Implementation Strategy

1. Action plan summary

Author: Ayile Lemma Tessema, MOH employee in Southern Nations Nationalities and Peoples (SNNP) Region, Ethiopia. I am working as Health Management Information System (HMIS) coordinator in RHB.

This is an individual project.

My Creator Project is “Data Improvement Plan for SNNP region, Ethiopia” which is specifically focused on “Improving immunization data utilization of health facilities in SNNP region, Ethiopia” aimed to assure regular use immunization data as per national standard by facility data review team & EPI persons.

My implementation strategies are directly aligned with national CMYP strategies & priority areas. (please refer the linkages described on the next part)

The proposed actions are capacitating the facility data review team & EPI persons on data utilization through formal training, mentorship & on job trainings, establishing routine monitoring system of data utilization by facilities, recognizing & rewarding best performing facilities on data utilization, developing & applying regional HMIS regulation to improve accountability.

These actions are proposed based on the diagnosis of current regional situations & gaps of immunization performance, data quality & data use and as on the identified root causes to underutilized immunization data by facilities in my project.

Appropriate use of immunization data in a regular manner, allows the facilities to continuously identify the gaps & root causes for under-achievement of their objectives & targets of immunization program. Based on the causes, facilities will made information-based decisions to tackle the causes, select high impact interventions and will take the actions. This process will enhance timely identification of problems & making evidence base decisions & actions that improve performance of immunization program.

Currently performance review teams, who are responsible for routine data utilization were established in almost all health centers & hospitals. PRT guideline & minutes tools are developed & distributed to all levels.

2. Linkages to EPI goals

The national Comprehensive Multi-Year Plan 2016 – 2020 which is prepared in 2015 used as foundation for developing regional as well as sub-regional immunization planning and implementation of immunization activities. The plan encompasses all components of immunization services: service delivery, vaccine supply, quality and logistics, disease surveillance and accelerated disease control, advocacy, social mobilization and communication and program management.

There are two types immunization plans at regional level. The first one is the five years strategic planning which is planned every 5 years at each level integrated with other programs. The second one is annual immunization planning which is also prepared at each level of the health system annually.

An annual operational plan will be prepared at the national level based on this strategic plan. Districts in association with health facilities will develop detailed micro plans in annual planning forum based on the national strategic plan and regions will aggregate the district micro-plans to develop regional immunization plans.

My plan is focused on improving data utilization of health facilities mainly through strengthen data review teams & routine monitoring of data utilization by facilities. This plan has directly linkage with national CMYP & regional 5 years Health Sector Transformation Plan /HSTP/ because of the following some reasons.

The national CMYP is implemented within the framework of the GIVS in four main strategic areas and the Monitoring and Evaluation, accountability frame work of GVAP.

Situational analysis of national CMYP indicated that “one of the major challenges identified in the HMIS include gap in establishment and functioning of performance review teams, poor documentation and dissemination of routine information and monitoring and evaluation”

The Strengths, weaknesses, opportunities and threats (SWOT) analysis of national CMYP mentioned that “Gap in completeness and timeliness of routine EPI data and Inadequate triangulation of information” are mentions as weakness.

Objective 7 of national CMYP also indicated that Strengthen program Monitoring and Evaluation:

• Through programmatic reviews and EPI performance monitoring system in all districts using HMIS captured data by 2017.
• Achieve 90% timeliness, accuracy rate and completeness of HMIS reports at all levels by 2017

On the Strategic Areas/Approaches part of the CMYP, the immunization data quality data use issues are mentioned as “ The quality of immunization and surveillance data will be regularly monitored and its use at each level promoted. Information generated from HMIS and surveys will be used for advocacy and for program and service improvement.”

According to national performance monitoring/review team /PRT/ guideline, the teams are responsible to regularly review the data quality, coverage (including quality & equity indicators) and use of their data for decision making.

