Retracing The Steps: A Guide To Undertaking Economic Evaluation On project Interventions

Fellow's Name: 

Shadrack Owando

Fellow's Track: 

Health Economics

Fellows Cohort: 

First Cohort

In evaluating its programs, AMREF has so far thrived on a three-tier non economic system of evaluation comprising of baseline, mid-term and end-term project assessments. These evaluation reports have been relied on in guiding management decisions on project performance as spelt out in the organization’s draft M & E framework of 2010 - 2017.
From economic perspective however, the assessments have had their share of limitations as the net benefits of the projects are not comprehensively captured. For instance, the inability of such assessments to capture the non-market costs has led to inadequate conclusions in reporting. To bridge the gap, the introduced an economic technique to the existing evaluation system by developing a guide for the undertaking cost benefit analysis.
The guide aimed at enhancing management decisions through comprehensive evaluation of project interventions.
The development of the guide was based on participatory methods in order to ensure stakeholders’ involvement. That way, the project would be able to tap into the experiences and lessons learnt in the evaluation of other past interventions, in addition to fostering ownership of the resultant guide. The expected primary audiences of the guide are usually program managers, especially in the health sector. Project leaders, M&E officers and co-coordinators, and other non-governmental organizations working on health related programs are also targeted. Through the use of evaluation tools in this guide, it is hoped that project staff and other stakeholders are able to collect and produce data or verify results that can be used for public relations and promotion of project achievements.

A Mobile Based Electronic Medical Records System To Improve HIV Prevalence Estimates Among Most At Risk Populations In The Coast Region, Kenya

Fellow's Name: 

Stephen Omondi

Fellows Track: 

Health Informatics

Fellows Cohort: 

First Cohort 

 

Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ART (FHI, 2010a). Kenya has a large number of qualified, unemployed health care workers. The key to success will be developing effective mechanisms to engage these trained staff. In addition, efforts to employ auxiliary staff, such as adherence counselors and outreach workers, are a high priority.
In the Coast region this epidemic seems to be aggravated by the concentration of tourist destinations, the illicit drug problem and the lack of formal employment avenues. Young Kenyans get into prostitution and drug abuse as a result of desperation and the massive gap between the rich and the poor.
This project aims at improving HIV prevalence estimates among Most at Risk Populations (MARPS) in the Coast Region, Kenya by linking the existing Health Management Information System to a mobile based Electronic Medical Records system and also redesign it so that it can speedily generate reports. The MARPs indicators vary slightly from region to region and therefore the project extensively use existing documentation to accurately identify the indicators necessary to estimate prevalence.
The indicators identified are then designed into a form that is the basis of a web based electronic medical records (EMR) system that captures information using Nokia Data Gathering (NDG) software running on cell phones . The cell phones are remotely linked to a database which is hosted  by a secure and versatile server.
The use of cell phones and NDG aimed at circumventing the inherent problems that are associated with paper based systems while at the same time breaking down barriers that are location dependent.

Records And Pharmacy Systems Integration And Expansion With GIS For Thika Level 5 Health Facility Comprehensive Care Clinic

Fellow's Name: 

Wilfrida Momanyi

Fellows Track: 

Health Informatics

Fellows Cohort: 

First Cohort 

 

Health care is an information exchange business where clinicians collect data on patients (history and physical examination) record all these data and transmit it to various departments of care.  This information is necessary to provide and manage healthcare at all levels ranging from individual patients to systems within the health sector.  The efficiency and effectiveness of any health system at all these levels is dependent on accurate and timely data.  In developing countries, electronic medical records (EMRs) are becoming a necessary component for efficient collection, storage and retrieval of patient medical information of many illnesses including   the Human Immunodeficiency Virus (HIV). 
The number of People Living with HIV/AIDS (PLHIV) receiving Anti-retroviral Therapy (ART) in Kenya is growing at an alarming rate (KAIS, 2007).  This growth has an impact on the weak health systems and the transition from paper-based to EMRs (B. Mamlin et al, 2006).
In Kenya, many health facilities in the public sector depend on weak paper-based storage and retrieval systems mainly due to the slow uptake of Information and Communication Technology (ICT) and massive implementation of disparate health information systems. 
One main disadvantage of managing PLHIV on ART on disparate health systems is that some vital information such as weights, heights, BMI (for adults) and CD4% that need to be monitored regularly can easily escape the attention of the clinicians if the patient visits one section because the systems do not share information.  This information is necessary for efficient patient monitoring in order to improve clinical management and program intervention among PLHIV.  In order to efficiently and effectively collect, store, analyze and disseminate health information, linking existing disparate health information systems is vital.

