Group 3

External Data Quality Assurance and

Revised 33 New Health Indicators
 

1
 GROUP MEMBERS
1.Abdu Mohammed
2. Abduselam Seid
3. Eliyas Birhanu
4. Ebrahim Ahmed
5. Hadi Murah
6. Mekides Zegeye
7. Mohammed Amin Hannewi
 
2
 Outline
• Define Health System
• Health system building block
• Overview of old and new indicators
• Data quality and quality assurance

3
 Health System

• A health system is the sum total of all organizations,

people, resources and all activities whose primary
purpose is to promote health, to restore or maintain
health
=> To protect or improve health

4
Health System Building Blocks

5
 Health information system (HIS)

• HIS refers to any system that captures, stores, manages or

transmits information related to the health of individuals or
the activities of organizations, which will improve health care
management decisions at all levels of the health system
• Product: Availability and use of reliable and timely
information on health determinants, health systems
performance and health status.

6
Domains of Measurement …

Indicators
Health Information Data Sources

Administrative
Census records

Vital
registration Services
records

Pop based Individual

surveys records

Population-based Institution-based

8
 Sources of data…
Data sources of the Ethiopian HIS:
 Community level: CHIS, surveys and different household
studies
 Facility level (HCs, Hosp. Private Facilities): Routine HMIS
report & surveillance report (PHEM), facility based researches
and surveys
 Woreda, Zonal and Regional levels: HMIS, Surveillance data,
administrative data, surveys
 National level: HMIS, Census, demographic and health surveys
(DHS), national household surveys, different national level
researches, modeling and estimates
9
 Health Management Information System (HMIS)

• Health Management Information System (HMIS): is the

routine collection, aggregation, analysis, presentation and
utilization of health and health related data for evidence based
decisions for health workers, managers, policy makers and
others

10
Health Management Information System (HMIS)……

Purposes of HMIS:

• Availing accurate, timely and complete data to support

decision making at each level of the health system

• Strengthening the use of locally generated data for evidence

based decision making

11
Components of HMIS
Information management
• Data collection: Recording of health data using
individual and family folder, registers, tally and
reporting formats
• Data processing: is a process of cleaning, entering
and aggregation of data.
• Data analysis and presentation: is a process of
interpretation and comparison of generated
information in the form of sentence, tables and
graphs.
12
Components of HMIS…

Using information for management purposes

• Problem identification: identifying problems using key
indicators
• Prioritizing problems and decision making : Problems identified
should be prioritized and decide what types of actions need to
be taken.
• Action taking: Implementing the agreed action.
• Result monitoring: Assessing the desired result has been
achieved.

13
HMIS Indicator Revision-2017
Process: Why and How?

14
The rationale for the current indicator revision

 Gap in monitoring HSTP and annual health sector performance using

the existing indicators
 Emerging of new initiatives and programs( NICU, Emergency and
critical care, New vaccines (IPV,HPV1&2,MCV2,), NNP…..
 Focus on new priorities in health system (Emerging diseases and
expansion of control programs (NCDs and NTD)
 Focus on Quality, equity and universal health coverage
Moreover, it will be a good opportunity to review the gaps or limitations of
existing lists of core HMIS indicators & make corrections accordingly
 Indicator revision Guiding principle

• Consistent with HSTP (strategic objectives and

indicators)
• Consistent with international and national standards
• Feasibility (in terms of cost, time, data burden, ...)
• In line with the basic principles of health Information
System
• The significance of the indicator should be justifiable
• Participatory process
 Methods followed during revision
• National Advisory committee discussed on the need for indicator revision &
established TWG
• Document review
– Existing HMIS indicators
– HSTP indicators
– International indicators(WHO 100 Global set of indicators, SDG indicators…)
– Program implementation manuals/strategies (NNP, AYHS, Quality
strategy…..)
– Program modification( HIV(Test and treat, three 90’s, EPI……)
• TWG discussed with program experts on proposed indicators
• Five day Consultative workshop conducted on draft indicator list
• A one-to-one discussion held on the final draft list at Ministerial level
• The final indicator list presented for MoH council of directorate and endorsed.
Summary of the major changes of the revised
HMIS-2017

