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IMPLEMENTION OF AN ELECTRONIC ART REGISTER:
FREE STATE PROVINCE
Presenter: Mr. F. Nkomo (FSDoH)
Background
• Since the inception of ART programme in the Free
State Department of Health (FSDoH), services were
monitored through non-standardised excel spread
sheets and this could not support the process of
quantifying the impact of the programme in the
province
Background - Non-standardised Tools
Background
• In 2012, FSDoH implemented a standardised ART register
for monitoring ART services
• This new register was implemented in line with the
National Department of Health guideline
– It was mandatory for all facilities managing 500 or more patients
to implement the electronic ART register
– Other facilities had to implement the paper ART register
– This was to improve monitoring of services and data quality
Aim & Methods Aim:
• The aim of the study is to describe the implementation of ART electronic register
Method:
• Consultative meetings to facilitate buy-in were conducted in the facilities
• Facility assessments were conducted, and all facilities with 500 or more patients
were provided with all the required equipment and training in preparation for the
implementation of the electronic register
• Facilities had to back-capture all the information from patient files as from the
date of initiation
• Implementation were monitored in phases, from 0 - 6
ELECTRONIC REGISTER MONITORING PHASES
Phase 0 Preparation for electronic ART register (Buy-in meeting with facility managers, Filing, orientation, process flow etc.)
Phase 1 Installation and training
Phase 2 Back capturing
Phase 3 Back capturing with live capturing
Phase 4 Live capturing (back capturing complete) and data cleaning in progress
Phase 5 Data signoff by DIT/PIT after completion of data clean up and baseline audit
Phase 6 - completed
Live site and site able to produce Monthly and Quarterly reports
ILLUSTRATION OF TRANSITION OF ART RECORDING SYSTEM
Paper Register
Electronic Register
Results
2012 2013 2014 2015
Total Implemented
145 205 214 228
Phase 0-5 94 117 56 15
Phase 6
51 88 157 213
PERCENTAGE OF PHASE 6 FACILITIES ACROSS THE FREE STATE PROVINCE
BY END OF 2015
100%
91%
85%
91%
100%
Results of Implementation
0
10000
20000
30000
40000
50000
60000
2012 2013 2014 2015
Nu
mb
er
Total ART Patients Remaining in Care In the Free State per District
fs Fezile Dabi District Municipality
fs Lejweleputswa District Municipality
fs Mangaung Metropolitan Municipality
fs Thabo Mofutsanyana DistrictMunicipality
fs Xhariep District Municipality
Number of ART Patients Remaining in Care Free State 2012 - 2015
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
200000
2012 2013 2014 2015
adult remaining onart tot
child remaining arttot
Male and Female Clients Started on ART 2004 – 2015
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Adult naïve male start
Adult naïve female start (IncludingFemale pregnant at ART Start)
Male and Female Clients Started
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Adult naïve male start
Adult naïve female start
Female pregnant ART start
Challenges
• Computer Theft
• Non-functional anti-virus or none
• Lack of back-up systems
• Shortage of data capturers
• Recording of patient information in the clinical stationery
• Regressing facilities (Facilities which were on phase 6, but regressed to back-capturing phase)
Conclusion
• The implementation of the electronic register and collecting the most essential variables, timely and accurate reporting and monitoring of ART services is possible even in difficulty and resource constraint environments.
Acknowledgements
• Dr. P. Chikobvu (FSDoH)
• Me. Tsibolane (FSDoH)
• Me. K.M. Setlogelo(FSDoH)
• Mr. R.A. Khajoane (FSDoH)
• Me. M.R. Nophale (FDoH)
• Mr. T.L. Makhoba (FSDoH)
THANK YOU!