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Sustaining the Impact: Population and Reproductive Health

Sustaining the Impact: Population and Reproductive HealthMEASURE Evaluation develops measures, tools, and guides to support strong data collection and monitoring and evaluation by family planning program implementers, donors, and stakeholders. MEASURE Evaluation conducts research and evaluation to inform program and policy decision making, develops methods to improve health information systems, and builds local capacity to conduct research. This brief shares more.

Evaluation de l’infrastructure informatique des trois ministères concernés par l’approche « Santé Unique » au Burkina Faso

Evaluation de l’infrastructure informatique des trois ministères concernés par l’approche « Santé Unique » au Burkina FasoLe renforcement du système d’information sanitaire (SIS) dans les pays en développement est de plus en plus basé sur des outils sophistiqués et des logiciels nécessitant une infrastructure en technologies de l’information et de la communication (TIC) adéquate permettant la capture facile, le transfert, le stockage, le traitement et l’analyse des données tout en pouvant aussi soutenir une large diffusion de l’information produite pour éclairer le processus de prise de décisions.

Le choix du Burkina Faso pour l’instauration d’une plateforme électronique de gestion des données de la surveillance selon l’approche « Santé Unique » a nécessité un audit de l’état des infrastructures TIC existantes au sein des trois ministères concernés par cette approche : le Ministère de la santé, le Ministère de l’environnement, de l’économie verte et du changement climatique et le Ministère des ressources animales et halieutiques

L’outil d’évaluation des infrastructures TIC, développé par MEASURE Evaluation, a permis d’évaluer les capacités des différents niveaux du système de santé afin de fournir une indication sur l’état actuel de son infrastructure TIC ainsi que sur les actions nécessaires pour son amélioration selon les objectifs à atteindre.

Une auto-évaluation mixte avec des méthodes qualitatives et quantitatives a permis de collecter les données auprès du personnel de gestion des données de chaque structure de la pyramide sanitaire. Elle a aussi pu déterminer les bases de développement d’une architecture intégrée du SIS qui permettraient une interopérabilité entre les sous-systèmes d’une approche « Santé Unique » au Burkina Faso et de formuler des recommandations pour une mise à niveau de l’infrastructure soutenant le SIS du Burkina Faso.

Evaluation de l’infrastructure informatique des trois ministères concernés par l’approche « Santé Unique » au Burkina Faso

Quality of Tuberculosis Services Assessment in the Philippines: Report

Quality of Tuberculosis Services Assessment in the Philippines: ReportAccording to the 2018 Global Tuberculosis Report released by the World Health Organization (WHO), tuberculosis (TB) is the tenth leading cause of death and is the leading cause of death from a single infectious agent. Heads of state committed to ambitious targets aimed at eliminating TB during the first-ever United Nations High-Level Meeting on Tuberculosis conducted in September 2018 at the United Nations General Assembly.

WHO has identified 30 countries where the TB burden is high, including the Philippines. The country has one of the most severe epidemics, with an estimated 500 new cases per 100,000 population. This rate is higher than the 150 to 400 per 100,000 population in most of the 30 high-burden TB countries. In response, the Philippines has enacted a TB law, which called for the creation of a national strategic plan. The Republic of Philippines National Tuberculosis Control Program responded with the Philippine Strategic TB Elimination Plan, running from 2017 to 2022.

Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively. Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services. A Quality of TB Services Assessment (QTSA) was conducted by MEASURE Evaluation in the Philippines to assess the quality of TB services in randomly selected health facilities. Its purpose was to identify where services were of high quality and where there were gaps and to ensure that TB patients were receiving the care that they deserve. The QTSA assessed three domains of quality of care: the structure of the health facility, the service delivery process, and the outcomes of service delivery. The results were used to develop programs or interventions to improve TB service delivery.

Access the report. The QTSA tools adapted for use in the Philippines are available here: https://www.measureevaluation.org/resources/publications/tl-19-38

Sustaining the Impact: Orphans and Vulnerable Children

Sustaining the Impact: Orphans and Vulnerable ChildrenThrough programming for orphans and vulnerable children (OVC), the United States President’s Emergency Plan for AIDS Relief (PEFPAR) aims to mitigate the multidimensional and acute impacts of HIV and AIDS on children, by providing holistic, community-based care and support services.

Strengthening the systems that support vulnerable children and families ensures that children living with HIV receive the services they need and that children who are affected do not acquire the virus.

MEASURE Evaluation’s strategic approach MEASURE Evaluation improves programs for OVC by improving the quality and accessibility of data on programs and target populations. MEASURE Evaluation is building OVC monitoring and evaluation (M&E) capacity globally by developing indicators and tools, evaluating programs, triangulating data, and providing technical assistance and mentoring.

Our recent work includes a suite of activities covering routine monitoring, costing, size estimation, social service system strengthening, outcomes monitoring, and national OVC M&E system strengthening. This brief shares more.

