1. Design of HMIS – Challenges Group 1: –Design of data-collection tools – operational level not involved –Late submission and inconsistencies in data –Lack of human resources, staff turnover –Workload –Incomplete data –Lack of standardized reporting from private sector

2. Design of HMIS – Challenges Group 2 –Not enough staff involved in design; too much data is being collected –Myriad of reporting formats, according to type of services (NGOs, FBOs), periodicity (inconsistent)

3. Design of HMIS – Solutions Group 1 –Consult lower levels and other stakeholders in design of tools, and include more tool pre-testing at this level –Increased, proper training on M&E and reporting, software to ease data entry and compilation. Increase awareness of the need for timely reporting. Make sure staff understand why data are needed and how data are used. –Advocacy and increased political commitment and collaboration with NGOs to assist. Include training to address human-resource challenges. –Simplify data-collection tools –Create new posts (funded!) –Increase private-sector training. Create awareness of NTP policies, supervision of the private sector, and restrict license renewal pending reformed data collection. Use “sticks and carrots” to enforce reporting by the private sector.

4. Design of HMIS – Solutions Group 2: –Involve operational-level staff in the design of forms –Integrate the various existing reporting forms with one national format

5. Data collection - Challenges Group 2: –Staff turnover, especially in high-HIV prevalence areas, staff need a lot of training –Incompleteness in recording and poor attitudes towards recording –Lots of inconsistency; cases show up in one register but not the other –Triangulation is not done –Delay in submission

6. Data collection - Solutions Group 2: –Training as continuing CMEs, create awareness about the need for data. –Quarterly progress-review meetings, including quality of data as a topic to be covered. –Strengthen supportive supervision

7. Self assessment – Challenges Group 2: –Reports are only forwarded up to next level, no self assessment.

8. Self assessment - Solutions Group 2: –Encourage use of the indicators at facility level as a management tool.

9. Use of Data - Challenges Group 1 –Data are not used by decision-makers. Group 2: –Not a lot of training, beyond international courses such as Arusha. –Rigidity in targets –Lack of feedback

10. Use of Data: Solutions Group 1: –Involve these stakeholders in the design of systems to ensure they use them and perform cost-benefit analysis to show policymakers the importance of data use. Group 2: –Mid-level managers should have better training. They also need to develop a curriculum and build capacity at district level. –Reinforce need for feedback in support and supervision visits. –Localize needs for use of information, put the data in context, indicator based.