Changes on:
 Indicators

 Registers
 Tally sheets

 Reporting formats

18
 Revised HMIS indicators
2014_HMIS
2017_HMIS
Tt Indicator:122
Tt indicators:131

Continued: 83 Modified: 15 Dropped: 24

New:33
 MCH&DPC indicators

Program area Old HMIS_2014 Revised HMIS_2017

Maternal Health 13 14
PMTCT 7 7
EPI 10 13
Child health 5 8
Nutrition 6 8
HIV 14 10
TB 16 15
TB/HIV 5 4
Leprosy 3 3
NCD 5 3
NTD 2 2
Malaria 5 5
All disease 3 3
Total MCH&DPC indicator 94 95
 MCH&DPC indicators

Program area Existing Modified New Total

Maternal Health 12 2 14
PMTCT 4 2 1 7
EPI 8 5 13
Child health 5 1 2 8
Nutrition 4 2 2 8
HIV 5 2 3 10
TB 6 5 4 15
TB/HIV 4 0 0 4
Leprosy 3 3
NCD 2 1 3
NTD 1 1 2
Malaria 5 5
All disease 3 3
Total MCH&DPC indicator 62 12 21 95
 Health system and Other program indicators summary
Program area Old HMIS_2014 Revised HMIS_2017
Hygiene and environmental health 3 2

Resource mobilization and utilization 4 4

Health insurance 0 3
Quality of health service 6 8
Pharmaceutical supply and service 1 4

Evidence based decision making 4 3

Health infrastructure 4 4
Human capital and leadership 4 4
Regulatory 0 1
Community ownership 2 3
Total 28 36
 Health system and Other program indicators(36)
Program area Existing Modified New Total
Hygiene and environmental health 2 2

Resource mobilization and utilization 3 1 4

Health insurance 3 3

Quality of health service 3 1 4 8

Pharmaceutical supply and service - 1 3 4

Evidence based decision making 3 3

Health infrastructure 4 4
Human capital and leadership 4 4
Regulatory 1 1
Community ownership 2 1 3
Total 21 3 12 36
 HMIS Indicator Reference Guide: Categorization

C1: Improve Access to Health Services (97 indicators)

C2: Community Ownership (3 indicators)
F1. Resource Mobilization and Utilization (4 indicators)
F2. Health Insurance (3 indicators)
P1. Quality of health Services (8 indicators)
P2. Pharmaceutical Supply and Services (4 indicators)
P3. Evidence Based Decision making (3 indicators)
CB1. Health Infrastructure (4 indicators)
CB2. Human Capital and leadership (4 indicators)
CB3. Regulatory System (1 indicator)
Health Data Quality
 Presentation Outline
• Introduction to Basic Concepts, definitions of data
Information & Data Quality
– Importance of data quality
– Symptoms of data quality problems
• Dimensions of data quality
• Data quality assurance techniques
– Lot quality assurance technique
– Visual Scanning
– RDQA
 objectives
• General
– …provide knowledge and skills to enable health care workers,
health information managers, and administrators at all levels to
improve quality of health care data in all its dimensions
• Specific
– To improve health care workers and administrators
understanding of concepts and issues related to data quality
– To familiarize Health workers and Managers on Major data
quality dimensions
– Demonstrate processes and techniques for assessing and
addressing gaps in data quality
– Improve skills of health care workers and Health managers on
conducting different data quality assurance techniques
The Knowledge
Kno Spectrum
wle
dge
(know
how,
understand
ing,
insight,
experience

Information , Intuition,
and
contextuali
zed
informatio categorized,
(contextualized,
n)
calculated and condensed)

Data
(Facts and figures which relay something specific, but
which are not organized in any way)
 What Is Data Quality?
• Data quality is often defined as “fitness for use.”

• What does this mean?

 Data are fit for their intended uses in operations, decision
making, and planning.
 Data reflect real value or true performance.

