dhis2-users team mailing list archive

[Knut Staring <knutst@xxxxxxxxx>]

Smart Paper Forms "integrated with DHIS2, CRVS, LMIS"

---------- Forwarded message ---------
From: Rustam Nabiev <shifoclub@xxxxxxxxx>
Date: Wed, Sep 12, 2018 at 7:35 PM
Subject: Re: External evaluation results of MyChild Solution based on Smart
Paper Technology in Afghanistan
To: BID Initiative Discussions <bidinitiative@xxxxxxxxxxxxxxxx>


Dear Chilunga,
The biggest challenge was to take away existing paper forms from health
workers' work processes. Once that was done, health workers were keen on
using Smart Paper Forms and we didn't encounter resistance from them. On
the contrary, health workers were keen to integrate the new solution as
part of their daily routines, they seem to love it and we understand why.
I would equally love it if someone created a solution which would
potentially save 60-70% of my routine admin time.

When MoPH was informed about the total cost of ownership, data quality,
admin time saved for health workers and other benefits of Smart Paper
Technology, MoPH decided to take away existing paper forms (registers,
tally sheets, monthly reporting forms) from health worker's work processes.

Regarding transfer/integration of new work processes into existing health
system structure, it took some time to figure out locally adapted processes
to update, print, distribute and archive Smart Paper Forms. It was also
important to monitor whether health workers were able to build capacity to
new team members and community health workers how to properly use Smart
Paper Forms, which we measure by amount of errors made per month. It was
also possible to transfer maintenance of scanning stations, as scanning
stations are placed in district/provincial health office. We know that
continuous technical support and continuous need for capacity building are
two big bottlenecks for sustaining eHealth interventions.

What we are learning at this stage is how to build a capability of the
health system to do continuous quality improvement to improve quality of
care (this is Shifo's understanding of data use). It's incredibly important
to get this right, as it can have a big potential in improving quality
of care and health outcomes.

Shifo's target is that 95% of health facilities would be doing continuous
quality improvement to improve indicators that are below the target. Let's
see if Shifo's Data4Action interventions can help in reaching that target.

Smart Paper Technology is a solution to digitise hand-recorded smart paper
forms, which would create Electronic Birth and Immunisation Register for
each health facility. Smart Paper Technology has a potential to digitise
health records within Primary Healthcare. Smart paper forms are used at the
point of health service delivery to register individual children, assign
unique ID and record delivery of child health services. Smart Paper
Forms are then scanned and digitised at the scanning centre, and processed,
after which digital data is generated and integrated with DHIS2, CRVS, LMIS
and other systems. Here is a short description of how this machine works:
https://shifo.org/doc/rmnch/RNMCHSolutionProcess.pdf

Hope I answered your questions.

