Not another database lesson learned in the development of sustainable information systems for HIV-related programs in Indonesia

Transcription

1 Not another database lesson learned in the development of sustainable information systems for HIV-related programs in Indonesia Suzanne Blogg HIV Cooperation Program for Indonesia

2 Introduction to Indonesian Setting Ministry of Health decentralised Some NGOs receive more support than others Some provinces more wealthy than others M&E staff often do not have qualifications High staff turnover Most do not have anti-virus subscriptions on the computers available and some use their personal computers Some staff have limited computer skills Software is often not licensed Access to internet can be limited in some areas

3 Types of Data Collected Monitoring data outputs Number of trainings conducted Number of people reached by programs Number of condoms, needles syringes distributed Number of people referred to health services by outreach workers Evaluation data outcomes, impact Percentage people using condoms with casual partners or with clients Percentage injecting drug users not sharing needles and syringes Quality of services, client satisfaction with services Impact of programs on individuals

4 Monitoring Data

5 What people develop databases for Methadone registration so people can access methadone in more than one clinic Information about Needle Syringe Programs provided in Community Health Centres and by NGOs Information about NGO programs for sex workers, gay men and injecting drug users HIV treatment (ART) provided in hospitals Services provided to inmates of prisons and detention centres

6 What has worked for Monitoring data Minimum data Clear definitions of key indicators Only include indicators service providers can collect Excel templates One sheet for each year Disaggregated by month and gender Annual refresher training in Excel for staff in services

7 What has not worked for Monitoring databases Complex Linux systems with passwords Monitoring databases with built in behaviour surveys with many indicators/questions Ongoing maintenance with IT support budgets limited Regular changes to indicators being collected or changes to lists Reliant on government departments to maintain and supervise Poor access to internet

8 Excel vs Database for Monitoring Data Issues Excel Spreadsheet Database Changes to indicators Easy Difficult IT support Minimal, low skill High level of skill Workload Minimal Data entry for all occasions of service Internet access Once a month Regular Budgets allocated for IT support, virus checkers and access to internet Minimal IT support and maintenance can be expensive Timeliness Usually good Dependent on adequate number of staff to enter data, usually not good Data Analysis and Reports Simple Complex but can be fast if reports defined

9 Information System thinking needed rather than database Service provided Data entered on form or in registration book Service users Service providers Manager, Funders Data analysed and results disseminated Data sent via internet Data entered into computer Excel spreadsheet or Database Aggregated or Individual, monthly or daily

10 What has worked for Evaluation data Train-the trainer approach (with most talented partner staff from each province) Excel data entry templates with data validation Excel pivot tables for analysis Refresher workshops with service providers every year for socialising survey approach, data entry, analysis (Excel) and presentation (PowerPoint) Provincial report writing workshops with Trainers (MS Word) Ownership of the information which is then used for planning

11 Sustainability Issues Many databases last a few years (at most) without intensive support Licenses often expire when funders stop supporting programs IT support is often costly and rarely planned for in long term budgets Bugs are often not sorted out before expansion Reports are tagged on the end of the database design without much deliberation

12 Where are they now? Methadone registration system (HCPI) gone Needle syringe program database in health centres (IHPCP) gone NGO program information (FHI) - gone Jakarta AIDS Information System (Jakarta Gvt) gone SIHA System Information HIV and AIDS expanding with many issues (GF)

13 Evolving Program Designs Many program designs specify the need for a database rather than an information system Programs often have to develop a database with an IT expert (e.g. Global Fund - AIDS and TB programs), even if not practical in the field Some databases have less than 50% compliance from service providers but the data available are reported There is an assumption that databases are superior to spreadsheets

14 EVALUATION

15 What has not worked for Evaluation data Software that requires an expensive license as most service providers do not have ongoing funds Each service/university/ government department have staff familiar with different statistical software packages, e.g. STATA, SPSS Staff use statistical tests inappropriately because the tests are there

16 Conclusions Databases can be very useful tools when appropriately resourced In countries with limited resources, spreadsheets often work well for collecting monitoring data Sustainable information systems need to be specified in program designs rather than databases which are often expensive, impractical in the field and unsustainable in the long run Any information system needs local ownership and local use of data to improve quality and to have an impact on service provision Any system required ongoing supervision and support