Transcript Valerie Koscelnik, ICAP - I-Tech

Utilizing Facility Data for
Program Monitoring
Valerie Koscelnik
Track 1 ART Program Meeting
Maputo, August 12, 2010
Outline
• Framework for health system components and
outcomes
• Transition short & long term goal/objective
• Transition Logic model
• Measurements:
– Site and Regional readiness
– Outcome indicators
• Data quality assessments
• Summary and conclusions
Health Systems Building Blocks
and Key Health Outcomes
Overall Health Outcomes
Transition monitoring: What are we looking for?
Long term goal & shorter-term objective
• Long term goal: sustained local ownership with
maintenance of excellent patient care and good patient
outcomes. Ultimately, a vision of an effective
strengthened health systems.
• Shorter term objective: Sites and local partners
(governmental and/or NGO) able to accept/absorb and
grow the program with delivery of high quality care
Source: Transition Logic Model Working Group
Transition Logic Model Inputs
and outputs individualized per partner
Process/Health System
Measurements
• Site maturity: SCA-like tools
• Technical and organizational competency of
local government and NGO partners
• Ownership – Performance & accountability
documentation TBD
Source: Transition Logic Model Working Group
Site readiness
Kenya
• Locally developed site readiness tools assessing key domains
ICAP-Kenya Track I Rapid Maturity Assessment Tool for Health
Facility Transition:
• Assessed (1) services offered, (2) HR, (3) general management, (4)
financial management, (5) quality management (6)
procurement/supply chain management and (7) performance
indicator: retention of patients in last 12 month
• Facility is ready for transition if scores 90% or greater
• Facilities below 90% require continued capacity building for
transition
State and site readiness:
Nigeria
• Structured assessment of state institutions and sites by (1)
governance/leadership, (2) organizational structure, (3 & 4) HR
& fin management, (5) external relationships, (6) service
delivery, (7) pharmacy and (8) laboratory
• Scale used to determine priority states for transition
State Y
State X
Clinical Quality of Care
Outcome indicators
•
•
•
•
•
•
•
Adult care and treatment
Pediatric care and treatment
PMTCT
TB/HIV
Laboratory
Counseling & Testing
Adherence and Psychosocial support
Need to focus on priority set of key Quality of Care
indicators
ICAP priority quality indicators:
Standards of Care (SOC)
Rationale:
• Five priority quality indicators selected to allow for comparisons
across sites, programs and countries*
• Creates a limited, manageable core set of indicators for program
monitoring and review of quality
Data sources:
• Routinely-collected site-level indicator data reported every quarter
for HIV care and treatment (Track 1 reporting indicators), TB/HIV,
and PMTCT programs
• Data imported from country aggregate databases or hand-entered
on on-line indicator database
• Data checks are run on the data to ensure internal and cross-quarter
consistency
* Countries and site can select specific SOCs for monitoring & CQI activities
Priority Quality Indicators
Program area
Priority
indicator
Definition
1
Eligible patients in care and treatment receive
cotrimoxazole at enrollment and last visit
2
HIV infected children under one year of age
receive ART
3
Patients enrolled into treatment remain in care
for at least 6 months
TB/HIV
4
All patients in care and treatment receive TB
screening at enrollment and during the quarter
PMTCT
5
HIV-infected pregnant women in PMTCT
services receive multi-drug ARV prophylaxis
Care and
Treatment
Priority Indicator 1
Target: 95% of eligible patients in care and treatment receive
cotrimoxazole
Aggregate data
Measured by Proportion of eligible patients in care and treatment receiving
cotrimoxazole at enrollment
Numerator
Numerator: Number of HIV-positive persons receiving
cotrimoxazole prophylaxis
Denominator Denominator: Number of HIV-positive persons eligible to
receive cotrimoxazole prophylaxis according to national
guidelines
To start centrally collecting in fall 2010
Priority Indicator 2
Target: 95% of HIV infected children under one year of age
receive ART
Aggregate data
Measured by Proportion infected children under one year of age receiving
