1. Use of SOC data by ICAP-Ethiopia for quality improvement Tsigereda Gadisa MD,MPH M&E Director, ICAP-EthiopiaJuly, 2010

2. Using data for program improvement Three key interlinked factors affecting data use • Effective Reports compilation; relevance, validity, completeness, timeliness, simplicity & big picture demonstration • Skilled Managers; result oriented, curios and good data use aptitude and committed in building result orient management culture • Organizational culture for evidence based learning and improvement; setting simple but informative performance measures & creating regular forum to follow though the results

3. Results Oriented Culture • Reward and recognize • Encourage learning • Seek involvement • Use data routinely • Lead improvement efforts • Take responsibility • Stimulate positive action

4. ICAP Standards of Care Site support team Onsiteteam Assess and improve implementation Assess and Build Capacity Site Independence Site Start-up Assess and improve quality Goal 1: Implement a chronic care model of HIV care and treatment (comprehensive, family focused) Goal 2: Build capacity to promote program sustainability and independence

5. SOC Data use for quality improvement Cycle Define standards of care (SOCs) and measures of quality Measure Standards of Care Design and implement intervention Identify Problems Prioritize problem areas

6. SOC Indicator setting and data compilation in ICAP Ethiopia • With the TA from ICAP NY clinical team ICAP-E clinical Service department adopted the Care and treatment (adult and Ped); PMTCT, and TB HIV SOC • Indicators were modified to our context • Manual data collection instrument and SOP drafted • The instruments were pilot tested in one regional office for feasibility and user friendliness

7. Lesson learned during pilot testing the SOC instrument • The process was cumbersome and time consuming; it required • Manual tally and compile the tally • Entering the compiled data in to excel sheet • Make the calculation for each indicator • Compile the report and • Provide feed back to site provider by next visit

8. Action taken to make the instrument user friendly and provide immediate feed back • Clinical service and M&E department discussed to automate SOC data collection instrument • SOC database developed for the five SOC instrument in use (adult C&T, Ped C&T, HEI, PMTCT and TB HIV)

9. Major objectives of SOC database • Reduce work load on the site support team in data compilation • Facilitate the data capturing and analysis • No manual tallying • Facilitate instant feedback to the site staff on strength and areas for improvement • Facilitate easily follow up of action points

10. Standard of Care Database (SOC DB)

11. SOC Data use for quality improvement matrix More closer look in to data quality Ask why? Measure Standards of Care Simple count Gross performance More closer look in to Service quality Ask why? Data quality Routine Report SOC Common Data Source for SOC, Data Quality Assessment & Routine report TB/HIV C &T HCT PMTCT

12. ARV Prophylaxis, at ANC PMTCT SOC VS routine report at Selected ICAP-Ethiopia supported sites; Dec-9 toApril-10

14. TB Screening among newly enrolled in care,Ginbot,01 (May-09) and Ginbot,02 (May-10)

15. Added advantage of SOC data as measure of quality of Services • Provide an in-depth look in to a program by looking in two the practice (not aggregate) • Facilitate live discussion between the site support team and site level providers on the identified success or problem areas & draw action points • Guide the site support team to prioritize and focus areas for intense mentoring

16. Added advantage of SOC data as measure of quality of Services • Captures key quality indicators not included in routine report(eg. Follow up CD4 for Pre-ART Pt; • Compliment CQI effort by breaching the gap created due to timing of routine report compilation (ARV prophylaxis at ANC)

17. FutureDirection • Expand the SOC assessment to capture soft but important quality indicators in all technical areas we support and automate them • Fully integrate the priory SOCs as part of routine SOC • Enhanced use of SOC data for CQI • Build the capacity of site providers to complete, interpret and act on SOC data

18. †መሰግናለሁ Amesegnalehu Thank You