Upgrading of Monitoring and Evaluation Information System for AMREF in Kenya

Fellow's Name:

Benard Muchoki

Fellows Track: 

Health Informatics 

AMREF has in the past made efforts to put in place a functional information system aimed at standardizing information collection, processing, storage and reporting on project activities through a Quarterly Planning and Reporting (QPR) database system (2000) and the AMREF Kenya Country Office Projects Database (KPD) (2007). KPD is currently in use but has been found to have functional limitations which challenge its effective implementation throughout the organization.
This project focused on upgrading the former M&E Information Application by developing a web based application that effectively addresses limitations identified in the former M&E Information Application. The goal of the project was to enhance data management for decision making and the general purpose was to enhance data capture and reporting of AMREF Kenya Country Office (KCO) projects activities and results. The objective of the project was to improve system usability through redesigning of the former existing M&E information system; to develop reporting structures designed to meet various organizational requirements; to develop appropriate user guides for the upgraded system; to improve access to newly generated knowledge products and to enhance user skills in utilizing the system through training. The current system has so far helped in improving operational efficiency, improving ease of access leading to increased system usage, as well as benefit the organization by standardizing data collection and reporting processes within intervention projects and consequently provide adequate, timely and up to date information for decision making.
The project was developed using the Waterfall model. This is a phased approach to building a system dividing systems development into formal stages where the outputs from one phase serve as the initial inputs for the following phase. During each phase, additional information is usually gathered or developed, combined with the inputs, and used to produce the deliverable for that phase.

Revising The Tool for Identifying The Poor For National Health Insurance Fund (NHIF) in Kenya

Fellow's Name: Angela Oloo Akumu

Fellows Track: Health Economics 

 

In Kenya, National Hospital Insurance Fund (NHIF) has been striving to reach and register members from both the formal and informal sectors. Given the high poverty rates of 46 percent, majority of Kenyans would not be in a position to pay the monthly contributions. Since the year 2003 there has been need for NHIF to identify the poor because it wants to increase its insurance coverage. There have been further calls for transforming NHIF to NSHIF where identification of the poor would be vital. NHIF through the newly created Sponsored Programmes  division has managed to develop and pilot a tool to identify indigents. However, one of the key reccommendations from the pilot was that the tool needs to be modified. The goal of this project was to increase NHIF’s insurance level of coverage. The project's methodology and approach included: review of other tools for identifying the poor; review of methods of identification that captured poverty dynamics and vulnerability; testing  the tool; sensitizing stakeholders on the importance and use of the tool and disseminating the report.

A Web-Based Laboratory Information System For Kenyatta National Hospital Comprehensive Care Centre

Fellow's Name:                                                            

Philomena Waruhari

Fellows Track: 

Health Informatics

Laboratory results are paramount in ensuring quality of care to patients as they form the basis for disease diagnosis and timely treatment leading to better health outcomes. However, availability of patients’ laboratory results to the clinician in a timely and efficient manner is a challenge in most health care facilities as a result of the manual systems used in handling patients’ data. In particular, at KNH CCC facility, during the project implementation period, it was characterized by missing or misfiled laboratory results with up to 20 cases of missing results reported per day. Situational analysis showed the cause of the problem to be due to overworked staff as well as the distance between CCC’s records section where filing of laboratory results took place and KNH records department where patients’ files were stored. The benefits of adoption of innovative ICT technologies in health care delivery, with a particular focus on automated laboratory services were discussed. The project developed and implemented an integrated laboratory information system for KNH CCC laboratory which serves People Living with HIV/AIDS (PLHIV). It involved application of innovative interfacing techniques to link the main laboratory clinical analyzers to Laboratory Information Systems and International Quality Care (IQCare) Electronic Medical Records (EMR) system thereby facilitating automatic data acquisition and transmission. Thus, there was availability of test results to clinicians guaranteed, a reduction in transcription errors and increased productivity of the laboratory technicians as they were released from simple routine work to more skilled tasks. The project was implemented under the close supervision of the project supervisor and the mentor. The project period was  one year.

