VITAMIN A FIELD SUPPORT PROJECT

Transcription

1 VITAMIN A FIELD SUPPORT PROJECT A project of the A.I.D. Off.ce of Nutrition mnged by t1-- Interntionl Science nd Technology Institute, Inc. (ISTI)

2 Prepred for Office of Nutrition Bureu for Science nd Technology Agency for Interntionl Development Wshington, D.C. Contrct No. DAN-5116-C Project No IEF/MALAWI VITAMIN A PROJECT MANAGEMENT INFORMATION SYSTEM by The Interntionl Eye Foundtion with technicl ssistnce from Community Systems Foundtion Edited nd Produced by Vitmin A Field Support Project (VITAL) Interntionl Science nd Technology Institute, Inc North Kent Street, Suite 1016 Arlington, Virgini Phone (703) Fx (703) Report No. TA-5 Published Februry 1991

3 TABLE OF CONTENTS I. INTRODUCTION... 1 II. DESIGN OF THE MANAGEMENT INFORMATION SYSTEM... 2 III. DATA MANAGEMENT... 4 III.A Dt Inputs... 4 III.B Creted Vribles... 6 III.C Qulity Checks... 7 IV. PREPARATION OF REPORTS AND USE OF INFORMATION... 9 IV.A Internl Review... 9 IV.B Externl Reporting V. MALtWI TRIP REPORT (August 3-5, 1990) V.A Introductiop V.B.escription of.'e MIS V.C Trip Activities V.D Findings nd Conclusion V.E Recommendtions AITACHMENTS i nw~/mamawi VfiMN A PROJrCT2/91

4 TABLE OF CONTENTS I. INTRODUCTION.. II. DESIGN OF THE MANAGEMENT INFORMATION SYSTEM... 2 III. DATA MANAGEMENT...4 III.A Dt Inputs... 4 III.B Creted Vribles... 6 III.C Qulity Checks...7 IV. PREPARA1ION OF REPORTS AND USE OF INFORMATION... 9 IV.A Internl Review... 9 IV.B Externl Reporting V. MALAWI TRIP REPORT (August 3-5, 1990) V.A Introduction...15 V.B Description of the MIS...i 15 V.C Trip Activities V.D Findings nd Conclusion V.E Recommendtions ATr'ACHMENTS i mr/mmawi VrrAMIN A POJECr2/91

5 I. INTRODUCTION The Interntionl Eye Foundtion's Vitmin A Project is two-yer $0.7 million project designed to distribute vitmin A cpsules to children nd postprtum mothers, to improve infnt nd child feeding prctices, nd to identify nd tret eye diseses in the Lower Shire Vlley of Mlwi. The four interventions nd strtegies for their delivery re summrized in Attchment 1. With technicl ssistnce provided by the Interntionl Science nd Technology Institute, Inc. (ISTI) nd the Community Systems Foundtion (CSF) through the Vitmin A Field Support (VITAL) Project, IEF is working to develop mngement informtion system (MIS) for its vitmin A ctivities in Mlwi. This MIS will subsequently be used s model for IEF's projects in Guteml nd Hondurs, nd my be dpted for use by vitmin A projects implemented by other gencies. Since the MIS is designed to be expndble to trck other child survivl (CS) interventions, it my lso be used s model for informtion mngement for CS projects in Mlwi nd other developing countries. 1 IEN/MALA VITAMIN A PROJECT 2/91

6 U. DESIGN OF THE MANAGEMENT INFORMATION SYSTEM The IEF/Mlwi MIS includes both continuous monitoring of helth informtion t the villge level nd periodic ssessments using qulittive studies nd surveys. Project inputs nd outputs re continuously monitored, nd monthly summry reports provide estimtes of progress in chieving the coverge objectives. A bseline survey completed October 1989, ided in estblishing trgets for ech of the objectives (s.;e Attchment 1) nd the end of project survey will be conducted to mesure progress towrd the trgets for ech of the objectives. The system is designed to be fully functionl with mnul opertion. Bsic tbultion nd initii nlysis of monitoring dt tke plce t the level t which the dt re collected, during supervisory sessions with the first level helth worker. The MIS hs been utomted to ssist t 'he centrl level with dt entry, nlysis nd disply. However, users re tught to perform mnul qulity checks nd nlysis before they re instructed in the use of the custom-designed softwre which utomtes these functions. The detiled tsk list for MIS development nd time schedule for implementtion re provided s Attchments 2 nd 3. The design of the system is unique in its emphsis on the importnce of immedite use of the informtion for supervision nd for motivtion of both helth workers nd their communities. To chieve this prompt use of the informtion, the MIS uses strtegy bsed on ggregtion nd interpreition of the primry dt during monthly supervisory sessions held by the Helth Surveillnce Assistnts (HSAs, or first level supervisors) with the Villge Helth Promotors (VHPs, or volunteer helth workers) whom they supervise. This on-site interprettion of the dt lso provides mechnism for erly detection of errors nd improving dt qulity, s well s bsis for immeditely prising helth workers nd their communities for their successes. The objectives of the MIS re s follows E To ssist project mngement by trcking progress towrd project objectives; 0 To structure supervisory encounters through defined performnce indictors for considertion during supervision sessions; * To document improvement in performnce indictors over time, including reduction of error frequency; N To identify trining needs nd ssess trining effectiveness by defining gps in knowledge nd performnce; 2 1F/MALAWI VrrAMIN A PROJECT 2/91

7 To fcilitte qurterly reporting to IEF hedqurters by orgnizing dt collected into n pproprite frmework to serve s the core of report; To provide the groundwork for mid-term nd finl evlutions, presenting project chievements in tbulr nd grphic formts for review by evlutors; nd To prepre selected project dt in useful formt for presenttion to the Ministry of Helth (MOH), other privte volunteer orgniztions (PVOs), helth workers nd community members. 3 nw/mamawi VITAMIN A PROJECT 2/91

