From data to action: Using Service Performance Assessment and Improvement (SPAI) process to promote utilization of HIV & AIDS data generated through Lot Quality Assurance Sampling (LQAS) survey. Experiences from East Central Uganda

1. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
From data to action: Using Service Performance Assessment
and Improvement (SPAI) process to promote utilization of HIV
& AIDS data generated through Lot Quality Assurance
Sampling (LQAS) survey .
Experiences from East central Uganda
Authors: Presentation to the
Odong Tonny, Denis Businge Capacity Building Summit,
todong@starecuganda.org Birchwood Conference Center,
Johannesburg, South Africa.
21st March 2013

2. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Background to STAR- EC
 A five years (2009-2014) program funded
by USG through USAID
 Implemented by JSI Research & Training
Institute Inc.(JSI) in collaboration with
Ministry of Health-Uganda
 Serves about 9% of the country’s
population (Approx. 3.1m people)
 Works through district based structures
and Civil Society Organizations (CSOs)
 Operates in 9 Districts of East Central
The 9 districts served: Uganda
Bugiri, Buyende, Namutumba, Namayingo,
Mayuge, Iganga, Luuka, Kamuli & Kaliro
Program goal: To increase access to, coverage of, and utilization of quality and comprehensive
HIV&AIDS and TB prevention, care and treatment services

3. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Description of context
 Many community based HIV & AIDS and TB programs /
projects often gathers a lot of data
These data are generated from multiple sources such as;
- Routine disease surveillance
- Health facility records
- Surveys
Annually, STAR – EC conducts survey using Lot Quality
Assurance Sampling ( LQAS) technique
The first survey focusing on TB and HIV & AIDS indicators was
conducted in 2009 and this generated a lot of data
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4. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Description of context .
 However, most lay program implementers have limited capacity
to make meaning out of the available data
 Thus the use of data to influence key decisions is severely
affected
Methodology
 In 2010, Management Sciences for Health (MSH) / STAR- E
LQAS project introduced SPAI process in East Central Uganda
as a technique to promote data utilization
 STAR – EC applied this technique on 2010 LQAS survey
results
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5. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Key steps undertaken in SPAI process
 District based program implementers ( who formed SPAI team)
were convened for 5 days residential workshop.
 The list of all indicators that were investigated during 2010
LQAS survey was provided to the team
 The team thoroughly reviewed the indicators and identified
those that were poorly performed as well as the sub- counties
affected
 The affected indicators and sub- counties were later prioritized
for performance improvement
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6. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Key steps cont…..
Example of how indicators and sub- counties were prioritized
Indicator Target Of all sub counties
surveyed, Sub- counties
scoring below target
1.Proportion of men who know a mother can 59% Bunya A, B and E
transmit HIV to her infant during pregnancy
2. % of adults (15years and above) who have 57% Bunya B and C
ever taken an HIV test
Bunya A, B and E
3. % of adults (15 + years ) who know a 57%
place where to get ARVs for HIV patients
( Bunya B and E
Priority sub- counties for intervention
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7. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Key steps cont….
 The team later conducted constraint analysis by discussing the
factors leading to poor uptake of HIV Testing and Counseling
(HTC) services in the affected sub counties
 The next step involved target and objective setting of the desired
health situation that the district needs to achieve ( e.g. achieve
70% population tested for HIV)
 Next, the team developed Performance Improvement ( PI)
strategy by looking at critical activities and means to deliver
them. E.g. training of health workers, creation of more out reaches for HTC services,
effective mobilization for HTC services, supplies- timely requisition of HIV test kits, better
records management, infrastructural development etc.
 Lastly, the team developed performance improvement and
monitoring plans
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8. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
An extract of PI plan generated during SPAI process
Strategy PI Activities Planned Respo Critical Source of Time Frame
Element Products nsible PI Critical
for PI Perso Resources Resources
n Requirem Start End
ents Date Date
1.Training Training in HCT 4 training Dr. One STAR-EC, 24th 8th April
sessions of 30 Muwa Vehicle, MOH, January 2011
1.1 Identification & training of trainers
participants nguzi Fuel , SDS 2011
1.2 Identification & invitation of Facilitators of the completed Venue,
TOT Facilitator
1.3 Identification & invitation of trainee participants s,
Stationery,
1.4 Identification & hire of venue Perdiem,fu
1.5 Training of health workers in HCT el,Vehicle,
Venue,
Training of health workers in comprehensive 2 trainings of 30 th th
11 13 May
HIV/AIDS care participants each April 2011
1.1 Identification & training of trainers undertaken 2011
1.2 Identification & invitation of Facilitators of the
TOT
1.3 Identification & invitation of trainee participants
1.4 Identification & hire of venue
1.5 Training of health workers in HCT

9. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Results
STAR-EC LQAS results: 2010-2012
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10. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Challenges
 SPAI process requires trained facilitators to guide the lay program
implementers
 SPAI can best be conducted in a workshop setting thus need for funds to run
the workshop
 Activities and strategies proposed needs to be implemented using the
available resources in the district but program implementers tend to think of
external funding
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11. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Lessons Learned
SPAI is a good approach that;
- Enable lay program implementers to discuss and analyze data
- Identify health service gaps & set priorities
- Come up with action plans to address the gaps
- Promotes service uptake through data utilization
Collaboration between implementing partners is critical to
introduce good practices in HIV intervention
Conclusion
Data generated through LQAS surveys and other means are relevant
only if the data can be used to effect change.
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12. Strengthening TB and HIV&AIDS
Responses in East Central Uganda
Acknowledgement
 Government of Uganda (GoU)
 USAID
 JSI / STAR- EC
 MSH/STAR- E LQAS
 EC district SPAI teams & Program implementers