Review of ART/EMR Development Process

1. Review of ART/EMR Development Process Anne K. Barsigo NASCOP 11 November, 2009

2. Initiation Meetings • ART partners • WHO • CDC • FHI • NASCOP • USAID • NACC • 1st Meeting took place at NASCOP,all partners attended • 2nd Meeting, WHO, CDC, FHI & NASCOP

3. PILOTING OF ART EMR • PHR+ currently HS 20/20 developed a database and installed in Eastern Province, 10 sites • Computers procured and Health care workers trained using ART M&E tools manuals, and the use of the database • Only two supervisory visits done • System failed due to lack of proper planning, poor management and lack of ownership at all levels.

4. Development Partners Support • WHO • Hired consultant to support Gov EMR Development • Development of pre & assessment tool • Carried out pre-assessment to inform assessment • Provided support for some meetings • CDC • Carried out Assessment – Selected ART sites • Have committed funds for EMR thru I-TECH • USAID • Have made commitment through HS 20/20 • Have supported most of the EMR workshops

5. Other Partners • HS 20/20 • Hired M&E specialist for NASCOP • Supports other EMR processes • APHIA II’s • Provide support thru representatives • Made verbal commitment to support process but not no financial indication! • Other partners have participated though not given commitment, • Any other commitments?

7. Rationale • Rapid Scale up of ART programme in Kenya • Volume of patients and data continues to grow, hence manual systems not efficient in long run • Multiple ART/EMRs already in existence • Existing ART/EMRs not compatible with each other and not always oriented towards fulfilling national M&E requirements • Existing ART/EMRs dependant upon external partner for operation, support and sustainability

8. General Principals • ART/EMR review and development to be undertaken within broader context of development of EHRs for all services in Kenya. Development of ART/EMRs to lead the way. • Consolidation and updating of existing systems to meet national specs. A single system will not be imposed. • Ownership of existing systems will not change even after update to national specs, and will serve as potential nodes for scale up.

9. General Principals • Phased implementation starting with exiting ART/EMR sites and moving on to high volume sites which lack a system. • National specs and functionality framework for Kenya will draw from and meet international standards and be officially gazetted by KEBS.

10. Agreed Approach 1: • Development and adoption of multi-year “Road Map” for ART-EMRs by NASCOP • Inventory of all existing ART/EMR systems • Mapping locations of existing systems and their current scale up roadmap • Summarize the basic specs and functionality of existing ART/EMR systems.

11. Agreed Approach 2: • Drafting the basic specs and functionality framework for national ART/EMR systems. • Agreement on proposed national specs and functionality framework. • The national specs and functionality framework will address the following areas: • Clinical patient management • Medical records management • Software • Governance and regulatory environment • Hardware and infrastructure

12. Agreed Approach 3: • Analysis of the existing ART/EMR systems against the agreed the national specs and functionality framework • Development of an upgrade plan for each existing system to meet the national basic specs and functionality • Agreement on proposed upgrade plan for each of the existing EMR systems • Upgrade all exiting ART/EMR to meet national specs and functionality framework

13. Agreed Approach 4: • Identification of a single ART/EMR which meets all basic specs and functionality framework for national ART/EMR systems. The “default” system which will be offered to sites without an ART/EMR or which chose to discontinue use/support to current system. • Strengthening of capacity of national institutions (HMIS, NASCOP) to fully support all aspects of operation of the “default” ART/EMR system.

14. Agreed Approach 5: • Develop a phased 3-5year scale up plan and management plan based on the upgraded sub-systems as scale-up nodes • Facilitate workshop to review the draft scale-up and management plan • Finalize and submit the scale-up and management plan • Develop user guidelines and system maintenance tools

15. Agreed Approach 6: • Develop user/health worker training and orientation materials • Training of TOTs • User/health worker/DHMT/PHMT training/orientation • Etc.

16. Immediate Next Steps: • Drafting the basic specs and functionality framework for national ART/EMR systems. • Agreement on proposed national specs and functionality framework.

17. What will it take? • Partner support - technical • Funding from donor organizations • Long term commitment to facilitate sustainability • By all partners and GOK • Appropriate skills profile – consultants and implementing organizations • Will vary at different levels, needs to be defined for National, all the way to facility level

18. Technical Support Required • To develop appropriate systems • To deploy and use the systems • To provide support for the systems • To support and maintain the systems

19. Funding Required for initial EMR develoment

20. ACKNOWLEDGEMENT • ICAP • APHIA II • NBI hospital • Aga khan • USAID • MSH • Partners • Ampath • Faces • G.o.K Facility staff • All other partners • ART EMR committee • ART SYS SUBCOM • NASCOP • HS 20/20 • WHO • CDC • EGPAF • WRP • APHIAs • ICRH

21. I am ready for a tough Discussion!!

22. THANK YOU ASANTE SANA MWEBALE NYO!