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Data Matters

Posted on by Amalia Benke, MPH, Health Scientist, Global Immunization Division
Amalia Benke, MPH, Health Scientist, Global Immunization Division
Amalia Benke, MPH, Health Scientist, Global Immunization Division

Frontline health workers have incredibly tough jobs. Almost always they have competing priorities, with only a limited number of resources at their disposal. These are the doctors, nurses and support staff who work at the point of care. These are the people who deliver our babies, help keep us healthy, and heal us when we are sick.

Because health workers have so many competing priorities, certain less visible tasks –like recording and reporting of health data—can slip through the cracks. When people don’t know where they fit into the bigger picture, time-consuming and tedious tasks like recording vaccine doses in a child health register can seem trivial. They might not realize how the data they collect and report are used to monitor, evaluate, and improve health services and why the accuracy of the data is so important.

The health of a population is supported by strong health systems. Reliable, high quality data are needed in order to allocate resources and make strategic decisions about program planning and policy development. . Without high quality data, kids can miss out on essential, basic preventive care like vaccines. Just over 50% of children in Uganda are fully vaccinated, leaving many of them and their communities vulnerable to preventable but deadly diseases.

Uganda vax coveragePoor quality data can lead to a multitude of problems for health programs. For example, if the number of vaccines given in a certain month at a health facility is under-reported to the district office responsible for vaccine forecasting and purchasing, that health facility is likely to experience stock outs of essential, life-saving vaccines. In addition, if data are recorded poorly at the health facility level, it’s impossible to have high-quality data at all other levels of the health information system.

It is often said that the first step in improving something is to admit that there is a problem. But how do you know if you have a problem with data quality? In 2013, Uganda’s Ministry of Health (MOH) conducted a Data Quality Self-Assessment to better understand the causes of poor immunization data quality in the country. The self-assessment provided several recommendations on how to improve the quality of immunization data. To help address these challenges, CDC partnered with WHO-Uganda, UNICEF, the Uganda EPI program (UNEPI), the MOH and other stakeholders to develop the Data Improvement Teams (DIT) strategy.

What makes a good Data Improvement Teams mentor?

  • A good mentor must be able to provide SMART (Specific, Measurable, Achievable, Realistic and Time-bound) recommendations that are immediately actionable, and
  • She or he must be able to communicate feedback to health workers and district staff in a constructive way that fosters mutual trust and respect.

Through the DIT strategy, Makerere University School of Public Health students and district staff involved with disease detection, immunization, and biostatistics are trained by CDC and partners. The objective of the interactive, hands-on training is to give DIT trainees the capacity and tools needed to improve immunization data quality through mentorship and oversight. Then they are deployed for five days to assess immunization data quality at health facilities and the district health office using a simple action-oriented approach to providing mentorship to local staff and recommendations on improving data quality.

The purpose of doing an assessment at each health facility and district health office is to demonstrate to frontline health workers and district staff where they fit into the larger health puzzle and why their recording and reporting are essential contributions to program planning and policy development.

DIT districts mapIn November 2014, the DIT strategy first launched in Soroti and Hoima Regions (see map), and 13 teams were trained and sent to work at the district level. To date, DITs have visited and provided mentorship to health workers at more than 1500 health facilities in Uganda and staff at all 56 districts. Depending on the challenges identified, mentorship can focus on topics ranging from data recording, reporting, analysis, interpretation and use.

Accurate recording of data is the first step to improving immunization data quality and enables the EPI program to make programmatic decisions based on reliable data. Data should be used at all levels of the system to make evidence-based decisions and take action, from the lowest to highest levels of the system. When data only get reported upward, opportunities can be missed to immediately improve access to and utilization of health services at the health facility level. For example, if health facility staff analyze the health facility data using monitoring charts and update them regularly, they are better able to determine how many children have missed scheduled vaccinations and can determine how to reach unvaccinated children.

The DIT strategy aims to not only identify challenges related to data quality at the health facility and district level, but also to determine the root causes of data quality issues. What we’re finding is that data quality issues stem from a variety of different causes – from lack of knowledge on how to correctly record immunization data, to not having enough standard data collection tools available, to not having enough resources to physically send the monthly report to the district level (sometimes health facilities are very far away from the district office). There’s no magic bullet to improve data quality, and it’s important to understand the root causes in order to develop targeted, specific and immediately actionable recommendations. Emphasizing the importance of every person’s contribution is also critical; being part of such a large health system, it’s easy to feel lost and unimportant.

The need for high-quality data has never been greater. At the end of the day, improved data quality means that mothers, children, and families will have better access to improved health services. With the DIT strategy only partially implemented, it’s difficult to quantify any immediate results. However, from on-the-ground experience, I can say that we are making progress – with all credit due to the men and women who fully dedicate themselves to improving public health.

