IMPROVE REPORTING OF ART CLINIC OF ADJUMANI HOSPITAL PAUL AGWE VUDRI (B.SWASA) MEDIUM-TERM FELLOW OCTOBER, 2013

Transcription

1 IMPROVE REPORTING OF ART CLINIC OF ADJUMANI HOSPITAL BY PAUL AGWE VUDRI (B.SWASA) MEDIUM-TERM FELLOW OCTOBER, 2013

2 Table of Contents (ii) Declaration... 3 (iii) Role played by the fellow during the project cycle... 4 (iv) Acknowledgement... 5 (v) Acronyms... 6 (vi) Abstract Introduction/background... 8 Introduction... 8 Background Literature review Statement of the problem Project objectives (a) Main Objective (b) Specific Objectives: Methodology Table showing data collection method Project out come Showing the trend of reporting time during the project cycle Lessons learned Challenges faced and how they were overcome Summary, Conclusion, Recommendations and the next steps Summary Conclusions Recommendations Next steps References Appendices... 18

3 (ii) Declaration I, Paul Agwe Vudri do here declare that this end of project report entitled Improve reporting of ART clinic of Adjumani hospital has been proposed and submitted in fulfillment of the requirement of the medium-term fellowship program at Makerere University School of Public Health and has not been submitted for any other academic or non academic qualifications. Signed Date.. Paul Agwe Vudri, Medium-term Fellow Signed Date.. Mr Ojja Michael Institution Supervisor Signed Date.. Ms Mary Dutki Academic Supervisor

4 (iii) Role played by the fellow during the project cycle Bellow are the roles performed by the fellow during the project cycle: 1. In March, 2013 delivered feed back from MakSPH/CDC fellowship program to the stakeholders at Adjumani hospital 2. Spearheaded problem identification meetings 3. Coordinated the development of the project proposal submitted to MakSPH/CDC fellowship program 4. Directed and supervised the project implementation 5. Chaired the project monitoring and evaluation team 6. Was the team leader for the project dissemination exercises to senior management committee of Adjumani hospital and to the District health office 7. Was responsible for accountability to MakSPH/CDC fellowship program 8. Compiled and submitted the final project report to Adjumani hospital management and to the MakSPH/CDC program 9. Headed the team that ensures continuity of the project.

5 (iv) Acknowledgement I hereby by extend my heart felt gratitude to the following people for the technical, financial, physical and moral support they have offered right from project identification, monitoring, evaluation and dissemination phase for without their support it would not be a success MakSPH/CDC fellowship program for the training and technical support the institution offered Mr. Joseph Matovu, Mary Dutki and all the MakSPH/CDC fellowship staff for the technical guidance they offered towards the project Gratitude goes to Mr. Michael Ojja the institutional supervisor, Dr Dominic Drametu the medical superintendent and Vicky Opia the in charge ART clinic for their continuous support to the project right from the initiation stage to the end My sincere tanks goes to the general staff of ART clinic for their positive welcome of the project of which can not stop without mentioning Paricia Judith.

6 (v) Acronyms 1 ART Anti Retroviral Therapy 2 CDC Centre for Disease Control 3 CME Continuous medical Education 4 DHO District Health office 5 MakSPH Makerere University school of public health 6 M&E Monitoring and Evaluation 7 MOH Ministry of Health 8 NMS National Medical Stores 9 OpenMRS Open Medical Record System 10 SMC Senior management committee 11 UHIN Uganda Health Information Network

7 (vi) Abstract Adjumani hospital ART clinic was in state of consistent late reporting to the DHO and MOH by 5 days after every deadline days. The clinic entirely and solely relied on paper based data collection, processes and manual analysis and reporting as a result of this there was late reporting and difficulties in quantification of necessary drugs. The project introduced and operationalised an OpenMRS data base to help mitigate tedious paper based reporting and drug quantification. As a result of the electronic reporting, timeliness of reporting has improved from 5 days after deadline to reporting on expected dates

