Ivoire  Kenya   Ghana  Tanzania  Togo  Rwanda   Angola  Burundi  South Africa  DRC

3. Goal: To strengthen health system capacity for fistula prevention, detection, treatment, and reintegration Active in: Bangladesh, Democratic Republic of Congo, Niger, Nigeria, Togo, and Uganda In Guinea with funding from Islamic Development Bank & other donors Fistula Care Plus 2013 - 2018

4. Accurate, timely, and complete monitoring is essential in NGO-led health partnerships. Generally, health projects collect large volumes of data Routine program/facility data Metrics on program implementation, fidelity, and coverage Common result: complex data management systems Pro: Gather important information Con: Burden on health system partners Con: Difficult to sustain at project’s end Global context

5. Increased recognition that big data can bring big problems Push for ‘100’ essential indicators (WHO) Measurement & Accountability for Health Summit (World Bank/USAID/WHO): Push for harmonization, alignment, and interoperability of indicators and data systems Broader agreements re: alignment and country ownership in development: Paris Declaration for AID Effectiveness Accra Agenda for Action Global context

6. FC+ conducts a wide range of activities and works through numerous local partners and supported facilities FC+ collects data on 25 core program indicators as well as many additional clinical indicators In some countries, selected fistula indicators are part of routine HMIS; however, many FC+ indicators require additional data collection Data collection in FC+

7. Weneed a way to collect& manage data that: Provides information for management Is practical and adds value for health system partners Is sustainablepastprojectlifespans Project need

8. District Health Information Software version 2 (DHIS2) is a free, open-source, web-based data platformdeveloped by the University of Oslo. Adoptednationally in many countries, including: Burkina Faso, Gambia, Ghana, Liberia, Nigeria, and Sierra Leone. Adopted by bilateral/multilateral programs including PEPFAR and the Global Fund for AIDS, TB, and Malaria Question: Can DHIS2 help healthprojectsgather, report, and act on data effectively, efficiently, and sustainably? Potential solution – DHIS2

9. FC+ developed DHIS2 data collection & management database in 2014 FC+ started collecting and reporting data using DHIS2 in early 2015 Internal review conducted to identify database strengths, challenges, and opportunities for sustainability past FC+ project Overview of FC+ adoption of DHIS2

10. Data collection formsdesigned to collectclinical, training, outreach, and other data in formats compatible with DHIS2 parameters Databasedevelopment: One-week training by external consultant Four months of 1 staff member’s time Training: M&E staff: 3-hour virtual orientation & 4-day in-person workshop Global leadership staff: 2 day in-person workshop Data entry: Currently, healthfacilities report quarterly to FC+ M&E staff in each country M&E staff enter data into DHIS2 Review findings: Required inputs

11. FC+ DHIS2 database collects data on 150 clinical and program indicators. Database used to: Collect and aggregate data from 9 countries (including beyond FC+) and 64 supported health facilities Generate HQ and donor reports Generate information & visualizations for quarterly data for decisionmaking (DDM) meetings Generate dashboards to track key indicators; being prepared for direct access by partners and donors. Review findings: Database outputs

12. Rapidlyadapt data collection tools for new locations and indicators Produceindividualizeddashboards for data tracking Applydetailed but simple validation rules to ensure data quality and increaseusers/partners’ confidence in validity of reports Access a community of users for no-cost, mutualtechnical assistance. Review findings: System advantages

13. Review findings: System challenges • Ensuring data are clean, correct and complete • Ensuring adequate training/rollout to users unfamiliar with this type of system • DHIS2 doesn’t allow mixing of letters and numbers in data entry – no 99/999s, DKs, N/As • Training data– events, individuals and tracking • On-line manual/ user community support

14. Operationalizing a qualitative clinical monitoring tool that has been converted into quantitative measures for collection via DHIS2 Will enable faster identification of quality problems and comparison of facilities Using GIS coordinates (entered for each facility) to: Map service availability and coverage Analyze fistula service users’ access to care Evaluate potential for inter-operability and HMIS integration in each FC+ country using DHIS2 Database expansion plans

15. Data entry – before and after

16. Data entry – DHIS2

17. Global FC+ Dashboard

18. DHIS2 Data Visualization Capacity

19. DHIS2 GIS Capacity

20. The open-source DHIS2 platform provides a cost-effective way to gather, analyze, and report data for NGO health projects Although the FC+ DHIS2 database is purpose-built, it can be adapted, adopted, and sustained by partner health systems (at the district, regional, or national levels) at low cost Conclusion