8 HI. DATA MANAGEMENT The dt needs to ssess project effectiveness for the four interventions re defined in the "indictors" column of tble in Attchment 1. As outlined in tht tble, the dt sources for these indictors include both the HSA's monthly reports nd the surveys conducted t the beginning nd end of the project. Progress towrd the vitmin A supplementtion nd oculr disese detection nd tretment objectives (project objectives 1, 2 nd 4) will be monitored continuously nd lso mesured by the surveys t the beginning nd end of the project. Progress towrd the improved feeding prctice objective will be ssessed during the bseline nd end-of-project surveys nd mid-term "convenience" smple survey t the villge rllies. In ddition to these quntittive ssessments of project effectiveness, there re periodic ssessments of the qulity of project ctivities (correct dosing, correct trget groups, ppropriteness of eductionl messges, etc.), nd qulittive or formtive reserch to refine project strtegies. III.A Dt Inputs Although the dt inputs for the qulittive studies re expected to evolve in response to the findings during the formtive reserch, the dt inputs for continuous monitoring nd for the beginning nd end-of-project surveys were defined t the outset of the project. Continuous Monitoring The project's primry interfce with its beneficiries is provided through the VHPs, who conduct home visits to provide services nd to motivte mothers to bring their children under six to the qurterly villge rllies. The VHPs re selected by their communities nd re responsible for bout fifty fmilies with pregnnt women or children under 6. Using simple roster (Attchment 4), the VHP identifies postprtum women nd children who fil to receive vitmin A t rlly sessions. These homes re promptly trgeted for visits to provide necessry doses of vitmin A nd trgeted helth eduction. Beneficiry-specific dt re kept only in the VHP's roster. Using n instrument which provides frmework for monthly supervisory encounters (Attchment 5), the HSA bstrcts key dt from the VHP's roster for the monthly report. The dt elements submitted to project mngers in the HSA's monthly reports (nd entered for utomted dt processing) for ech VHP's service re include 1. HSA nme (coded) 2. Month of report 3. Yer of report 4. VHP nme (coded) 5. Dte of supervisory visit 4 EN/MIUAWI VITAMIN A PROJECI 2/91

9 6. Number of trget households (with either children under 6 or pregnnt women 7. Number of children under 6 8. Number of these children (under 6) who ttended the most recent rlly session 9. Number of non-ttenders (mong children under 6) who receive services (helth eduction or vitmin A s scheduled) during follow-up household visits 10. Number of infnt less thn two months of ge 11. Number of mothers (with infnts less thn 2 mos of ge) who received vitmin A from the VHP 12. Number of mothers (with infnts less thn 2 mos of ge) who received vitmin A from nother (non-project) source 13. Number of vitmin A cpsules given to supply the VHP Becuse this input dt for the MIS is ggregted by the nine HSAs (ech of whom supervises four to eight VHPs), there is one file of 13 vribles for ech of ihe pproximtely 70 VHPs. Input of previously ggregted dt hs been selected s dt mngement strtegy to improve the qulity of supervision through immedite feedbck on dt qulity,, rid prompt nlysis nd use of the results t the level t which the dt re collected. Guidelines for qulity control for the dt re outlined in Section III.C below. The strtegy of ggregting dt t the first level supervisory level lso limits the dt entry nd nlysis burden. Input of monthly updtes of beneficiry-specific dt would require processing pproximtely 18, files, nd would be prticulrly imprcticl in view of the frequency of in- nd out-migrtion of Mozmbicn refugees. Although the MIS depends lmost exclusively on the HSA's monthly reports for routine dt input, the three Ophthlmic Medicl Assistnts (OMAs) in the project re provide informtion regrding the ophthlmic screening nd services which they provide t every qurterly rlly. The form used by the OMAs to record clinicl findings nd services delivered during the rlly sessions is provided s Attchment 6. Periodic Evlutions The project hs evlutions scheduled for the middle nd end of the project. In view of the brief durtion of the project, the cluster surveys to mesure project effectiveness will be conducted only t the beginning nd end of the project. Therefore, the ssessment of project effectiveness for the mid-term evlution will depend lrgely on the system for continuous monitoring nd monthly reports. Effectiveness dt will be vilble from the monthly reports only for Objectives 1, 2 nd 4. 5 IW/MALAWI VITAMIN A PROJECT 2/91

10 A smll "convenience smple" survey of infnt nd child feeding prctices will be conducted during the rlly sessions prior to the mid-term evlution to ssess erly progress in improving knowledge nd feeding prctices (Objective 3). This "mini-survey" will lso be used to ssess the qulity of the helth eduction being provided by the project. The instrument to be used in this survey includes mny of the sme questions s for the bseline nd end-of-project surveys nd is provided s Attchment 7. The end of project survey, like the bseline survey, will be conducted using the clssicl EPI cluster methodology. The survey instrument used for the bseline survey is provided s Attchment 8, nd the summry of the results s Attchment 9. Additionl questions my be dded to this instrument t the end of project to provide pproprite bseline dt required for ny follow-on project ctivities. Qulittive Reserch Project stff hve nticipted tht the most difficult of the objectives will be tht regrding improved infnt nd child feeding prctices. Qulittive reserch hs been conducted by project stff primrily to identify brriers to chieving the improved feeding prctice objective nd, therefore, refine eductionl nd trining strtegies s needed. Focus groups conducted to dte hve documented current feeding prctices nd beliefs which re potentil brriers nd must be ddressed in designing eductionl messges. Reports of these findings re vilble in project files. III.B Creted Vribles Using the dt entered from the monthly reports, coverge estimtes for vitmin A distribution nd ophthlmic screening will be generted s follows Vitmin A coverge mong children 6 to 71 months will be estimted by dding the number of children under 6 t the lst rlly session (#8) plus the number of cpsules given to children under 6 t the follow-up visits (#9), nd dividing by the totl number of children under 6 (#7). Every child 6 to 71 months old who ttends the vitmin A distribution rlly session will receive n pproprite dose (unless they hve received dose from nother source in the pst 3 months). Although the coverge my be overestimted if the rosters re not complete, the inclusion of children under 6 months of ge, who receive no vitmin A, will likely produce slight underestimte of ctul coverge in the trget ge group. Vitmin A coverge mong women delivered ini the pst 2 months will be estimted by dividing the number of mothers with infnts under 2 months who received vitmin A (#11 plus #12) by the totl number of mothers of infnts less thn 2 months of ge (#10). The ccurcy of mothers' reports of receipt of vitmin A from other sources is likely to be quite good, in view of the unique 6 nf/maawi VrAMIN A PROJECT 2/91

