Health Management Information System

1. Health Management Information System Routine Data Collection for HIV/AIDS Programmes - Introduction Training Materials – Module 3 (Introduction) & Unit 1

2. Introduction Objectives of the Module • To revisit data management process for each programme- • To understand revised data collection and reporting requirements/tools Module 3 Unit1 : Data Collection - Introduction

3. Introduction • In line with the revised HIV/AIDS Strategy • The HIV/AIDS indicators set has been revised • To ensure indicator driven data collection • Existing tools have been revised-(Example HTC register) • For some programmes (Example - HEI)new data collection tools have been introduced • Revision of indicators done for programmes with • Routine data collection • Non Routine data collection Module 3 Unit1 : Data Collection - Introduction

4. Overview of Data Collection Systems The revised essential indicator set covers the following programmes I. Programmes with Routine Data Collection Demands • HIV Testing and Counselling • Prevention of Mother-to-Child Transmission • HIV-Exposed Infant Follow up • Care and Treatment • Post-exposure Prophylaxis for HIV • Voluntary Medical Male Circumcision II. Programmes with Non Routine Data Collection Demands • Blood Safety • Abstinence, Be faithful and consistent Condom use • Most-At-Risk Persons • Prevention with Positives (PwP) • Home and Community-Based HIV Care • Systems Governance and Support [Cutting across] Module 3 Unit1 : Data Collection - Introduction

5. Overview of Data Collection Systems • Non-routine data collection systems will be managed at individual programme level • Channels of reporting are different from programme to programme • Timing of reporting [hence collection] varies across programmes • Guided by standard definitions and guidelines already developed [refer to the Indicator Manual] Module 3 Unit1 : Data Collection - Introduction

6. Introduction to Routine Data Collection Tools • Type of data collection tools • Individual patient/client cards • Patient listings – Registers • Collation forms • Aggregation and Reporting Module 3 Unit1 : Data Collection - Introduction

7. Introduction to Routine Data Collection Tools • Individual patient/client cards • Patient-held or • Facility-retained • Patient/client-held • Held by client [mostly] for continuity of care • Used for short periods of time • Usually shifts most of its contents to the register • Examples • Mother baby booklet (formerly Maternal health card & Child health card) Module 3 Unit1 : Data Collection - Introduction

8. Introduction to Routine Data Collection Tools • Patient/client-held • Pros • Opportunity for seeking service outside the issuing facility • Decisions can quickly be made by the receiving service provider on the basis of details already on card • Cons • Highly prone to loss and damage • Propensity for duplicating data elements onto registers • Recipe for gaps when conducting a detailed clinical review for quality of care • Compromise in data integrity - may be falsely updated Module 3 Unit1 : Data Collection - Introduction

9. Introduction to Routine Data Collection Tools • Individual Patient/client Cards • Facility-retained [cards] • Privacy and confidentiality • Longevity of use – demand for a detailed history • When used in conjunction with registers – registers only retain data needed for health unit management and higher demands • Examples • HIV Care/ART Card • HIV-Exposed Infant Card • OPD/IPD cards – general Module 3 Unit1 : Data Collection - Introduction

10. Introduction to Routine Data Collection Tools • Facility-retained Cards • Pros • Preserves confidentiality • Preserves content integrity - facility retains responsibility of all the contents on the document • Can be used to verify/update related records on registers • Cons • Locks client/patient to one facility • Missing cards in high-volume facilities • Consumes storage space with time Module 3 Unit1 : Data Collection - Introduction

11. Introduction to Routine Data Collection Tools • Registers or Patient Listings • Cross-sectional, longitudinal or both • Cross-sectional • Patients/clients are listed according to the timing of the visit – as a primary grouping criterion • Usually more than one entry is made for each patient/client [as many as the visits] • Useful for short-duration services • May contain detailed client/patient information Module 3 Unit1 : Data Collection - Introduction

12. Introduction to Routine Data Collection Tools • Cross-sectional • Examples • HTC & Laboratory Register • Antenatal Register • Maternity Register • Postnatal Register • Minor Theatre Register • Post-Exposure Prophylaxis Register • Nutrition & HIV/AIDS Register Module 3 Unit1 : Data Collection - Introduction

