SWOT report for Case-Based

Surveillance of HIV in

Tanzania

http://mesh.lshtm.ac.uk/

MeSH Partners

MeSH Working Groups

The Working Group Structure of MESH comprises four working groups:

Routine Case-Based Surveillance WG

• Phase 1: Assess and report on the current landscape of patientinformation and surveillance systems and provide recommendationsfor pilot activities to implement / strengthen RCBS

• SWOTs

– Tanzania completed

– Upcoming in partnership with WHO, NASTAD, CDC: South Africa, Kenya,Haiti

• Phase 2: In-depth work and pilots

– provide technical and strategic input to adapt or develop patientinformation systems to report into CBS; develop approaches tothe analysis of data to support measuring outcomes along thecare continuum

Background – HIV M&E in

Tanzania

• M&E of HIV for Government and international concentrates on programme inputs, processes and outputs.

• Standard monthly reports (eg DHIS) use aggregate numbers– Numbers tested, numbers enrolled in care, numbers on ART

– Aggregated at district and regional level feeding in to national data

– Data available for analysis using Dashboard

• Alternative M&E through the Care and Treatment data from selected clinics– Aggregate data submitted to MoHSW quarterly (separate to DHIS)

– Data collected every 2-3 years for analysis

• PEPFAR clinics collect more detailed data for monthly report

Objectives of SWOT

• Assess the strengths, weaknesses, opportunities and threats for carrying out a full CBS for HIV surveillance in Tanzania

• Determine the current resources used for M&E of HIV

• Gauge feasibility of implementing HIV CBS –resources; policies; data needs; supervision; technical needs; human resources

• Contribute to the strategic plan for surveillance of HIV, and to any technical working group for the implementation of CBS

SWOT methods

• Review of documents: Policies, data tools, SOP

• Interviews with national, regional and district leaders– To explore the implementation of existing systems

• To visit sites (hospitals, health centres, dispensaries and laboratories) in Dar and Mwanza regions:– To determine the delivery of services, and the recording of data

– To explore systems used for notification of other diseases

– To assess the demands of data collection and management on HR

• To document evidence on CBS from international organizations, and national partners

SWOT structure

• Team of seven personnel in SWOT team, under MoHSW, supported by local partner

• Over two weeks of activity

• 23 interviews with 30+ personnel at different levels in Dar-es-Salaam and Mwanza Region

• Nine facilities visited (2 private, 2 referral laboratories, 3 hospitals, 2 health centres and 2 dispensaries)

• Interview notes written up and findings transcribed using standard template for SWOT

SWOT findings – Strengths

• The current system is a strong foundation for CBS - data are collected and entered into individual patient records and MoH registers

• The system for collecting data from all points of the cascade exists

• Existing procedure for reporting aggregate data up from clinics to sub-national and national level - can be built on

• Understanding of unique identifiers (UI) is present throughout M&E system

SWOT team at laboratory in a health centre.

SWOT findings - Weaknesses

• Over reliance on paper-based registers and aggregate reporting

• The unique identifier for patients is inadequate (duplicates?)

• The interconnectivity between the patient records and HMIS reporting system exists but needs to be developed further

• Data quality needs to be addressed, with CTC data, lab performance and test results (little data use at local / sub-national level)

SWOT team with Regional Officers in Mwanza.

SWOT findings - Opportunities

• Interest among stakeholders in moving CBS forward

• Basic systems are in place to build a strong CBS system

• Defining a unique identifier which would link HIV services, and would facilitate de-duplication

• CBS would also necessitate better data quality systems, and supervision, which would enhance the use of the data

• Build a career structure for those working with the data

Interview with key personnel.

Tz SWOT findings - Threats

• The main threats to the success of CBS come from resource and staff limitations, which would undermine clinical care and/or data quality

• Unacceptability (to facilities) of patient level data flowing all the way to national level – threat to patient confidentiality

• Data quality needs to be high, and this may impose constraints on the delivery of CBS

Approach and entrance to health facility.

Tz SWOT output and next steps

• SWOT Report completed and available (Nov 2015)

• Results reported to MoHSW lead and technical WG

• Feedback to WHO, UNAIDS, donors (CDC, USAID, Gates Foundation)

• Present at conferences to learn from other experiences

Next steps:

• Brainstorm for solutions to known and unknown problems to implementation– Implementation research around feasibility of data

collection at diagnosis

– UCSF and MeSH personnel to work with MoHSW

Conclusions

• Basic systems in place in Tanzania (and probably in other countries with similar HIV services), but need strengthening and development– Human resources

– Simplifying the reporting systems (electronic transfer)

– Supervision and training of staff to perform the data quality checks

• Data gaps require technical solutions and SOP to ensure the data are checked, managed and used properly.– Data collection at diagnosis

– Data on the cascade from smaller clinics with only paper records

– Data from lab tests

Recommendations

• Overall support for the development of CBS, with the following areas needing enhancement, and more work

• Explicit policies for the implementation

– HIV notification, confidentiality, data security, vital registration (of deaths)

• Unique identifiers required, with good de-duplication

– at diagnosis, and checked and verified for all events

• IT systems for data collection, linkage between sites and reporting

• Quality assurance of data – completeness, accuracy

– routine validation of data and lab results, supervision, enforcement of SOP