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Ukraine Infectious Disease Program

Ukraine Infectious Disease Program. Health Information Systems and Management Reform. Collaborating Agencies. Started in 1997 as a collaboration between the USAID, BASICS, CDC, MOH and PATH PATH became the lead organization with the technical assistance provided by all partners

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Ukraine Infectious Disease Program

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  1. Ukraine Infectious Disease Program Health Information Systems and Management Reform

  2. Collaborating Agencies • Started in 1997 as a collaboration between the USAID, BASICS, CDC, MOH and PATH • PATH became the lead organization with the technical assistance provided by all partners • Funded by USAID; the 2nd and 3rd years of work supported through the Technologies for Child Health (Health Tech) Cooperative Agreement between USAID and PATH

  3. Background: • Grew from lessons learned from diphtheria campaigns in Ukraine, which identified weakness of existing HIS • Lack of reliable data on vaccine distribution, consumption, coverage and wastage • Confusion over target population definitions, campaign strategies and contraindication criteria • Non-standard statistical methods, contradictory reports and statistics between oblasts • Excessive record-keeping and reporting requirements

  4. Program Goal: Improve the public health management, infectious disease prevention and control activities through reform of the MOH's health information system by improving - the quality of the information collected, and - the utilizationof the information by and for management

  5. Program Activities (1): Established multi-disciplinary, multi-level working group • assessed the current status of data collection, processing and utilization; • identified deficiencies in the system; • established priorities and recommended changes • monitored progress of the reform

  6. Program Activities (2): • Working group developed methods and materials for the introduction of revised policiesand practices, and for training staff • Three oblast wide workshops and National conference on management information conducted to introduce findings • Establishment of the National level Working Group to advise and coordinate country-wide adoption of the program reforms

  7. Program Activities (3): • replication of previously developed management and public health surveillance reforms in the all country • Series of regional training seminars for oblast epidemiologists and pediatricians on the revised reporting policies and procedures, forms and monitoring tools

  8. Accomplishments: • Every level of the public health service delivery system, from the MoH, oblast SES to the village ambulatory clinic, now has the capability to accurately forecast needs and monitor and evaluate their activities

  9. Accomplishments: • Standardized internationally accepted definitions and methods for calculating base populations for surveillance statistics, annual work plans and monitoring of program performance are in use

  10. Accomplishments: • Immunization managers have the capacity to accurately monitor supplies from existing stores to the point of consumption, track vaccine balances and rationalize distribution.

  11. Accomplishments: • Oblasts now have the ability to monitor and respond to vaccine wastage. For the first time, oblast and national authorities have evidence of the extent of the problem, and the information tools necessary to effectively address it.

  12. Accomplishments: The problem with excessively and inconsistently applied contraindications to immunization, which had been identified and documented by the new HMIS, was successfully addressed, and the number of contraindications in the new immunization schedule was radically reduced.

  13. Accomplishments: Armed with the HMIS data demonstrating inefficiency of the decentralized vaccine procurement mechanism, with documented evidence of frequent stockouts affecting immunization coverage rates, the Ministry of Health has succeeded in 2001 in re-establishing central procurement of vaccines in Ukraine

  14. Summary This has resulted in: • Identifying “problem” administrative territories and health settings • Targeted interventions to identify and correct the source of program deficiencies • More children being immunized with those immunizations being more timely

  15. Software application UKRVAC-01 for monitoring of immunization at oblast and central level

  16. PURPOSE Ukrvac is a supplement to HMIS that helps 1) process big flow of quality data at oblast and central level in a timely manner 2) quickly draw immunization manager’s attention to regions with sub-optimal performance 3) present information in a suitable form to decision makers and as a feedback to health workers at lower levels 4) store the data electronically for future reference

  17. DATA ENTRY • WHO - assistant epidemiologist or PC operator (in oblasts) • WHEN - every month • HOW LONG - usually no more than 2-3 hours ---------- Accuracy verification and protection from accidental mistakes of an operator during data entry: - data validation - automatic verification of totals - conditional formatting of data entered

  18. SYSTEM OUTPUT: 1. MONTHLY REPORTS ON IMMUNIZATION PRACTICE • number and types of immunizations given • use of vaccines • contraindications • timeliness All data are protected from changes

  19. Number and types of immunization given, Cumulative numbers, Coverage in % Vaccine flow and usage data Timeliness of immunization and contraindications

  20. 2. CONTRAINDICATIONS TO DTP(tables and graphs) • by type (short-term, long-term, permanent) • by oblasts and rayons/towns • by months • structure (DTP-1,2,3) All data are protected from changes Conditional formatting function

  21. The overall number of contraindications have reduced. Proportion of children contraindicated to DTP 1-3 for a long term has dropped from 4% to 2.6%

  22. The focus of attention should be on selected low compliance regions

  23. 3. TIMELINESS OF IMMUNIZATIONS(table and graph) • by oblasts and rayons/towns • by months All data are protected from changes Conditional formatting function

  24. Vaccine shortages result in delayed immunization

  25. 4. IMMUNIZATION COVERAGE(tables and graphs) • Breakdown by oblasts and towns/rayons • Monthly and cumulative data in tables and dynamically built graphs • For all antigens: BCG, Polio (1-7), DTP (1-4), DT, Td, d, Hep B, Measles, Mumps, Rubella All data are protected from changes Conditional formatting function

  26. Frequent stockouts

  27. Decentralized procurement: no mumps vaccine in 5 oblasts, whereas other preparations might have been bought in excessive quantity

  28. 5. USE OF VACCINES(tables and graphs) • For each vaccine: • vaccine flow in oblasts and rayons/towns every month • monthly balances at oblast, rayon/town stores and in health facilities • usage/wastage patterns by oblasts/rayons/towns and months Graphical presentation of all vaccines usage patters in regions Conditional formatting function All data are protected from changes

  29. Reasons for high wastage need to be investigated and customized action plans developed

  30. More than 6-month supply of DPT issued to health settings Severe shortage of basic vaccines A lot of DPT in stock but no Mumps vaccine

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