 Data meet reasonable standards when checked against

criteria for quality.

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 Importance of Data Quality- for patient/Client

• …more likely to receive better and safer care if healthcare

professionals have access to accurate and reliable data to support
decision making.
• Access to accurate and reliable data such as the results of
investigations, allergies, potential drug interactions or past
medical history supports healthcare professionals provide care
that is appropriate to assessed needs.

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 Con't…

• Service users are more likely to receive better

care if performance data used to support
quality improvement is of good quality and
reflects actual performance.
 Importance of Data Quality-for health care providers and managers

• Form an accurate picture of health needs, programs, and services

in specific areas
• Inform appropriate planning and decision making (such as
staffing requirements and planning healthcare services)
• Inform effective and efficient allocation of resources
• Support ongoing monitoring, by identifying best practices and
areas where support and corrective measures are needed

32
 Symptoms of Data Quality Problems

 Different people supply different answers to the same question.

 Data are not collected in a standardized way or objectively
measured.
 Staff suspect that the information is unreliable, but they have no
way of proving it.
 There are parallel data systems to collect the same indicator.

33
 Symptoms of Data Quality Problems (2)

 Data management operational processes are not documented.

 Data collection and reporting tools are not standardized;
different groups have their own formats.
 Too many resources (money, time, and effort) are allocated to
investigate and correct faults after the fact.
 Mistakes are spotted by external stakeholders (during audits).

34
 What Is Data Quality Assurance?

A systematic monitoring and evaluation of data to uncover

inconsistencies in the data and data management system, and
making necessary corrections to ensure quality of data

35
Data Quality Dimensions
Accuracy
and
validity

Accessib
Reliability
ility

Data
Quality
Complet Legibilit
eness y

Timeline
ss
 Accuracy
• Original data must be accurate in order to be useful
• Documentation should reflect the event as it actually
happened
Examples of Accurate Data Examples of Accuracy Checks (Computer
Systems)
• All relevant facts pertaining to the • For hospital or health center patients, the
episode of care are accurately date of admission must be the same as or
recorded earlier than the date of discharge.
• The vital signs are what were • A laboratory value must fall within a certain
originally recorded and are within range of numbers or a validity check must be
acceptable value parameters, which carried out.
have been predetermined and the • Consistency edits can be developed to
entry meets this value compare fields – for example a male patient
cannot receive a pregnancy test.
 Reliability(Consistency)
• Yielding the same results on repeated collection,
processing, storing and display of information
• Examples of reliability/consistency
– ICD diagnosis on Patient form should be the same with
diagnosis written on OPD abstract register
– The demographic information of the patient recorded on
integrated individual folder is the same as that recorded
on other medical forms within integrated folder.
Reliability(Consistency): What to check?
Outliers (within bounds) detection
– Eg. Check for outliers of selected data elements by comparing with previous months

report

Trends in reporting over time, to identify extreme or implausible values month-

to-month or year-to-year
– Eg. Currently on ART: check current month with previous month report

Compare with other indicators with which the indicator has a predicable

relationship, to determine whether the expected relationship exists between the

two indicators
– Eg. ANC1 with Number of pregnant mothers tested for HIV during pregnancy
 Completeness
• Completeness on data recoding tools (Registers, cards/forms)

– refers all necessary data elements on registers/forms/cards

should be filled immediately after provision of the service

by the care provider

• Data(Report content) completeness

– refers the extent to which facility and district filled all data

elements in the reports or data base for all reportable events

 Completeness ….
• Report Completeness

– helps to examine the total reports received from all health

facilities from the total reports expected for a given period of

time

– All health posts and Health facilities are expected to send

monthly (service and disease report), every quarter (Quarter

service report) and annual service report with in the national

schedule
 Calculating completeness
Completeness of data (%) =
# values entered (not missing) in the report
# Total data elements in the report
 

Completeness of reports (%) =

# reports received in a given period
# Total reports expected
 
 
 Timeliness
• Information, especially clinical information, should be documented
as an event occurs, treatment is performed or results noted.
• Delaying documentation could cause information to be omitted
and errors recorded.
Example of timeliness
– A patient’s identifying information is recorded at the time of
first attendance and is readily available to identify the patient at
any given time.
– On discharge or death of a patient in hospital, his or her
medical records are processed and completed, coded and
indexed within a specified time frame.
 Timeliness…..
• All expected reports are ready within a specified time frame, having been
checked, verified and sent to the next level with in a due date.

