Preventing Cervical Cancer Through Effective Data Use: Practical Tools Jenn Drummond, MPH IDCCP Lead Technical Advisor Megan Wysong, MPH M&E Team Lead, Jhpiego/USA John E. Varallo, MD, MPH Senior Technical Advisor, Jhpiego/USA Global Health Mini University 2016
ACKNOWLEDGEMENTS Collaboration among countries and international agencies WHO, CDC Foundation, CDC, Gates Foundation, George W. Bush Institute, and Jhpiego Field testing with Ministries of Health in Botswana and Tanzania Draws upon previous WHO publications and cervical cancer project documents Originally developed by Jhpiego
OUTLINE OF PRESENTATION 1. 2. 3. 4. 5. General overview of the IDCCP Project Patient and Program Monitoring Toolkit: Overview Facility-based Surveillance Toolkit: Overview Speed Dating Summarize learning and next steps for the initiative
Improving Data for Decision-making in Global Cervical Cancer Programs (IDCCP) Project Improving Data for Decision-Making in Cervical Cancer Programmes (IDCCP) Project The Need A global absence of standardized tools and guidance, technical expertise, and implementation support for countries that are seeking to collect and use highquality data to monitor, evaluate, and improve their screening and treatment programs. The Grant Goal: To improve and accelerate the availability of data for planning and improving global cervical cancer programs by gathering information on data systems in select country contexts, and by developing global standards, tools, and guiding information Timeframe: January 2014 to June 2016 Donor: Bill & Melinda Gates Foundation s Neglected Infectious Disease (NID) program strategy area
Bill and Melinda Gates Foundation Grant Activities Improving Data for Decision-Making in Cervical Cancer Programs CDC Foundation 1. Data Systems Assessments CDC/DGHT Indiana University 2. Standardized Toolkit Population-based Survey Modules CDC/DCPC John Snow International Facility-based Surveys CDC/DGHT Jhpiego Patient and Program Monitoring CDC/DGHT Jhpiego 3. Web-based Knowledge Management Bush Institute Johns Hopkins University Center for Communication Programs Bush Institute Program Costing WHO Levin & Morgan Southern Methodist University CDC/DGHT Outcomes Evaluation WHO International Agency for Research on Cancer 4. Coordination Pink Ribbon Red Ribbon Bush Institute WHO 5
IDCCP Toolkit Components How to identify opportunities for strengthening country data and data systems? How to measure population coverage of cervical cancer screening and secondary prevention? How to routinely monitor patients and programs? How to survey facilities for service readiness, service availability, service quality? How to estimate costs of cervical cancer screening & treatment programs? How to estimate outcomes of cervical cancer screening and treatment programs? Part 1: Rapid Situational Assessment of Cervical Cancer Data and Data Systems Part 2: Population-based Survey Modules for Cervical Cancer Part 3: Patient & Program Monitoring for Cervical Cancer Part 4: Facility-based Surveys for Cervical Cancer Part 5: Cervical Cancer Prevention and Control Costing Screening and Treatment Module Protocol for the Evaluation of Patient Outcomes
PATIENT AND PROGRAM MONITORING TOOLKIT
INTRODUCTION TO PPM TOOLKIT System of key indicators, data collection, and data management and use tools to monitor national programs and improve cervical cancer programs FOCUSES ON Pre-cancer screening methodologies: VIA Cryotherapy LEEP Aggregate systems DOES NOT FOCUS ON Methodologies HPV vaccine Colposcopy Biopsy Sentinel site surveillance or electronic medical record system
PURPOSE OF PPM AND THIS TOOLKIT PURPOSE Systematic means of capturing client-level data Summarizing it with appropriate aggregation Providing guidance on how info can be strategically used at the facility, subnational, and national levels THIS TOOLKIT CONTAINS Fundamental tools and info to develop and improve existing M&E systems Data elements and indicators that are derived from and feed into WHO global cervical cancer indicators 1 1 Comprehensive Cervical Cancer Control: Guide to Essential Practice, 2 nd Edition, 2014
