PEPFAR/CDC Site Monitoring System Goal and Objectives
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1 PEPFAR/CDC Site Monitoring System Goal and Objectives Goal: To standardize clinical site quality monitoring by PEPFAR/CDC in-country staff through assessment and scoring of site performance on key program area elements. Objectives: o Monitor clinical site capacity to provide high-quality HIV/AIDS services in all program areas o Identify quality gaps and make recommendations for improvement o Demonstrate CDC s accountability for its funded activities and ensure maximum return on investment o Strengthen capacity for clinical site monitoring among Ministries of Health and PEPFAR-funded implementing partners
2 PEPFAR/CDC Site Monitoring System Assessment Approach Comprehensive yet rapid assessment Not an in-depth evaluation or full-scale supervision visit Identify pressing issues requiring remediation or more intensive evaluation Can be completed by 2-3 CDC staff in 2-3 hours Cross-training of staff required to limit size of teams Focus on issues that directly impact service quality Capitalize on presence at site Emphasis on direct observation of clinic processes, operating procedures, infrastructure, register and medical record review, etc. Data useful at the site level but can also be aggregated for use at program/country level
3 PEPFAR/CDC Site Monitoring System Assessment Tool HQ and field technical staff determined key standards of care for HIV service delivery across program areas (based on international standards and normative guidance) to form the basis of a rapid site quality assessment Program Area = Assessment Standard = Domain Core Essential Element (CEE) 7 (1 optional) Med Management 3 3 (1 optional) 2 Supportive supervision 1 5 (1 optional) 4 Waste management 1 oratory 6 (1 optional) Injection safety 1
4 DOMAIN Core Essential Element (CEE) DOMAIN Core Essential Element (CEE) AD_CTX_PT Patient tracking MED_MGMT_SCR Supply chain reliability AD_CTX_AS Adherence support MED_MGMT_SCM Supply chain management AD_CTX_CTX Cotrimoxazole MED_MGMT_MED Medication dispensing AD_CTX_ART ART eligibility AD_CTX_PHDP PHDP TB_HIV_SCRN TB screening AD_CTX_NA Nutritional assessment TB_HIV_IC TB infection control AD_CTX_REF (Optional) Reference materials TB_HIV_IPT (Optional) IPT PD_CTX_CTX Pediatric care and treatment LAB_BIOSAFE Biosafety PD_CTX_TB Pediatric TB screening LAB_TI Testing interruptions PD_CTX_GM Growth monitoring LAB_TEST_SOP Test SOPs PD_CTX_SC Pediatric supply chain reliability LAB_QTM Quality Testing Monitoring LAB_QMS Quality Management Systems (QMS) _HIV_TC Routine HIV testing LAB_SPUTUM (Optional) Sputum microscopy _ANC in ANC _CTX CTX for pregnant women WASTE_MGMT Waste management _PITC PITC at maternity _ARV_LD ARVs at L&D INJ_SAFE Injection safety _ARV_HEI ARV prophylaxis for HEIs _EID EID QM_QI_SYS system _CTX_HEI CTX for HEIs QM_QI_PERF Performance review _SC Supply chain reliability for SS Supportive supervision _IC Informed consent Monitoring & Evaluation _AE_MGMT Adverse event management PLAN_TRGT Targets TC_ MON_REG Registers TC_QA HIV testing QA MON_MED_RECS Medical records TC_DOC documentation MON_DQA Data quality assurance REP_RES Results reporting
5 PEPFAR/CDC Site Monitoring System Implementation CDC staff conducted SMS visits to clinical sites receiving direct support (via a CDC-funded implementing partner) for service delivery, and only those program areas supported by CDC were assessed on a site visit. Sampling of sites (e.g. by performance, volume, and location) and accrual of site visits varied by country, so summary data should not be compared across countries. Results from each site visit were summarized in a dashboard and discussed with site staff in an out-brief session. Information from SMS assessments were used to guide improvements at sites and among implementing partners. These data show results of initial SMS visits conducted between July 2012 and June 2014 to more than 4,100 sites in 21 countries.
6 PEPFAR/CDC Site Monitoring System Lessons Learned Monitoring service delivery at the site level is essential to ensuring high quality program implementation and maximizing the return on investment. Comprehensive and pragmatic tools that allow rapid assessment of site performance are integral to sustainability of systematic site supervision. SMS has helped build local institutional capacity to conduct site and partner monitoring and use of performance data to guide programmatic decision-making.
7 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; 21 Countries (4,137 sites)*
8 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Botswana (36 sites)* Domain not assessed
9 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Cambodia (55 sites)* Domain not assessed
10 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Cameroon (243 sites)* Domain not assessed
11 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Cote d Ivoire (97 sites)* Domain not assessed
12 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; DRC (284 sites)*
13 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Ethiopia (173 sites)*
14 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Guyana (32 sites)* Domain not assessed
15 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Haiti (231 sites)* Domain not assessed
16 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Kenya (820 sites)*
17 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Lesotho (79 sites)* Domain not assessed Domain not assessed Domain not assessed
18 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Malawi (108 sites)*
19 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Mozambique (131 sites)*
20 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Namibia (50 sites)*
21 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Nigeria (385 sites)* Domain not assessed
22 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; South Africa (406 sites)*
23 ** ** CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Swaziland (38 sites)* ** and supported by PEPFAR, but not by CDC.
24 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Tanzania (374 sites)*
25 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Uganda (373 sites)*
26 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Vietnam (96 sites)* Domain not assessed
27 CDC Site Monitoring System - Initial Site Visits July 2012 June 2014; Zambia (75 sites)* Domain not assessed
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