11 ppernce of the cpsules. Although infnt mortlity my reduce the denomintor nd result in n overestimte of coverge, it is lso less likely tht mothers of neontes who hve died will receive vitmin A, lthough this prctice is encourged. Coverge with eye exmintions nd tretment of oculr disese mong children 0 to 71 months will be estimted by dividing the number of children under 6 t the lst rlly session (#8) by the totl number of children under 6 (#7). Every child t the villge rlly sessions is to receive screening exmintion nd tretment or referrl for ny eye disese. III.C Qulity Checks The MIS is designed to provide multiple qulity checks, including logic nd rnge checks of the input dt nd performnce qulity checks s n id to supervision..ogic nd Rnge Checks for Dt Inputs Dt entered from the HSA monthly reports will be screened t the time of entry nd the opertor lerted of ny outlying vlues, nonsense dt, or internl inconsistencies. Any detected dt qulity problems will be summrized by HSA nd by VHP nd discussed t the next supervisory encounter. Vlues entered will be flgged for query or confirmtion unless they re non-negtive nd unless E N E The dte of the report (#2 nd #3) corresponds to the dte of the supervisory visit (#5) in month nd yer. The codes entered for the HSA (#1) nd VHP (#4) correspond to codes for existing helth workers. The month numbers (#2 nd #5) do not exceed 12 nd the yer greter thn 88 nd less thn 99. * The number of children who ttend the rlly sessions (#8) plus those who receive vitmin A during follow-up home visits (#9) does not exceed the totl number of children under 6 (#7). * The number of mothers with infnts less thn 2 months who receive vitmin A (#11 plus #12) does nc exceed the number of infnts less thn 2 months old of ge (# 10). 0 The number of cpsules given to ech VHP (#13) does not exceed 30 (the "cp" on the stock kept by ech VHP). 7 IIF/MAAWI VITAMIN A PROJEC 2/91

12 A finl "qulity check" on the ccurcy of these clculted coverge estimtes will be obtined during the end of project survey. Actul coverge with ech of these interventions will be mesured using cluster survey technique s outlined in Section III.A bove. Performnce Oulity Checks Dt qulity checks outlined bove provide n importnt source of informtion on performnce qulity for the VHPs nd HSAs. Additionl importnt performnce qulity checks re performed during the rlly sessions, by reviewing the VHP's roster, the qulity of the HSA's reports bstrcting the dt on tht roster, nd the qulity of rlly opertions s follows M N The HSA will perform routine qulity checks s prt of the review of the VHPs roster during the supervisory visit, discussing wys to improve dt qulity prior to bstrction for the monthly report. The guidelines for these qulity checks re provided s Attchment 10. The VHP's roster will be reviewed by the OMA nd/or PCV to ssess the ccurcy of the dt reported in the roster nd the HSA's previous monthly report(s). Feedbck regrding dt qulity will be provided to the HSA prior to the villge rlly. Rlly opertions will be monitored by the OMA nd/or PCV to ssess three res of performnce qulity * All children 0-71 months old who ttend the rlly must receive visul screening nd their presence must be recorded on the VHP rosters. N Distribution of vitmin A will be monitored to ssure tht ll children 12 to 71 months old receive 2, IU, infnts 6 to 11 months old receive 1, IU, nd tht younger infnts (0-5 months old) receive no vitmin A. The qulity nd effectiveness of helth eduction will be ssessed bsed on the ttendnce t the rlly sessions nd the chnge in nutritionl prctices documented by the bseline nd end-of-project surveys. In ddition, mid-term ssessment of the qulity nd effectiveness of helth eduction will be performed using smll survey (Attchment 7) of mothers ttending the rlly sessions, s outlined in section III.A Periodic Evlutions bove. 8 IEF/MALAW] VITAMIN A PROJECr 2/91

13 IV. PREPARATION OF REPORTS AND USE OF INFORMATION The utomted MIS prepres reports for use in both internl review for mngement nd for externl reporting. As outlined bove, the MIS is designed to provide immedite reports on dt qulity nd worker performnce t the time of dt entry. Plnning for the villge rlly sessions is ided through production of plnning reports. The MIS lso genertes personnel reports which summrize ech worker's trining history nd exmintion scores. Accounting reports include both budget mngement nd commodities mngement reports. Reports to be used for externl review include reports on progress towrd progress objectives for presenttion to the community nd project sttus reports for presenttion to IEF hedqurters, project evlutors, USAID, the Ministry of Helth nd other gencies. IV.A Internl Review Four kinds of reports will be produced by the MIS for internl use by project stff Plnning Reports To id in plnning the schedule nd logistics for project ctivities, the MIS my be used to generte pinning reports. The plnning report provides list of meetings to be scheduled nd ssists in plnning for villge rlly sessions. The rlly session plnning function ids by detiling supplies needed, tsks to be completed prior to the dte of the session, nd provides suggestions regrding other logistics such s vehicles to be used (bsed on seson nd remoteness of the villge), other gencies to be consulted or notified prior to finlizing the schedule, nd specil constrints to be ddressed t ech site (e.g., specil problems in ech villge). Clendrs of tsks re developed bsed on the following constrints n The monthly reports will be due in the project office following month. on the 3rd dy of the * Every three months, t the end of the month, ll project stff (including the Project Director, Coordintor, Bookkeeper, PCVs nd OMAs) will meet to discuss project sttus, schedules, nd feedbck to HSAs. If possible, the collted results of the monthly reports will be reviewed t tht time nd feedbck prepred for circultion to the HSAs. 9 IE/MALAWI VrrAMIN A PROJECt 2/91

