IMA Level 1 certification course in data improvement planning (Fall 2018) Week 2 Community assignment Step 1. Select a country for this assignment. We recommend that you select the country that you know best. This is usually the country where you work. Step 2. Join the WhatsApp group for this country. You will find an Update with links to join the country groups. Do not join more than one group. Step 3. Identify the questions you want to answer about data flow, data tools, and the performance of your country’s monitoring system. List and prioritize 2-5 questions that you want to answer toward the improvement of data for decision-making. These questions may include:  How does dataflow? • From facility to district EPI management team. • From district to regional EPI management team. • The regional EPI management team to FMOH DHIS2. • FMOH DHIS2 shares the data with National EPI team. • After the National EPI staff analyze the data collected from the system and then share with FMOH, UNICEF and WHO.  What are the different reporting layers (that is, who reports to whom) and what are the requirements for timeliness and reportingfrequencies? • The data is prepared in the health facilities that record the number of vaccinated children and women on daily basis and put into monthly summary forms (from 1-5 of the next month). • The district receives all the data that comes from the facilities under their catchment area and submits to regional level EPI team on monthly basis (from 1-5 of the next month). • Regions HMIS focal person uploads the data in the DHIS2 system monthly (from day 5-10 of next month). • National EPI staff the data collect and analyze data from the system and then share with FMOH, UNICEF and WHO (15-20 of next month).  Who first collects the data, prepares paper reports, enters data into electronic systems, receives and reviews reports? • Health facility EPI staff collects the data forms used in the month and make summary then share with the head of the facility which will check the data before submission to the district team. The district EPI staff review the reports they receive from the facilities and shares with the regional HMIS focal person. • The HMIS focal person reviews the data he/she received from the districts and uploads electronically in the DHIS2 system. • The national EPI team receives the data from the DHIS2 system, reviews, analysis and then shares with the WHO and UNICEF who will do further reviews and analysis.  What measures and procedures are in place for data verification, cleaning and feedback? What process is followed if data seems to bewrong? • Facility level EPI staff verify their data by checking their monthly required coverage, vaccines they received, used, wasted, and drop-out rate and compare to their monthly achievements. • District level EPI team will verify completeness and timeliness of the data, they receive from the facilities if they observe anything wrong they ask the facilities concerned to recheck and submit revised one. • Regional HMIS focal persons check the data they receive from the districts of their regionand do the verification relevant to their capacity and upload the data to the DHIS system. • The National EPI team verify, and analyze the data on monthly basis. If there are mistakes they inform the regional HMIS focal persons and ask to revise and resubmit them.  Who are relevant players/stakeholders at each level? What do they do with the data (for example, collect, enter into electronic system, analyze, use to make decisions,etc.)? • Facilities and district collect data. • Regional HMIS focal persons enter data in the system. • FMOH National EPI team collects data from the DHIS2 system. • FMOH National EPI team analyzes the data. • FMOH, UNICEF and WHO use the data for planning and decision making. Step 4. Identify and collect relevant background documents and other sources of information for your selected country. You may want to start with what you already know (usually from experience) or what you can learn from your colleagues. However, in order to build a compelling analysis, you need to rely on evidence that is not only anecdotal. Potentially useful sources of information include:  recent data-related reviews such as data quality self-assessments (DQS) or service availability and readiness assessments(SARA)  strategic plans like the comprehensive multi-year plans (cMYPs) and annual plans ofaction  recent programme reviews: EPI reviews, post-introduction evaluations (PIEs), surveillance reviews and other EPI-relatedreviews  country documentation on surveillance standards (including casedefinitions);  standard operating procedures (SOPs) for data collection, archiving andreporting;  data collection tools; and annualreports  paper-based tools and information systems for data entry, management, andanalysis  country documentation or SOPs on data tools (paper or electronic) including SOPs on responsibilities and financing of printing the monitoringtools  organigram of the EPI team, HMIS team, and if available, post description of data managers or other staff dealing with monitoring, systems, andanalysis  other available documentation related to immunization data: country bulletins, peer-reviewed literature, ad hoc reports, and other descriptions of the informationsystem. Step 5. Share the most useful resources you find in our Scholar community SHARES. Go to our community SHARES to upload the most useful documents that you find. https://cgscholar.com/community/community_profiles/ima-level-1-english-fall-2018/community_shares  The country name must be included in thetitle.  Each SHARE must include a description. Summarize why you are sharing this document and how ituseful.  