8 1-Introduction/background Introduction The project aimed at building and implementing an Open MRS data base and improving human capacity to effectively operate the OpenMRS. Background Adjumani ART Clinic was established in 2004 and is funded by the Government of Uganda, 2226 patients have enrolled and 987 patients are active in care to date. The clinic offers treatment to HIV/AIDS, TB and Leprosy patients and operates three weekly clinics namely family, Adults and Adolescents clinic days. The clinic has previously been utilizing paper based data collection and reporting procedures, analysis has been manual as result data collection and reporting has been tedious and time consuming and results have been of poor quality Bellow is the previous data flow of the clinic before the implementation of OpenMRS. Clients Cards Register s Paper based Compilation and Analysis MS DHO

9 2-Literature review Reporting in health systems is a core activity that needs to done with care because this is where health care delivery can be evaluated as clearly expressed by (WHO) which states that health information is the foundation of better health, therefore strong health information system is an integral part of health system. Therefore it is worth investing toward achieving effective and efficient health information reporting system because of the immense benefit it accrue to the health system such as controls emerging endemics and monitor progress, empowers the community with the timely information for timely quality service, improve evidence base for effective health policy and improves government resource mobilization and accountability (WHO) Poor data undermines confidence in the information used to plan and commission services. (NHS, UK) According to the (NHS, UK), poor reporting is caused by poor training, lack of awareness of data use, absence of standard guidelines to measure data and poor/ bad integral data system. Therefore there is need for having strong and functional health information system since it helps in planning, monitoring, sense of direction and quick and effective reporting (WHO) More so the problem of poor reporting and health information can best be solved by embarking on information technology (AFHCR, April 2006) according to the agency health technology has a big potential of enabling dramatic transformation in delivery of health care making it safer and more effective. Nevertheless report by the University of Michigan indicates that efficient and effective health system information helps in delivery of health care information to the community. In Uganda for example health management and information system plays an enormous role in the health system and service delivery of Uganda such as surveillance and drug ordering (UHIN, July 2011)

10 So for many reasons Uganda has been in drive of promoting quality health information system by ensuring coordinated and centralized reporting system and advocate for data use at all levels (Kapiriri et al, 2003) Therefore the above summary of the literature review clearly tells us that effective and efficient health information system is key and the back bone of quality health care provision at every levels and it can be done best through embarking on information technology 3-Statement of the problem Adjumani hospital ART clinic was consistently reporting late to the DHO and MOH, up to 5 days after the deadline days. The clinic solely relied on paper-based tools for data collection, processing, analysis and reporting In addition to late reporting there was poor ordering of drugs from the NMS hence stock out of drugs for the clients and sometimes wastage of drugs in case of over-ordering. 4- Project objectives (a) Main Objective To improve data use in Adjumani Hospital by September 2013 (b) Specific Objectives: To reduce late reporting from 5 days after deadline to 1 day by September 2013 To train 100% of staff in Art clinic on management and operation of OpenMRS

11 3. Methodology Table showing data collection method S/no. Data collection method Data collection tool 1 Used the available data Data compilation guideline 2 Interviews Interview guideline 3 Web based data Data collection guideline Graph showing implementation method 1. Procurement of hard ware 2. Installation of OpenMRS 3. Staff training in OpenMRS Entry of patient files into the OpenMRS Quality data Sustainability and Dissemination of project result Reporting and drug ordering

12 Implementation At this stage we did the procurement of the necessary inputs, installed the solar power, hired an IT specialist to install the openmrs and trained the staff on the operation of the new data base, data entry in to the openmrs, procession of the report using the openmrs and reporting to DHO and MOH. M&E Monitored data entry process, completeness of entry, accuracy and saving to the back up system Dissemination Conducted dissemination within ART to ART clinic Disseminated to SMC Disseminated to the DHO Sustainability Included data entry in to the unit roster hence data entry will continue to be one of the core responsibilities of the team. Data management has been included among the activities to be funded by Baylor Uganda West Nile region.