14 On lternte Mondys (every Mondy for Ngbu stff), ll project stff will meet to discuss project mngement nd dministrtion. Dt from the project MIS will be reviewed t this meeting prior to report to the HSAs. The first Wednesdy fter the 15th of every month, the Project Coordintor, PCVs nd OMAs nd HSAs will meet to discuss project sttus, schedules, nd to provide feedbck to HSAs. Rlly sessions will be scheduled for the remining dys within the following constrints Public holidys nd district nd re level officil meetings will be blocked out so tht no rllies cn be scheduled on these dys. Other commitments, including the leve schedule for OMAs, HSAs, nd PCVs will be blocked out to ssure tht no rllies re scheduled for these res while helth workers re wy. Schedules of other helth ctivities (under five clinics or other gencies' helth ctivities which require ttendnce of the sme beneficiries or helth personnel) will be consulted to ssure tht there will be no conflicts. Trvel time (including sesonl during riny seson) will be tken into considertion in plnning the schedule, including for selection of morning or fternoon strt time (generlly fternoon sessions during the riny seson, December to Mrch) nd clustering of remote villges during two or three dy excursions (Gg re only). To dte, rllies hve been scheduled in Ngbu, then northern Chikww, then Nsnje. Generlly there is one rlly per dy nd the 2 vehicles re ech sent out pproximtely 3 times per week. Preprtion for rlly sessions will be plnned, including development of tsk lists. Letters nnouncing the proposed dtes for rllies re sent to the Regionl Helth Officer (RHO), District Helth Officer (DHO), nd the HSAs 2 to 3 months in dvnce to ssure tht the dtes re cceptble. These notifiction letters re generted with the ssistnce of the plnning softwre. The proposed dte for the rlly session for ech villge re then presented in letters (which my lso be computer generted) to the villge leders (chief nd/or Mlwi Congress Prty leder) 1 to 2 months in dvnce to 10 I /jmalaw VITAMIN A PROJECT 2/91

15 confirm the cceptbility of tht dte. HSAs, who usully tke responsibility for notifiction, notify their supervisor t the helth center, the prty leder, villge helth committee chirmn, nd the VHP of the proposed dte. HSAs then remind the villge of the rlly one week in dvnce, when other community leders re requested to help ensure notifiction of community members, lthough the VHP tkes primry responsibility for house to house notifiction. One dy prior to the ccepted dte, the VHP reminds community leders nd mothers of the rlly plns (unless she hs been notified of schedule chnge), nd reminds mothers to bring their crds. On the dy prior to ech session, supplies for tht rlly session rc ssembled by the PCVs, including Vitmin A cpsules (2 bottles if for Gg) Tetrcycline (depending on vilbility) Other medictions (chloroquine, prcetmol, orl rehydrtion slts, nd penicillin V) Rod to Helth Crds Pper nd pens Copy of the HSA's most recent monthly report to review nd compre to the VHP's roster Summries of coverge dt from the performnce reports for the villge nd VHPs visited A tsk list for ech rlly session will be developed for ech key person. Tsks which do not vry from session to session hve been detiled in the project's detiled implementtion pln. VHC members will be incorported into these ctivities nd will be delegted specific tsks s fesible. Verifiction of the roster nd comprison with the HSAs lst monthly report will be performed prior to the rlly by the PCV. At the beginning of ech rlly, villge leders nd community members will be presented with dt from the previous month(s) summrizing coverge chieved. After the rlly is completed, the roster will be reviewed gin by the VHP, HSA nd PCV to ssure tht ll children who hve ttended hve been checked off nd the no-shows hve been checked for follow-up visits. 11 I]T/wMAWI VITAMIN A PROJECr2/91

16 0 The HSA or OMA will review the under fives crds to ssure tht there is single crd (consolidting dt onto one crd s necessry), nd tht dt re correct s entered. Mothers who fil to bring crds will be sent to retrieve them or be issued new crd s necessry. * Tsk lists will include specil notes (such s regrding villge-specif;c constrint, or probletrns with low turnouts for pst rllies) nd reminders, including trnspeiition needs (e.g., whether four-wheel drive vehicle my be required). Personnel Reports Personnel records will be mintined by the project MIS, trcking dt for ech individul helth worker. Files will include nme, ge, eductionl level, nd trining history. Periodic refresher course ttendnce nd chievement on pr'- nd post-tests will lso be entered s obtined. These dt will be presented in tbulr formt to ssist in identifying trining needs or needs for specil ttention to workers with poor exmintion performnce. Dt from the monthly reports my be merged with personnel records to permit correltion of performnce indictors with trining history nd exmintion scores. Performnce Reports Performnce reports will be produced to review the input dt, creted coverge vribles nd qulity checks. These reports my be produced s summry report (to review project performnce), by geogrphic re (to report to communities) or by helth worker (to provide feedbck on performnce t the OMA, HSA or VHP level). Reports to ech worker will summrize the chievements in tht workers ctchment re nd will lso provide detils for ech worker supervised. These reports will lso be used to provide incentives to helth workers or communities nd to identif, those whose chievements merit specil recognition or wrds. Performnce reports re displyed in tbulr nd/or grphic disply s pproprite. Although these dt my esily be computed mnully, the project MIS softwre provides summry outputs such s those provided s Attchment o. Prior to meeting with the HSAs, project stff will prepre performnce reports foi thc ISA summrizing project performnce, performnce in the HSA's ctchment re, nd peiformnce indictors for ech VHP supervised by the HSA. The HSA will subsequently use this informtion during his monthly supervisory visits. 12 n!p/mlawi VITAMIN A PROJECr2/91

17 Accounting Reports Accounting reports include finncil mngement nd commodities mngement reports. Records of receipt nd disbursement of finncil nd commodity resources will be trcked by the project ccountnt in ledgers ccording to IEF procedure. The project bookkeeper nd IEF hedqurters will consider using spredsheet softwre to utomte these recording nd reporting ctivities. In nticiption of expnding ctivities fter the end of this project period, the commodities trcking system will be developed with the cpbility to include other commodities (in ddition to vitmin A nd tetrcycline ointment). The system will lso be djusted to trck expenditures by intervention to fcilitte cost-effectiveness clcultions s dditionl interventions re dded to IEF ctivities. IV.B Externl Reporting The MIS lso prepres project dt in formts designed for externl reporting Reports to the Community Informtion regrding villge or district level performnce indictors is prepred for presenttion to comnunity leders. Key informtion for reporting to communities will include the coverge indictors ("creted vribles" s detiled in Section III.B bove) nd the nutritionl prctice indictors (ssessed in the bseline nd end-of-project surveys nd in the mid-term survey of mothers t rlly sessions). This informtion will ssist in motivting communities to improve ttendnce t rlly sessions nd promoting prticiption of community leders in project ctivities, including supervision of the VHP. A smll opertionl reserch study will be conducted by project stff to ssess the effectiveness of lterntive methods of communiction of the concepts of proportion s n id to feedbck of project performnce indictors. Coverge or helth prctice indictors will be presented using lterntive methods nd comprehension ssessed to compre the success of ech communiction strtegy. The method of presenttion which is selected s most effective will be used routinely by the project in providing feedbck to communities. Project Sttus Reports Project sttus reports will be produced qurterly ccording to IEF hedqurters guidelines for reporting from the field. These reports, which will include summry dt on project performnce indictors, my lso be used to brief the MOH, USAID, or other 13 II/MAAW1 VrrAMAN A PROJMC 2/91

