Integrated Monitoring and Supervision Approaches The Gambia Olimatou Kolley SMC Focal Person NMCP 14 February 2017

Outline Objectives Roles of different Supervisors Digital data collection Data Quality Assurance Team Purpose of doing supervision this way Benefits Challenges of supervisor

SMC Monitoring and Supervision Aim: Assess performance of CHWs, HFWs and other supervisors during SMC Provide feedback on their performance Identify opportunities for improvement within a supportive environment Encourage and motivate them to do a good job

4 different levels of supervision Team District Regional Central

Tools Central level monitoring checklist Team supervisors form District supervisors form National supervisors form Health Facility End of cycle report Referral form ADR or PV form Community worker competency checklist Ipad/Adroid devices

Roles of Team Supervisors Observe 4-6 distribution teams and each team consisting of 1 CHW and 1 data collector Ensure every household is reached and every eligible child is treated Support distribution teams to be well prepared before each SMC cycle with all needed materials Ensure the safety of children who receive SP+AQ Ensure SMC medicines are delivered timely, safely and correctly Ensure all children with fever are referred to the health facility to be tested for malaria Provide on site mentoring, coaching and feedback to distribution teams as needed

Roles of District Supervisors Supervises 4 to 5 team supervisors Uses a vehicle to ensure that all their teams are seen on a daily basis Conduct spots checks to ensure that: -right dose and quantity has been administered -caregivers understand messages given by CHW -completeness of distribution card -any missed household or child Review and collate data from team supervisors and send to regional data manager Conduct Nightly meetings with team supervisors to discuss challenges and coverage so that informed decisions can be made in preparation for the following day Complete supervisor end of cycle report

Roles of Central & Central level supervisors Regional Responsible for regional coordination and oversight of all SMC activities during the four cycles Central Responsible for the overall coordination of SMC activities and there is one present in every district during delivery Report any issues that may arise to national coordinator

Role of Health Facility Workers Receives, store and distribute SMC drugs to team supervisors Manage all referrals Manage children with AEs and SAEs and complete the National pharmacovigilance forms Complete and submit health facility End of Cycle report to the district supervisor on the last day of each cycle

Digital Data Collection Central Level monitor observing data being entered into the iPad

We use Digital Data Collection tools and processes in The Gambia Digital SMC Register SMC Register T Treated M Sick R Refused E Excluded Treated – Sick – Refused - Excluded

Process An ICT4D strategy utilizing digital monitoring, evaluation, accountability and learning platform (eValuate), where teams of data collectors and community health workers utilize tablets and android phones through house-to-house: Register beneficiaries (and households/ caregivers) Issue beneficiary cards with a distinctive QR code (this contains a digital profile of bio, household and treatment data that is scanned before each SMC distribution to identify the beneficiary within the system) and distribute SMC over four cycles. All beneficiary (and household) data is captured digitally on the devices utilizing iFormBiulder (a digital representation of paper forms) and synced to the CRS iCloud (in real time or near real time) for more quality data, rapid analysis, and systematic problem-identification and problem-solving

Roles of Data Quality Assurance Team To ensure that data collected was of quality, a data quality team led by the MoH Monitoring and Evaluation Coordinator was set up in 2016 to: Do the monitoring and auditing of data Correct any errors and inconsistencies if present before synching data Produce reports in real time for use in the field

Methodology for Conducting Data Quality Assurance Quality checked at each level from distribution site before synching to regional and national level Field data quality team review the data to make sure that all the forms are filled and save correctly before they can be synced Regional Quality assurance team check the data to further ensure completeness and accuracy and report any inconsistences observed in the data to the district supervisor. The NMCP MEAL Coordinator, CRS MEAL Officer and the regional data managers conduct the last data checks before building and sharing the report.

Purpose of doing supervision this way Ensure every household is reached and every eligible child is treated equitably Observe distribution teams to ensure that SMC drugs are delivered safely and correctly Provide on site mentoring, coaching and feedback to distribution teams to improve performance Ensure every level of supervisor is performing their role correctly Ensure each drug administered is accounted for Ensure data collected digitally is of quality by setting up a data quality team to conduct data audits in the field Solve technical issues that may arise while collecting data Ensure that data collected is available at the end of each day

Benefits Distribution done correctly and professionally Biographical and distribution records of beneficiaries captured electronically and available for all four cycles Records of beneficiary available for consequent cycles so that SMC is not administered to children not eligible Timely management of AEs and SAEs by Health Facility Workers Availability of near real time data to be able to make informed decisions in preparation for the next day

Benefits Cont’d Data collected are reliable and of good quality Having information on daily coverage by district so that more focus and effort can be put where needed for improvement Using eValuate allows permanent record of beneficiary data and enables quick analysis of data for decision making Everyone including the donor can see the same data for more transparency

Heavy rains and flooding causing damaged and impassable roads especially in URR making it difficult for supervisors to reach certain communities Data synchronization was a problem in most communities due to poor internet connectivity Challenges

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