INTENDED AUDIENCE National health sector staff engaged in designing, adapting or maintaining M&E systems Decision-makers who use data to improve programs NGOs, private-sector providers, CSOs, donors and academic groups to ensure their systems are aligned with the global guidance and national system Consensus building on data recording in Guyana
TOOLKIT BASICS Instruction on how to build the engine not drive the car How to apply the tools to the development and improvement of the M&E system Does NOT include instruction on how to complete tools or train providers Provides standard indicators and tools to be used across and within countries Builds on systems already in place; does not replace existing systems
ESSENTIAL COMPONENTS Core and optional indicators Data collection, collation and analysis tool samples Electronic data capture and visualization system: DHIS 2 Data quality and training guidance
CERVICAL CANCER CONTROL CORE INDICATORS (WHO, 2014) Screening Coverage of the Target Population: Percentage of women aged 30 49 years who have been screened at least once since age 30 Data Source: Population Survey Screening Rate of the Target Population: Percentage of women aged 30 49 years who have been screened over a 12 month period, disaggregate first screen from repeat screen Data Source: Routine Service Delivery Registers / Summaries Screening Test Positivity: Percentage of [first time] screened women aged 30 49 years with a positive result in the previous 12-month period Data Source: Data Source: Routine Service Delivery Registers / Summaries Treatment Rate: Percentage of [first-time] screen-positive women completing appropriate treatment for pre-cancer and treatment for invasive cancer in the previous 12-month period Data Source: Data Source: Routine Service Delivery Registers / Summaries + Cancer Registries Impact Indicator: Cervical cancer age specific incidence and mortality Data Source: Population-based or sentinel hospital-based cancer registries
INDICATORS
TOOLS STANDARD CERVICAL CANCER DATA COLLECTION TOOL SAMPLES AND DATA ELEMENT CHECKLISTS Sample Client Form Screening / Treatment Register Monthly Summary Additional facility forms include: referral form, client card, referral follow-up listing, etc.
DATA CAPTURE USING DHIS2
DATA USE POSTER AT FACILITY-LEVEL Those that document data can use their data to identify trends / patterns, gaps, and progress toward targets and standards.
PROVIDER TRAINING WITH INTEGRATED M&E SESSIONS
FACILITY-BASED SURVEILLANCE TOOLS
FACILITY-BASED SURVEILLANCE TOOLS Service Availability Facility Readiness Assessment Supportive Supervision
SERVICE AVAILABILITY PURPOSE Mapping: Identify existence or physical presence of facilities and mobile clinics Systematic survey at the national or subnational level Used to improve cervical services by assessing the equitable distribution of facilities and mobile clinics INTENDED USERS MoH, national planners, health administrators, partner organizations
FACILITY READINESS ASSESSMENT PURPOSE Assess facility capacity to deliver cervical cancer screening and treatment services; level of readiness Ensure that the facility has the necessary inputs or core elements required for services A precondition for service quality, it does not ensure quality Done as Baseline and as Periodic assessment of level of readiness INTENDED USERS MoH, facility supervisors, program managers, internal/external evaluators, partner organizations
FACILITY READINESS ASSESSMENT
FACILITY LEVEL OF READINESS AND SUMMARY SCORE
SUPPORTIVE SUPERVISION PURPOSE Focus on quality: 1) provider performance; 2) data quality and meeting key indicator benchmarks Also assesses level of facility readiness INTENDED USERS Clinical trainers/supervisors, M&E advisors, program managers, supervisors, and providers (peer and selfassessment)
FACILITY READINESS ASSESSMENT
PROVIDER PERFORMANCE
PROVIDER PERFORMANCE
DATA MANAGEMENT AND MEETING KEY INDICATOR BENCHMARKS
PERFORMANCE AND FACILITY READINESS SUMMARY SCORE
REVIEW TOOLKITS 1. 2. Divide into 2 groups 1 group review the PPM Toolkit and the other group review the FBS Toolkit (20 min) 3. 4. Switch (20 min) Summarize next steps