Transcript Ukraine Infectious Disease Program

Ukraine Infectious Disease
Program
Health Information Systems and
Management Reform
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Collaborating Agencies
 Started in 1997 as a collaboration between the
USAID, BASICS, CDC, MOH and PATH
 PATH became the lead organization with the
technical assistance provided by all partners
 Funded by USAID; the 2nd and 3rd years of
work supported through the Technologies for
Child Health (Health Tech) Cooperative
Agreement between USAID and PATH
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Background:
• Grew from lessons learned from diphtheria campaigns in
Ukraine, which identified weakness of existing HIS
– Lack of reliable data on vaccine distribution, consumption,
coverage and wastage
– Confusion over target population definitions, campaign
strategies and contraindication criteria
– Non-standard statistical methods, contradictory reports and
statistics between oblasts
– Excessive record-keeping and reporting requirements
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Program Goal:
Improve the public health management,
infectious disease prevention and control
activities through reform of the MOH's
health information system by improving
- the quality of the information collected, and
- the utilization of the information by and for
management
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Program Activities (1):
Established multi-disciplinary, multi-level
working group
• assessed the current status of data collection,
processing and utilization;
 identified deficiencies in the system;
 established priorities and recommended changes
 monitored progress of the reform
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Program Activities (2):
• Working group developed methods and
materials for the introduction of revised policies
and practices, and for training staff
• Three oblast wide workshops and National
conference on management information
conducted to introduce findings
• Establishment of the National level Working
Group to advise and coordinate country-wide
adoption of the program reforms
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Program Activities (3):
 replication of previously developed management
and public health surveillance reforms in the all
country
 Series of regional training seminars for oblast
epidemiologists and pediatricians on the revised
reporting policies and procedures, forms and
monitoring tools
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Accomplishments:
• Every level of the public health service
delivery system, from the MoH, oblast SES
to the village ambulatory clinic, now has the
capability to accurately forecast needs and
monitor and evaluate their activities
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Accomplishments:
• Standardized internationally accepted definitions
and methods for calculating base populations for
surveillance statistics, annual work plans and
monitoring of program performance are in use
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Accomplishments:
• Immunization managers have the capacity
to accurately monitor supplies from existing
stores to the point of consumption, track
vaccine balances and rationalize
distribution.
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Accomplishments:
• Oblasts now have the ability to monitor and
respond to vaccine wastage. For the first
time, oblast and national authorities have
evidence of the extent of the problem, and
the information tools necessary to
effectively address it.
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Accomplishments:
The problem with excessively and
inconsistently applied contraindications to
immunization, which had been identified
and documented by the new HMIS, was
successfully addressed, and the number of
contraindications in the new immunization
schedule was radically reduced.
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Accomplishments:
Armed with the HMIS data demonstrating
inefficiency of
the decentralized vaccine
procurement mechanism, with documented
evidence of frequent stockouts affecting
immunization coverage rates, the Ministry of
Health has succeeded in 2001 in re-establishing
central procurement of vaccines in Ukraine
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Summary
This has resulted in:
• Identifying “problem” administrative
territories and health settings
• Targeted interventions to identify and
correct the source of program deficiencies
• More children being immunized with those
immunizations being more timely
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for monitoring of immunization
at oblast and central level
Software application UKRVAC-01
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PURPOSE
Ukrvac is a supplement to HMIS that helps
1) process big flow of quality data at oblast and central
level in a timely manner
2) quickly draw immunization manager’s attention to
regions with sub-optimal performance
3) present information in a suitable form to decision
makers and as a feedback to health workers at lower
levels
4) store the data electronically for future reference
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DATA ENTRY
 WHO - assistant epidemiologist or PC operator (in oblasts)
 WHEN - every month
 HOW LONG - usually no more than 2-3 hours
---------Accuracy verification and protection from accidental
mistakes of an operator during data entry:
- data validation
- automatic verification of totals
- conditional formatting of data entered
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SYSTEM OUTPUT:
1. MONTHLY REPORTS ON IMMUNIZATION
PRACTICE




number and types of immunizations given
use of vaccines
contraindications
timeliness
All data are protected from changes
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Number and types
of immunization
given,
Cumulative
numbers,
Coverage in %
Vaccine
flow
and
usage
data
Timeliness of
immunization and
contraindications
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2. CONTRAINDICATIONS TO DTP
(tables and graphs)
 by type (short-term, long-term, permanent)
 by oblasts and rayons/towns
 by months
 structure (DTP-1,2,3)
All data are protected from changes
Conditional formatting function
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PERCENTAGE OF CHILDREN WITH CONTRAINDICATIONS TO DPT 1-3
UKRAINE
2000
16%
The overall number of contraindications have reduced.
Proportion of children contraindicated to DTP 1-3 for a
long term has dropped from 4% to 2.6%
14%
12%
10%
8%
6%
4%
2%
0%
Jan
Feb
Mar
Apr
May
Jun
Jul
Long-term and permanent
Aug
Temporary
Sep
Oct
Nov
Dec
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Long-term and permanent
Temporary
UKRAINE
Sebastopol
Kiev City
Chernigiv
Chernivtsi
Cherkassy
Khmelnitsky
Kherson
Kharkiv
Ternopil
Sumy
Rivno
Poltava
Odessa
Nikolaev
Lviv
Lugansk
Kirovograd
Kievska
Iv-Frankivsk
Zaporizhzhia
Zakarpatie
Zhitomir
Donetsk
Dnipropetrovsk
Volyn
Vinnitsa
December
December
Crimea
PERCENTAGE OF CHILDREN WITH CONTRAINDICATIONS TO DPT 1-3
UKRAINE
2000
16%
The focus of attention should be on selected low compliance regions
14%
12%
10%
8%
6%
4%
2%
0%
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3. TIMELINESS OF IMMUNIZATIONS
(table and graph)
 by oblasts and rayons/towns
 by months
All data are protected from changes
Conditional formatting function
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TIMELINESS OF DPT-3 IMMUNIZATIONS
(at the age of 6mo 29d), UKRAINE, 2000
100
95
Coverage, %
90
85
80
75
70
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
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Dec
Vaccine shortages result in delayed immunization
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4. IMMUNIZATION COVERAGE
(tables and graphs)
• Breakdown by oblasts and towns/rayons
• Monthly and cumulative data in tables and
dynamically built graphs
• For all antigens: BCG, Polio (1-7), DTP (1-4),
DT, Td, d, Hep B, Measles, Mumps, Rubella
All data are protected from changes
Conditional formatting function
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Frequent stockouts
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Decentralized procurement:
no mumps vaccine in 5 oblasts, whereas
other preparations might have been bought
in excessive quantity
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5. USE OF VACCINES (tables and graphs)
 For each vaccine:
 vaccine flow in oblasts and rayons/towns every month
 monthly balances at oblast, rayon/town stores and in health
facilities
usage/wastage patterns by oblasts/rayons/towns and months
Graphical presentation of all vaccines usage patters in regions
Conditional formatting function
All data are protected from changes
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Reasons for high wastage need to be
investigated and customized action
plans developed
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Severe shortage of
basic vaccines
More than 6-month supply of DPT issued
to health settings
A lot of DPT in stock but no Mumps
vaccine
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