13 6-Project out come Over 900 clients files entered in to the OpenMRS Graph showing number of clients reports entered in to the OpenMRS each month June, 2013 July, 2013 August, 2013 September, Total Total The project has greatly reduced late reporting from 5 days after every deadline to a day before the deadline. Showing the trend of reporting time during the project cycle S/n Reporting Actual Reporting Remarks month reported time deadline 1 June /07/ /07/2013 Reduction of late reporting from 5 days after deadline to 2 days (40%) 2 July /08/ /08/2013 From 5 days to exact deadline day (100%) 3 August /09/ /09/2013 From 5 days to 2 days(40%) drop back 4 September /10/ /10/2013 From 5 days to 1 day before deadline day (120%)

14 Bellow is a bar graph showing reduction in time of reporting in each month. Reduced work load of having many papers and registers before Staff got motivated to work with the new initiative due to the simplicity it brought in the unit. For example this initiative really have made our work easier, all of us now have a reason to smile Nursing Officer/in charge ART clinic. Greatly reduced the cost of operation in ART clinic For example the unit used to spend 160,000= on printing, photocopying and scanning. Meaning that the unit saved 640,000= for the last three months of June, July, August and September.

15 7-Lessons learned A functional data base not only solves the problem of reporting but also contributes to solving multiple problems within the organizations operational activities among which are it reduces work load, motivate staff to work hard and reduces the general operation costs of the facility. Data base such as OpenMRS needs quite big among of funds if it is to have short out come and more so when it is to cover the entire hospital Good priority setting aids problem solving with a minimum resource. Success of any project needs stakeholder s involvement so that they get buy and owns the project. 8- Challenges faced and how they were overcome Challenges Inverter break down which delayed data entry. Data entry in to the OpenMRS is too demanding and needs quite a lot of time We had few data entrants which slowed the progress of data entry. Expectation from the project was quit high How these challenges were overcome We brought on board the hospital technician to the M&E team who played important role in rectifying technical problems with the inverter. We agreed and have data entry schedule which runs up to the night hours Trained more staff in data entry in to the OpenMRS

16 9-Summary, Conclusion, Recommendations and the next steps Summary Late reporting is a very big problem which face most of the facilities in Uganda but according to the out come of this project it can be adequately solved by establishment of modern electronic data bases such as OpenMRS of which at the end will not only solve the problem of poor reporting but will also reduce facility operation costs, motivates the staff to work and reduces work load when implemented successfully. However we should note that for it to be successful we should always accord adequate funding towards its implementation due to its demanding nature. Conclusions Establishment of data base like OpenMRS is justifiable in solving problem reporting if implemented successfully. Recommendations The District Health Office needs to scale up OpenMRS to cover other ART clinics in the District. Next steps To lobby and to ensure that M&E is budgeted for within the hospitals annual plan. To mentor more staff in data entry, processing and reporting. To conduct dissemination exercises within the unit, to the SMC, to the DHO and to the MakSPH/CDC fellowship program.

17 References WHO: Issues in Health Information: NHS report: causes of poor data quality/information age. WHO: The need for strong health information system: AFHCR(April 2006): Health Information technology: University of Michigan: Community Benefit report: UHIN(July, 2011): FHI360-SATELLITE Health Care: L. Kapiriri et at(2007): Using burden of disease information for health planning in developing countries: The experience of Uganda, Social Science and Medicine 56, No. 12, Elsevier

18 Appendices Lists of staff trained in data entry and procession in to the OpenMRS on 15 th June S/N NAME DESIGNATION TELEPHONE 1 Agwe Vudri Paul Medical Social Worker Opia Vicky Assistant Nursing Office Paricia Judith Comprehensive Mid wife 4 Male Adams Comprehensive Nurse Rokani Alba Assistant Nurse Letio Agnes Records Apio Dorethy Assistant Nursing officer 8 Kinyaa Harriet Records

19 Training program line up for ARTclinic staff Venue: Anns guest house Details: hands on training on the operation of OpenMRS Date: 15/06/2013 Date: 15/06/2013 TIME MORNING RESPONSIBLE PERSON 08-08:30 Arrivals and registration Agwe Vudri Paul 08:30-09:30 Opening remarks DHO 09:30-10:00 Introduction to data management Agwe/Vicky 10:00-11:00 BREAK FAST 11:00-12:00 Introduction to openmrs Mr Deo/Agwe 12:00- Data entry in to the openmrs Mr Deo 1:00PM 1:00-2:00PM LUNCH 2:00-3:00PM Data procession and analysis Mr Deo 3:00-4:00PM Practicum Mr Deo 4:00-4:30PM Summery and Closure Mr Agwe/Vicky

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