QUALITY DATA FOR QUALITY HEALTH SERVICES
Data is the lifeblood of health services. It is the raw material for making decisions about the health of individuals and services which they access. Quality of health data is therefore paramount because it translates to good or bad decisions. How does one assess the quality of data being collected and reported from the health facilities in a country’s health sector? Simple, conduct a data quality audit of a national scale from a sampled group of clinics and hospitals to ascertain whether the data being produced meet the quality standard.
One of the ways to achieve this has been to support the Ministry’s Strategic Information Department (MOHSID) in strengthening Health Information Systems (HIS), and Monitoring and Evaluation (M&E) Systems that are used to routinely collect, collate, analyze, and produce information to inform evidence-based health care services, which will in turn produce positive health outcomes. This is where the national Data Quality Audit or DQA stemmed from.
From the 17th – 28th of October, a national DQA was conducted. To achieve this, a group of 12 trained DQA auditors randomly selected a representative sample of health centres and hospitals that reported data from April to June 2016. Due to resource constraints, priority programs were selected. These are: ART, HIV testing services, Child Welfare and cervical Cancer. The data derived from this sample will be an indication of nation-wide data quality status.
The results of this audit will provide the MOH, PEPFAR and implementing partners an opportunity to verify reported program performance data, and assess the ability of the data management systems and M&E reporting system to report quality data, as well as allowing MoHSID to establish a baseline national data error rate that will inform data quality improvement and ongoing monitoring of such data quality improvement.
In other words, the audit will not only allow the MoHSID to assess the quality of program data, but will also pin point weaknesses and strengths of the data management and reporting system, hence giving the MoHSID, an opportunity to strengthen the system where necessary.
The DQA on the ground
With technical and financial support from PEPFAR, the DQA team consisted of representatives from MOH SID, IHM Southern Africa and MEASURE Evaluation who provided technical assistance on the coordination, planning, DQA protocol development, data collection and analysis.
The team verified and recounted the numbers in the registers and in the electronic health information system (CMIS) against the numbers the health facilities had reported to their regional offices each month between April and June 2016. If the numbers did not match, the anomaly would be classified as a data discrepancy and reasons for discrepancy noted. Some of the larger hospitals posed a more difficult task due to the sheer size of the number of patients that they serve. To carry out the DQA in facilities such as these, the audit team split into groups so as to cover the various service centres: OPD, VCT, casualty, TB, and the various wards. At OPD and VCT, the team was looking at specific elements on the registers: identifying the number of individuals undergoing HIV testing and counseling counts for individuals and couples, as well as the number of people who received their HIV test results.
There were four teams, one for each region. In the Hhohho region, Ms Khosi Mokoena from the Strategic Information Department led the DQA. She also conducted interviews with the Sister-in-Charge at each department. At the outpatient department, she met with Sister Magagula and wanted to find out if the team would review the data before sending it off to the regional office each month, and if the team knew how to analyze the data. She further inquired if Sister Magagula knew how many patients she saw each month, and if the team could see which ailments were high each month.
Data analysis for this exercise is underway. What is becoming clear however is that, data analysis and use at the point of collection (health facilities) if one of the weakest parts of HMIS. The norm was to collect and collate the data and send them to the regional offices. This is one of the several issues the DQA aims to address moving forward.
Mokoena also wanted to identify what the SID team could do to assist the OPD department in strengthening their data. The big concern seemed to be the lack of training, especially for the team at the Red Stamps Section. A recommendation made from the DQA team to the health facility staff was for them to familiarize themselves with their own data and to task their designated Health Information Officers to compile monthly statistics which they could review at their meetings.
Each of the 28 health facilities which were included in the DQA were given a preliminary report after the audit, with recommendations such as the ones mentioned above. Furthermore, a work plan for improvement was given to the facilities.