18 gencies regrding project sttus. Project ccounting dt my be incorported into reports to USAID nd IEF hedqurters. Tbulr or grphic disply my be selected for these dt s pproprite. Child Survivl Progrm Reports The project MIS is designed to prepre the dt in formt for reporting to USAID/Wshington in ccordnce with Child Survivl Reporting requirements for nutrition nd vitmin A projects. Updted trget popultion dt, ccounting (including finncil nd commodities) dt, nd coverge estimtes my be bstrcted for CS reporting from the most recent qurterly sttus report. Evlutions The MIS will ssist project stff in prepring for project evlutions. Although only preliminry output will be vilble t the time of the mid-term evlution, dt qulity should be dequte to ssure three to four "rounds" of villge rllies with relible coverge dt by the time of the end-of-projert evlution. Tbulr nd grphic reports of project performnce will be prepred to brief evlutors, who will lso review previous qurterly Project Sttus Reports. 14 /MAMAWI VrrAMMN A PROJECt 2/91

19 V. MALAWI TRIP REPORT (August 3-5, 1990) V.A Introduction The bckground for the VITAL project is described bove. A prototype MIS hd been developed t Community Systems Foundtion by tem heded by Dr. Slly Stnsfield nd Dr. Frnk Zinn prior to the trip. The purpose of this trip wl to introduce the MIS to the IEF/MALAWI Vitmin A project. This introduction included review of the MIS softwre by future users with the gol of developing strtegy for integrting the MIS into locl project ctivities, nd fine-tuning the softwre to best meet locl needs. Stnsfield nd Zinn mde the visit to Lilongwe nd Blntyre from August V.B Description of the MIS The system ws designed nd implemented in FoxPro 1.02 (copyright Fox Softwre, Inc.). The reports were developed nd tested prior to the trip using dt provided by IEF/Mlwi. The system ws designed in wy tht it would meet the mngement needs of the IEF/IEF project, provide stndrd vitmin A project evlution mesures to project dt for reporting purposes, s well s be flexible enough tht it could be esily dpted to other vitmin A interventions. The MIS is designed in Lotus-type menu structure. There re seven min menu options, nd choices underneth ech. The six menu options re INFO, FORMS, DATA, QUALITY, REPORTS, OTHER, EXIT. Ech of these options will be described in limited detil. (The descriptions here refer to the MIS version finlized fter the revisions mde during nd fter this trip). Info. The INFO option provides informtion on the project nd the MIS, s well s descriptions of ech of the menu options. Forms. The FORMS option enbles the user to see the structure of dt collection forms, nd the structure of dt storge. There re six forms tht re used to collect dt 1) bckground nd trining informtion on OMAs, 2) bckground nd trining informtion on HSAs, 3) bckground nd trining informtion on VHPs, 4) the HSA monthly report form, 5) bckground informtion on the villge, nd 6) rlly plnning form. The options in the forms menu re used to disply ech of the forms, the dt structure of ech form, nd the dt qulity checks performed within nd mong forms. Dt The DATA option enbles the user to enter dt into specified form, delete records from specified files nd print out individul forms tht hve been entered into the system. 15 nf/malawi VITAMIN A PROJECT2/91

20 Qulity. The QUALITY option enbles the user to execute dt qulity checks. These checks re identified erlier in this report. Reports. This option enbles the user to generte five stndrd reports. Most of these reports cn be generted for - specified subset of the dt. The stndrd reports re Performnce A summry report tht shows progrm coverge by HSA. Supervision. A report tht shows coverge nd follow-up for ech VHP. This report is ment to be useful in the supervisory meetings between VHPs nd HSAs. PerformnceGrph. A pie chrt presenttion of coverge. Personnel. A report on bckground nd trining of project personnel. Rlly Plnning. A report tht genertes time lines nd check lists for plnned rlly sessions. Other. An option tht performs set-up, verifiction, bck-up nd restore opertions. xit. To exit the MIS or run DOS shell.. V.C Trip Activities August 3 August 4 August 5 August 6 Meeting with USAID to discuss purpose of trip nd VITAL project. Meeting with John Brrows, representtive of IEF-Bethesd Working session with Brrows nd IEF/MALAWI project director, Pul Courtwright to review project nd MIS implementtion strtegy. Working session with Brrows to revise roster forms collection form, nd to revise MIS to reflect input mde during Aug. 4 meeting. Meeting of Stnsfield nd Brrows (Zinn gone) with IEF field stff to review chnges to forms nd reports. 16 niemawi VrrAMIN A PROJECr 2/91

21 V.D Findings nd Conclusion In the meetings tht ddressed the integrtion of the MIS into the project, IEF identified number of importut issues. However, few generl comments should be mde t the strt. First, the MIS is being introduced t n opportune time, in some respects, s the project director is new nd hs not hd chnce to estblish his operting procedures. This should llow n esy doption of the MIS. At the sme time, the input the project director could provide on the design nd implementtion of the MIS ws limited s he hd not yet hd much experience mnging the project. Furthermore, the use of the MIS will be delyed s the project director hd scheduled leve of bsence (from August 4 until erly October), thus delying his involvement in the project. Following re issues identified s importnt to the MIS nd mngement of the project Forms. The tem brought some recommendtions regrding chnges to the reporting forms which would simplify nlysis, result in more ccurte trcking of pregnnt women, s well s trcking of the source of vitmin A cpsules provided to children. As result of these recommendtions, chnges were mde to the forms. Dt Collection A number of dt collection errors were identified through the IEF/MALAWI project dt sent to Ann Arbor. It is cler tht the VHPs need to be better trined in the collection of dt, nd the HSAs must be better trined so they understnding the mening of the numbers entered into the reporting form, nd cn identify certin errors t tht time (see Attchment 10). Reports Locl project personnel were generlly hppy with the MIS nd its reporting outputs. A few reports were removed from the MIS bsed on comments from IEF. For exmple, the MIS development tem hd proposed mpping s possible reporting option. IEF didn't see much prcticl benefit from mpping output, s the project re is so smll. Other reports were revised to reflect dt provided by the new field forms. Finlly, project stff were interested in reports tht would id them in mngement of the project (s opposed to simply meeting reporting requirements). As result, rlly post plnning report ws developed tht would provide ssistnce in scheduling rllies nd provide checklists useful in insuring tht necessry tsks re performed prior to the sessions. V.E Recommendtions It ws decided tht the best pproch to implementing the MIS ws for the chnges to be mde to the forms immeditely. This ws crried out during the trip. The dt collected during August would then be sent to Ann Arbor where it would be used to mke further debugging checks of the MIS. In ddition, the output chnges to the 17 ME/MAAWI VrrAWN A PROJECr2/91

