Integrated Monitoring and Evaluation of HIV Programs in Malawi
Dr Andreas Jahn 1,2 1 Dept. for HIV and AIDS, MOH, Malawi 2 I-TECH
Malawi
Slide 2
Malawi Context July 2011: Integration and Innovation preART
Exposed Infant follow-up ART PMTCT STI TB Family Planning HTC Data
Collection tools, reporting, Supportive Supervision and now
Clinical Mentoring were and are the foundation of the successful
HIV program
Slide 3
M&E: An iterative process Data Collection in integrated
M&E tools Quarterly Supportive Supervision to EVERY site
Clinical Mentoring for select sites Comprehensive Quarterly Report
disseminated
Slide 4
Integrated M&E for HIV Programs
Slide 5
ANC Integrated Register Double Duty: M&E tool is also a job
aid 5 ANC visits Summary outcomes Deduplication at data entry
Slide 6
Line Register: Mother on left; Infant on right of page Labour
and Delivery
Slide 7
ART Patient Card
Slide 8
Patient Cards
Slide 9
THYOLO DISTRICT HOSPITAL 48 Arch Back Files containing 2,400
patient cards
Slide 10
Quarterly Supervision Visits to all Sites Prevent protocol
drift Rapid chart review identify and discuss irregular cases
Consultation & mentoring on complex cases Physical drug stock
check Assess clinic infrastructure, staffing Review and discuss
data (content and quality) Disseminate program and protocol updates
Provide constructive feedback & encouragement
Slide 11
Logistics for ART Supervision Visits to all 650 PMTCT/ART sites
each quarter 20 Teams of 3 supervisors (Pool of 75) MOH HIV Dept.
staff Experienced ART clinicians & nurses Quarterly supervisors
training USD 110,000 (transport, accommodation, allowances)
Slide 12
Integrated HIV Service Supervision Form 1.Contact details of
staff at each site 2.Quality of service checklist 3.Follow up on
previous action points 4.Next visit date 5.M&E reports from
HTC, ANC, maternity, exposed child and pre-ART follow-up, ART and
TB 6.Physical drug stock count 7.Award of Certificate of Excellence
/ Book for clinical mentoring
Slide 13
Feedback & Encouragement Formal assessment on supervision
form No problems on quality check list Few errors on cohort
analysis
Slide 14
Outcomes from Supervision Round 2012 Q1
Slide 15
Running the M&E System Clinic Staff (Clinician, Nurse,
Clerk) Fill patient card at each visit Enter all new patients in
register Perform quarterly cohort analysis Fill report form
Supervision Team Review all treatment cards Check updating of
outcomes in register Check cohort analysis (usually repeat
tallies)
Slide 16
Quarterly Cohort Analysis Tallying of registration details of
new patients Review of all patient cards Tallying of secondary
outcomes (Regimen, Side effects, TB status, adherence) Updating of
primary outcomes in register (Alive on ART, Died, Transfer Out,
Stop, Lost) Tallying of all primary outcomes from register
Slide 17
Updating outcomes for reporting on Exposed Child, pre- ART, ART
Person 1 (Cards): Read out loud the registration numbers of cards
in the ACTIVE file Check for new deaths, defaults, TO, etc. Tally
secondary outcomes at the same time on a separate paper on the
side
Slide 18
QI Through Chart Review & Mentoring Expected number of new
initiations Correct determination of ART eligibility Identification
of ART interruptions Patients with side effects on wrong regimens
Adherence problems Review of complicated cases on the ward
Slide 19
QI Through Logistics Support Estimation of drug needs at each
site Monitoring of drug consumption Ad-hoc relocation of ARVs
Communication with DHO about infrastructure improvements
Slide 20
Closing the communication loop Action points from Supervision
team given to the Zonal and District ART Supervisors, and
Implementing Partners Plan clinical mentoring follow-up Debrief at
central level: Ongoing and emerging issues
Slide 21
Comprehensive Quarterly Reports Data entry, cleaning, analysis
Site level data based at MOH Report writing Dissemination by email
and through TWG Information feeds into SCM Closing the
communication loop (2)