Introduction
Methods
Landscape analysis methodological process
Assessment tool development
Assessment of sites using MNCH data collection systems through semi-structured interviews: piloting the VPASS Assessment Tool.
Results
VPASS Assessment tool domains
Domain | Brief description and Reporting suggestion |
---|---|
Purpose of the system | Description of the uses of the data obtained by the system such as surveillance, research and/or, clinical care |
Geographical location | Name of the site or sites currently using the system for MNCH data collection such as country, city, region or district |
Scale of implementation | System coverage scale at the site such as National, Provincial, Regional, district, etc |
Experience in MNCH data collection | Time of system use at the site in months or years |
MNCH variables under surveillance | List of MNCH variables/outcomes collected routinely: GAIA Maternal and Neonatal Outcome Case Definitions [21] |
Data capture place | Where the data collection takes place such as at health facility or at community level |
Level of data disaggregation | Whether the data is aggregated or disaggregated (individual data) |
Method and frequency of data collection | If the Data is collected prospectively or retrospectively. If it is collected routinely and without interruption or only under specific circumstances |
Data capture format | Whether the data is captured onto an electronic form and/or paper based |
Data standardization on MNCH variables | If the system and site comply with applicable standards for data formats and coding schemes; and explain if relevant |
Newborn follow-up | Whether they follow up newborns and for how long (in days, weeks, or months) |
Representativeness | If they follow the whole population or if there are groups that are systematically excluded from the reporting system. Explain if relevant |
Reliability | Possibility to link between identifier number (ID) of the mother and identifier number (ID) of the newborn |
Integration with other registers | Capability to integrate data with other health registers such as registers that provide vaccine-related information (i.e., vaccine type, number of doses, injection site) |
Feasibility of adding new variables | Whether the site can implement new healthcare coding standards (e.g., ICD-10) or new MNCH variables; and explain if relevant |
Data management policies | If they comply with applicable federal and state statutes and regulations |
Data confidentiality | Whether the procedures to ensure patient privacy and data confidentiality are in place |
Staff training | Whether those operating the system receive training and what type of training |
Site experience in MNCH active safety surveillance | Explain if the site has performed MNCH active safety surveillance |
Availability of baseline data | Report if the site has baseline data for potential use when conducting active safety surveillance |
Internal data quality monitoring | If the site or system perform a real-time internal data validation during the data entry process; include explanation if relevant |
External data quality monitoring | Whether they perform external/audits assessments for data validation; and how |
Data quality and data completeness (*) | If data quality and data completeness is appropriate enough to the point, they can support active safety surveillance |
Timeliness (*) | Whether the time between crucial data reporting steps appropriate is appropriate |
Assessment of sites using MNCH data collection systems
Assessment tool domain | MNCH DATA COLLECTION SYSTEM | |||||
---|---|---|---|---|---|---|
DHIS-2 Purpose: Clinical Care | INDEPTH Purpose: Clinical Care | GNMNHR Purpose: Research | ||||
Geographical location | Rwanda | Uganda | Burkina Faso | Mozambique | Zambia | India |
Scale of implementation | National Level | National Level | District level (Nanoro) | District level (Manhica Health Research Center) | Province level (Lusaka) | Village level (Belagavi) |
MNCH variables under surveillance | See Supplementary Material | |||||
Data capture place | Health facilities and community level | Health facilities and community level | Community level only | Health facilities and community level | Mainly at health facilities | Health facilities and community level |
Level of data disaggregation | Individual data | Only aggregated data | Only aggregated data | Individual data | Individual data | Individual data |
Methods and frequency of data collection | Prospectively and regularly | Prospectively and regularly | Retrospectively and regularly | Retrospectively and regularly | Prospectively but only for research purposes | Prospectively but only for research purposes |
Data capture format | Mainly electronic | Electronic and paper based | Mainly paper based (Electronic only during specific projects) | Mainly paper based (Electronic only during specific projects) | Switching from paper based to electronic format (through REDCap) | Switching from paper based to electronic format (through REDCap) |
