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Zambia PMTCT Training Package. Prevention of Mother-to-Child Transmission of HIV. Module 9: Monitoring & Evaluation and Logistics Management. Learning Objectives. Understand the role of health care providers in record-keeping and monitoring PMTCT programs, at the facility and national level
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Prevention of Mother-to-Child Transmission of HIV Module 9: Monitoring & Evaluation and Logistics Management
Learning Objectives • Understand the role of health care providers in record-keeping and monitoring PMTCT programs, at the facility and national level • Explain the importance of logistics management and planning to the provision of quality PMTCT services • Demonstrate the use of Monitoring and Evaluation (M&E) data collection tools (registers, tally sheets etc) and data use for decision making.
Introduction • M and E assess if progress is being achieved in line with expectations through the use of routine data collection. For the success of PMTCT program it is critical that M&E systems are put in place to have a functional and reliable record keeping, monitoring and reporting system. • Logistics and commodity management also forms a critical component in the management of the PMTCT program. This enables health facilities to plan and manage commodities (medicines and medical supplies) used in the prevention of mother to child transmission.
Introduction • Correct decision making and better management of commodities can only be achieved if accurate, timely and complete data is collected from correct data sources (registers, tally sheets etc). In addition health workers need to ensure that information is documented appropriately.
National and Facility Data • National level indicators generally cover service delivery, quality of care, and management-related information • This information helps to plan, monitor and evaluate the quality and effectiveness of the program. • At the facility level, planners and managers require more detailed information to make decisions about how best to spend the facility’s resources to meet the needs of clients and ensure quality of care.
What is good data? • Reliable, • Accurate • Complete • Consistent • Dependable • Corresponds to the right coverage
Factors contributing to good data • Understand the data • Record the data every time • Record all the data. • Record the data in the same way every time. • Timely reporting
Data Usage • Information is good because it can be used • Data that cannot be used should not be collected • At facility level, the better you understand the data that you record, the better able you will be to utilize that data to assess and improve the quality of your own programs
Patient Data Monitoring Tools • Paper System • CT / PMTCT Counselling Register • Safe motherhood and Tally Sheet • Delivery Register and Tally Sheet • Family Planning Register and Tally Sheet • Under-5 Register • Client Cards
Paper System • Mother’s Card • Family Planning Card • Under-5 Card • Smart Card. • Monthly PMTCT Reporting Form • HIV Testing Management Records for Labs • Counselling and Testing Sample Referral Form • Registers: • Laboratory Results Sample Register • VCT Quality Control Sample Sheet
Electronic System-Smart Care • It is an integrated computerised patient and reporting management system • Its aimed at collecting a patients entire medical record (EHR) for ANC, PMTCT, CT, ART, MCH etc. • The system is based on existing ministry of health and cooperating partner data collections tools. • SmartCare is used in those facilities that have capacity to use it, such as availability of electricity
SmartCare Data Collection • Computer (using touch screen and/or keyboard). • Reports generated are the same as those used in the paper based system • Provides a method that aggregates data from the facility level to the national level, which augments the HMIS / DIS system. • The reports are printed via a printer
Patient Held Tool • SmartCards (which resembles an ATM card) are issued to patients, to be presented each time the client / patient accesses a service. • A standardised training is conducted for Smartcare.
PMTCT Indicators • New ANC attendees • Tested for HIV • HIV positive results • Male partner tested for HIV • Assessed for ART eligibility • Referred for ART • Opting for 6 months EBF at 1st visit • Live Births (HIV-exposed) • ARV prophylaxis dispensed • ARV prophylaxis taken by woman during labour
PMTCT Indicators • ARV prophylaxis to baby • Started on Cotrimoxazole within two months • HIV test to HIV-exposed baby at 6 weeks • HIV test to HIV-exposed baby at 12 months • HIV test to HIV-exposed baby at 18 months • HIV test of baby at 6 weeks - positive • HIV test of baby at 12 months - positive
Logistic Management • Drugs and Medical Supplies Logistics Management System (LMS) is the system through which health programme commodities are selected, quantified, procured, transported, stored, distributed and issued or dispensed to meet customer expectations. • LMIS is responsible for gathering information about the quantities issued or dispensed to users at each level to determine the quantity and schedule for future commodity needs.
The Six Rights of LMS The RIGHT DRUGS & SUPPLIES in the RIGHTQUANTITIES and in the RIGHT CONDITION are delivered to the RIGHT PLACE at the RIGHT TIME for the RIGHT PRICE
Importance of Logistics • Lack of proper and up-to-date Inventory Information System results in: • Over-stocking & expiry before use • Under-stocking or shortage leading to interruption of services
Importance of Logistics • Lack of proper storage makes products: • Ineffective • Unsafe • Vulnerable
GRZ DONORS MOH MSL Hospitals Districts Wards Health Centers Clients The Zambian Logistics Management System
Logistics Management Information Systems (LMIS) • The basic purpose of an LMIS is to collect and report information to other levels in the system in order to make decisions regarding the quantity and time to distribute drugs and medical supplies
Activities in the LMS • Drugs and medical supplies are procured & stored • Drugs and medical supplies are moved from one level to another • Drugs and medical supplies are dispensed to clients
Essential Logistics Data • Stock on hand • Consumption data • Data on losses • Data on adjustments
Patient and Logistics Data Monitoring • Patient Care Records • Laboratory Records for HIV Tests for Laboratory Technicians • Commodities and Logistics Management Records
Commodities and Logistics Management Records • Stock Control Card • Stock Control Book • Patient Drug Log Books • Ward Chart • Prescription • Supply Voucher - Health Center • Supply Voucher - Ward
Commodities and Logistics Management Records • Requisition for Drugs and Medical Supplies • LMIS Quarterly report Form • Quantification spreadsheet • Discrepancy report • Disposal form • Goods Received Note