My steps to improve data use in facilities are focused more of on the PRT guideline & gaps identified in my project, includes:

Strengthen data review team of health facilities (which is chaired by facility heads & included EPI unit head) through: -

Step 1: Ensure that all facilities established PRT

Step 2: Capacity building of PRT members & other EPI staff on immunization data, recording & reporting tools, indicators, data quality assurance & data use

Basic Training

Provide Comprehensive HMIS/information use (including PRT roles) training to PRT members & EPI staff of facilities (Health centers, Hospitals).
Provide basic HMIS training to heads of health posts

Step 3: Establish & implement routine electronic/paper-based monitoring system for review team activities/performance

Develop guideline & tools to monitor review team activities at each level
Organize the system for monthly monitoring of review team performance internally & between levels

Orient regional & sub-regional leaders about
Develop PRT activity report flow system

Conduct regular monitoring & feedback provision on monthly base internally & between levels
Conduct biannual assessment

Step 4: Organize & implement regular mentorship on immunization data use to facility review team members

Select skilled mentors from districts & facilities & Provide training on information use mentorship
Implement data use mentorship quarterly to each facility using the national standard tools

Step 5: Organize on job trainings on data use to other facility staff

Develop guideline, tools & monitoring system for on job training of HMIS at facility level
Provide orientation to PRT members on the guideline of on job training
Implement & follow the HMIS on job training to all service providers at facility level

Step 6: Develop & implement regional level HMIS regulation

Discus with regional managers about the importance of HMIS regulation on data quality & data use improvement
Develop regional level HMIS regulation document, approve by regional managers & apply
Develop regional level HMIS regulation, test, approve & apply

Better use immunization data will have high contribution to improve & strengthen immunization goals & outcomes of my region as well as the country

Steps how my actions contribute immunization goals & outcomes

PRT & EPI units will monthly conduct the following steps: -

Monthly immunization data quality check
Monthly analyze & discuss/interpret all immunization indicators & disaggregates (at least on coverage, quality, equity, safety & supply)
Identify major problems/gaps related immunization coverage, quality, equity, safety & supply, prioritize problems, will made root cause analysis and select root causes
Decide on interventions: select high impact interventions based on the root causes
Develop an action plan with specified actions, timeliness & responsibility that address their decisions
Allocate/Mobilize resources
Implement their actions, follow & monitor the results
Evaluate the progress of their decisions during the next month meeting

3. Stakeholder support and action

If stakeholder is skeptical, I will collect more evidences, discuss & describe the details of the problem & the outcome of the project with the stakeholders. Identify their interests and assess the reasons why they are not interested on the plan. If necessary, I will revise some parts of the plan without affecting the overall objective of the plan.

The support of other scholars especially higher professionals & researchers is very helpful to get scientific evidences about the problems on the immunization data utilization of our facilities, to review & evaluate my interventions

4. Budget and timeline

Budget Summary

Detail Budget Breakdown

n order to secure the proposed resources, I will organize the following steps:

1. First of all, I describe my plan to immunization & HMIS departments of the SNNP RHB, and ensuring the agreement & acceptance of both departments.
2. Identify primary stakeholders specifically those who are supporting/funding the immunization program & the information system
3. Request the regional health bureau to arrange discussion forum on the plan & about resource mobilization with primary stakeholders.
4. Prepare discussion forum for resource mobilization with primary stakeholders including development partners & NGOs working & supporting the immunization program and information system.
5. Convincing partners & the RHB to support the proposed resources of their area of interests
6. Identify resources promised by stakeholders and securing.

Steps that have already taken are

1. The plan is submitted to HMIS & MNCH department & accepted with few comments
2. I am preparing two guidelines (Regular data use monitoring & regional HMIS regulation) with other 3 persons assigned by the RHB
3. The RHB will assign trainers
4. The RHB promised to cooperate vehicles during the implementation

Steps that needed to complete are:

• Discussion with primary stakeholders
• Getting fund to provide training at initial phase.
• Getting financial support to conduct data use mentorship

5. Credibility and potential impact

Please reffer the attached here word document if any thing thet is not visible