Timeliness (%) = # reports submitted or received on time

# total reports available or received
 

“Data Delayed is data denied”

 Legibility

• All data whether written, transcribed and/or printed

should be readable.
Examples of legibility
– Hand written demographic data are clearly written and readable.
– Handwritten notes on patient form, admission card, and any
other medical records registers are clear, concise, readable and
understandable.
– Handwritten National classification of disease (NCoD) clear
and easily understandable to transcribe in to Register

Data quality should start at the point of data collection.

 
 Accessibility
• All necessary data are available when needed for patient care and for all other
official purposes.
• The value of accurately recorded data is lost if it is not accessible.
• Examples of accessibility
– Medical/health records are available when and where needed at all times.
– Abstracted data are available for review when and where needed.
– In an electronic patient record system, Clinical information is readily
available when needed.
– Statistical reports are accessible when required for Performance monitoring
team, planning meetings and government requirements or for any official
need.
 Quick Plenary Discussion

What are the roles and responsibilities that should

be carried out at each level of the health system to
assure production of high-quality data?

47
 Maintaining Data Quality by RHIS Management Level

Central Level
Health Facilities Intermediate Level
(Service Delivery Sites) Provide guidelines on data
collection, reporting, and
management procedures

Review reports received; submit

aggregated reports Ensure timeliness and
completeness of reporting
Collect and enter initial data
Ensure timeliness and
completeness of reporting Monitor quality of data throughout
all levels
Summarize patient data and check
quality of registers
Monitor quality of data captured
and reported Monitor quality of data captured
and reported

Complete, verify, and submit

summary reports on time Conduct routine supervisory visits Conduct routine supervisory visits

Routinely analyze and use data Routinely analyze and use data Routinely analyze and use data
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Most Common Problems Affecting Data Quality across System Levels

Technical determinants

• Lack of guidelines to fill out the data sources and reporting forms
• Data collection and reporting forms are not standardized
• Complex design of data collection and reporting tools
Behavioral determinants

• Personnel not trained in the use of data sources & reporting forms
• Misunderstanding of how to compile data, use tally sheets, and prepare
reports

• Math errors occur during data consolidation from data sources, affecting
report preparation
 Con't….
Organizational determinants

• Lack of a reviewing process, before report submission to

next level

• Organization incentivizes reporting high performance

• Absence of culture of information use
Data Quality Assurance Tools
 Data Quality assurance tools

LQAS RDQA DQA PRISM

• Self-assessment  at facility • To assess whether
level • Self-assessment by • Assessment by funding
technical, behavioral and
• Simple and uses small program agency organizational
sample size for continues • Flexible use by • Standard approach to determinants have
quality assurance at facility programs for implementation influence on RHIS
level monitoring • Conducted by external performance
• can be used through data • and supervision or to • used by People involved
audit team
accuracy check lists • in the collection, analysis
• limited to few data quality
prepare for an external • Limited input in to
audit and use of data in RHIS
components (mostly recommendations by • provide structured way for
accuracy) • Program makes and programs assess the quality of data
• Data elements selected implements own and use of information
randomly. action plan
• Indicators selected
purposive way.
Lot Quality Assurance Sampling (LQAS)