Kind regards
Rustam


On Wednesday, September 12, 2018 at 5:24:40 PM UTC+2, cputa wrote:
>
> This is fantastic work and certainly very encouraging results. Were there
> any challenges related to change management as we have observed that even a
> good intervention can be limited by health worker perceptions and
> attitudes. Did you have to deal with any resistance? If so how did you
> address it? I am really interested in the practical issues of implementing
> such a program.
>
> Thanks
>
> Chilunga
>
>
>
> *From:* bidini...@xxxxxxxxxxxxxxxx [mailto:bidini...@xxxxxxxxxxxxxxxx] *On
> Behalf Of *Rustam Nabiev
> *Sent:* 12 September 2018 13:10
> *To:* BID Initiative Discussions <bidini...@xxxxxxxxxxxxxxxx>
> *Subject:* External evaluation results of MyChild Solution based on Smart
> Paper Technology in Afghanistan
>
>
>
> *External evaluation results of MyChild Solution based on Smart Paper
> Technology in Afghanistan. Assessing data quality, operational costs,
> efficiency gains and transfer of work processes to the existing health
> system.*
>
>
>
> In 2015, the Shifo Foundation, the Swedish Committee for Afghanistan
> (SCA), IKEA Foundation, and the Ministry of Public Health (MoPH) in
> Afghanistan started a joint collaboration to strengthen child health
> services in Afghanistan. Data and information are fundamental to inform
> decisions and assist key stakeholders to allocate appropriate resources to
> continuously improve the quality of health services. Therefore, one of the
> main objectives of the collaboration was to strengthen the quality of data
> and its utilisation in the Expanded Programme on Immunisation using an
> innovation based on Smart Paper Technology called MyChild Solution.
>
> MyChild Solution is an innovation developed by Shifo Foundation based on
> Smart Paper Technology. The solution was implemented and evaluated to
> inform evidence-based decisions on the scale up of the programme. MyChild
> Solution was implemented in 141 health service delivery points including
> fixed, outreached, and mobile clinics in the Mehterlam District of Laghman
> Province in Afghanistan. Currently, using MyChild Solution, more than 45,000
> children have ben registered, more than 9,000 children are fully vaccinated
> and 10,000 children are being followed up with SMS messages
> <https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fshifo.org%2Fen%2Fwork%2Fafghanistan%2F&data=02%7C01%7Ccputa%40path.org%7Cef6f42a890124065bf9208d618a03851%7C29ca3f4f6d6749a5a001e1db48252717%7C0%7C0%7C636723473805131387&sdata=AxEgzJVwNkK23MqWUlt0uQRD%2FMoGprtZcFBXGwXiEYo%3D&reserved=0> which
> inform parents about vaccination schedules.
>
> From the beginning of the programme, project stakeholders set several
> programme key success indicators which informed project development and
> external evaluations. These success indicators measured data quality such
> as completeness of data, timeliness, internal consistency, and
> external consistency and analysed if MyChild Solution could be integrated
> into the existing health system, thus sustained by the government.
>
> In June 2018,  two external evaluations were conducted to assess data
> quality, operational costs, and efficiency gains as well as transfer of
> work processes to the existing health system. This article summarises the
> results of these external evaluation reports.
>
> The data quality and review toolkit
> <https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fapps.who.int%2Firis%2Fbitstream%2Fhandle%2F10665%2F259224%2F9789241512725-eng.pdf%3Bjsessionid%3D93469D7B1437BBF829B24E4B1E748352%3Fsequence%3D1&data=02%7C01%7Ccputa%40path.org%7Cef6f42a890124065bf9208d618a03851%7C29ca3f4f6d6749a5a001e1db48252717%7C0%7C0%7C636723473805131387&sdata=XGWfPmdzSsfmZF0Qwgx17KDAT3LgWgInnIcT%2F4NpPFE%3D&reserved=0> developed
> by World Health Organisation was used to evaluate the quality of data
> generated by MyChild Solution. The assessment showed high quality data
> generated from MyChild Solution in every indicator, including: completeness
> (100%), timeliness (91,66%), internal consistency (100%), and external
> consistency (99,4%). Moreover, the ratio of data recording error was low in
> the study and ranged from 0.05% to 1.7% for two selected data recording
> errors.
>
> The second evaluation investigated time efficiency. This evaluation
> assessed the time health workers spent on administrative tasks during and
> after delivery of care with MyChild Solution and compared the results with
> existing Health Management Information (HMIS) tools. Results showed that
> 64% to 96% of time spent on administration could be reduced with MyChild
> Solution when compared to the current HMIS.
>
> Incremental cost analysis was done considering two scenarios. The first
> scenario took into account the monetary value of the reduced time for
