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ORIGINAL ARTICLE
Open Access

Using Data to Improve Programs: Assessment of a Data Quality and Use Intervention Package for Integrated Community Case Management in Malawi

Elizabeth Hazel, Emmanuel Chimbalanga, Tiyese Chimuna, Humphreys Nsona, Angella Mtimuni, Ernest Kaludzu, Kate Gilroy and Tanya Guenther
Global Health: Science and Practice September 2017, 5(3):355-366; https://doi.org/10.9745/GHSP-D-17-00103
Elizabeth Hazel
aJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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  • For correspondence: ehazel1@jhu.edu
Emmanuel Chimbalanga
bSave the Children, Lilongwe, Malawi.
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Tiyese Chimuna
cIndependent Consultant, Lilongwe, Malawi.
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Humphreys Nsona
dMinistry of Health, Lilongwe, Malawi.
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Angella Mtimuni
eFormerly with the Ministry of Health, Lilongwe, Malawi.
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Ernest Kaludzu
dMinistry of Health, Lilongwe, Malawi.
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Kate Gilroy
fMaternal and Child Survival Program, Washington, DC, USA.
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Tanya Guenther
gSave the Children, Washington, DC, USA.
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  • FIGURE 1
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    FIGURE 1

    Malawi iCCM Routine Reporting Data Flow

    Abbreviations: HSA, Health Surveillance Assistant; iCCM, integrated community case management.

  • FIGURE 2
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    FIGURE 2

    HSA Caseload Reporting Consistency at Baseline (2012) and Endline (2013) for Fever, Diarrhea, and Pneumonia, Dowa and Kasungu Districts Combined, Malawi

    Abbreviations: HSA, Health Surveillance Assistant; RVR, results verification ratio.

    An RVR of 1.00 indicates perfect reporting, while less than 1.00 indicates overreporting and greater than 1.00 underreporting.

  • FIGURE 3
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    FIGURE 3

    Wall Chart Template Use at the HSA and Health Facility Levels at Endline (2013), Dowa and Kasungu Districts Combined, Malawi

    Abbreviation: HSA, Health Surveillance Assistant.

  • Figure4
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    Health Surveillance Assistants in Malawi review iCCM data using wall chart templates.

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    TABLE 1.

    Data Quality and Use Package Implemented in Malawi

    Processes to Improve Data Demand and UseElements of the DQU Package Design and Implementation
    1. Assess and improve the data use context
    • Participatory baseline data quality assessment, using tools based on the PRISM framework and MEASURE Evaluation data quality audit tools, and involving national and district iCCM managers

    2. Engage data users and data producers
    • Engagement of HSAs, health facility staff, district manager, and national IMCI unit staff in designing the package training materials and tools

    3. Improve data quality (quality defined as accurate, complete, and timely)
    • Baseline data quality assessment to identify barriers to data quality

    • Provision of calculators to HSAs to improve accuracy of monthly tallies

    • Refresher training on how to complete routine registers and reports

    4. Improve data availability (availability defined as data synthesis, communication, and access to data)
    • Development and dissemination of standardized wall charts to display data onsite

    • Training on analysis, interpretation, and presentation of data for HSAs, health facility, and district staff

    5. Identify information needs
    • Consultations with national, district, and facility staff and HSAs to document and prioritize information needs for monitoring iCCM

    • Working with district IMCI coordinators to identify reporting “benchmarks” and “action thresholds” and to agree on response to levels below the agreed-upon action threshold

    6. Build capacity in data use core competencies
    • General training on data management, use, and interpretation

    • Involvement of district staff in data collection and supervision to build leadership capacity and to better advocate for data use in their districts

    7. Strengthen the organization's data demand and use infrastructure
    • Development of written guidance on iCCM data analysis and use

    • Provision of data display templates

    8. Monitor, evaluate, and communicate results of data use interventions
    • Evaluation of the DQU package through mixed-methods, pre-post assessment and estimation of cost for scale-up

    • Dissemination of findings in Malawi and globally to leverage resources to expand to other districts (and countries)

    • Abbreviations: DQU, data quality and use; HSA, Health Surveillance Assistant; iCCM, integrated community case management; IMCI, Integrated Management of Childhood Illness.

    • Based on the Nutley and Reynolds logic model to strengthen data demand and use.13

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    TABLE 2.

    Sample Size for the DQU Intervention and Evaluation, Dowa and Kasungu Districts, Malawi, 2012–2013

    DQU ImplementationBaseline AssessmentEndline AssessmentMatched Data
    Districts2222
    Health facilities691099
    HSAs426383631
    • Abbreviations: DQU, data quality and use; HSA, Health Surveillance Assistant.

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    TABLE 3

    Availability and Completeness of Reporting Forms at the HSA and Health Facility Levels for the Previous Month, Baseline (May 2012) vs. Endline (June 2013)

    KasunguDowaTotal
    BaselineEndlineBaselineEndlineBaselineEndline
    HSA levela
    Available93% (25/27)96% (23/24)95% (57/60)80% (37/46)94% (82/87)86% (60/70)
    Complete74% (20/27)79% (19/24)95% (57/60)63% (29/46)89% (77/87)69% (48/70)
    Health facility levelb
    AvailableMissing100% (24/24)100% (23/23)44% (11/25)N/A71% (35/49)
    CompleteMissing100% (24/24)95% (22/23)16% (4/25)N/A57% (28/49)
    • Abbreviation: HSA, Health Surveillance Assistant; iCCM, integrated community case management.

    • ↵a Denominators represent all iCCM-trained HSAs associated with selected health facilities that would be expected to submit reports.

    • ↵b Denominators represent all health facilities supporting iCCM that would be expected to submit reports to the district.

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Global Health: Science and Practice: 5 (3)
Global Health: Science and Practice
Vol. 5, No. 3
September 27, 2017
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Using Data to Improve Programs: Assessment of a Data Quality and Use Intervention Package for Integrated Community Case Management in Malawi
Elizabeth Hazel, Emmanuel Chimbalanga, Tiyese Chimuna, Humphreys Nsona, Angella Mtimuni, Ernest Kaludzu, Kate Gilroy, Tanya Guenther
Global Health: Science and Practice Sep 2017, 5 (3) 355-366; DOI: 10.9745/GHSP-D-17-00103

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Using Data to Improve Programs: Assessment of a Data Quality and Use Intervention Package for Integrated Community Case Management in Malawi
Elizabeth Hazel, Emmanuel Chimbalanga, Tiyese Chimuna, Humphreys Nsona, Angella Mtimuni, Ernest Kaludzu, Kate Gilroy, Tanya Guenther
Global Health: Science and Practice Sep 2017, 5 (3) 355-366; DOI: 10.9745/GHSP-D-17-00103
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