Abstract : THAE0105LB Presenting Author: Dr S.Venkatesh Deputy Director General

1. Strengthening Data Management under National AIDS Control Programmein India through Web-based Strategic Information Management System Abstract :THAE0105LB Presenting Author: Dr S.Venkatesh Deputy Director General

2. Outline

3. India’s NACP: An Evidence-led Approach

4. Spectrum of Activities Institutional Collaboration & Cross-learning

5. Issues with Earlier System • Fragmented data collection tools • Inadequate quality control measures • Difficulty in undertaking integrated analysis • Limited data use at lower levels of programme management • Limited options for advanced data analysis • No data visualisation options SIMS developed as a solution to improve data management, analysis & use

6. Monitoring and Evaluation System Monitoring & Evaluation System Dashboard & Key Indicator Update SAS Analytics & SAS Business Intelligence Outcome / Impact Assessment Programme Progress Reports Learning Forums External Evaluation Reports Programme Management State of Epidemic and Response M&E Feeds into Products of M&E Planning, Policy Making Published Research Reports Sources of M & E Reports thru SIMS Surveillance Evaluations / Assessments Research and Studies SAS Data Integration Source: Operations Manual for SIMU, August 2007

7. Framework for Strategic Information

8. Strategic Information Management System • A web-based application with sophisticated tools for data analysis & integration from data sources/platforms for data entering, monitoring, analyses & reports generation • Has provision for offline data entry using MS-Excel • Has enhanced transparency – One version of data available for NACO/ SACS/DAPCU /RU • Launched in August 2010 • Personnel trained in 4 phases • All India rollout in a phased manner from 1st August to 1st Dec, 2011

9. Key Features of SIMS • An Integrated Web-based Reporting, Data Management & Decision Support System • Reporting Unit based data capturing - Monthly reporting from over 20,000 reporting units across the country (includes 15,538 ICTCs/FICTC, 1,137 DAC supported Blood Banks, 1,136 STI, 1,825 TI, 162 LWS, 1,295 ART & Link ART Centres) • Automatic aggregation of key indicators • Integrated with all other databases such as Surveillance, PLHA database, survey data, etc • Individual level reporting from ICTCs & ART Centres Moving towards HIV Case Reporting • Modular, Expandable & Scalable with Slice & Dice capabilities • Intelligent analysis for data use at all levels • Standard & Custom Reports • Options for advanced analysis using SAS • Linked to GIS System for spatial analysis • Has options for dissemination of standard outputs through Share Point Portal

10. Advantages of SIMS (1) • Enhances transparency & credibility of data, as only one version of centralised validated data is available from Reporting Unit (RU) to National level level at any given point in time. • Provides real time access to data at all levels. Can be used for real time monitoring of field activities. • Though design is web-based, entry can be done both in online & offline formats. No need for continuous internet connection at RU. • Can manage multiple types of users at all levels through rights-based user management. Facilitates stakeholder involvement in SIMS management. • Provides options to build in robust validation checks to improve data quality.

11. Advantages of SIMS (2) • Allows for generation of customised dashboard reports on key indicators for each programme component at any level • Provides multiple options to carry out different types of analyses of data, from simple aggregations to advanced statistics, all through one platform • Facilitates effective presentation of key outputs, including tables, graphs, maps etc. & wider dissemination through portal • Improves decision making by enhancing ease with which data across different sources can be triangulated, due to its integrated model • Has built-in consistency checks & alerts to programme managers when data goes beyond (above/below) acceptable thresholds • Has huge potential to become a customised Decision Support System for programme managers at different levels

12. Reporting Unit (Sub-District Level) DAPCU (District Level) SACS (State Level) NACO (National Level) Monitoring and Data Quality Feedback to RU Monitoring and Data Quality Feedback to DAPCU and/or RU Monitoring and Data Quality Feedback to SACS Use data to assess district-level trends Use data to inform resource allocations Use data to assess state-level trends and high priority districts Data Flow, Feedback & Data Use in SIMS Data Flow Direct reporting if no DAPCU Use data to evaluate performance against targets Feedback

13. Three Modules in SIMS

14. Scale up-Service facilities 2013 TI: Targeted Intervention (Urban MARPs) LWS: Link Worker Scheme (Rural MARPs) STI: Sexually Transmitted Infections CSMP: Condom Social Marketing Programme ICTC: Integrated Counseling & Testing Centre ART: Anti Retroviral Treatment 2007 TI LWS STI CSMP ICTC ARTC No. of TI No. of Dists. No. of Clinics No. of Dists. No. of Centres No. of Centres

15. SIMS Users Community Support Centre • Enrolment • Treatment • Adherence • Inventory Mgmt • Staffing • Outreach coverage • Facility linkage • Commodity Distribution • Staffing & Training • AIDS demographics • Opportunistic Infections • Patient Volume • Patient Symptoms ART Centres NGO’s for Targeted Interventions ICTC Strategic Information Management System F-ICTC (CHC/PHC) • Service volume • Profile of Positives • In & Out Referrals • General Health data Blood Banks Gynecology OPDs • Volume & Profile • Testing Results • Inventory Mgmt STI Clinics • Pregnancy Information • Women Health issues • Clinic volume • Syndromatic Diagnosis • Coverage of ANC syphilis screening • Laboratory Procedure • Inventory Management NACO SACS DAPCU

