THE IMPORTANCE OF DATA QUALITY

Data Symposium Crowne Plaza, Rosebank

21 May 2012 Rentia Voormolen

Background of ESI Project

Implemented by JSI John Snow Incorporate Funded by USAID ESI Project Enhancing Strategic Information To contribute towards reducing the burden of HIV and AIDS in Southern Africa by enhancing the use of information for evidence based decision making

Content of Presentation
1. Basic principles of Data Quality

2. Using the DHIS to optimise Data Quality 3. DQ pivot tables on Timeliness and Completeness of data in DHIS

WHAT IS DATA QUALITY?

The REAL world
In the real world, project /program activities are implemented in the field. These activities are designed to produce results that are quantifiable. Data Management System An information system e.g. DHIS, represents these activities by collecting the results that were produced and mapping them to a recording system.

Data Quality: How well the DMS represents the real world

Real World

Data

Management
System

Accurate, timely and accessible health care data play a vital role in the planning, development and maintenance of health care services. Quality improvement and the timely dissemination of quality data are essential if health authorities wish to maintain health care at an optimal level (WHO, 2003).

WHY IS DATA QUALITY IMPORTANT?

Good Quality RAW data = Good Quality INDICATORS Evidence that can be trusted enables managers to optimize health care coverage, quality and ultimately health status by : forming accurate pictures of health needs, programs & services in specific areas informing appropriate planning and decision making allocating and using resources effectively and efficiently supporting ongoing monitoring to identify best practices to learn from and areas where support and corrective measures are needed improve quality of care

Daily
-Collection during each patient/client contact - Validation & sub-totals

Weekly
Interim aggregation & validation

Monthly
1st Validated clinician/service point summarised to facility manager 7th Validated facility summary submitted for capturing 10th Export of facility captured data sent to next level

15th Capturing, import, validation & export completed

DQ WHERE, WHEN & WHO ?

Feedback in 5 days 20th District import, validation & export completed Feedback in 5 days 30th Provincial import, validation & export completed Feedback in 5 days 10th of following month National import, validation & saving on server Feedback in 5 days

Data flow timelines: DHMIS Policy

Do the right things right the first time!

CRITERIA FOR DATA QUALITY

Reliable Appropriate Validity Reliability Integrity Correct Complete Consistent

Valid
Easy Sensitive Specific

Precision
Timeliness

Comprehensive
Comparable

ACCURACY CHECKS raw data

Eyeballing visual scanning
missing data values / gaps inconsistencies / unlikely values

calculation errors
unusual month to month variation / fluctuations

duplication
preferential end-digits data entered in the wrong box

USING THE DHIS TO OPTIMISE DATA QUALITY

DHIS is the Routine Health Information Reporting System of NDoH (DHMIS Policy:7)

Min / Max out of range Graph

Colour Coding Values out of range

Validate in Data Entry

Data Completeness Report

Data marked for Checking Report

Absolute Validation Rules

Statistical Validation Rules

Gap and Outlier Analysis

Data Integrity Check

What does the DHIS data tell us about Data Quality? Data quality pivot tables
Monitor Timeliness and Completeness of Monthly DHIS health facility data submitted to NDoH Developed by ESI Accepted by HIS task team Currently for internal use To be incorporated in DHIS Pivot tables for external use

Definitions of timeliness and completeness

Timeliness is the % of expected health care facilities that reported into the DHIS database for the last reporting month (DHMIS policy 60 days) Completeness is the average % of expected health facility reports that were captured into the DHIS for the last 12 reporting months

PROXY INDICATOR TO MEASURE TIMELINESS AND COMPLETENESS

Indicator: Reporting rate (%) Target 95%
Numerator: Number facilities which reported/captured data on a specific element Denominator: Number facilities for which this data element is activated for capturing into the DHIS

Proxy data elements used to identify facilities

PHC total Headcount Clinic, CHC, Mobile & Satelite clinics

Delivery in facility CHC, MOU, District, Regional, Tertiary & Central Hospitals
Usable beds District, Regional, Tertiary & Central Hospitals

Ranges used for colour coded pivot tables

< 70 (69.5) % - Critical 70 (69.5) to 94 (94.4) % improvement needed 95 (94.5) to 100% - target met

GP: Hospital Reporting Rates T 95%

Month-Year Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Average Ekurhuleni MM 100 100 100 100 100 100 100 100 100 100 100 100 100 Johannesburg MM 100 100 100 100 100 100 100 100 100 100 100 100 100 Sedibeng DM 100 100 100 100 100 100 100 100 100 100 100 100 100 Tshwane MM 100 100 100 100 100 100 100 100 100 100 100 100 100 West Rand DM 100 100 100 100 100 100 100 100 100 100 100 100 100 Average 100 100 100 100 100 100 100 100 100 100 100 100 100

Timeliness reporting rate for the last reporting month Completeness average reporting rate for the last 12 reporting months

GP: PHC Reporting Rates T 95%

Month-Year Feb-11 Mar-11 Apr-11 Ekurhuleni Johannesburg West Rand MM MM Sedibeng DM Tshwane MM DM 97 95 95 98 98 98 100 100 100 96 96 96 98 98 98 Average 97 97 97

