Figures & Tables
Figures
- FIGURE 1
Data Accuracy Verification Ratios for Antenatal Care, HIV Testing and Counseling, Family Planning, and Acute Respiratory Infection Indicators by District, Malawi, 2016
- FIGURE 2
Data Quality Assessment Recommendations to Strengthen the HMIS
Abbreviation: HMIS, health management information system.
Source: Malawi Ministry of Health (2007).27
- FIGURE 3
Agenda for Building Country Leadership for Data Use, Malawi
Tables
- TABLE 1.
Key for Hot Spot Table Coloring Scheme Indicating Systems Assessment Results and Recommended MOH Actions
Percent of Facilities Responding Positively to Questiona Corresponding Color Interpretation 80–100 Green No specific action recommended. MOH can seek to identify actions that may improve or sustain facility compliance. 60–80 Yellow MOH should undertake actions to improve compliance. The timing and nature of the action depend on the functional area and how critical the component is to HMIS functioning. <60 Red MOH should seek to immediately identify underlying reason for low compliance and undertake action to increase compliance in the short-term. Abbreviations: HMIS, health management information system; MOH, Ministry of Health.
↵a “Positively” is defined as responding in affirmation to the question. For most questions, this included only those facilities that answered “yes”; depending on the context of the question, it may also include facilities that answered “partly.” This is indicated in the Results section of the article. Eight questions about stock-outs of registers and reports were worded in the inverse, so “no” answers were considered to be responding “positively.”
- TABLE 2.
Characteristics of Health Centers and Hospitals Selected for the Data Quality Assessment Compared With All Health Centers and Hospitals in Malawi, 2016
Selected Health Centers (n=90) All Health Centers (N=466) P Value Selected District Hospitals (n=13) Selected Rural Hospitals (n=3) All Hospitals (N=113) P Valuea Monthly outpatient department attendance, median (IQR) (March–May 2016) 2240b (1371, 3174) 2264 (1371, 3213) .40 9595c (7276, 14737) 1202 (779, 7032) 5308 (2686, 9331) .01 Location .55 .57 Rural, No. (%) 87 (97) 455 (98) 13 (100) 3 (100) 111 (98) Urban, No. (%) 3 (3) 11 (2) 0 (0) 0 (0) 2 (2) Managing authority .11 <.01 Government, No. (%) 73 (81) 340 (73) 13 (100) 1 (33) 48 (42) CHAM, No. (%) 16 (18) 108 (23) 0 (0) 2 (67) 43 (38) Adventist Health Services, No. (%) 1 (1) 18 (4) 0 (0) 0 (0) 22 (20) Abbreviations: CHAM, Christian Health Association of Malawi; IQR, interquartile range.
↵a Comparing combined district and rural hospitals with all hospitals.
↵b For 18 selected facilities, there were missing outpatient attendance data for at least 1 month.
↵c For 2 facilities, there were missing outpatient attendance data for at least 1 month
- TABLE 3.
Data Quality Dimension Scores for Availability and Completeness, by Facility Type, Malawi, 2016
Health Centers (n=90) District Hospitals (n=13) Rural Hospitals (n=3) DHOs (n=16) Availability score, median (IQR) 0.92 (0.79, 1.00) 0.96 (0.88, 1.00) 0.75 (0.71, 0.79) 0.94 (0.71, 1.16) Completeness score, median (IQR) 0.88 (0.71, 1.00) 0.92 (0.79, 1.00) 0.75 (0.67, 0.83) 0.99 (0.98, 1.00) Abbreviations: DHO, district health office; IQR, interquartile range.
- TABLE 4.
Data Accuracy Verification Ratios Comparing DHIS 2 to Facility Registers and DHIS 2 to DHO Reports by Facility Type, Malawi, 2016
Facility Registers DHO Reports to DHIS 2 (n=16) Facility Registers to DHIS 2 (n=106) Health Centers (n=90) District Hospitals (n=13) Rural Hospitals (n=3) ANC ratio, median (IQR) 1.00 (0.97, 1.13)a 1.00 (0.88, 1.06) 1.08 (0.00, 2.50) 1.00 (0.98, 1.13) 1.00 (0.96, 1.10) FP ratio, median (IQR) 0.99 (0.82, 1.36)b 0.93 (0.80, 1.08) 0.23c 1.00 (0.95, 1.08) 0.94 (0.70, 1.07) HTC ratio, median (IQR) 1.00 (0.99, 1.05) 0.77 (0.61, 0.93) 0.99 (0.93, 1.00) 1.00 (0.96, 1.01) 1.00 (0.97, 1.05) ARI ratio, median (IQR) 0.87 (0.33, 1.18) 0.61 (0.20, 0.94) 0.08 (0.07, 0.42) 1.00 (0.83, 1.00) 0.73 (0.27, 1.05) Abbreviations: ANC, antenatal care; ARI, acute respiratory infection; DHIS 2, District Health Information System 2; DHO, district health office; FP, family planning; HTC, HIV testing and counseling; IQR, interquartile range.