ART (Track 1 reporting)
Numerator
Number of patients <2 who were newly started on ART during
the reporting quarter
Denominator Number of patients <2 who were newly enrolled in care during
the reporting quarter
Priority Indicator 3
Target: 90% of patients enrolled into treatment remain in care for at least
12 months
Aggregate data
Measured by
Proportion of patients >6 years of age enrolled into treatment
who received ARVs for 6 out of 6 months (Track 1 reporting)
Numerator
Number of ART patients >6 years of age who received ARVs
for 6 out of 6 months
Denominator
Number of patients >6 years of age started on ART in a given 3
month period (e.g. for Oct-Dec reporting, Aug-Oct of year prior)
Priority Indicator 4
Target: 95% of all patients in care and treatment receive TB
screening at enrollment
Aggregate data
Measured by
Proportion of all patients in care and treatment receiving TB
screening at enrollment
Numerator
All new HIV patients screened for TB at enrollment during the
reporting quarter
Denominator
All new HIV patients enrolled in care during the reporting
quarter
Priority Indicator 5
Target: 95% of HIV-infected pregnant women in PMTCT services receive
multi-drug ARV prophylaxis
Aggregate data
Measured by
Proportion of HIV-infected pregnant women in PMTCT services
in ANC receiving multi-drug ARV prophylaxis
Numerator
Number of HIV positive pregnant women in ANC receiving
multi-drug ARV prophylaxis including HAART during the
reporting quarter
Denominator
Number of HIV positive pregnant women enrolled in ANC
(known positive and tested positive) during the reporting
quarter.
Indicators across country programs
Site specific trends in priority quality (SOC)
indicators
Mozambique
Site-specific trends in priority quality (SOC)
indicators by site
Rwanda
DQA Indicators
Routinely Reported
Indicator
Data
Source
DQA Sample Gold
for Quarter
Standa
of Interest
rd
DQA
Indicator
Denominat
or
DQA Indicator
Numerator
(completeness
base on gold
standard)
% Eligible patients
receiving CTX when
enrolling in HIV care*
Pre-ART
Register
Random
sample
Clinical
File
# in CTX
eligible in
DQA sample
# with
documented CTX
% HIV+ children <1 yrs of
age receiving ART*
Pre-ART
Register
All Children
<1 yrs
Clinical
File
# in DQA
sample
# with
documented ART
start date
% Patients enrolled in ART
who remain in care for 6 of
6 months*
ART
Register
Random
sample from
respective 6mo cohort
period
Clinical
File
# in DQA
sample
# with
documented visit
6 of 6 months
% Patients in HIV care and
treatment receiving TB
screening at enrollment*
Pre-ART
Register
Random
sample
Clinical
File
# in DQA
sample
# documented TB
screening at
enrollment
% HIV+ pregnant women in
PMTCT services receiving
multi-drug prophylaxis*
PMTCT
Register
All HIV+
pregnant
women
ANC
Register
# in DQA
sample
# with
documentation of
multi-drug
prophylaxis
* Quality Indicator
DQA Indicators (con’t)
Routinely Reported
Indicator
Data
Source
DQA Sample for
Quarter of
Interest
Gold Standard
DQA Indicator
Denominator
DQA Indicator
Numerator
(completeness
base on gold
standard)
# Patients currently
on ART
ART
Register
All patients on
ART
ART Register
N/A
# visiting ART
clinic and
receiving
ARVs
% Patients enrolled
on ART for 6 months
with a CD4 value
ART
Register
Random
sample from
respective 6mo cohort
period
Clinical File
# in DQA
sample
# with
documented
CD4 count at 6
months
% Patients screened
for HIV when
enrolling in TB
services
TB
Register
All new
patients
TB Register
# in DQA
sample
# with
documented
HIV screening
% Patients screen for
HIV when enrolling in
VCT or other POS
VCT/PO
S
Register
All new clients
VCT/POS
Register
# in DQA
sample
# with
documented
HIV screening
Summary
• Readiness assessments critical to determine status of
health system components and provide important
information for transition preparation and monitoring
• Quality indicator data at site and country levels provide
critical outcome data on quality of health system
outcomes before, during and after transition
• Data quality audits are important and can serve to
monitor performance and could inform continued funding
and accountability
Conclusions
Data must always inform programs
Data must continue to inform all aspects of
transition efforts