22 MIS will be implemented before erly October, nd the MIS revision nd reporting output will be sent to Mlwi t tht time. The reporting output could lso be used for the project evlution scheduled for erly October. We lso recommend tht the MIS be evluted regulrly nd systemticlly. The system is designed in such wy tht it cn be esily modified to include dditionl dt collection nd reporting cpbilities. The MIS should chnge to ccommodte the needs of the project. These project needs re likely to chnge over time. 18 II/MALAW] VrrAMIN A PROJI CT 2/91

23 AT'ACHMENTS

24 ATTACHMENT1 IEFIMALAW VITAMIN A PROJECT MANAGEMENT INFORMATION SYSTEM STRATEGIES FOR TRACKING DELIVERY OF PROJECT INTERVENTIONS RVTM CMEQ4ANIASOF DELIVEY INDICATORS TAROM DATA SOURCES 1) Seml-nnul Vitmin A supplementtion to chldren 6 months to 6 yrs of ge Mss distribution t vinge rllies followed by home distribution by VHPs for defulters % of children 12 months to 6 yrs of ego who hve received vitmin A Inthe pst 6 months 80% HSAmonth.'yrepots (b ccd rorn VHP rosters)beginning & end of project srve 2) Vitmin A supplementtion of mothers within 2 months of delivery Home distribution by VHPs % of women delivered In pst 12 months who received vitmin A fter delivery 80% HSA monthly re..ols (bmced Irom VHP rosters) Beginning & end of project mveys 3) Promotion of pproprite infnt nd child (4) feeding prctices Helth eduction provided t villge rllies nd during home visits by VHPs trgeted to promote 4 key behviors 1) exclusive brest feeding through 3 months of ge; % of Infnts who re ppropritely fed (exclusively brestfed through 3 months, brestfed throughout infncy nd receiving complementry foods fter 6 months of ge) 90% Beginning nd end of project surveys 2) feeding of children under 6 t lest 4 times per dy % of children months who re fed 4 or more times per dy 50% Beginning nd end of project surveys 3) ddition of errgy-dense foods to every mel for children under 6 nd; % of children months who receive energy dense foods (ol. ft sugr nuts) 4 or more times per dy. 30% Beginning nd end of project surveys 4) ddition of vitmin A-rich foods dily for children under 6 Men number of dys in pst week tht t lest one Vitmin A-rich food is consumed by children 6-71 months. 4 Beginning nd end of project surveys 4) Eye exmintions nd tretment or fr for children under 6 Screening exmintions nd tretment by OMAs t vllge rllies % of children 6-71 months who hve been screened In pst 6 months 75% HSA monthlyreporl (bscted from VHP rosters) Beginning & end of project surveys

25 Attchment 2 IEF/MALAWI VITAMIN A PROJECT DETAILED TASK LIST FOR MIS DEVELOPMENT (VITAL/CSF/IEF) Phse I 1. Specify Monitoring nd Evlution Needs During n initil working session in Ann Arbor, the project tem will review informtion needs for the IEF vitmin A project tem in Mlwi. Tking dt needs into considertion (including reporting, nd for project mngement) nd dt sources (including service delivery setting, project offices nd project personnel), prdigm for informtion flow will be developed nd specific dt inputs nd outputs will be selected. 2. Detiled Review nd Adjustments The drft pln for the MIS will be submitted for review by IEF nd VITAL stff. Approprite chnges will be mde in the MIS bsed on recommendtions from IEF nd VITAL. These reviews nd comments will be communicted by mil, phone nd/or FAX. 3. Define Mnul nd Computerized Systems Ptterns of flow for dt inputs nd outputs for the MIS will be defined in greter detil during meetings with ll project tem members. Instruments for dt collection nd informtion will define the role of ech member of field stff in collecting nd using ech dt element. 4. Specify Systems nd Develop Frmework of Computerized Version CSF will prepre specifictions for computerized dt mngement, including smple menus nd outputs for review. 5. Review Prototype Prototype MIS with menus nd outputs will be reviewed by IEF stff nd VITAL during Wshington meeting. 6. Prepre Mnul Protocol nd Complete Computer Progrm Development 21 MVPM A VITAMIN A PROJECT 2/91

26 Bsed on the review, nd recommended djustments, menus nd outputs will be finlized nd progrmming completed for ech component of the MIS. 7. Digitize Mps To ssist with grphic disply of dt by geogrphic res, mps of the IEF project re will be digitized in preprtion for overly with region or villge-specific dt. 8. Prepre Documenttion Mnuls to be used for reference nd trining in the use of MIS will be prepred prior to their introduction into the field. Phse II 1. Provide for Computer Trining of In-Country Users IEF field stff will provide short course nd/or menu-driven trining softwre for selected project stff to ssure tht they re minimlly "computer literte" prior to introduction of the computerized version of the MIS. 2. Conduct Field Test The first introduction of the MIS in the field will begin with trining provided for Villge Helth Promoters, Helth Surveillnce Assistnts (Supervisors) nd Ophthlmic Medicl systems. Problem identifiction nd resolution of ny "bugs" will occur during the initil two (2) weeks of opertion t the villge levels. Feedbck mechnisms to villge nd Villge Helth PRomoter levels will lso be field-tested nd djustments mde s indicted. Phse III 1. Reformulte nd Prepre Finl Version Bsed on field experience, ny required chnges will be mde in the MIS instruments, mnuls nd softwre. Ech of these elements will be finlized nd duplicted for project use. 2. Prepre Report A summry of ccomplishments nd lessons lerned will be prepred for presenttion to VITAL, USAID nd other potentil users of similr technicl ssistnce. 22 w/mmawi VAMN A PROJECr2/91

