Mopani District

Monitoring and Evaluation: TIER.net

Presenter : Mongwe WM

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PRESENTATION OUTLINE

• Introduction

• Tier.net definition

• National TIER. Net implementation progress reporting

• Monthly/Cohort Report

• Resources

• Tier.net Implementation report

• Data report

• Tier.net maintenance

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Introduction

• South Africa has the largest ART programme globally with over 1.2 million people on ART. The presidential mandate to expand access to treatment implemented in April 2010 has seen a rapid increase in number of clients on ART. Standardization of ART monitoring will enable facilities, sub-districts and districts to track and respond to the expansion of ART services.

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Introduction (2)

• In December 2010 South Africa’s NDoH introduced the Tiered ART Monitoring Strategy comprising of a paper-based (Tier 1), non-networked (Tier 2) and Networked system(Tier 3) for patient monitoring in line with the WHOs 3 Tiered ART M&E strategy.

• The goal for the 3 Tiered approach is to provide tools that best suit the context of the facility to facilitate standardized reporting information management as well as patient management nation-wide.

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Tier.net Definition

• A national new monitoring and evaluation system for ART, called TIER.net (Three Integrated Electronic Registers).

• The 3-Tiered approach provides the tools to support

the ART monitoring with the system that best suits the context and resources available to the ART service point. The three tiers complement each other and all generate the minimum data required to manage the ART programme and produce the monthly and quarterly data elements as approved by the NHC and NHIS/SA on 10 March 2010.

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Tier.net Definition

• Each of the three tools generate the same monthly and quarterly

reports required for the long-term routine monitoring of patients on ART and these data meet the reporting requirement of the NDoH.

• The paper register is based on the WHO paper registers and aligned

to the 2010 clinical guidelines for the management of HIV and AIDS in Adults, Adolescents and Children. The electronic register was developed by the Centre for Diseases and Epidemiology Research (CIDER) at the University of Cape Town to electronically capture the minimum data elements required monitoring the ART services.

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TIER. Net implementation progress reporting DefinitionsT1 Paper register

Phase 0 Preparation for Tier.net (Buy-in meeting with facility managers, Filing, orientation, process flow etc)

Phase 1 Installation and training

Phase 2Back capturing

Phase 3 Back capturing with live capturing

Phase 4Live capturing (back capturing complete) and data cleaning in progress

Phase 5 Data signoff by DIT/PIT after completion of data clean up and baseline audit

Phase 6 - completed Live site and site able to produce Monthly and Quarterly reports

T2 Eligible based on TROA as reported from DHIS

TIER.Net Impl in

Progress Sum of phase 0 - phase 5

T3 SMARTER

Non-Standard anything other than paper register, TIER.Net or SMARTER

e.g. this is not exhautive, but these could include Therapy Edge, Therapy Edge light, Bookwise, PAAB, an

excel spreadsheet, a tick register)

Please include in the comments section the name of the system or a description of the system that is

being used.

If site is listed but not

an ART site

please record as non-standard and highlight the comments section red and indicate that the site is not

an ART site. We will remove from the master list. It exists in the list as it had previously reported ART

data but this could have been incorrect. 7

• The metric for success is facilities routinely submit monthly and quarterly cohort data to the DHIS according to the DHMIS Policy and the ART M&E SOP.

• Maintenance means – the facility follows the steps in the ART M&E SOP – such as:

• running the missed appointment reports according to the schedule outlined by the ART M&E SOP

• conducts quarterly audits • cleans the data using the data clean-up document prior to

submission of quarterly cohort data

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Definition of successful implementation

• Complete monthly data reporting is critical to the management of the ART programme.

• April 2012 the number data elements reduced from 140 data

elements to 4, with two additional calculated data elements.

• These are the minimum data required to monitor the ART service and serve an important purpose in managing the ART programme both within a facility but also nationally.

• These data inform enrolment into the programme and also resource utilisation and allocation, drug procurement estimations, and other district and facility management activities.

