1. Building Sustainable Strategic Information
Systems in Low-Resource Countries
Bobby Jefferson
Senior HMIS Advisor
AIDSRelief project
Futures Group International LLC
Presenting on behalf of Lanette Burrows, Pat Bass, Ian Wanyeki

2. AIDSRelief Overview
• PEPFAR Track 1.0 Initiative
– Catholic Relief Services – Prime (CRS)
– University of Maryland Institute of Human
Virology (IHV)
– Futures Group
– Catholic Medical Mission Board (CMMB)
– Interchurch Medical Association (IMA)
• 5-year project focused on increasing access to
high quality HIV care and treatment

3. AIDSRelief Overview
• Implemented in 9 countries:
– Guyana, Haiti, Kenya, Nigeria, Rwanda, South Africa, Uganda,
Tanzania, Zambia, Ethiopia (April 2009)
• Focus on building capacity for quality HIV care
and treatment
– lab, pharmacy, clinical services, M&E
• More than 212 local partner treatment facilities
(LPTF)
– Small Rural Health Centers
– Rural Health Clinics
– District Hospitals
– Mission Hospitals
– Urban High Volume hospitals

4. Where we work
7
29
212 ART
Treatment 18
Facilities (Clinics) 10 25
+ 122 satellite
Sites + 288 78
3
PMTCT sites
18
24

5. Futures Group Overview
• Futures Group provides strategic information
(SI) capacity building and focuses on:
– Improved data demand and information use (DDIU)
– Enhancing/implementing patient monitoring and
management (PMM) systems that meet local
requirements
– Enhancing Data quality for better services and
clinical outcomes
– Using local experts to build capacity at partner sites

6. Regional Software development teams
in Kenya, Rwanda, South Africa, India

7. Strategic Information
• Committed to collecting only information essential for
clinical management and quality improvement
• Capacity building (local ownership)
• Committed to feeding back information to the local partner
treatment facility (Clinic) to address gaps in program and
services

8. • To offer a library of tools and solutions built around
adaptive management, high quality data, and
sustainability
• Freely available software, no licensing fees
• User , Admin Training, and In-country Programmer
or Database Training available
• To develop requirements through practical field
experience and lessons learned
• To take a collaborative approach using local experts
throughout the development process

9. Patient Management and Monitoring
Typical Hospital Records Center

10. Finding patient information in the past

13. Key Features
• Stability and ease of use
– A browser-based, easy-to-use software tool with
robust underlying SQL database
– No Internet access required to use system
• Facility and Patient Dashboards
• Real Time data entry and reporting
• Custom reports

29. Monitoring our programs through
IQSolutions
Demonstrate outputs and outcomes
– Clinics ability to hit set targets
– Trend analysis
– CD4 count changes
– Mortality & Lost-to-follow-up rates
Case studies demonstrating outcomes
Using data collected on a routine basis for:
– Life table analysis
– Defaulter tracking
– Quality of life analysis

30. “After successful assessment, the IQ Care
system developed and supported by the
Constella Futures Group and Catholic
Relief Services came up top in terms of
overall features (technical and non
technical) and also in terms of largest
number of installations “
“From the above data, IQ Care comes out
strongly ….recommended for medium to
large ART centres.”
WHO and CDC sponsored EMR
Assessment Report , Kenya May 2009

31. Implementing Number of Number of
IQCare Sites Patients
Kenya 28 65,500
Uganda 20 63,000
Nigeria 27 60,000
Total 75 188,500

32. What does it provide us with? ARV Pickup Report
Missed ART > 20 days in August- December 2008 per LPTF
Local Partner August September October November December
Hospital # 1 78 21 12 4 3
Hospital # 2 51 23 5 0 0
Hospital # 3 25 22 7 5 5
Hospital # 4 17 19 13 1 1
Hospital # 5 5 0 0 0 0
Hospital # 6 5 1 0 0 0
Hospital # 7 2 0 1 1 2
Hospital # 8 1 1 0 0 0
Hospital # 9 0 0 0 0 0
Hospital # 10 0 0 0 0 0
Hospital # 11 0 0 1 0 0
TOTAL 184 87 39 11 11

33. What does it provide us with?
Close monitoring of the ART pick up habits over time at LPTFs has helped ensure that fewer
patients miss collecting their ARTs on time
All sites
200
180 184
160
140
120
100
87
80
60
39
40
11
20
11
0
August September October November December

34. Reporting
• ARV Pickup Report
• CDC Track 1.0 Quarterly Report
• Monthly TRAC MOH reports
• Custom user and Data quality reports
• Cohort mortality report
• Display on screen or export to Excel

35. Three sites showing the sub-districts they service

36. # Defaulters per village – Green <5, Yellow 5-10, Red >10

37. Capacity Building and decision making
• Identify defaulters per village or sub-district
– Deploy adherence counselors to follow-up
• Identify trends
– Link defaulter data to average distance travelled or
average time taken reach the site
• Provide supplemental services (transport)
• Open field service centers

38. Select a village to see the defaulter list and HCW assigned

39. Other Developments
• Electronic first (E-First) data entry
• Paperless Clinics
– Pilot in Kenya
– Pilot in Nigeria Clinic
• Wireless at Clinics
– Security, Use of HTTPS,
– OpenSSL

40. # Defaulters (red) vs avg distance travelled to reach site (blue)
Thank you