27 ORAFT-ImPLEmENTATION SCHEDULE FOR VITAMIN A IN -AAIAU ArTPv-me- - TAHEc TIMESC~jD~t. IN IF-VK.SDows for 1 TAMKS Molw Jun J.I Aug Sop ()e Now Doc Jo Fb Mr Apr My JUA Jul Aug Sep Grmsl 1. RAE NoS mmm.- -wvmm AE mdat "" & 2ov 5 &H 6~ wtw CF. juw M Temfemb & VTAL m 2 pps oouzn. prlemkf o CmpAw Tniro t c 4 2-1*0 oiin-1 I I CsmdW -F;; TUo # 'im M I mw s %+. 14SA 4L OSAA ~i llmovauui & %&w suu Plpm ftprt on mo 4 7 T[T 15msr I 5I08 I i M - Mlwi Gm Guteffol H -Hor~iurs ArCNN

28 Attchment 4 ROSTER OF FAMILIES WITH PREGNANT WOMEN AND CHILDREN UNDER 6 Nmeod Mother Nmes of Cild=n irtht Pst 6th Birthy E N60&" R'd VItAfmm yn Yes No C3 NModw R'd Vit Af m ) Yes No n 0 Sevtcm Atte-ndM 1~f Yes No FU 1 (with nrds) nd Servi -Eh Dwring Fnlcw-up inme 2nid O=rr 3r Ouru 4t Outer Yes No FU YcsNo FU Yes No FU J Vi Nme Moher Nme ~,x Put 6th i Moder Rw'd %tafrom Yes No ModwrR'd VtAfm ut.. Yes No o Yes No FU 2nd..vzif Yes No FU- 3x.i1r Yes No FU 4f ou Yes No IU M thr Nmef NmdPst Nmesc4ofYes Child= zl~ C 6th Modw Rc'd Vit A from No N&6 Rw'd Vl A fm C es1n Yes No Yes No FU 1 u Zthi d S Yes No FU C 3 r d Qurt Yes No FU 0 C Yes 4 Ou it r No FU Nmeo Pst 6th Mdw Rm'd VMtAhm Mmdw Ree'd VitAftUn Nme -C-] o0 YesNo ONODm o Yes No 120 Yes No FU C30 O Yes No F 0 C] 0 C 0 O Yes No FU O-] Yes No O- FU

29 CHIWERENGERO CHA MAKOMO OMWE ALl NDI AMAI APAKATI KOMANSO ANA OCHEPERA ZAKA 6. MAYI MWANA TSIKU LOBADWA TSIKU MAI ANAL- MAI MWANA LOMWE ANDIRA VIT. ANALAN- ANA OBWERA KU KAMPEINI OMWE Al NOI MAKADI NDI WAKWANA A KWA VHP DhIA Vrr. KUVENDERA ANA OMWE SANABWERE ZAKA 6 KAPENA PA A KWINA KAMPEINI KAMPEINI KAMPEINI KAMPEINI KAMPEINI YOYAMBA YACHIWIRI YACHITATU YACHINAI KUYE- K(U~E- KU' - 'UYE. INDE AYI INOE AYI INDE AYI NOFAA INDE AYI NDERA INDE AYI NOERA INDE AYI DERA 0 0 0] S MAY!I MANA KUYE. KJYE. KY- KUYE. INDE AYI INDE AYI INDE AYI NDERA INDE AYI NOERA INDE AYI NDERA INOE AYI NDEPA 0 0 c l C MWANA MAYI i(y. KUYE- KUY.VJE AVI INDE AVI INDE AYI NOERA INDE AYI DEFA [NDE AYI 'DER* INDE AYI ' D - ~~~INDE MWAJA 0 0 KUYE- KUYE- KUYE. KlfVE 12] INDE AY INDE AN'! INDE AYI NOERA INDE AVI NoERA INDE AYI 1OERA INDE AVI OjoA 0 0 ] O ] ] o o o o

30 Attchment 5 HSA MONTHLY REPORT HSA Month/Yer Nme of VHP nd Dte of visit *Households with - children <6 - pregnnt women Totl # Children <6 * Children <6 with crd t lst session # Children <6 receiving services (missed t rlly) during the follow-u- home visit Totl # Mothers with infnts <2mo # Mothers (with infnts <2 mos) given cpsule by VH * Mothers (with infnts <2 mos) given cpsule by other source # Cpsules given to supply VHP Observtions A Z 25 rr ~ -

31 LIPOTI LAPAMWEZI LA MLANGIZI WAZAUMOYO Dzin l HSA Mwezi/Chk Dzin l voluntiy Tsiku loyend m'mudzi # Mkomo omwe li ndi - n <6 yrs - m i p k t i # An onse <6 yrs # Ari <6 mkdi sikelo ulendo wpitwo # An <6 nthwi othndizidw yowyender # Ami onse n ocheper miyezi iwiri* * * * * * # Ami n <2 mos omwe nlndir vit A kw VHP *Mkomomweindi #Ami n <2 mos omwe *Ane6r nlndir vit A kwin kwke Vit A wopelekedw kw VHP 26CC w w vrci * RO r2 Zoon zin ndi zoonj ezer * 2 * * A 2/9

32 ATTACHMENT 6 RALLY EYE EXAMINATION FORM Totl Conjunctivitis Trchom II Xerothlmi II III Ctrct Cornel ulcer Trichisis Other Other T.E.O Used T.E.O Returned 27 nie/mawi VrrAMN A PROJCr2/91