Quality of family planning services in HIV integrated and non-integrated health facilities in Malawi and Tanzania

Quality of family planning services in HIV integrated and non-integrated health facilities in Malawi and TanzaniaBackground: The integration of family planning (FP) and HIV-related services is common in sub-Saharan Africa. Little research has examined how FP quality of care differs between integrated and non-integrated facilities. Using nationally representative data from Malawi and Tanzania, we examined how HIV integration was associated with FP quality of care.

Methods: Data were drawn from Service Provision Assessments (SPAs) from Malawi (2013–2014) and Tanzania (2014–2015). The analytic sample was restricted to lower-level facilities in Malawi (n = 305) and Tanzania (n = 750) that offered FP services. We matched SPA measures to FP quality of care indicators in the Quick Investigation of Quality (QIQ). We conducted bivariate and multivariate analyses of 22 QIQ indicators to examine how integration status was related to individual QIQ indicators and overall FP quality of care at the facility- and client-level.

Results: The prevalence of HIV integration in Malawi (39%) and Tanzania (38%) was similar. Integration of HIV services was significantly associated (p < 0.05) with QIQ indicators in Malawi (n = 3) and Tanzania (n = 4). Except for one negative association in Tanzania, all other associations were positive. At the facility-level, HIV integration was associated with increased odds of being at or above the median in FP quality of care in Malawi (adjusted odd ratio (OR) = 2.24; 95% confidence interval (CI) = 1.32, 3.79) and Tanzania (adjusted OR = 2.10; 95% CI = 1.37, 3.22). At the client-level, HIV integration was not associated with FP quality of care in either country.

Conclusion: Based on samples in Malawi and Tanzania, HIV integration appears to be beneficially associated with FP quality of care. Using a spectrum of FP quality of care indicators, we found little evidence to support concerns that HIV integration may strain facilities and providers, and adversely impact quality outcomes. Rather, it appears to strengthen FP service delivery by increasing the likelihood of stocked FP commodities and achievement of other facility-level quality indicators, potentially through HIV-related supply chains. Further research is needed to assess FP quality of care outcomes across the various platforms of FP integration found in sub-Saharan Africa.

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Data for Impact: What’s the cost of evaluations and other surveys?

Data for Impact: What's the cost of evaluations and other surveys?A core principle of Data for Impact (D4I) is to help countries focus on their knowledge gaps in health and to consider the full range of options to address those issues. The primary types of evaluations in D4I’s scope are process, outcome, impact, and economic evaluations and implementation science and operations research. D4I also conducts outcome monitoring surveys and implements formative studies to aid in intervention design and implementation. When planning any of these investigations, cost is an important consideration that may help determine the decision to do or plan for an evaluation or study.

Cost is dependent on many factors, including objective, design, method, sample size, geographic scope, and local context. Other factors that affect cost are, for example, the front-end work required to plan an evaluation or study—which can be substantial. This resource shares details to consider.

Facilitators, best practices and barriers to integrating family planning data in Uganda’s health management information system

Facilitators, best practices and barriers to integrating family planning data in Uganda’s health management information systemBackground
Health management information systems (HMIS) are instrumental in addressing health delivery problems and strengthening health sectors by generating credible evidence about the health status of clients. There is paucity of studies which have explored possibilities for integrating family planning data from the public and private health sectors in Uganda’s national HMIS. This study sought to investigate the facilitators, best practices and barriers of integrating family planning data into the district and national HMIS in Uganda.

Methods
We conducted a qualitative study in Kampala, Jinja, and Hoima Districts of Uganda, based on 16 key informant interviews and a multi-stakeholder dialogue workshop with 11 participants. Deductive and inductive thematic methods were used to analyze the data.

Results
The technical facilitators of integrating family planning data from public and private facilities in the national and district HMIS were user-friendly software; web-based and integrated reporting; and availability of resources, including computers. Organizational facilitators included prioritizing family planning data; training staff; supportive supervision; and quarterly performance review meetings. Key behavioral facilitators were motivation and competence of staff. Collaborative networks with implementing partners were also found to be essential for improving performance and sustainability.

Significant technical barriers included limited supply of computers in lower level health facilities, complex forms, double and therefore tedious entry of data, and web-reporting challenges. Organizational barriers included limited human resources; high levels of staff attrition in private facilities; inadequate training in data collection and use; poor culture of information use; and frequent stock outs of paper-based forms. Behavioral barriers were low use of family planning data for planning purposes by district and health facility staff.

Conclusion
Family planning data collection and reporting are integrated in Uganda’s district and national HMIS. Best practices included integrated reporting and performance review, among others. Limited priority and attention is given to family planning data collection at the facility and national levels. Data are not used by the health facilities that collect them. We recommend reviewing and tailoring data collection forms and ensuring their availability at health facilities. All staff involved in data reporting should be trained and regularly supervised.

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