Data standardization on MNCH variables | Yes. Based on ICD 10 standard code | Yes. Based on ICD 10 standard code | Yes. Based on ICD 10 standard code | Yes. Based on ICD 10 standard code | Not based on ICD or MedDRA standard codes | Not based on ICD or MedDRA standard codes |
Newborn’s follow up | Routine follow-up of newborns for 6 months postpartum | Newborn’s individual information is not routinely collected after delivery | Newborn’s individual information is not routinely collected after delivery | Routine follow-up of newborns for 6 months postpartum. (Childs followed up on regular rounds every six months) | Routine follow-up of newborns for 6 weeks postpartum | Routine follow-up of newborns for 6 weeks postpartum |
Data management policies | All sites comply with applicable data management national regulations | |||||
Data confidentiality | All sites use encryption of personal data | |||||
Data quality monitoring | All sites perform internal and external monitoring for data quality | |||||
Representativeness | In all sites no specific pregnant population is systematically excluded | |||||
Reliability | Possible to link Mother ID with newborn ID | It is not yet possible to link Mother ID with newborn ID | Possible to link Mother ID with newborn ID | Possible to link Mother ID with newborn ID | Possible to link Mother ID with newborn ID | Possible to link Mother ID with newborn ID |
Integration with other registers | Yes. It is possible to integrate MNCH individual data with electronic immunization registries [22] | Not yet possible for MNCH data | Not yet possible for MNCH data | Yes. It is possible to integrate MNCH individual data with local medical registries at health facilities | Not routinely (it requires permission from RTI) | Not routinely (it requires permission from RTI) |
Feasibility of adding new MNCH variables | Yes, it is possible | Yes, it is possible | Not enough information | Yes, it is possible | Yes, it is possible | Yes, it is possible |
Staff training | Yes. All sites provide continuous training to their staff | |||||
Experience in MNCH individual data collection | It collects MNCH individual data since 2017 (previously, only aggregate data were collected) | Not applicable since it only collects aggregated information | Not applicable since it only collects aggregated information | It collects MNCH individual data since 2016 | It collects MNCH individual data since 2008, when the Maternal Newborn Health Registry (MNHR) was created | |
Baseline data available | Yes, for all the variables collected | Yes, but only aggregated information for maternal and neonatal deaths | Yes, but only aggregated information for maternal and neonatal deaths | Yes, for all the variables collected | Yes, for all the variables collected | Yes, for all the variables collected |
Previous experience in MNCH active safety surveillance | No previous experience | No previous experience | No previous experience | No previous experience | Yes, but only within research context | Yes, but only within research context |
DHIS2 sites
“I think the biggest challenge we have is related to real-time data capture. I say this because vaccination is happening in almost every district and its wide. But we are not able to capture data in real-time. So, we are to enter it into the paper and then turn it into data entry, so we are not able to scale it to all the facilities”"You need to have people on the ground to be able to enter data, it requires technological support in terms Internet connectivity… So then also the skill set and skill levels, can all these health workers be trained to use the new technology” (Uganda, DHIS2).
"Since the DHIS2 implementation at the national level in 2012, we are using it at all levels, including private facilities. So, all public facilities are using it. Private facilities are using it and the other sites that are linked to the Ministry of Health. The ministry really encourages all partners and stakeholders to support the HMIS system, which is DHIS2" (Rwanda, DHI2)
GNMNHR sites
"It's not a national registry. It's within Lusaka, but within that vast Lusaka, it covers quite a number of 10 health centers, which is quite representative of the country. Most of the information collected can be extrapolated to a predictable extent." (Zambia, GNMNHR)
“If we just look into the process, it will start from the annual household survey. Our auxiliary social health advocates visit houses to see to it that any pregnancy should not get missed. So, we will register all the pregnant women. Additionally, we follow them up not only to delivery, but 42 days post-delivery” (Belagavi, GNMNHR)
INDEPTH sites
"As you may know, not all of the population or women will attend the health facility for the national health system; we may miss some of the population. So actually, HDSS, uh, let's see, a coverage gap and what we are collecting is actually births and pregnancies." (Burkina Faso, INDEPTH)"So, for some group of neighborhoods, we identified a key informant. So we visit them in order to collect the information or events that happened between our rounds. They collect information about their neighbors or their households or people who live in the neighborhood,". (Mozambique, INDEPTH)