> administration whereas the second scenario was conducted without the time
> reduction values. The evaluation also took into account two versions of the
> MyChild Solution. The first evaluation assessed MyChild Forms which is an
> innovation on facility-based data management tools. The second evaluation
> assessed MyChild Card which is an innovation modelled after the child
> health card.
>
> When adding the value of the reduced administration time, the total
> national cost of MyChild Card was 611,974 USD and the total national cost
> of MyChild Forms was 316,436 USD. Comparatively, the existing HMIS total
> national cost was 873,253 USD. Over a five-year period, MyChild Forms would
> save around 2,938,543 USD and MyChild Card would save around 1,378,875 USD
> compared to the existing HMIS system. When administration time is removed
> from the analysis, MyChild Card (501,622 USD) and MyChild Forms (206,126
> USD) amounted to be more costly than HMIS forms (195,581 USD). It is
> noteworthy that when administration time is excluded from the analysis,
> MyChild Forms were 5% more expensive than HMIS.
>
> The second report displayed the results of the transfer of work processes
> to the existing health system. This is one of the key elements to evaluate
> sustainability of the programme as well as how successful management was
> done by the local stakeholders in Afghanistan.
>
> The results indicate that 95% of the processes essential to the management
> of MyChild Solution had been transferred to the local stakeholders in
> Mehterlam District. In most cases, these processes had been transferred in
> a way that is both accurate and sustainable. The remaining 5% of processes
> are planned to be fully transferred to Mehterlam by the end of 2018.
>
> The external evaluation reports provide information on the effects of
> MyChild Solution from four different perspectives which give valuable
> insights to key stakeholders. These perspectives are data quality, cost,
> efficiency gains and transfer of work processes to the local level.
>
> Based on the findings derived from these external evaluations Shifo, SCA,
> and MoPH will collaborate to further expand and investigate the
> intervention on a broader level to inform decision making for the
> sub-national implementation of the programme. The programme positively
> addressed all the key success metrics set in 2015 and brings opportunities
> to empower health and social workers at all levels of healthcare delivery who continuously
> work to improve quality of child health services across the country based
> on reliable and relevant information.
>
> The full reports and additional information about MyChild Solution can be
> accessed using these links below:
>
> 1) Questing The MyChild Solution in Afghanistan- An external evaluation
> of Data Quality, Operational Cost and Efficiency:
>
>  https://shifo.org/doc/rmnch/MyChildExternalEvaluationAfghanistan2018.pdf
> <https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fshifo.org%2Fdoc%2Frmnch%2FMyChildExternalEvaluationAfghanistan2018.pdf&data=02%7C01%7Ccputa%40path.org%7Cef6f42a890124065bf9208d618a03851%7C29ca3f4f6d6749a5a001e1db48252717%7C0%7C0%7C636723473805141388&sdata=mEd3UTF5PEe9U5jPZ4GXD3ZBSGqXTaWnwhozL%2BsA0BQ%3D&reserved=0>
>
> 2) MyChild Solution in Afghanistan: An External Evaluation - Transfer of
> Work Processes to Existing Health System:
> https://shifo.org/doc/rmnch/ShifoExternalEvaluationTransferProcessAfghanistan.pdf
> <https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fshifo.org%2Fdoc%2Frmnch%2FShifoExternalEvaluationTransferProcessAfghanistan.pdf&data=02%7C01%7Ccputa%40path.org%7Cef6f42a890124065bf9208d618a03851%7C29ca3f4f6d6749a5a001e1db48252717%7C0%7C0%7C636723473805141388&sdata=9wUxIDfJeHGvPtLYPeP8eHi4Av4C%2FCbdRzmxRsupuLE%3D&reserved=0>
>
> 3) About MyChild Solution based on Smart Paper Technology:
> https://shifo.org/en/solution/
> <https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fshifo.org%2Fen%2Fsolution%2F&data=02%7C01%7Ccputa%40path.org%7Cef6f42a890124065bf9208d618a03851%7C29ca3f4f6d6749a5a001e1db48252717%7C0%7C0%7C636723473805151393&sdata=M0p1VNWSSY7MlEwxqVvBik3A0400kY0Jv113RjJBn2w%3D&reserved=0>
>
>
> 4) Project progress in Afghanistan: https://shifo.org/en/work/afghanistan/
> <https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fshifo.org%2Fen%2Fwork%2Fafghanistan%2F&data=02%7C01%7Ccputa%40path.org%7Cef6f42a890124065bf9208d618a03851%7C29ca3f4f6d6749a5a001e1db48252717%7C0%7C0%7C636723473805151393&sdata=t9ZNDm%2F%2B%2FaZoMIOpGL1oOAcXZ%2FHwTlgyS%2FJO4PLCmsg%3D&reserved=0>
>
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Knut Staring

Department of Information, Evidence and Research
World Health Organization, Geneva, Switzerland
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