approaches to health facility data collection and mapping

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E valuation Approaches to health Facility Data Collection and Mapping Bolaji Fapohunda, PhD. Dai Hozumi, MD, MPH JSI, Inc 29 March 2006

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Approaches to health Facility Data Collection and Mapping. Bolaji Fapohunda, PhD. Dai Hozumi, MD, MPH JSI, Inc 29 March 2006. Acknowledgement. Dai Hozumi - PowerPoint PPT Presentation

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Page 1: Approaches to health Facility Data Collection and Mapping

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Approaches to health Facility Data Collection and Mapping

Bolaji Fapohunda, PhD.

Dai Hozumi, MD, MPH

JSI, Inc

29 March 2006

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Acknowledgement

Dai Hozumi

for the presentation given the 2005 Mini MAQ University, in collaboration with Bolaji Fapohunda. That work is the source document for many of the

Slides in this presentation

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Objectives of this session

• Discuss the role of health facility mapping in strengthening health service delivery

• Disseminate key approaches to HF mapping, including advantages and disadvantages of specific approaches

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Presentation outline

• Role of health facility mapping/assessment:– What is it, what it does and what does not do

• Differences between health facility mapping and population based surveys

• Key approaches to health facility mapping:– Service Availability Mapping (SAM)– Service Provision Assessment (SPA)– Health Facility Census (HFC)– VCT and PMTCT mapping

• Conclusion

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Definition

• Facility: Any site where clients receive formal sector health services – May includes temporary sites/outreach

service sites– Includes stand-alone VCT; maternity homes;

hospices– Includes private doctor offices (limited

availability of information thus far)

Source: Fronczak, Nancy. 2006

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Why collect data on HF

• Huge investments in the formal health sector:– Construction and infrastructure development– Procurement of equipment and supplies– Procurement of medicines– Training – Pilot projects to strengthen service delivery and

systems (for specific services)

Source: Fronczak, Nancy. 2006

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7What are the key questions

answered by HF data?• Quantity and availability of services

– Where are the service delivery points?– What services available?– In what quantity/frequency?– How many health workers are working?

• Quality of services– Is there a standard of care guidelines? Are they being used?– Are health workers adhering to the guidelines?

• Support mechanism– Condition of building– Availability and condition of equipment– Availability of supplies– Management systems and practice

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Health facility versus population household based surveys

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Safest feasible infant

feeding

WellnessInfant is

HIV

positive

Improved

child

health

Growth monitoringCTMZ

MicronutrientsWater/ sanitationART adherence

counseling

Mother seeks care &

counseling for signs and symptoms

Mother recognizes signs and symptoms

Mother provides

safest/feasible IYCF, Vit A & Zinc suppl.

Mother continues to give safest/feasible IYCF, Vit A & Zinc supplementation

Provider gives appr.

HIV/AIDS care &

Rx.

Referral Level care

Provider gives appropriate

HIV/AIDS care & Rx based on

need &/or clinical staging

Mother accepts referral

Facility-based treatment/care

community- based

treatment/care

INS

IDE

TH

E H

OM

EO

UT

SID

E T

HE

HO

ME

Pathway to Child Survival: Pediatric HIV/AIDS(adapted from Waldman & Bartlett, 2000)

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Key questions answered by Population-based surveys

• What proportion of the population is using services? • What is the characteristics of individuals/ households

who are using services vis-a-vis those who are not? • What are the key facilitating and constraining factors

to service utilization? • What are the socioeconomic differences in morbidity

and mortality levels?• How are health outcomes impacted by access to

services?

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Advantages of HF data

• Contribute to health system strengthening• Important component of the national HIS• Increase the domains of data for

investigation, making triangulation possible• HF data can help determine whether

population based surveys are necessary, saving costs (e.g. the IMCI-MCE Survey).