• …is a technique useful for assessing whether the desired level of

data accuracy has been achieved by comparing data in relevant

record forms (i.e. registers or tallies) and HMIS reports

• …will be used to check data accuracy at Health Facility level

• Health Facilities will maintain a registry to record the data accuracy

check results and to look the trend of the data quality improvement

• HMIS Focal Persons from WrHO, ZHD and RHB will use the

LQAS method to check data accuracy during their supervisory

visits
 Lot Quality Assurance Sampling (LQAS)
• This is a method for testing hypothesis related with the level of HMIS data
quality whether it is achieved or not.
• It uses a sample size of 12 data elements and tries to check the accuracy of
reports.
• If the number of sampled data elements not meeting the standard exceeds a pre-
determined criterion (decision rule), then the lot is rejected or considered not
achieving the desired level of pre-set standard.
• Decision rule table is used for determining whether the pre-set criterion is met
or not.
• Comparison of LQAS results over time can indicate the level of change.
 Steps to carryout LQAS
Step 1: Decide the month for which you want to do the data accuracy
check( Health facilities are expected to do Monthly)
Step 2: Pre-fix the level of data accuracy that you are expecting, e.g. 70% or 85%
etc.
Step 3: Put serial numbers against the data elements (sum section) not
disaggregation in the Service Delivery or Disease Report that you want to
include in the data accuracy check ( Example: New acceptor, Repeat acceptors
not age or method disaggregation)
Step 4: Randomly select 12 data elements
Step 5: List down the selected data elements from the report on to the Data
Accuracy Check Sheet in Column 2 and Column 3
 Continued……
Step 6: Write down the reported figures from the Monthly HMIS Report for the selected data

elements in the Column 4 of the Data Accuracy Check Sheet.

Step 7: Recount the figure from the corresponding registers and note the figures on Column 5

of the LQAS check-sheet

Step 8: If the figures for a particular data element match or do not match put “yes” or “no”

accordingly in Column 6 or Column 7 respectively.

Step 9: Count the total number of “yes” and “no” at the end of the table

Step 10: Match the total number of “yes” with the LQAS Decision Rule table and determine

the level of data accuracy achieving the expected target or not.

 LQAS Example
Rand Reporting Element (3) Figures from Figure matching
om with the source
No. document
(1) Yes (7) No (8)
Report Tally Registe
(4) (5) r (6)

1 Repeat Acceptors 14 14 X
2 Deliveries attended by skilled health personnel 52 32 X
10 Fully Immunized infants <1 yrs. of age 12 15 15 X

18 2-5 yrs. age group who de-wormed 26 26 X

8 Measles doses given <1years of age 8 8 8 X
20 Live birth 32 28 X
5 Number of newborns weighed 28 28 X
35 Number of weights recorded with severe malnutrition 78 80 80 X

40 Pregnant mothers linked based on option B+ for the first 0 0 X

time
65 Early PNC within 0-48 hours 4 4 X
5 Vit A supplementation for 6-59 months of age 2 2 X
 LQAS Decision Rules

Decision Rules for sample Sizes of 12 and Coverage Targets /Average of 20-95%
Average Coverage (baselines)/Annual Coverage Targets (monitoring and
Sam Evaluations)
ple <20 20 25 30 35 40 45 55 60 65 70 75 80 85 90 95  
size % % % % % % % % % % % % % % % %

12 N/A 1 1 2 2 3 4 5 6 7 7 8 8 9 10 11
 LQAS at Health Facilities
• Health facilities should conduct LQAS check for disease reports

(OPD & IPD) using the same methodology and keep Accuracy sheet.

• If the LQAS score doesn’t meet the standard or (<90%), PMT

members should revitalize all reportable data elements and check

with source document for accuracy and prepare new report.

• The HMIS focal should do LQAS check by repeating the same

procedure after having the revised report.

• Health facilities should report the first LQAS score in the monthly

reporting form

• Health facilities should monitor the trend of LQAS across a

months to see the changes overtime

 LQAS Important Discussion Points
• How many data elements on the data accuracy sheet that they
match?
• What is the data accuracy level achieved?
• Does that level meet the desired data accuracy level?

