Transcript Document

Utilizing an innovative M&E system to improve
referral mechanisms for HIV & AIDS and TB services:
Lessons from East Central Uganda
Presentation to the 16th ICASA,
Addis Ababa , Ethiopia.
5th December 2011
Author: Odong Tonny
Organization: Strengthening TB and HIV & AIDS Responses in East
Central Uganda ( STAR-EC) /JSI
Email: todong@starecuganda
Background to STAR-EC program
 A five year (2009-2014) program funded
by USG through USAID
 Implemented by JSI Research & Training
Institute Inc.(JSI) in collaboration with
Ministry of Health-Uganda
 Serves about 9% of the country’s
population (Approx. 3m people)
 Works through district based structures
and Civil Society Organizations (CSOs)
The 9 districts served:
Bugiri, Buyende, Namutumba, Namayingo,
Mayuge, Iganga, Luuka, Kamuli & Kaliro
 Operates in 9 Districts of East Central
Uganda
Program goal: To increase access to, coverage of, and utilization of quality and comprehensive HIV&AIDS
and TB prevention, care and treatment services
Issues
 Referral and Networking is an important component of any
community based HIV & AIDS and TB program/intervention
 Primarily, referral is intended to link people within the
community to different health service providers based on
their identified health needs ( e.g. Chronic care, HCT, STI
screening, wrap around services etc.)
 In East Central Uganda, referral services are mainly offered by
lay volunteers – namely; Community Support Agents ( CSAs)
and Village Health Teams (VHTs)
Issues cont….