13. Introduction to Routine Data Collection Tools • Cross-sectional • Pros • Groups patients by date of service provision making page summaries possible • Recorder does not have to flip through old entries to update with current interaction • Cons • Redundancy – a lot of blank fields in records as not all columns are updated on each visit • Wasteful – Similar information is repeated on each visit – name, sex, age, address etc. • Quality review – difficult to review quality of service and data as one record is spread across many page or registers Module 3 Unit1 : Data Collection - Introduction

14. Introduction to Routine Data Collection Tools • Registers or Patient Listings • Longitudinal • Patient listing is organised according to a specific criteria • One record (line) for each patient usually retained and updated at specified intervals • Usually contains data for health unit management • Examples • HIV-Exposed Infant Register • ART Monthly Register Module 3 Unit1 : Data Collection - Introduction

15. Introduction to Routine Data Collection Tools • Longitudinal • Pros • Provides a continuous record in one place • Easy to review for quality of care • Cons • Need for additional tools – demands for accompanying cards and separate collation forms • Difficult to update on the spot – usually updated after service provision from cards • Propensity for data gaps – when update after the service Module 3 Unit1 : Data Collection - Introduction

16. Introduction to Routine Data Collection Tools • Registers or Patient Listings • Cross-sectional and longitudinal • Retains the “one line per patient” attribute and updates as key events take place • Has a no grouping criteria but updated longitudinally • Example • Pre ART Register – Patients entered in the order of enrollment in care and events updated longitudinally Module 3 Unit1 : Data Collection - Introduction

17. Introduction to Routine Data Collection Tools • Collation Tools • Activity Sheets • Only contains data needed for health unit management • They are date and visit-based • When they include patient identifiers – are sometimes referred to as “tick or activity” registers • Examples • Care and Treatment Activity Sheet • Pros • Serves as an alternative source of summaries where it is not easy to do so directly from registers • Provides an avenue for audit • Cons • Their design usually leaves behind unresolved conflicts with conventional registers • Generates volumes of paper pages Module 3 Unit1 : Data Collection - Introduction

18. Introduction to Routine Data Collection Tools • Tally Sheets • Like activity sheet, contains reportable data only [health unit management] • Count of provider-patient/client interactions through use of tallies • Tallying is done on contact or from registers • Do not include patient identifiers • Examples • Care and Treatment Tally Sheet • Pros • Good for single-service or fewer service interactions such as in curative care • Cons • Unreliable – no record link, hence difficult to audit • When used on similar services in more than one department – creates additional collation tasks and some pages may go missing Module 3 Unit1 : Data Collection - Introduction

19. Introduction to Routine Data Collection Tools • Aggregation Forms • Designated form for each level • Eg PHC, Hospital, District, etc • Example = Cohort Summary Form • Comprehensive forms • Only services completed by each facility • Same form flows through the hierarchy • Usually in paper form from facility to district level and may be electronic from district upwards Module 3 Unit1 : Data Collection - Introduction

20. Codes – Indicators and Data Elements • Why the coding? • Cross-referencing within and across documents is easier • Consistency in definition [in one place] • Computerisation is easier, e.g. data dictionary • Ease of identification – codes identified with programmes • Indicators have been coded according to programme areas eg • HIV01-01 • HIV = HIV programme on the HIS tools • HIV01 = Programme #1 (HTC) under HIV • HIV01-01 = Indicator #1 under programme # 1 [HTC] under HIV programmes • Data elements listed according to programmes • Could not be attached to individual indicators • Some data elements needed by more than one indicator • Data elements ordered and code according to services Module 3 Unit1 : Data Collection - Introduction

21. Objectives – A preview of Units 2-7 • Reviewing the possible scenarios in the service provision for different programmes • Understanding data management • Indicators • Data sources • Data collection procedures • Data flow and reporting requirements Module 3 Unit1 : Data Collection - Introduction

22. Thank you Module 3 Unit1 : Data Collection - Introduction