1. Towards Shared Patient Data: Harmonization of District Health Information System Data for Nationwide Reporting Towards Shared Patient Data: Harmonization of District Health Information System Data for Nationwide Reporting Authors: Kibaara C. 1,2, Blat C. 1,3, Mutegi E 1,2, Nyanaro G 1,2, Kulzer J 1,3 1. Kenya Medical Research Medical Institute (KEMRI) 2. Family AIDS Care and Education Services (FACES) 3. University of California San Francisco (UCSF) Presenter Kibaara Charles K. 7 th February 2014 7 th KASH Conference 5-7 Feb. 2014, Kenya

2. Program Background  Family Aids Care and Education Services (FACES) CDC/PEPFAR-funded HIV prevention, care and treatment program; launched in 2004 7 districts (4 counties) in over 140 health facilities  Goal - support and build Ministry Of Health (MOH) capacity to deliver comprehensive quality HIV services  Enrollment & VMMC by Dec 2013 Cumulative enrollment in HIV Care: 138,501 Cumulative ART : 63,669 Cumulative VMMC: 48,737

3. Background/Introduction  One central source of health data is needed for government and partner/donor reporting Rongo District Hospital

4. Background/Introduction  Monitoring and Evaluation (M&E) systems in Kenya historically vertical  Parallel tools for data collection developed and used by implementing partners and MOH  Extra burden on health facility workers implementing both systems  District Health Records officers overwhelmed by entering volume of data from sites  Incomplete datasets cannot be used for decision making  Need for one primary data source within each sub county

5. Study Objectives  To examine the extent of harmonizing data across systems  Ensuring data streamlining is an ongoing M&E processes nationwide

6. Materials and Methods DHIS-2  Demographic Health Information System (DHIS-2) Dedicated M&E system implemented by Kenya MOH Kenya, Tanzania, Uganda, Rwanda, Ghana, Liberia, and Bangladesh currently use DHIS- 2 Utilized to track national response to HIV and other health indicators

7. Materials and Methods Harmonization Process  FACES and MOH collaboration Voluntary Medical Male Circumcision (VMMC) program data strengthening In preparation for DHIS-2 transition from FACES M&E system, harmonization plans evolved FACES M&E Officers and MOH District Health Records Information Officers (DHRIO) partnered Supported DHRIO office with a Health records Information Technician (HRIT)

8. Materials and Methods Harmonization Process cont’ Implemented routine VMMC data review and harmonization in July 2012 Mentorship and on job training conducted to strengthen data entry Site reports cross-compared monthly VMMC reports Discrepancies counter-checked against clinic registers

9. Materials and Methods Evaluation Methods  Baseline (pre-harmonization) October – March 2012  Follow up (post-harmonization) January – June 2013  Data from 3 district hospitals in Nyanza Migori District Hospital (MDH) Macalder District Hospital Rongo District Hospital (RDH)

10. Materials and Methods Evaluation Methods cont.  Data discrepancies examined and compared pre- and post-harmonization  A two-sample test of proportions used Compared ratio of VMMC figures reported in DHIS-2 to F-EMR figures at baseline and follow-up

11. Results FacilitiesBaselinePost - Harmonization DHIS-2FACESRatioDHIS-2FACESRatio Migori District Hospital 392:7330.53327:3231.01 Macalder District Hospital 204:4340.47440:514.86 Rongo District Hospital 264:8820.30428:4261.00 Voluntary Medical Male Circumcision (VMMC) Data Discrepancies

12. Discussion  Data harmonization led to improved number consistency across reporting systems, thereby enhancing data integrity

13. Conclusion and Recommendations  Collaboration with MOH and IP M&E to harmonize data resulted in better data alignment  To support nationwide transition to DHIS-2 Channel national and programmatic resources towards broad harmonization efforts and ongoing quality assurance activities

14.  MOH  FACES  KEMRI  UCSF  U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)  U.S. Centers for Disease Control and Prevention (CDC)  The women, men and children in the communities served The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of U.S. Centers for Disease Control and Prevention/the and the Government of Kenya This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S Centers for Disease Control under the terms of Cooperative Agreement # PS001913 Acknowledgements

15. Questions