• What measures should be taken if the desired accuracy level is

not achieved?
• What will be the possible cause for low LQAS score?
• What should be done to improve the LQAS score in the next
months?
 Visual Scanning (Eye Balling)
• It is a simple method used at health facility to check for consistency of reports
before/after conducting data entry.
• PMT members should sit together and look across each line and then from top to
bottom to identify:
– missing data values
– unexpected fluctuations beyond maximum/minimum values
– inconsistencies between linked data elements
• Use the data validation Checklist

– possible mathematical errors

Data Cleaning: A process used to determine inaccurate, incomplete, or unreasonable data and then
improving the quality through correction of detected errors and omissions
 Routine Data Quality Assessment (RDQA)
• RDQA is an assessment tool that can be used to self-assessment and monitor

progress and evaluate the RHIS status

• Unlike to LQAS, the RDQA help the Health facilities and administrative health

units to verify reported data against to source documents and to look RHIS system

implementation.

• It is a simpler version of the DQA

• The RDQA tool should be applied regularly to monitor the trend in data quality.

• It is recommended to be implemented quarterly by administrative health unit and

Health facilities can use for self-assessment purpose in a much customized way.
 Objectives of RDQA
Verify
– Rapid verification of quality of reported data.
– Capacity of information systems to collect, manage and report
quality data.

Implement measures to:

– Strengthen data management, reporting systems
– Improve data quality

Monitor
– Performance of data management, reporting systems
– Capacity to produce quality data
 Steps in Conducting an Assessment

• Verify and validate performance information to ensure that data are

of reasonable quality
• Review data collection and processing procedures to ensure
consistent application
• Review program capacity and human resources
• When data quality issues are identified, take steps to address them

• develop and implement a budgeted action plan for strengthening

the system
 RDQA core components
Data Verification: document reviews
– Accuracy  re-counted vs. reported results

Reporting Performance
– Timeliness, completeness of reporting, availability of reports

System Assessment
– Are elements in place to ensure quality reporting?
– Qualitative: Assesses strengths and weaknesses of functional areas
of M&E system
 When to Assess
• Integrate data quality control mechanisms into standard operating procedures
• Integrate data quality checks into routine supervisory visits
• Conduct periodic formal assessments
• Full RDQA vs. Data Verification only
• Timeline can be different but this is what we suggest
 How to select Service delivery sites
The Ethiopian MOH recommends the following sample size and methodology for
RDQA (especially for DV):

In regions with zones:

• Randomly select 4 zones
• From each of the selected zones, randomly select three Woredas
• From selected Woredas, select randomly one health center or hospital

In Regions without zones

• Randomly select 4 Woredas
• From each selected Woredas, randomly select three health centers or hospitals
 SD selection con't….
For Zonal level
• Randomly select 4 Woredas
• From selected each Woredas, select randomly three health centers
or hospitals
For Woreda level
• Use census of all health centers and hospitals in the Woreda

N.B One Health post can be selected randomly under each HC

that selected in the DV
 Select Indicators for Data verification

Determination of indicators and reporting period that

should be included in the assessment is also an important
step in RDQA. It is recommended that up to Seven to nine
indicators can be selected based on the priority area.
 Indicator selection con’t…
The criteria for selecting the indicators for the RDQA could be the
following:

1. Must review indicators: Indicators that should be selected first

depending on the indicator’s national and global importance/ priority.
2. Relative magnitude of the indicators: The amount of budget and
activity associated with the indicator(s).
3. Case by Case Purposive Selection: Indicators for which data quality
questions exist and the government wants to be routinely verified. Those
reasons should be documented as justification for inclusion.
 Data Verification
• In-depth verifications at the Service Delivery Sites
a).Verify reported data against recounted from registers
b).Cross-check secondary data source (Registers) with
the primary data source (Medical records).
c).Verify the primary source of data (Medical records) against the
secondary source of data (registers) (Optional)

If their is Electronic system it is better to select the same

service area to cross-check.
a) Reported Data against Recounted ∑A / ∑B
Indicators Description HF1 HF 2 HF3 HF4 HF5 HF6 HF7 VF=
A/B

