Cash Transfers for Improved Maternal and Child Health Data: A Pilot Study Supporting Health Management Information System in Malawi

Background The health management information system (HMIS) is an integral component of a strong health care system. Despite its importance for decision-making, the quality of HMIS data remains of concern in low- and middle-income countries. To address challenges with the quality of maternal and child health (MCH) data gathered within Malawi's HMIS, we designed a pilot study consisting of performing regular cash transfers to district-level HMIS offices. We hypothesized that providing regular cash transfers to HMIS offices would empower staff to establish strategies and priorities based on local context, consequently obtaining and maintaining accurate, timely, and complete MCH data. Methods The pilot intervention was implemented in Mwanza district, while Chikwawa, Neno, and Ntchisi districts served as control sites. The intervention consisted of providing cash transfers to Mwanza's HMIS office following the submission of detailed budgets and lists of planned activities with their respective targets and outputs. In the control districts, we performed regular interviews with the HMIS officers to track the HMIS-related activities. We evaluated the intervention by comparing data quality between the post-intervention and pre-intervention periods in the intervention and control districts. Additionally, we conducted interviews with Mwanza's HMIS office staff to determine the acceptability and appropriateness of the intervention. Results Following the 10-month intervention period, we observed improvements in MCH data quality in the intervention district (Mwanza). The availability and completeness of MCH data collected in the registers increased by 22% and 18%, respectively. The consistency of MCH data between summary reports and electronic HMIS improved from 73–94%. The qualitative interviews confirmed that, despite some challenges, the intervention was well received by the participating HMIS office. Participants preferred our strategy to other conventional ways of supporting HMIS that fail to give HMIS offices the independence to make decisions. Conclusions This pilot intervention demonstrated an alternative approach to support HMIS offices in their daily efforts to improve data quality. Given the Ministry of Health (MoH)'s interest in strengthening its HMIS, our intervention provides a strategy that the MoH and local and international partners could consider to rapidly improve HMIS data with minimal oversight.

Midwives' Acceptance of Using mHealth to Improve Data Quality of a Maternal and Child Health Program (Preprint)

BACKGROUND Maternal and child health (MCH) remains an important agenda item in the Sustainable Development Goals (SDGs). Unfortunately, despite strong commitments, the maternal mortality ratio in Indonesia remains high. Program performance, particularly good midwife performance, is the main factor that can reduce the maternal mortality ratio. Improving midwife performance must be supported by the availability of data or evidence. However, midwives still experience problems with data collection in the MCH program. OBJECTIVE This study aimed to strengthen the quality of maternal and child health (MCH) data produced by mHealth. METHODS Three research avenues were evaluated: a) ensuring quality data are produced, b) building mHealth to fit the needs of midwives so that mHealth is acceptable to midwives, and c) identifying challenges midwives face when using mHealth RESULTS The MCH data generated by mHealth met the data quality criteria consisting of data completeness, correctness, currentness, and consistency. Midwives in the villages showed enthusiasm for using mHealth and accepted the mHealth which is supports their daily work. One of the challenges of using mHealth is the lack of integration with the Community Health Center information system. CONCLUSIONS The mHealth system produces quality data that can improve the current poor data quality, and this application can be easily used by midwives. The midwives generally accepted the application and agreed that mHealth helps with their daily work in MCH services CLINICALTRIAL This research has obtained ethical permission from the ethics commission of the Public Health Faculty Universitas Indonesia register number 477/UN2.F10/PPM.00.02/2019.

Knowledge, Attitude and Practice of Health workers in Using Health Information Management System in Volta and Eastern Regions, Ghana: Findings from the Pre- and Post-Surveys (Preprint)

BACKGROUND Despite the increasing attention to electronic health record (EHR) system in the field of global health, most African countries still depend on inconvenient and inaccurate paper-based system. Good Neighbors International and Evaluate 4 Health have recently supported Ghana Health Service (GHS) on rollout of EHR system called e-Tracker in two Regions in Ghana -- Volta (recently renamed to Oti and Volta Regions), and Eastern Regions. The e-Tracker is an Android-based tracker capture app that collects maternal and child health (MCH) data electronically and transmit the data into the District Health Information Management System (DHIMS)-2 managed by District Health Offices in Ghana. The GHS has implemented this new mHealth program in the Community Health Planning and Services (CHPS) in the three regions. OBJECTIVE This study aims to evaluate the improved capacity and behavioral change of health workers in using an EHR technology, the e-Tracker system to deliver MCH services. Specifically, this study assesses the changes in Knowledge, Attitude, and Practice (KAP) of the health workers towards MCH data management by comparing the pre- and post-survey results. METHODS To assess behavioral change towards the e-Tracker system, KAP of frontline health workers were measured through self-administered surveys before and after implementing the e-Tracker system. The surveys were conducted among participants of the e-Tracker system training sessions, with a purposive sampling scheme. A total of 1,124 health workers from Volta and Eastern Regions participated in both pre- and post-surveys. This study used McNemar's Chi-Square test and Wilcoxon signed-rank test for a pre-post comparison analysis. Random-effects ordered logistic regression analysis and random effects panel analysis were also conducted to identify factors associated with the level of KAP. RESULTS The results of the pre-post comparison analysis showed significant improvement in the Knowledge and Practice levels, but the positive response to the Attitude(acceptability) towards electronic data management were reduced compared to the pre-survey. The result of random-effects ordered logistic regression showed that 'days of overwork' was significantly associated with health worker’s Attitude towards this emergent e-Tacker system. CONCLUSIONS In Ghana, the e-Tracker system is planned to be scaled up nationally, increasing the need to evaluate its impact on MCH data management, and user's Attitude for sustainable utilization of the new technology. This study provides empirical evidence that the e-Tracker system has a positive impact on health workers' KAP in managing MCH data. The findings imply that using a tablet computer-based e-Tracker system could enhance Knowledge and Practice on MCH data management. However, efforts to increase acceptability of the new technology among health workers are necessary for sustainable usage of the e-Tracker system and its scale-up.