May-11
Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Average

95
95 94 98 97 98 98 99 99 97

98
98 98 98 96 98 98 96 96 97

100
100 100 100 97 100 100 100 97 100

96
97 97 97 97 96 95 95 95 96

98
98 98 98 96 98 98 98 98 98

97
97 97 98 96 98 97 97 97 97

GP: PHC Reporting Rates - PMTCT

PHC Facility reporting rates - selected PMTCTdata elements (Target 95%)
PHC total headcount Antenatal 1st visit Antenatal client HIV 1st test

Cervical smear in woman 30 years and older

Antenatal 1st visit before 20 weeks Antenatal client CD4 1st test Antenatal client HIV 1st test positive Antenatal client initiated on AZT Postnatal care mother within 6 days after delivery Antenatal client initiated on HAART Antenatal client eligible for HAART
0 10 20 30 40 50 60 70 80 90 100

GP: PHC / District - PMTCT

Johanne West Ekurhuleni sburg Sediben Tshwan Rand DataElementName MM MM g DM e MM DM Antenatal 1st visit 95 96 95 93 97 Antenatal 1st visit before 20 weeks 94 94 92 92 93 Antenatal client CD4 1st test 94 91 92 85 90 Antenatal client eligible for HAART 82 41 68 49 66 Antenatal client HIV 1st test 95 95 96 91 97 Antenatal client HIV 1st test positive 94 91 91 86 89 Antenatal client initiated on AZT 93 90 93 86 88 Antenatal client initiated on HAART 78 47 67 58 62 Cervical smear in woman 30 years and older 92 93 93 94 96 Medroxyprogesterone injection 96 98 100 97 100 Norethisterone enanthate injection 97 99 100 97 99 Oral pill cycle 97 99 100 97 99 Postnatal care mother within 6 days after delivery 14 80 90 85 74 Average 86 87 91 86 88

Averag e 95 93 90 59 94 90 90 62
93 98 98 98 65 87

GP: Hospital Reporting Rates - PMTCT

Hospital reporting rates - selected PMTCT data elements (Target 95%)
Antenatal client on HAART at delivery Usable beds - total

Delivery in facility
Delivery in facility under 18 years Antenatal client Nevirapine taken during labour

Caesarean section in facility

Live birth to HIV positive woman Termination of Pregnancy performed Antenatal client on AZT before labour Sterilisation - female Medroxyprogesterone injection Norethisterone enanthate injection Oral pill cycle Maternal death in facility IUCD inserted Sterilisation - male 0 10 20 30 40 50 60 70 80 90 100

GP: PHC Reporting Rates - ART

PHC facility reporting - selected ART data elements (Target 95%)
PHC total headcount Suspected TB case with sputum sent Male condoms distributed STI treated - new episode Sputum results received within 48 hours HIV positive new patient started on Co- Suspected TB case smear positive STI partner treated - new Suspected TB case smear positive - treatment HIV positive new patient started on INH Adult patient started on ART during this month - HIV positive adult patient eligible for ART Female condoms distributed HIV positive child under 15 years eligible for ART New child under 15 years started on ART during Adult patients remaining on ART at end of the Children under 15 years remaining on ART at
0 10 20 30 40 50 60 70 80 90 100

GP: PHC / District - ART

Johanne West Ekurhul sburg Sediben Tshwan Rand DataElementName eni MM MM g DM e MM DM Adult patient started on ART during this month - new 89 66 83 74 81 Adult patients remaining on ART at end of the month - total 0 0 0 Children under 15 years remaining on ART at end of the month - total 0 0 0 Female condoms distributed 70 60 64 68 77 HIV positive adult patient eligible for ART 87 63 83 71 81 HIV positive child under 15 years eligible for ART 30 15 49 27 36 HIV positive new patient started on Co-trimoxazole prophylaxis 85 88 96 84 93 HIV positive new patient started on INH prevention therapy 73 77 90 78 90 Male condoms distributed 95 97 97 96 98 New child under 15 years started on ART during this month 29 14 46 25 33 Sputum results received within 48 hours 92 96 98 92 96 STI partner treated - new 92 84 84 85 86 STI treated - new episode 93 97 99 97 98 Suspected TB case smear positive 90 88 89 85 80 Suspected TB case smear positive - treatment start 86 83 85 82 77 Suspected TB case with sputum sent 96 97 99 96 98 Average 79 76 83 76 81 Average 78 0 0 67 76 28 88 79 97 27 94 87 96 87 83 97 78

GP: Hospital Reporting Rates - ART

Hospital reporting rates - selected ART elements (Target 95%)
Children under 15 years remaining on ART at end Adult patients remaining on ART at end of the Usable beds - total Adult patient started on ART during this month - new HIV positive adult patient eligible for ART New child under 15 years started on ART during Suspected TB case with sputum sent Suspected TB case smear positive HIV positive child under 15 years eligible for ART Male condoms distributed HIV positive new patient started on Co-trimoxazole STI treated - new episode Sputum results received within 48 hours Suspected TB case smear positive - treatment start Female condoms distributed HIV positive new patient started on INH prevention
0 10 20 30 40 50 60 70 80 90 100

The best way to improve Data Quality is to USE the data!

THANK YOU
SIYABONGA REALEBOGA BAIE DANKIE.