Fellowship Experience

Fellowship experience is based on the comments and feedback received from some some of the fellows in the previous fellowship program (UoN HIV Fellowship Program).
These are some of the compliments the fellowship received:

'During the UoN HIV Fellowship Program training, I have acquired knowledge and skills in integration of policies and goals from the international and national HIV/AIDS response local programming; planning, implementation, monitoring and evaluations of innovative evidence-informed HIV/AIDS programs; development and implementation of supply chain management systems for essential commodities to support HIV Programs and mobilization and management of resources for efficient HIV program development and management.’

-DR. Amos Omondi Oyoko MPH; MBCHB

Program Management Fellow-3^rd Cohort

'The two year Fellowship period has immensely built my competencies in Health informatics in regard   to HIV/AIDS program. Thanks to PEPFAR and UNITID Fellowship.

When I joined the programin November 2011, I didn’t have much idea on what really goes on. Having had taken some duration of time in University teaching and administrative work, indeed, I did not think about it beyond class work, plenty of CATS and assignments. Now I know better. The knowledge have gained through experiential learning is indescribable. I cannot find an appropriate adjective to describe my encounters at UNITID HIV Fellowship program. It was AWESOME. The webcast sessions by the University of Washington were just informative moments. It was a period that provided me with an understanding: that knowledge doesn’t reside in books but in actual practice. I cannot exhaust the details of my fellowship here but will echo Albeit Einstein words: “try not to become a man of success but rather a man of value. Thanks to architects and partners of UNITID Fellowship Program. Thumbs-up!'

-Meshack Kawinzi MSc – ISE

                                                                                                               Health Informatics Fellow-3^rd Cohort

The QM fellowship was an eye opener to me; as a healthcare manager I learnt to apply a systems approach in understanding and managing inter-related processes towards improving efficiency and effectiveness in the various aspects of healthcare delivery. During project implementation, I applied the wealth of knowledge acquired in the didactic learning to achieve set objectives; particularly involvement of people through formation of Quality Improvement Teams. People are the essence of any organization and their involvement through sharing knowledge, encouraging and recognizing their contribution, utilizing their experience and operating with integrity enables their abilities to be used for the benefit of the organization. The mentorship aspect of this program was very useful to me as I benefited immensely from the wealth of experience from my mentor Dr Anne Mungai and supervisor Dr Atieno Adede. I can say without a shadow of doubt that the experience has not only been transformative but it has also given me a competitive edge as a healthcare manager and not even the sky is the limit for me.  I will forever be grateful to UNITID for enabling me to pursue this very wonderful program.’

-DR. Rose Kwamboka Misati

B. Pharm, Msc. (Pubilc Health)

Quality Management Fellow

'I must stress that institutional capacity building is pivotal to the attainment of the national health sector strategic priorities. The Monitoring and Evaluation Medium Term Fellowship Program has enabled me to further build my capacity in M & E and thus providing me with technical skills that have greatly and positively enhanced my service delivery.’

-Rosemary T. A. Kombo 

MPH; PGD Global Health and Epidemiology; BA (Social Work)

Monitoring and Evaluation Medium Term Fellow

3^rd Cohort

 

‘The fellowship opened a new chapter in my career growth path through experiential learning and has equipped me with skills to resolve real issues in the health domain. Before the Fellowship I was an IT Support Supervisor but presently I am a Technical Advisor – Standards.’

-Samuel Kang’a  MSc-IT

Health Informatics -2^nd Cohort

The UoN HIV Fellowship is an all rounded program which added to my body of my knowledge. I have been able to acquire professional skills in monitoring and evaluation. The program was work-based in nature thus I was able to adequately use what I learnt, at my place of work. Interacting with various people from various cadres in the health profession was key and we were able to network and exchange ideas. Moreover, the lecturers and staff of the program were very instrumental and gave us the necessary support to make the fellowship program a success.’

-Barmao Joy Chepkurui

BSc. Nursing

Monitoring and Evaluation Medium Term Fellow

3^rd Cohort

                                          1st Cohort fellows graduate during the UNITID Fellowship