Effectiveness of e-Tracker System in Strengthening Health Information System in Volta and Eastern Regions, Ghana: Findings from the Pre- and Post-Surveys (Preprint)

BACKGROUND Despite the increasing attention to electronic health record (EHR) system in the field of global health, most African countries still depend on inconvenient and inaccurate paper-based system. Good Neighbors International and Evaluate 4 Health have recently supported Ghana Health Service (GHS) rollout its EHR system called e-Tracker in three Regions in Ghana -- Upper East, Volta (recently renamed to Oti and Volta Regions), and Eastern Regions. The e-Tracker is an Android-based tracker capture app to collect maternal and child health (MCH) data electronically and transmit the data into the District Health Information Management System (DHIMS)-2 managed by District Health Offices in Ghana. This mHealth program has been implemented in the Community Health Planning and Services (CHPS) in the three Regions. OBJECTIVE The aim of this study is to evaluate whether the use of the e-Tracker system has been effective in improving the quality of MCH data management in Ghana. Specifically, this study assesses changes in the knowledge, attitude and practice (KAP) of the health workers regarding MCH data management by comparing the pre- and post-survey results. METHODS To assess the effectiveness of the e-Tracker system, KAP of frontline health workers were measured through self-administered surveys before and after the implementation of the e-Tracker system. The surveys were conducted among participants of the e-Tracker system training sessions, with a purposive sampling scheme. A total of 1,124 health workers from Volta and Eastern Regions participated in both pre- and post-surveys. McNemar’s Chi-Square test, Wilcoxon signed-rank test were used for a pre-post comparison analysis. Also conducted were random-effects ordered logistic regression and random effects panel analysis. RESULTS The results of the pre-post comparison analysis showed significant improvement in the Knowledge and Practice levels. However, the level of Attitude towards electronic data management has worsened compared to the pre-survey when they hadn’t start to use the e-tracker system. The results of the regression analyses showed that demographic and environmental factors had impact on Attitude and Practice. These findings imply that using a tablet PC-based e-Tracker system could enhance the health data management system in Ghana but external support would be needed to improve Attitude towards the emergent system. CONCLUSIONS In Ghana, the e-Tracker system is to be scaled up nationally, increasing the need to evaluate its capability and sustainability more comprehensively and rigorously. This study provides empirical evidence for the effectiveness of the e-Tracker system and some policy implications for a nation-wide scale-up of the mHealth system. This study may also provide insights for other African countries regarding strengthening health data management and health information system. CLINICALTRIAL null

Description Data Completeness in Maternal & Child Health (MCH) Handbook in Temanggung Regency

Background: Maternal mortality rate in Central Java in 2015 was still high, at 111 / 100,000 live births. Therefore developed a method for early detection of the cause of death in “Desa Siaga“ Program. In this program include a community-based surveillance. Sources of primary data recording surveillance activities are MCH handbook. Therefore it needs to know how the completeness of MCH handbook as a basis for the development of surveillance system in the villageMethod: Data collection techniques using observations with the checklist instrument to describe data completeness MCH handbook. Population study is MCH handbook what owned by Mothers who have children under five. Samples were MCH handbook in 31 villages with category Active “ Desa Siaga” in the working area three health centers in the district of Temanggung.Results: The average of data completeness in MCH Handbook was 45.29%. For 13 MCH Handbook section was observed, there are only 3 parts completeness above 50%, Ten other parts percentage is less than 50%. Conclusion: There are many data that useful for screening high risk pregnant woman and nutrition growth are incomplete. Incomplete data in MCH Data shown that data is not be urgent in MCH Services. Data in MCH Handbook couldn’t be database for MCH Surveillance in “Desa Siaga “ Program