ANC4 Recounted=A 10 50 70 20 30 40 20 240 0.89

Reported=B 12 65 70 20 25 45 30 267
SBA Recounted=A 111 44 2 20 10 9 15 211 0.93

Reported=B 121 43 0 12 25 9 15 225

Penta 3 Recounted=A 25 45 30 12 20 10 0 142 0.83

Reported=B 38 59 30 16 15 13 0 171
Currently Recounted=A 10 22 10 5 40 19 20 126 1.94
on ART
Reported=B 0 12 4 5 32 12 0 65
Meseals Recounted=A 20 55 34 14 45 25 27 220 0.79

Reported=B 12 42 23 22 95 36 47 277
TB all Recounted=A 41 71 29 78 9 1 12 241 1.14
forms Reported=B 29 36 34 80 6 10 17 212
According To WHO RDQA the acceptable range of DV

is between 90%-110%
– DV < =90% is over reporting
– DV >=110% is under reporting

From the Example

• Antenatal care forth Visit, Penta 3 and Meseals show over-reporting
• Currently on ART and TB all forms shows under-reporting
• Skilled delivery shows acceptable report

Multiplying 1-DV by the actual reported data will give us the adjusted (corrected) report.
Cross-check secondary data source (Registers) with the primary data source (Medical
records).

Step 1. Count total recoded data on the register and take 5-10% of the total recoded
data in the specific register
– Example if total SBA recoded in the register is 200 will take 5% which is
10 to verify the data at medical record room.
Step 2. To randomly select medical records, divide the total number recorded by the
required number of the sample (e.g. 10) to obtain the sampling interval. In this
Example the sample interval will be 20 i.e. we will take every 20 th client/patient…..

N.B if the percent calculated from the recorded data is less than one randomly take
two clients/patients from the register to verify at Medical record room.
Cross checks data on register….
Indicators Description HF1 HF 2 HF3 HF4 HF5 HF6 HF7

# clients Medical 5 4 10 3 2 5 2
record Matched
with register
ANC4 # Selected clients 10 6 10 20 4 6 2
on Register
(A / B)*100 50% 66.6% 100% 15% 50% 83% 100%
# Medical record
Matched with
register
SBA
# Selected on
Register
(A / B)=

Summary
# of HF with DV (register vs Medical records) for selected Indicators
We can calculate the proportion of
  <50% 50-75% 75-85% >85% HF with DV against medical records
ANC4  1  3  1  2 at AHU level
SBA        
 c) Verify the primary source of data (Medical records) against the secondary
source of data (registers)

• These may be optional in the quarter data verification and can be

done in annual base comprehensive RDQA
• it is a method of randomly selecting 10-20 medical records from
the Card room and verifying if all the data elements supposed to be
recorded in the register are well captured.
• We can summarize the data for selected medical records as
complete or incomplete.
 Data Verification
2. Community Level data verification

– For selected priority indicators the team should randomly select 5 % from
primary data source (Registers) and verify whether the patients or clients
have accessed the service within specified period.

– The team should have house to house visit and accompanied by Kebele
HEW for easily accessing the House hold of the clients

– The team should document basic demographic information (Name,

Kebele, gote House number, phone number) date the service provided,
type of service provided before departure to home level verification.
Summary
# of HF with DV (register vs Medical records) for selected Indicators
We can calculate the proportion of
  <50% 50-75% 75-85% >85% HF with DV against medical records
at AHU level
ANC4
SBA        
 System Assessment
• M&E Capabilities, Roles and Responsibilities

• Training
• Data Reporting Requirements

• Indicator Definitions
• Data-collection and Reporting Forms and Tools
• Data Management Processes

• Data Quality Mechanisms and Controls

N.B System assessment part can be done in annual base

 After the RDQA

• Review the output of the RDQA

• Develop a system strengthening plan, including follow-up actions

• Plan on sharing the outcome with the levels and sites that
participated in the RDQA

Description of Action
  Identified Weaknesses Responsible(s) Time Line
Point
1        
2        
3        
4        
                 
THANK YOU!!