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Completeness

Monthly/Cohort Report

• Monthly report – To be printed on the 5th of each month* – A hard copy signed by Facility Manager – The signed copy faxed to Sub-district Office by 5th of each month – The signed copy filed in ring binder in Facility Managers office

• Cohort report – Interpreted cohort report to be printed on the 5th of each new

quarter – A hard copy signed by Facility Manager and kept in ring binder in

Facility Managers office – A dispatch to be sent to sub-district office on 5th of each new quarter

Dates are a guide, if the province has a different data flow date, please adhere to these dates. The intention is to ensure complete and valid data is reported on time.

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A total of 108 facilities were assessed for the Tier implementation in Mopani district. The number is comprised of 89 PHC facilities, 8 CHCs, 8 Hospitals and a 3 non-medical sites in Ba-phalaborwa, Maruleng and Greater Letaba sub-districts

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12

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96/108 (89%)

10/108 (9%)

2/108 (2%)

0%0% 0%

Mopani Tier Implementation Report

PHASE 6 PHASE 5 PHASE 1 PHASE 2 PHASE 3 PHASE 4

Mopani Tier Implementation Report per Sub-District

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10 0 0

10 0 0 0 00 0 0 0 00 0 0 0 0

4

0

4

1 1

18

35

22

11 10

0

5

10

15

20

25

30

35

40

Greater Letaba Greater Tzaneen Greater Giyani Ba-phalaborwa Maruleng

Phase 1

Phase 2

Phase 3

Phase 4

Phase 5

Phase 6

ART Data Reporting Rationale In 2010 when the 3-Tiered Strategy was adopted standardised definitions for enrolment and retention on ART were introduced. Total remaining on ART (TROA) consists of all active patients remaining on ART in a facility. Facilities should not report ever started. New patients started on ART New is comprised of all patients started on ART who are naïve to treatment, or who have not previously had triple therapy for greater than 30 days. Adult started on ART during this month – naïve Child under 15 years started on ART during this month – naïve Total clients started on ART during this month – naïve (calculated) Total remaining on ART Total remaining on ART (TROA) is comprised of all patients who have started ART and excludes those who died, transferred out or are lost to follow up and includes patients who have transferred into the clinic. Adult remaining on ART at end of the month – total Child under 15 years remaining on ART at end of the month – total Total clients remaining on ART at end of the month (calculated) Data purpose: These data inform enrolment into the programme and to understand the active number of patients on ART. This data is used to inform resource utilisation and allocation, staffing, drug procurement estimations, and other district and facility management activities.

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0

10,000

20,000

30,000

40,000

50,000

60,000

Ba-

Phalaborwa LM

Total

Greater

GiyaniLM Total

Greater

LetabaLM Total

Greater

TzaneenLM Total

Maruleng

LM Total

Mopani

District

Adult remaining on ART at end of themonth - total

5,680 9,776 8,982 18,826 4,262 47,526

Child under 15 years remaining on

ART at end of the month - total359 582 575 1,350 310 3,176

Total clients remaining on ART at endof the month

6,039 10,358 9,557 20,176 4,572 50,702

Mopani District TRIC March 2014

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Maintenance of TIER. Net • This ensures facility based staff are sufficiently

capacitated to manage the monitoring tool and produce supporting management reports

• The results is that a facility effectively manage their patient population, and producing high quality data

• High quality data enables the District, Provincial and National Department of health to manage their ART programme, patient population and drug procurement

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• It shouldn’t happen

• Data capturers are the key ingredient to the success of these systems. The introduction of capturing new patient data must take into consideration existing staff, and their ability to support the capture of additional folders, in the context of their current workload.

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Notes on regression

• Importantly, as we move towards integrated capture vacant positions will have an exponential impact on the data completeness of all programme data. A sustainability plan must be developed to ensure facilities are not left without data capturers.

• Data capturer posts must be permanent positions.

• Training plans must be in place to rapidly train new staff, even in an in-service training capacity whilst awaiting longer training.

• Vacancies must be avoided

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Notes on regression (2)

• Discuss data as part of the DIT (district monitoring forum)

• Scale up TIER.Net implementation to all T1 facilities

• TIER.Net scale up to all facilities – The NHC took the decision to expand the TIER.Net

implementation to all facilities and reduce the use of the paper register to only sites that are unable to accommodate computers.

– This introduces a new challenge of scaling up implementation to previously defined ‘ineligible’ sites whilst also maintaining the momentum of implementation in implementing sites to achieve phase 6.

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