At program inception, the CSAs and VHTs had
difficulty in tracking, managing and reporting data
on referral activities due to lack of an innovative
and simplified M&E system
It was thus difficult to know;
a)
b)
c)
d)
The number of people referred by the CSAs/VHTs
Whether the people referred received services or
not
The quality of services offered by the service
providers; and
To advocate for services that were lacking in the
region
Intervention
 STAR – EC promotes the use of innovative M&E
system at community level
 In collaboration with National Community of
Women Living with HIV&AIDS (NACWOLA) and other
CSOs, STAR- EC program introduced and train the
CSAs and VHTs on simple to use Monitoring and
Evaluation tools.
 The tools include:
1)
2)
3)
4)
5)
CSAs/VHTs diaries
Referral directory
Referral form
Referral register
Data summary and reporting tool s/Electronic database
Summary of use of each M&E tool
1. CSAs/VHTs diaries
- Books used by the CSAs and VHTs to document
client health problems and other particulars
2. Referral directory
- A book that lists all the possible health service
providers in East – Central region of Uganda
- They are used by CSAs and VHTs to identify relevant
service providers based on client needs
3. Referral form – has two sections
1-Referral section: Filled by the CSAs/VHTs and given to client to go to an
appropriate service provider
Name of Client:____________ Client’s age/Sex ________ Date:___________ Referral No:___
Village:___________ Parish:__________________ Sub-county:___________________
Organization / health facility client is referred to:________________________
Organization / health facility client is referring client: ________________________
Reasons for referral : ( Please use the code below and explain)
Name of person referring the client:_______________________
Designation: __________________________________ Tel:_________________
2-Feedback section: Filled by the service provider and given back to the
client who later takes it to the CSAs/VHTs who referred him/her
Client Referral No:____
Date client was received by the organization: _________ /________ /__________
Service(s) offered to client:______________________________________________________________
Comments on service(s) provided to the client/follow up actions/further support needed:
Name of service provider who attended to the client:_______________________
Designation: __________________________________Date:_________________
4. Referral register – Used by the CSAs/ VHTs to capture information
from referral and feedback forms
Date referred
Client
Name
Parish
Sub-county
Age
Sex M/F
Referral
Number
30
M
1
9/2/2010
Simon Nakav Iganga
ule
TC
John Kasubi Gulu
15
F
2
9/3/2010
Edton
33
M
3
9/1/2010
Kiira
JMT
Client
Status
referred by (Old/New)
Org.
NACW
OLA
NACW
OLA
NACW
OLA
Services
referred
for: (Use
codes
below)
New
1,2
New
Old
Organisatio Services
n/health
received
facility
following
client is
referral
referred to (Use codes
below)
1
Iganga
Hosp.
ITC
none
3
ITC
none
Indicate
follow
up/further
support
needed
1
Codes for services
1.
Anti-retroviral therapy (ART)
8.
Treatment for other medical conditions
15.
Legal support
2.
ART adherence counseling
9.
Home based care
16.
Microfinance/IGA
3.
HIV counseling and testing
10.
Food/nutrition support
11.
Material support (blankets, beddings, soap etc)
17. Post test club/peer
support
18. PLHIV group services
4.
PMTCT ( counseling, testing, ARV prophylaxix, infant feeding
counseling
5.
TB screening/treatment
6.
STI Services
12. Education support for children (scholastic
materials)
13. Family planning
7.
Septrine
14.
Discordant couple services
19.
Youth support group
20. Discordant couple
services
21.
Other services (Please
name them)_____
Note with * TB registered patients referred for HCT ** HIV positive
clients referred for TB screening (in follow up column indicate TB+
those to have TB)
Note: Indicative word OVC against
name of OVC referred
5. Reporting form- has two sections
1- Referral section-allows the CSAs/VHTs to report on the # of people referred
by sex and services
NEW CLIENTS
OLD CLIENTS
CATEGORIES OF REFERRAL SERVICES
CODES
Number of individuals referred in the Month
(Note: Count this from column called
status in the referral register)
1 ART
2 ART adherence couns eling
3 HIV couns elling & tes ting
TOTAL
FEMALES MALES
TOTAL
FEMALES MALES
0
0
1
1
1
1
2
0
0
1
1
2
0
0
0
0
1
1
0
1
1
0
0
0
PMTCT ( couns ens elling, tes ting, ARV,
4 prophylaxis , infant feeding couns elling
5 TB s creening / Treatment
6 STI s ervices
7 Septrine (CTX)
8 Treatment for other medical conditions
9 Home Bas ed Care
10 Food/Nutrition Support
11 Material Support
12 Education s upport for children
13 Family Planning
14 Dis cordant couple s ervices
15 Legal s upport
16 Microfinance/IGA
17 Pos t Tes t Club
group s ervices
182 PLHIV
A total of
new clients
(1 male and 1 female) were referred in the month. Both
19 Youth Support Group
were referred
for
ART
services
and only one male was referred for ART adherence
20 Dicordant Couple Services
counseling
21 Safe Medical Circumcis ion
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2-Feedback section- allows the CSAs/VHTs to report on the # of people who
received services for which they were referred by sex and services received
OLD CLIENTS
CATEGORIES OF REFERRAL SERVICES
CODES
Number of individuals who received s ervices
after referrals by types of s ervices
1 ART
2 ART adherence couns eling
3 HIV couns elling & tes ting
NEW CLIENTS
FEMALES MALES
TOTAL
FEMALES MALES
TOTAL
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
PMTCT ( couns ens elling, tes ting, ARV,
4 prophylaxis , infant feeding couns elling
5 TB s creening / Treatment
6 STI s ervices
7 Septrine (CTX)
8 Treatment for other medical conditions
9 Home Bas ed Care
10 Food/Nutrition Support
11 Material Support
12 Education s upport for children
13 Family Planning
14 Dis cordant couple s ervices
15 Legal s upport
16 Microfinance/IGA
17 Pos t Tes t Club
18 PLHIV group s ervices
Out of the
newSupport
clients referred
Youth
Group ( previous slide), only the male client received
19two
Services
ART service.
The femaleCouple
client did
not receive the ART service and yet she was
20 Dicordant
referred21
for Safe
it Medical Circumcis ion
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Flow chart linking the M&E tools for referrals
Tool 5(data summary
form): Data summarized
for reporting
Managers use data
for decision making
& Planning
Tool4( referral register): Information is
recorded in referral register
Tool3 (referral form): Referral form is filled
Tool 2 ( referral directory) : Primary data collector identifies
relevant service providers
Tool1 ( CSAs/VHTs diaries): Primary data collector records details of
the clients and needs
Clients who received health services following referrals before and after
Number of Clients
full implementation of M&E tools by the CSAs/ VHTs
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
-
Clients referred
Clients who received Services
49%
Jul - Sept 2010 (M&E
tools not fully
implemented)
16,325
7,943
75%
Jan - Mar 2011 (M&E
tools fully implemented)
12,810
9,596
With good M&E tools and client follow up by CSAs/VHTs, its possible to
establish the actual proportion of people who received health services after
referrals and institute an appropriate measure
Challenges
 Some of the CSAs / VHTs do not follow up clients
to pick referral forms
 Some health facility staff/service providers lack
the will to fill the feedback form even when they
offered services
Lessons learned
 Without an innovative M&E system simple enough
to deploy at grass root level, it is often not possible
to establish whether those referred received services
or not
 Community Volunteers (CSAs/VHTs) have to be
supported to appropriately refer their clients for
specialized services
Way forward
 STAR-EC will promote the use of volunteer friendly
M&E tools to improve monitoring of referral activities
for HIV & AIDS, TB and wrap around services
 Data review will be conducted on quarterly basis to
assess the trend in referral service provision and come
up with corrective actions
 STAR- EC will also scale up involvement of community
volunteers in Monitoring & Evaluation of referral
activities
Acknowledgement








USAID
JSI Research & Training Institute, Inc. (JSI)
Ministry of health, Uganda
ICASA organizers, Ethiopia
District personnel
NACWOLA
STAR- EC partners
Authors
STAR-EC contact:
Plot 10 Kiira Lane, Mpumudde Division
Jinja Municipality
P.O.Box 829, Jinja, Uganda
Tel: (+256) 332 260 182/3/4 or +(256) 434 120 225
Fax: +256 434 120 232
E-mail: [email protected]
Web: www.starecuganda.org