16. Management of SIMS at NACO Level • Stabilizing Active Reporting Units (RU) in SIMS • Defining ‘active’ & ‘de-active’ RU • Developing guidelines for creating, activating & de-activating RUs under different components • Managing Unique Centre Code System in SIMS to ensure error-free reporting • Monitoring & addressing issues reported from RU/ DAPCU/ SACS • Analysis of Bugs reported/ identified & coordination with Software team for timely resolution • Streamlining User Access Rights for smoother & efficient data management • Development of responsibility matrix & guidelines for data management at different levels • Development, printing & distribution of user manuals, data definitions, wall charts etc. for SIMS formats under all programme components

17. State AIDS Control Socities(SACS): Roles & Responsibilities • Ensure availability of required Computer & Internet connectivity in reporting units, District AIDS Prevention Control Units & SACS • Actively monitor SIMS training programme & progress of SIMS rollout • Include SIMS review as a part of all the review meetings & tours/visits • Handhold concerned SACS officers in rolling out SIMS • State M& E Officer - nodal person for SIMS, supports & supervises SIMS training activities & takes the lead as resource person • Respective programme component division Officer deputed for SIMS Reporting Unit training for supervision & to clarify doubts regarding respective formats • Technical Support Unit actively involved in all activities - SIMS roll out

18. Roles & Responsibilities At Primary Reporting Units • Data is entered • Individual (ICTC/ART) • Monthly (STI/BB/TI etc) • Entered data is validated & sent(forward) to DAPCU At DAPCU level • Receive data sent by Primary Reporting Units • Scrutinize data for: • Completeness of reporting • Correctness of reporting • After validation, send (forward) the data to next level (SACS) • If errors/incomplete data/queries are found, would revert the data to the reporting unit level, ask them to correct and resend • Enter the data required to be entered at DAPCU level, validate & forward to SACS

19. Structured Trainings on SIMS- Induction & Refresher • Detailed induction training to new recruits at reporting unit level, using standard training schedules & material • Includes hands-on practice • Annual Refresher trainings to all Reporting Unit staff on respective modules in SIMS • Trainings include basic computer skills for users who are not well versed with IT • Focussed repeat trainings & Orientation sessions for poor reporting RUs • Mandated SACS to develop quarterly training plans & share with NACO • Focus on close monitoring of trainings & timely submission of training reports

20. Data definitions developed to standardise reporting

21. Data Quality Monitoring System • Framework & Guidelines developed for a comprehensive, systematic data quality monitoring system: • Validation checks within SIMS • Consistency checks & Alerts • Checklists for periodic quality review of data • Plan for periodic field visits to monitor data quality • Checklists for spot checks, register verifications & random checks • All review meetings to include SIMS data quality review • Periodic Data quality reports with identified quality indicators • Clear Responsibility Matrix

22. National & State Helpdesks • National Helpdesk with 2 persons functional since March 2012 • Dedicated mobile numbers for direct contact from across the country • Provides real time support by telephone & email • Immediate resolution of issues through remote access to users’ computers • Maintenance of detailed log of all issues reported • Act as liaison between users & software team for resolution of issues • State level Helpdesks set up in all states with 60 persons with local language proficiency

23. NACO website: http://www.naco.gov.in

24. Steps to Improve SIMS Reporting (1) • Project Directors & nodal persons at SACS instructed to focus on reporting thro’ SIMS: • Avoid parallel mechanisms of reporting & use only SIMS • Closely monitor & handhold non-reporting units • Focus on SIMS reporting during field visits & review meetings • Review SIMS implementation progress in each component at SACS level review meetings • Regularly generate reports & monitor progress

25. Steps to Improve SIMS Reporting (2) • SACS to ensure computer availability • Sharing of computers at co-located facilities • Use of internet café or other closest internet points • Procure/Upgrade computers, where necessary • SACS to ensure internet connectivity in RUs: • provide datacards • instruct sharing of co-located facilities • map nearest internet points; make provision for travel & internet charges • identify back up mechanisms, such as paper-based reporting to DAPCU

26. Managing Data Outputs • Standardising reports & ensuring error & bug-free reports • Regular dissemination through Share Point Portal • Customised component-wise dashboards to capture key indicators • Alert mechanisms for priority attention of programme managers • Development of analytics module including triangulation, advanced analysis using SAS • Operationalising GIS component for spatial analysis • Development into a fully functional Decision Support System

27. Promoting SIMS Data Analysis & Use • Capacity building of SACS personnel on data analysis & data use • Quarterly SIMS bulletins at NACO & SACS • Two analytic reports/person in SIMU of SACS • Monthly SIMS Update from NACO M&E division to other programme divisions, highlighting key indicators, issues & recommended actions

28. Reporting Status 2013-14

29. Key Challenges • Software developer related issues: delay in development & resolution of bugs, frequent change of Project Staff • Frequent changes in formats due to evolving programme needs • Computer & internet connectivity • Computer literacy of users at facilities in different levels • Change of SIMS users • Standardisation of SIMS management protocols at NACO & SACS • Development of capacities at state level to manage SIMS & manage data through SIMS • Ownership by programme divisions & SACS to improve quality, utility & value of SIMS data

30. Lessons learnt • A web-based integrated data management system offers us an opportunity to improve programmereporting, data quality & data use at all levels of programmemanagement. • A strong system push needed from national level to Reporting Unit level to implement the system. • Focus should be on building infrastructure & computer skills of users is critical. • Standardised management protocols help promote stabilility & continuity of the system. • Ownership of SIMS by programmedivisions & SACS is essential to improve its functionality & utility.

31. Thank You