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Comparing a paper based monitoring and evaluation system to a mHealth system to support the national community health worker programme, South Africa: an evaluation.

Neupane S, Odendaal W, Friedman I, Jassat W, Schneider H, Doherty T - BMC Med Inform Decis Mak (2014)

Bottom Line: Clinical referrals, data accuracy and supervised visits were compared and analysed for the paper and phone systems.The most common error that occurred was summing the total number of visits and/or activities across the five household activity indicators.Few supervised home visits were recorded in either system and there was no evidence of the team leader following up on the automatic notifications received on their cell phones.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa. sunisha.neupane@gmail.com.

ABSTRACT

Background: In an attempt to address a complex disease burden, including improving progress towards MDGs 4 and 5, South Africa recently introduced a re-engineered Primary Health Care (PHC) strategy, which has led to the development of a national community health worker (CHW) programme. The present study explored the development of a cell phone-based and paper-based monitoring and evaluation (M&E) system to support the work of the CHWs.

Methods: One sub-district in the North West province was identified for the evaluation. One outreach team comprising ten CHWs maintained both the paper forms and mHealth system to record household data on community-based services. A comparative analysis was done to calculate the correspondence between the paper and phone records. A focus group discussion was conducted with the CHWs. Clinical referrals, data accuracy and supervised visits were compared and analysed for the paper and phone systems.

Results: Compared to the mHealth system where data accuracy was assured, 40% of the CHWs showed a consistently high level (>90% correspondence) of data transfer accuracy on paper. Overall, there was an improvement over time, and by the fifth month, all CHWs achieved a correspondence of 90% or above between phone and paper data. The most common error that occurred was summing the total number of visits and/or activities across the five household activity indicators. Few supervised home visits were recorded in either system and there was no evidence of the team leader following up on the automatic notifications received on their cell phones.

Conclusions: The evaluation emphasizes the need for regular supervision for both systems and rigorous and ongoing assessments of data quality for the paper system. Formalization of a mHealth M&E system for PHC outreach teams delivering community based services could offer greater accuracy of M&E and enhance supervision systems for CHWs.

Show MeSH
Clinical referrals and back referrals. Proportion of the referrals addressed and captured on the phone and the paper system. Referrals addressed on the paper system exceeds 100% due to accumulation of previous months` referrals, which were brought into the clinics in the successive month.
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Figure 4: Clinical referrals and back referrals. Proportion of the referrals addressed and captured on the phone and the paper system. Referrals addressed on the paper system exceeds 100% due to accumulation of previous months` referrals, which were brought into the clinics in the successive month.

Mentions: The proportion of referrals to the health facilities that were completed using phone and paper records respectively is illustrated in Figure 4. In the last three months, the paper data shows that more back referrals were received than referrals made. This was due to accumulation of previous months’ referrals, which were not brought in to the clinics in the same month (indicated from the mHealth data). The phone system was able to link each individual referral to its outcome, whilst in the paper system, the total count of forms sent to the clinic and forms returned to the CHW was done but these forms were not linked. This resulted in referral completion rates of over 100% on paper data (Figure 4).


Comparing a paper based monitoring and evaluation system to a mHealth system to support the national community health worker programme, South Africa: an evaluation.

Neupane S, Odendaal W, Friedman I, Jassat W, Schneider H, Doherty T - BMC Med Inform Decis Mak (2014)

Clinical referrals and back referrals. Proportion of the referrals addressed and captured on the phone and the paper system. Referrals addressed on the paper system exceeds 100% due to accumulation of previous months` referrals, which were brought into the clinics in the successive month.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4150556&req=5

Figure 4: Clinical referrals and back referrals. Proportion of the referrals addressed and captured on the phone and the paper system. Referrals addressed on the paper system exceeds 100% due to accumulation of previous months` referrals, which were brought into the clinics in the successive month.
Mentions: The proportion of referrals to the health facilities that were completed using phone and paper records respectively is illustrated in Figure 4. In the last three months, the paper data shows that more back referrals were received than referrals made. This was due to accumulation of previous months’ referrals, which were not brought in to the clinics in the same month (indicated from the mHealth data). The phone system was able to link each individual referral to its outcome, whilst in the paper system, the total count of forms sent to the clinic and forms returned to the CHW was done but these forms were not linked. This resulted in referral completion rates of over 100% on paper data (Figure 4).

Bottom Line: Clinical referrals, data accuracy and supervised visits were compared and analysed for the paper and phone systems.The most common error that occurred was summing the total number of visits and/or activities across the five household activity indicators.Few supervised home visits were recorded in either system and there was no evidence of the team leader following up on the automatic notifications received on their cell phones.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Public Health, University of the Western Cape, Cape Town, South Africa. sunisha.neupane@gmail.com.

ABSTRACT

Background: In an attempt to address a complex disease burden, including improving progress towards MDGs 4 and 5, South Africa recently introduced a re-engineered Primary Health Care (PHC) strategy, which has led to the development of a national community health worker (CHW) programme. The present study explored the development of a cell phone-based and paper-based monitoring and evaluation (M&E) system to support the work of the CHWs.

Methods: One sub-district in the North West province was identified for the evaluation. One outreach team comprising ten CHWs maintained both the paper forms and mHealth system to record household data on community-based services. A comparative analysis was done to calculate the correspondence between the paper and phone records. A focus group discussion was conducted with the CHWs. Clinical referrals, data accuracy and supervised visits were compared and analysed for the paper and phone systems.

Results: Compared to the mHealth system where data accuracy was assured, 40% of the CHWs showed a consistently high level (>90% correspondence) of data transfer accuracy on paper. Overall, there was an improvement over time, and by the fifth month, all CHWs achieved a correspondence of 90% or above between phone and paper data. The most common error that occurred was summing the total number of visits and/or activities across the five household activity indicators. Few supervised home visits were recorded in either system and there was no evidence of the team leader following up on the automatic notifications received on their cell phones.

Conclusions: The evaluation emphasizes the need for regular supervision for both systems and rigorous and ongoing assessments of data quality for the paper system. Formalization of a mHealth M&E system for PHC outreach teams delivering community based services could offer greater accuracy of M&E and enhance supervision systems for CHWs.

Show MeSH