↵a n=89.
↵b n=86.
↵c Only 1 selected rural hospital provided family planning services.
- TABLE 5.
Key Findings for Systems Assessment Functional Areas, by Health Systems Level, Malawi, 2016
Functional Area Indicator Health Centers (n=90) No. (%) Hospitals (n=16) No. (%) DHOs (n=16) No. (%) Staff responsibilities Staff members have received training for HMIS-related functions 52 (58) 13 (81) 15 (94) Indicator definitions Written definitions for all 4 indicators of interest (ANC, FP, HTC, ARI) available in facility or DHO 39 (43) 12 (75) 9 (56) Reporting guidelines Reporting guidelines available at facility that describe what should be reported, how reports are to be submitted, to whom, and when 90 (34) 8 (50) 6 (38) Data use Regularly use data to calculate indicators 48 (53) 12 (75) 12 (75) Registers and reporting forms No stock-outs of any registers or reporting forms during the past 12 months 23 (26) 6 (38) - Registers and reporting forms Sufficient copies of data collection tools available in the DHO to meet the needs of all health facilities in the district - - 7 (44) Display of routine data One or more information displays present at time of assessmenta 83 (92) 15 (94) 13 (81) Internal data quality checks Consistency checks of collected data routinely conducted 37 (41) 7 (44) 7 (44) Supervision Regular supervisory visits from district 47 (52) 10 (63) 4 (25) Computerized registers Facility uses computerized registers 9 (10) 15 (94) - Abbreviations: ANC, antenatal care; ARI, acute respiratory infection; DHO, district health office; FP, family planning; HMIS, health management information system, HTC, HIV testing and counseling.
↵a Evaluated the following displays: maternal health, child health, facility utilization, disease surveillance, map of catchment area, summary of demographic data.
- TABLE 6.
Association of Selected Facility Characteristics With Data Quality Dimensions, Mean (P Value)
Facility Characteristic Data Quality Dimension Availability Score Difference Completeness Score Difference Accuracy Difference ANC FP HTC ARI Partner support 1.27 (.12) 0.02 (.57) 0.04 (.78) 0.11 (.54) −0.07 (.30) −0.04 (.82) Statistical clerk employed 0.03 (.39) 0.01 (.69) −0.08 (.58) −0.08 (.65) −0.07 (.25) −0.36 (.07) Managing authoritya 0.08 (.07) 0.08 (.09) −0.22 (.15) −0.58 (.26) −0.03 (.49) −0.11 (.71) Facility locationb −0.13 (.25) −0.09 (.42) −0.14 (.08) −0.05 (.84) −0.18 (.18) −0.12 (.79) Regular supervision visits from district −0.02 (.43) −0.01 (.78) 0.18 (.16) 0.07 (.67) −0.08 (.18) 0.22 (.21) Regular supervision visits from central level 0.04 (.22) 0.04 (.31) −0.02 (.87) −0.14 (.47) 0.13 (.04) 0.19 (.33) Supervisory visit within last 6 months 0.07 (.05) 0.03 (.35) −0.39 (.03) −0.09 (.60) 0.06 (.37) 0.21 (.29) Consistency checks of data routinely conducted −0.08 (.64) 0.05 (.76) −0.05 (.45) 0.09 (.14) −0.15 (.43) 0.14 (.46) Facility uses computerized registers for one or more service areas 0.02 (.66) −0.00 (.96) - - - - Facility uses computerized registers for designated service area (ANC, FP, HTC, outpatient department) - - −0.23 (.23) −0.58 (.31) −0.05 (.77) −0.32 (.15) Facility has appropriate and adequate space for secure organization and storage of registers and reports 0.02 (.73) 0.02 (.65) −0.66 (.18) 0.15 (.62) 0.05 (.65) −0.08 (.78) Facility uses its data to track performance toward meeting targets 0.06 (.04) 0.08 (.02) 0.07 (.59) −0.27 (.13) 0.08 (.24) −0.03 (.88) Programmatic decisions taken by the facility are based on analyzed data/results 0.04 (.23) 0.02 (.56) -0.37 (.13) −0.21 (.38) −0.01 (.94) 0.08 (.71) Abbreviations: ANC, antenatal care; ARI, acute respiratory infection; CHAM, Christian Health Association of Malawi; FP, family planning; HTC, HIV testing and counseling.
↵a Difference between facilities managed by the government and facilities managed by CHAM or Adventist Health Services.
↵b Difference between urban and rural facilities.
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