In the “Credit” section, cite the source (organization and/or authors) if youknow. Step 6. Perform a rapid review of these sources and evidence for data flow, tools, and performance of your country’s monitoring system. Limit your review to find: • reliable sources (if they exist) that describe the data flow and data tools used in your country’s monitoring system;and • Not available • Evidence that will help you identify strengths and gaps (through SWOT analysis) of the performance of your country’s monitoring system. SWOT analysis helps to realize the level of current performance of your program and the strengths we have are availability of existing standard reporting forms, availability of administrative databases, existing risk assessment procedure for public health alerts, federal member states and regional mandate and credibility, existing HMIS SOP, availability of National cMYP 2016-2020. All that documents can facilitate to improve the immunization activity and the data follow. Besides, the threats facing this program are lack of awareness by regional health authorities as to what refuse occurs at the regional and district level, Poor communication among implementation partners and Insecurity. The weaknesses are data management tools are not printed and distributed in all levels since January 2018, lack of feedback from the data analyzed to the Federal States, regions and the districts, fragmented immunization information system, lack of motivation for the EPI teams processing the data at facility and district levels, Illegible and incorrectly filled out forms of some facilities and low reporting rates and completeness. Furthermore, the opportunities we have are presence of International and National NGOs running Health facilities mandating reporting, awareness by regional HMIS focal persons and agencies running EPI activities in all levels of their data follow duties, awareness by most EPI teams of where to obtain and submit reporting forms, preference by implementing agencies for electronic reporting, presence of UNICEF and WHO and other International donors, availability of GAVI funding support, and recent development of RED/REC approach micro-planning. Step 7. Summarize the quality of the available evidence. Summarize the quality and completeness of your findings. If you rely on personal experience or the experience of colleagues, please state this explicitly. Consider these questions: Were you able to answer the questions you listed? It is acceptable for your review to be incomplete. What is the strength or level of evidence for what you have found? Can you identify gaps in the sources you reviewed? If your findings are incomplete, what else would you need to know to build a more comprehensive picture? • Somali EPI recording and reporting system starts from facilities to districts and regions to DHIS2 to National EPI team analyzed and then shared with the concerned people. • There are gabs for DPI data such as low coverage data for Penta3 (60%) in 2018, low reporting rate, AEFI is not reported at all, high wastage rate, high drop-out rate, some districts and areas are not accessible for EPI services due to insecurity and weak supervision and monitoring of all levels. Step 8. Describe the data flow of your country. Map out the data flow of your context, drawing on your findings. Prepare a flow chart showing data flows and data tools being used across all levels.  The following diagram is showing the data following of Somalia. Step 9. Make a SWOT analysis. Make a SWOT analysis for the monitoring system in your country. Analyze the Strengths, Weaknesses, Opportunities, and Threats. List of strengths, weaknesses, opportunities and threats (SWOT) for the Somali immunization data reporting. INTERNAL EXTERNAL Strengths: • Existing standard reporting forms • Availability of administrative databases • Existing risk assessment procedure for public health alerts • FMOH, States and regional mandate and credibility • Existing HMIS SOP • Availability of National cMYP Threats: • Lack of awareness by regional health authorities as to what reviews occur at the regional level and district level. • Poor communication among implementation partners • Insecurity. Weaknesses: • Data management tools are not printed in all levels in 2018. • Lack of feedback from the data analyzed to the Federal States, regions and the districts. • Fragmented immunization information system • Database not regionally accessible • No evidence of guidance document on review process • Lack of motivation for the EPI teams processing the data of facility and district levels. • Illegible and incorrectly filled out forms of some facilities. • Low reporting rates and completeness. • No co-financing approach used. Opportunities: • Presence of International and National NGOs running Health facilities mandating reporting • Awareness by regional HMIS focal persons and agencies running EPI activities in all levels of their data follow duties • Awareness by most EPI teams of where to obtain and submit reporting forms • Preference by implementing agencies for electronic reporting • Presence of UNICEF and WHO and other International donors. • Availability of GAVI funding support. • Recent development of RED/REC approach micro-planning. To this end, the following components of the monitoring system may be examined:  a governancefoundation;  the people at all levels of thehierarchy;  the processes for data collection andverification;  the tools that are used for collection, reporting, and use (both paper-based and electronicsystems);  the extent to which data areused. Step 10. Summarize what you learned from all of the other steps. • During this exercise I have learned the importance close monitoring of proper data recording, reporting, reviewing, analyzing, feedback to all levels and usage of data during planning. 2