Monitoring HIV/AIDS using Sample Vital Registration with Verbal Autopsy Gregory Kabadi on behalf of SAVVY partners

Outline SAVVY Overview Technical aspects for SAVVY Implementation plan SAVVY’s facilitation with RITA

SAVVY Overview ‘SAVVY’ = Sample Vital Registration with Verbal Autopsy A sample demographic surveillance system built around vital events monitoring Purpose is to provide improved monitoring and measurement of vital events Not available from vital registration systems, household surveys, etc. SAVVY will include cause of death ascertainment Supplemental information from periodic surveys “nested” within system SAVVY will consolidate and adapt “best practice” in Sample and demographic surveillance techniques Survey sampling methods Validated ‘verbal autopsy’ methods

SAVVY’s ORGANISATIONAL STRUCTURE National Level: Technical Staff at MOHSW, Other Gov Depts, Development Partners. SAVVY’s Implementing Partners: IHI & NIMR Mza District Level: DMO and CHMT, SAVVY’s District Coordinator Community Level Census Supervisors, Enumerators and Key Informants 4

Sentinel Panel of Districts (SPD) 5 FBIS = Facility-Based Info System SPD central SAVVY District Coordinator FBIS District Coordinator District Medical Officer KIs & Census Enumerators Facility I/C

Why SAVVY? Several millennial commitments to ‘do better’ with investments in population health and development Few reliable sources of information on mortality rates and causes of death- especially HIV/AIDS Strengthen the capacity of the Ministry of Health & Social Welfare to collect and use surveillance data to manage programs

SAVVY Sample Selection - NBS Probability Proportional to Size Enumeration area and households from Tanzania Mainland National estimates Stratified by rural-urban & gender Target population is adults Zones 7 zones (western, northern, central, S highlands, lake, eastern, southern) Districts Probability sample ~21 districts, ~3 per zone 208 EAs in total Households 30 households per EA

SAVVY Sampled Districts 8

What are the technical aspects? Censuses Conduct baseline census followed by periodic updates Deaths and births reported Mortality Surveillance System Deaths followed-up with ‘verbal autopsy’ Substantial and growing literature on the reliability and validity of this technique Provides accurate cause of death data at community level by age and sex Nested studies Behavioral, service satisfaction, health equity, SES

Implementation plan Sensitization and Govt buy-in Signing of MOU with NIMR Signing of MOU with NBS List of names of the sample districts including EAs from NBS Statistical Master Sample Plan/set up Financial & A/C reporting SAVVY staff recruitment So far, 2 hired at IHI, 3 at NIMR Mwanza Pending, 4 – 6 at IHI & NIMR Mwanza (all, fulltime) Pending 23 District Coordinators (District-based, fulltime) District-based, KIs + Census enumerators (abt 270, temp) Office set up, procurement of utilities + cars

Implementation Plan… cont’d Phased-in implementation of SAVVY 4 Pilot districts – 2010: Kinondoni, Bagamoyo, Geita & Kahama 12 districts by 2011; ALL by – 2012 Identification of key members in selected districts to organize district work and VA interviews Preparation of SAVVY field manuals, guidelines and SoPs Develop and pilot test data for census and VA both on Tablet PCs Training of field teams on data collection using Tablet PCs Write and submit Feasibility Study 11

Implementation Plan…..cont’d Establish vital events reporting system in pilot districts Train community Key Informants on recording & reporting of vital events Conduct baseline census in the first 4 SAVVY districts & Conduct verbal autopsy interviews Conduct supervision and quality assurance of baseline census Data management and analysis of baseline census, write report of baseline census Identification and training of physicians for coding of Verbal Autopsy data Set up of Steering Group (high level) & TWG 12

REGISTRATION OF BIRTHS & DEATHS, RITA - I RITA = Registration, Insolvency & Trusteeship Agency (Ministry of Justice and Constitutional Affairs) To register a birth or death event (birth within 90 days, death within 30 days): Birth or Death notification: B1 or D1 for a birth or death at a health facility resp B2 or D2 for a birth or death in communities resp Certificate, TShs. 3,500/= (about US $ 3) A birth/death event after the period recommended, more evidence will be needed, fee + penalty! A birth certificate: Given a name, Citizenship, know own parents and to be cared for, Retirement, Higher education A death certificate: Inheritance, Evidence to being an orphan, Sponsorship by Gov 13

REGISTRATION OF BIRTHS & DEATHS, RITA - II SAVVY will monitor and register all live births and deaths in its communities (SAVVY districts) RITA promised to issue SAVVY its notification registers (B1/B2 and D1/D2) that it will be distribute to Village Executive Officers (VEO) SAVVY’s KIs inform the SAVVY District Coordinator of vital events in their communities SAVVY Coordinator verifies events and collects data, registers them at the VEO (RITA’s registers) SAVVY Coordinator / VEO send the notification registers to the RITA’s District Officer for issuance of certificates 14

SAVVY’s Key Informants, Attributes A SAVVY’s KI should be appointed by community leadership (Ward or Village) for having the following attributes/qualifications to be able to report on vital events: - Be a resident of the community - Approved of by the community - Confidentiality - Of good rapport - Be able to read and write 15

WORKING TOOLS Key Informant A Bicycle A Simple phone (within network coverage) Incentive: for each birth or death reported Census Enumerators/Supervisors A Tablet PC Transport during census SAVVY District Coordinator A Tablet PC Transport 16

Conclusion Very powerful information platform to generate population-based demographic, health & mortality data NBS-endorsed, national sample; results stratified by residence & zone Provides economical, quality platform for detailed programme Monitoring & Evaluation Provides opportunity for fundamental & operational research Comparability over time: trend analysis Included in the MOHSW’s HMIS project for sustainability in the near future

ASANTENI