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Posted on by Amalia Benke, MPH, Health Scientist, Global Immunization Division2 CommentsTags , , ,

Working collaboratively to support Ebola response efforts in Sierra Leone

CDC’s FETP partnerships with African nations continue to be leveraged beyond their national borders and for new and unexpected health threats. Dr. Bao-Ping’s blog posted originally on March 31 is being highlighted again as a reminder of how FETPs support global as well as individual nation’s health security. In late November 2014, during the peak Read More >

Posted on by Bao-Ping Zhu, MD, PhD, MS, CDC Epidemiologist and Uganda FETP Resident AdvisorLeave a commentTags , , , , ,

CDC Observes World Environment Day

A woman and child outside their home threatened by frequent flooding. Photo reprinted with permission from Southern Illinois University, Carbondale, photo taken by Genna Ord

Climate change is any significant variation in temperature, precipitation, wind, or other type of weather that lasts for decades or longer. World Environment Day is celebrated every year on June 5 to raise global awareness to take positive environmental action to protect nature and the planet Earth. It is run by the United Nations Environment Read More >

Posted on by Rosland Martin, CDC National Center for Environmental Health1 CommentTags , , , , ,

If We Can Measure It, We Can Manage It: Tracking the Global Tobacco Epidemic

Field interviewer interviewing a participant for GATS Bangladesh 2009

Identified as the most preventable causes of death and disease in the world, the tobacco use epidemic is expanding to many low-and middle-income countries. Approximately 6 million people die annually from tobacco. To put this into perspective, the number of annual deaths from tobacco is equivalent to 2,699 Titanic ships sinking every year. Surveillance has Read More >

Posted on by Lauren Bartell, MPH, CHES and Emily Ridgway, MPHLeave a commentTags , ,

High blood pressure, also known as hypertension, has become a global crisis

Patient at the Edgar Cochrane Polyclinic in Barbados having her blood pressure taken.

In the United States, 67 million or 1 in 3 adults have high blood pressure (>140/90 mmHg), and only about half of these adults have their condition under control. Worldwide, high blood pressure is estimated to cause 9 million preventable deaths, and is expected to increase. Commonly referred to as the “silent killer” because it Read More >

Posted on by Pragna Patel, MD, MPH (CGH) and Barbara A. Bowman, PhD (NCCDPHP)1 CommentTags , ,

CDC Innovations: Real-Time Data Strengthens Uganda’s Efforts to End Mother-to-Child HIV Transmission

PMTCT infant

Identifying opportunities to improve global health sometimes requires creative thinking and new collaborations. In Uganda, the Centers for Disease Control and Prevention (CDC) exemplified this approach in developing a strategy to use the Emergency Operations Center (EOC) in Kampala – established with CDC’s assistance in 2013 – to help eliminate mother-to-child HIV transmission (MTCT). “The Read More >

Posted on by Betty Kagoro and Erik Friedly, CDC-UgandaLeave a commentTags , ,

World Malaria Day 2015

Figure 2: An antique rug beater.

World Malaria Day falls on Saturday this year, so I’ll spend some part of the day catching up on household chores. I can sometimes find moments of inspiration in the mental space created by simple tasks like running the vacuum cleaner. This year, malaria endemic countries and their global partners are reflecting on the remarkable Read More >

Posted on by S. Patrick Kachur, MD, MPH, FACPM, Chief, Malaria Branch, Division of Parasitic Diseases and MalariaLeave a commentTags

What I Saw as a Child Led Me to Champion Vaccines Today

Young Afghan children playing after receiving their polio vaccines during vaccination campaigns in 2014. ©Misgina Suba Abraha/UNICEF.

This post is part of the #ProtectingKids blog series. Read the whole series here. Living as a child in Kabul, Afghanistan in the 1970’s meant going to the bazaar on the weekends with my parents. My two sisters and I would climb in the back of our Volkswagen Kombi and my father would drive us Read More >

Posted on by Rebecca Martin, PhD, Director, Global Immunization Division1 CommentTags , ,

Stopping Ebola by Land, Water and Air

Photo credit: Justin Williams/CDC

This blog was originally posted on Huffington Post on February 18, 2015. Speed is paramount in our response to the Ebola epidemic in West Africa as we continue to be vigilant in the fight to extinguish Ebola. The faster we get to communities with suspected cases, the faster we protect the people there. That gets us Read More >

Posted on by Dr. Tom Frieden, MD, MPHLeave a commentTags , ,

Food Safety: A changing landscape in a global world

World Health Day 2015

The food supply in the United States is constantly evolving. U.S. consumers want convenience, choice, and diversity in the foods they eat. The U.S. is importing more food than ever before in order to meet these demands. In 2009, imported food accounted for 17% of food consumed by Americans (up from 15% in 2004). [1] Read More >

Posted on by Laura Burnworth and Suzie Heitfeld3 CommentsTags , ,