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12 Characteristics of system

strength affected by HF mapping • Provisions of basic services• Well integrated & complementary services:

public/private, static/outreach, different levels: (pry, secondary, referral)

• Efficient use of facility resources, including personnel, infrastructure, equipment, supplies and time

• Existence of coordinating mechanisms among key levels and programs: outreach departments, community workers etc

• Ownership by, & support for, national/community counterparts

• RHIS/monitoring & evaluation systems

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Profiles of key approaches

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Key approaches• Service Availability Mapping(WHO)

• Service Provision Assessment (ORC Macro/USAID)

• Health Facility Census (JICA)

• Facility Audit of Service Quality (UNC/USAID)

• VCT and PMTCT Mapping

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Service Availability MappingPurpose Supports decision making by providing planners with skills

and tools required to map and monitor services and resource availability on a regular basis

Key areas of information

•Location of health service delivery points•Availability and location of health services (MCH, HIV/AIDS, TB & Malaria)•Availability and location of health workers

What it does SAM is a district owned service monitoring system

Rapid and relatively inexpensive

Use of PDA and HealthMapper

Two phased approach: district SAM and facility SAM

What it does not do

Does not measure quality of services or resources.

Does not necessary provide detail information.

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16Service Provision Assessment

Purpose To provide information on quality of health services, as measured through resources, systems, and some observed practices

Key areas of information

•Availability of infrastructure and resources for a given service•Facility level support systems and maintenance of infrastructure and resources•Information on staff qualifications, training, supervision•Adherence to standards (observations and exit-interview)•FP, child health, maternal health, STI, TB, HIV/AIDS

What it does •Provides picture of the services and service quality•Validates reported information. Allows comparison between implementing organizations, facility types, and regions•Sample survey of facilities

What it does not

Does not provide representative information at the district level except specially requested and planned for

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Health Facility CensusPurpose To provide information for policy, planning, and management

of health system development with particular focus on physical assets

Key information

•Availability and conditions of physical assets•Location of health service delivery points•Availability and type of health services•Headcounts of health workers

What it does •Provide information on conditions and distribution of physical assets•Covers all health facilities•Cost estimates for future capital investment requirement

What it does not do

Does not collect information on service quality, patient satisfaction, and details of human resources

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Estimated cost of capital investment requirement for Malawi 2004 - 2009

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Facility Audit of Service Quality

Purpose Facilitates the mapping of availability and quality of all government and private facilities

Key areas of information

•Range of services offered, staffing and staff qualifications,

•Facility infrastructure – electricity, water, telephone, lighting, vehicles, privacy/capacity, emergency transportation, laboratory•Readiness to provide quality care •Digital maps of facilities and services available

What it does •Low tech application, minimal or no technical assistance needed for fieldwork; can be implemented by local staff

•Quick and low cost; feasible to repeat at intervals useful for monitoring applications (1-2 years)

•Measures standardized “short list” of service R/CH quality Produces integrated service profile covering all health facilities operating in district (government and private sector)

What it does not do

Trade off for rapid and low cost is the loss of some detail and in-depth information that would be available.

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VCT/PMTCT MappingPurpose To provide information on availability and locations of

VCT/PMTCT services

Key areas of information

•Availability and distribution of VCT/PMTCT services•Conditions of facilities where services are offered•Availability of health workers and their qualifications

What it does •VCT/PMTCT mapping is implemented by various organizations•Provides information on specific services being offered•Information used to come up with directory of services

What it does not do

Often covers only delivery points that are currently offering services

Does not collect information on potential service delivery points

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Displaying HF data

May display data using simple basic maps or advanced maps

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• Basic versus advanced mapping: • dot map or shaded polygon map; displays

simple patterns and geographic dispersions.• Choropleth, or shaded polygon maps can

also be a valuable way to display geographic data.

• Software requirements for basic mapping: EpiMap, SIGEpi (produced by PAHO), Healthmapper (WHO) as well as

• ArcGIS.Source: Spencer, John. 2006

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• Advanced Mapping: key is that data is explored in greater depth to produce fuller understanding of the geographic patterns. Require more sophisticated program such as ArcGIS, and additional training.

• Basic mapping may be transitioned to more advanced mapping if relevant information is available and there is adequate planning at the start of the Project

Source: Spencer, John. 2006

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Thank You

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Contact

• Bolaji Fapohunda: [email protected]

• Dai Hozumi: [email protected]