33 Attchment 7 MID-TERM SURVEY VILLAGE DATE FOR EVERY CHILD UNDER 6, COMPLETE THE QUESTIONS IN THE COLUMN FOR THE CHILD'S AGE (MORE THAN ONE CHILD MAY BE INCLUDED ON ONE FORM) AGE 0-5 mos 6-11 mos mos mos 1) Rod to Yes No Yes No Yes No Yes No Helth crd?[ ] [ ] [ ] [ ] [ ] [ ] [ ] ] 2) Dte of birth? 3) Did mother receive Yes No Yes No vit A fter deliver [) [] [] [] t helth fcility (non-project source)? 4) Did mother receive Yes No Yes No vit A within 2 mos. [] [) [] [ ] of delivery from the VHP or t villge rlly? 5) Is child brest fed?yes No Yes No Yes No 6) Does child receive Yes No Yes No Yes No other foods? [(] [- ) ] [1 (] [3] 7) How mny times dy is the child fed[) ( [ 3 [] [3 ] [31 ] in ddition to brestfeeding)? 8) How mny of the lst 7 dys hs the child eten green leves (nkwrii, bonongwe, cssv, gonni bwino,phundi, nsngow, chitmbe, dundw, kholow, khwny, khombwe), crrots, dzungu, ppy, or mngo? (circle ll tht ny child hs eten)? 9) How mny times per dy does this child [] [3] [] [] [] [] et some oil, ft, sugr, or groundnuts (circle ll tht ny child ets)? 10) H. this child's Yes No Yes No Yes No Yes No child's mother (-] [(] [-3 [-1 [3] [3-] [3] [ received ny teching from the VHP bout feeding her children? 11) If so, bout wht subjects hs she received teching from the VHP? 12) In wht foods is vitmin A found? 28 nw/mia vrramin A PROJECF 2/91

34 IILLAGE Attchment 8 BASE LINE SURVEY FORM DATE FOR EVERY CHILD UNDER 6, COMPLETE THE QUESTIONS IN THE COLUMN FOR THE HILD'S AGE (MORE THAN ONE CHILD MAY BE INCLUDED ON ONE FORM) AGE 0-5 mos 6-11 mos mos mos BORN 13/Apr/89-13/Oct/88-13/Oct/87 +3/Oct/83 12/Oct/89 12/Apr/89 12/Oct/88 12/Oct/87 1) Rod to Yes No Yes No Yes No Yes No Helth Crd? [] (] [) [] [] [ [] [] 2) Dte of birth? 3) Hd DTP3, polio 3, nd mesles before Yes No ge 12mos? (mesles dte? ) [) [-) 4) Did mother receive Yes No Yes No vita within 2 mos. [] [J] [31 [(] of delivery of this child (by history)? 5) Is child Yes No Yes No Yes No Brest fed? I-) [3] [3) [3] [3] [3] 6) Does child receive Yes No Yes No Yes No other foods? [] [) [) [-) [1-] [-) 7) How mny times dy is the child [3 [3 [3 [] [3 [] [3 [* fed? 8) How mny of the lst 7 dys hs the child eten green leves (nkwni, bonongwe, cssv), crrots, dzungu, ppy, or mngo? (circle ll tht ny child hs eten)? 9) How mny times per dy does this child [1 I]3 [L] [-] [.J et some oil, ft, sugr, or groundnuts (circle ll tht ny child ets)? 10) Hs child hd his Yes No Yes No Yes No eyes exmined by (3] [- [- [-] [(] [.] helth worker (by history) since 13/Apr? 11) Hs this child Yes No Yes No received dose of [] (] [-] [3] vitmin Adocumented) since 13/April? 12) Any evidence of Yes No Yes No trchom? 3 [3] (3 [ 29 MIMAIAWI VTrAMN APROJEC 2/91

35 Attchment 9 IEF MALAWI VITAMIN A PROJECT BASELINE SURVEY RESULTS (October 1989) Children Surveyed Infnts (0-11 mos) mos mos Totl Coverge Dt Rod to Helth Crds (0-71 mos) Fully Immunized (12-23 mos) Vitmin A to mothers of infnts (within 2 mos of delivery) Vitmin A to children (12-71 mos) (within pst 6 mos) Eye exm of children 6-71 mos (within pst 6 mos) Prevlence of Nutritionl Prctices Brestfeeding of infnts (0-11m) Brestfeeding mos Complementry foods 0-2 mos Complementry foods 3-5 mos Complementry foods 6-11 mos Approprite" infnt feeding Feeding 4 or more times per dy (24-71 mos) Energy-dense foods t lest 4x/dy 6-11 mos mos mos / % 106/ % 92/ % 94/ % 131/ % 255/ % 163/ % 38/ % 57/ % 113/ % 207/ % 128/ % 7/ % 22/ % 52/ % "Approprite" infnt feeding is defined s brestfed throughout infncy, never bottlefed, solely brestfed if less thn 3 mos, nd receiving complementry foods if 6 mos or older. 30 P/ftMAWWVITAMIN A PROJECT 2/91

36 Attchment 9 (continued) PERCENT OF HOUSEHOLDS REPORTING USE OF VITAMIN A-RICH AND ENERGY-DENSE FOODS FOR FEEDING CHILDREN 6-71 MOS Averge Frequency of Consumption of Vitmin A Rich Foods (men number of dys in pst week t lest one food eten) 6-11 mos mos mos Trchom Prevlence mos Vitmin A-Rich Foods Nkwni (pumpkin leves) Bonongwe Cssv leves Crrots Dzungu (pumpkin) Ppy Mngo 219/ / / / % 446/ % 196/ % 99/ % 3/ % 219/ % 331/ % 212/ % Energy-Dense Foods Oil Ft Sugr Groundnuts 150/ % 291/ % 419/ % 368/ % 31 E/NAAW VIAMIN A PROJECF 2/91

37 Attchment 10 HSA SUPERVISORY REPORT QUALITY CHECKS 1. Ask the VHP if there re ny new fmilies, pregnncies (*), deliveries, children who hve pssed their sixth birthdy (check the pproprite box), deths (---), or out-migrtions (X) which hve not yet been recorded. Assure tht both birth dte nd dte of deth re recorded for ny infnt who brethed or cried prior to deth. 2. Check the counts of children under 6 nd mothers of infnts under 2 months of ge by writing down todys dte nd ) subtrcting 6 yers, ssuring tht only children whose birthdte is fter this dte re included in the count (check the box on the roster for ny child who psses his sixth birthdy). b) subtrcting 2 months, ssuring tht only the mothers of infnts whose birthdte is fter this dte re included in the count. 3. Be sure tht the number of trget households does not exceed the number of children under six plus the number of pregnnt women. 4. Be sure tht the number of children who received services (children under 6 with crds t the lst session plus those who received services during home visits) does not exceed the totl number of children under Be sure tht the number of mothers who received vitmin A within 2 months of delivery (those who received from the VHP or rllies plus those who receive vitmin A from other sources) does not exceed the totl number of mothers with infnts less thn 2 months of ge (unless n infnt hs died since the mother received vitmin A). 32 P/MMAAW1 VrrAMN A PROJECI 2/91