1. Bridging the Divide: Interdisciplinary Partnerships for HIV and Health Systems Health Informatics - Leveraging HIV Scale-up for HIS/HM Kenyan Case Dr. Charles M. Nzioka, MD, MPH Public Health Specialist 16 – 17 th July 2010, Vienna, Austria Ministry of Health

2. Outline Vision/mission/Goal HIV Program overview Data sources for HIV program Initiatives to achieve one M and E system Challenges Way forward

3. Vision HIS Be a centre of excellence for quality health and health-related data and information for use by all

4. Mission To provide timely, reliable and accessible quality health service information for evidence-based decision making in order to maximize utilization of scarce resources

5. Goal Establish a functional, robust, effective and efficient Health Information System

6. HIV IN KENYA Current prevalence is 6.3% among 15-49yr olds (KDHS 2009) – Males 4.3% – Females 8.0% – Provincial prevalence range 0.9% -13.9% ServiceSitesAchievements HAART1065 336,980 HTC4,2003,946,862 PMTCT (HIV Testing)40001,072,468 HIV Service data by December 2009

7. Routine HIV Data Sources Routine Health Information System (HMIS): monthly collection and reporting of facility health data through file transfer protocol (FTP) system National Tuberculosis Control Programme Reporting (NLTPR): quarterly cohort reporting for tracking case finding and treatment outcomes for TB patients that receive HIV-related interventions National Blood Transfusion Services Reporting (NBTSR): monthly reports on blood collection/screening by regional & satellite blood transfusion centres Logistical Management Information System (LMIS): used for tracking commodities and supplies from the Kenya Medical Supplies Agency Essential Medicines and Medical Supplies System (EMMS): facilities use EMMS forms to procure drugs for (OI) and sexually transmitted infection (STI) drugs from KEMSA and reporting to NASCOP Early Infant Diagnosis for HIV Reporting (EIDR): independent database at Clinton Foundation for reporting by 3 DNA-PCR testing laboratories Kenya Programme Monitoring System (KePMS): MS-Access database capturing M&E data for PEPFAR-supported HIV/AIDS treatment and prevention programs. Managed by APHIA II Evaluation/ICF Macro Community Health Information System

8. Non-Routine HIV Data Sources ANC Sentinel Surveillance (ANC SS): ANC-based HIV testing at designated sites to monitor HIV seroprevalence among the general population Kenya AIDS Indicator Survey (KAIS): national population-based survey that collects information on HIV and STI prevalence and treatment, conducted every 5 years Kenya Demographic and Health Survey (KDHS): national population-based survey conducted every 5 years to generate information on HIV knowledge and sexual behavior Kenya Service Provision Assessment (KSPA): cross-sectional country-wide survey every 5 years to assess the capacity and quality of health services, including STI/HIV services

9. Information Flow for Routine and Non-Routine Data Sources for HIV and AIDS Division HIS PTLC HRIO NTPR DTLC CHAI KAIS, KDHS TB Clinic In- Charge PHRIO DHRIO MFLHMIS -FTP NASCOP LMIS District Pharmacist Pharmacy In-Charge District Stores EMMS USG- PEPFAR DLTLD KePMSNBTSR NBTS RBTC Data Clerks BTC Data Clerks EIDR PCR Testing Labs MCH & Laboratory In-charges ANC SS OTHERS: KNBS NCAPD Field Data Collector s CENTRAL LEVEL PROVINCIAL/ REGIONAL LEVEL DISTRICT LEVEL FACILITY LEVEL In-charges for MCH/FP, CCC, VCT, STI, OPD, IPD, Blood Banks NPHL LIS DMLT Lab In- Charge

10. Towards one M and E system - HIS strengthening ( HIS Policy, HIS SP) -Country picked to be one of the initial countries to implement Global Health Initiative – All inclusive process of Indicator harmonization – Development of Master Facility List – Development of standards for EMR for Patient level monitoring – Adoption of DHIS for aggregate facility level reporting – Mechanisms for routine data quality checks and assurance – Governance for the Health Sector

11. HIV Indicator harmonization Deliberate and concerted effort to review and harmonize HIV indicators includes; Global Fund, PEPFAR, UNGASS and others Use of a standardized and integrated reporting tool (MOH 711)from all health facilities

12. District MOH 711 Spreadsheet or Database Facility 711 Integrated tool MOH 711 - Data Element – Number of HIV +ve Tests Facility 711 Facility 711 Facility 711 Facility 711 KPMS USG Partner Database MOH FTP At District MOH FTP National NASCOP SCMS KEMSA LMU MAPPING ?

13. Development of Master Facility List (MFL) List of all existing facilities and services offered Each facility assigned a Unique identifier(code) Helps accurately determine number of expected reports hence computation of Reporting rates and completeness of reports In-built mechanism for regular updates Can be found at : www.ehealth.go.kewww.ehealth.go.ke

14. The ultimate goal –integrated HIS Human Resources Drugs & Supplies Financial and Expenditure Systems H.I.V. Malaria / Other Programmes G.I.S. / MAPPING Infrastructure / Equipment SURVEYS / RESEARCH/ HDSS/ VR Disease Surveillance Annual Operational Plans Morbidity / Mortality / HMIS Master Facility List

15. EMR: Electronic Medical Records Up to now the country had been relying on using paper based systems expect in a few donor run facilities Steps in adapting EMR – Assessment of all existing EMRs: Done – Development of standards for EMR: Done – Identification of an appropriate EMR – Upgrading Existing EMRs – Identification of Model sites for use of EMRs

16. Adopting of DHIS for aggregate facility level reporting DHIS: District Health Information systems Used in South Africa and Botswana Open source software that allows sending of facility reports into a National Database (Web Has inbuilt decision support systems hence allowing data use at the District level Customized to generate automatic reports for: UNGASS, UA, PEPFAR, AOP, etc.

17. Data Quality National TWG on data quality formed Have developed standard tools and methodologies to conduct Routine DQA Configured DHIS to have internal checks Regular supervisions, review meetings and feedback

18. Governance in the Health sector Joint planning and priority setting Joint monitoring Common management arrangements Mutual accountability Stewardship Public-private partnerships

19. Governance-achievements Joint planning, M&E cycle established (JPW). Code of Conduct signed, JFA development in progress. Coordination Framework (HSCC,ICCs) in place. Coordination network for implementing partners established (HENNET) Coordinating structure for private practitioners in place

20. Challenges and constraints Timeliness of reporting for service delivery at health facility level Limited data use/utilization and mechanisms to inform decision making process Data quality – lack of systematic validation process to ascertain the accuracy

21. Challenges Inadequate resources Human resource – Inadequate numbers – Limited skills Limited financial allocation

22. MOH MOEC MOF PMO PRIVATE SECTORCIVIL SOCIETYLOCALGVT NACP CTU CCAIDS INT NGO PEPFAR Norad CIDA RNE GTZ Sida WB UNICEF UNAIDS WHO CF GFATM USAID NCTP HSSP GFCCP DAC CCM T-MAP 3/5 SWAP UNTG PRSP Donor Collaboration and alignment, a challenge we are overcoming Source: WHO: Mbewe

23. Way forward [1] Implementation of HIS strategic plan – Resource Mobilisation & Collaboration for development - integrated system Enforcement of the HIS policy especially – Mandatory reporting by all service delivery points

24. Way forward [2] Utilization of ICT in health information System – Creation of district, provincial and national databases Continuous capacity development Strengthening & advocacy for data demand and information use at all levels

25. Thank you…