THE IMPORTANCE OF DATA QUALITY ANOVA Data Symposium Crowne Plaza, Rosebank 21 May 2012 Rentia Voormolen

Background of ESI Project Implemented by JSI – John Snow Incorporate Funded by USAID ESI Project – Enhancing Strategic Information To contribute towards reducing the burden of HIV and AIDS in Southern Africa by enhancing the use of information for evidence based decision making

Content of Presentation 1.Basic principles of Data Quality 2. Using the DHIS to optimise Data Quality 3. DQ pivot tables on Timeliness and Completeness of data in DHIS

WHAT IS DATA QUALITY? The REAL world In the real world, project /program activities are implemented in the field. These activities are designed to produce results that are quantifiable. Data Management System An information system e.g. DHIS, represents these activities by collecting the results that were produced and mapping them to a recording system. Data Quality: How well the DMS represents the real world Data Management System Real World ? 4

“Accurate, timely and accessible health care data play a vital role in the planning, development and maintenance of health care services. Quality improvement and the timely dissemination of quality data are essential if health authorities wish to maintain health care at an optimal level” (WHO, 2003).

WHY IS DATA QUALITY IMPORTANT? Good Quality RAW data = Good Quality INDICATORS Evidence that can be trusted enables managers to optimize health care coverage, quality and ultimately health status by :  forming accurate pictures of health needs, programs & services in specific areas  informing appropriate planning and decision making  allocating and using resources effectively and efficiently  supporting ongoing monitoring to identify best practices to learn from and areas where support and corrective measures are needed  improve quality of care

Daily -Collection during each patient/client contact - Validation & sub-totals Weekly Interim aggregation & validation 1st Validated clinician/service point summarised to facility manager 7th Validated facility summary submitted for capturing 10th Export of facility captured data sent to next level 15th Capturing, import, validation & export completed 20th District import, validation & export completed 30th Provincial import, validation & export completed 10th of following month National import, validation & saving on server Feedback in 5 days Do the right things right the first time! Monthly Data flow timelines: DHMIS Policy DQ –WHERE, WHEN & WHO ?

CRITERIA FOR DATA QUALITY Reliable Appropriate Valid Easy Sensitive Specific Validity Reliability Integrity Precision Timeliness Correct Complete Consistent Comprehensive Comparable

ACCURACY CHECKS – raw data Eyeballing – visual scanning  missing data values / gaps  inconsistencies / unlikely values  calculation errors  unusual month to month variation / fluctuations  duplication  preferential end-digits  data entered in the wrong box

USING THE DHIS TO OPTIMISE DATA QUALITY DHIS is the Routine Health Information Reporting System of NDoH (DHMIS Policy:7)

Min / Max out of range Graph

Colour Coding – Values out of range

Validate in Data Entry

Data Completeness Report

Data marked for Checking Report

Absolute Validation Rules

Statistical Validation Rules

Gap and Outlier Analysis

Data Integrity Check

What does the DHIS data tell us about Data Quality? Data quality pivot tables Monitor Timeliness and Completeness of Monthly DHIS health facility data submitted to NDoH Developed by ESI Accepted by HIS task team Currently for internal use To be incorporated in DHIS Pivot tables for external use

Definitions of timeliness and completeness Timeliness is the % of expected health care facilities that reported into the DHIS database for the last reporting month (DHMIS policy 60 days) Completeness is the average % of expected health facility reports that were captured into the DHIS for the last 12 reporting months

PROXY INDICATOR TO MEASURE TIMELINESS AND COMPLETENESS Indicator: Reporting rate (%) – Target 95% Numerator: Number facilities which reported/captured data on a specific element Denominator: Number facilities for which this data element is activated for capturing into the DHIS

Proxy data elements used to identify facilities PHC total Headcount – Clinic, CHC, Mobile & Satelite clinics Delivery in facility – CHC, MOU, District, Regional, Tertiary & Central Hospitals Usable beds – District, Regional, Tertiary & Central Hospitals

Ranges used for colour coded pivot tables < 70 (69.5) % - Critical 70 (69.5) to 94 (94.4) % - improvement needed 95 (94.5) to 100% - target met

GP: Hospital Reporting Rates – T 95% Month-Year Ekurhuleni MM Johannesburg MM Sedibeng DM Tshwane MM West Rand DMAverage Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Average 100 Timeliness – reporting rate for the last reporting month Completeness – average reporting rate for the last 12 reporting months

GP: PHC Reporting Rates – T 95% Month-Year Ekurhuleni MM Johannesburg MMSedibeng DMTshwane MM West Rand DMAverage Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Average

GP: PHC Reporting Rates - PMTCT

GP: PHC / District - PMTCT DataElementName Ekurhuleni MM Johanne sburg MM Sediben g DM Tshwan e MM West Rand DM Averag e Antenatal 1st visit Antenatal 1st visit before 20 weeks Antenatal client CD4 1st test Antenatal client eligible for HAART Antenatal client HIV 1st test Antenatal client HIV 1st test positive Antenatal client initiated on AZT Antenatal client initiated on HAART Cervical smear in woman 30 years and older Medroxyprogesterone injection Norethisterone enanthate injection Oral pill cycle Postnatal care mother within 6 days after delivery Average

GP: Hospital Reporting Rates - PMTCT

GP: PHC Reporting Rates - ART

GP: PHC / District - ART DataElementName Ekurhul eni MM Johanne sburg MM Sediben g DM Tshwan e MM West Rand DMAverage Adult patient started on ART during this month - new Adult patients remaining on ART at end of the month - total Children under 15 years remaining on ART at end of the month - total Female condoms distributed HIV positive adult patient eligible for ART HIV positive child under 15 years eligible for ART HIV positive new patient started on Co-trimoxazole prophylaxis HIV positive new patient started on INH prevention therapy Male condoms distributed New child under 15 years started on ART during this month Sputum results received within 48 hours STI partner treated - new STI treated - new episode Suspected TB case smear positive Suspected TB case smear positive - treatment start Suspected TB case with sputum sent Average

GP: Hospital Reporting Rates - ART

The best way to improve Data Quality is to USE the data!

THANK YOU SIYABONGA REALEBOGA BAIE DANKIE.