MRC PhD student

Level of study: PhD

Title: Evaluating the Process and Output Indicators for Maternal, Newborn and Child Survival in South Africa: a case study of HIV in KwaZulu Natal

Project summary:
The Department of Health has been moving towards district management and the District Health Information System is becoming a central component of the health information system. However, problems have been identified with the routine data systems with respect to the completeness and quality of data collected.

An attempt to assess trends in coverage of key high impact maternal, newborn and child survival interventions with a view to identify key policy and programmatic areas in each province, has identified several data quality issues with discrepancies observed between routinely collected data and survey data.

Particular problems have been identified in the routine data systems when examining the Prevention of Mother to Child Transmission of HIV (PMTCT) programme. PMTCT programme. The study conducted in KwaZulu Natal found that the routine statistics from three large, high HIV-prevalence districts were neither complete nor accurate and viable to track process performance or outcomes for PMTCT care. They found that data were missing from the District Health Information System (DHIS) between 29 and 87 percent of the time and that the DHIS deviated on average by 75 percent from the corresponding values found in the clinics registers for the six PMTCT indicators monitored.

Using various monitoring and evaluating frameworks like the HIV/AIDS and STIs 2007-2011 National Strategic Plan framework, the Performance of Routine Information System Management (PRISM) framework for strengthening and evaluating routine health information systems, the framework based on the continuum of care developed for the Countdown to 2015 initiative, and the U.N. guide for monitoring and evaluating child health programmes, this study seeks to evaluate the process and output indicators used in delivering these interventions, with an aim of establishing a more functional system of tracking progress in coverage using the DHIS, and to improve access to these HIV interventions at both the provincial and district levels. In particular it seeks to investigate how the DHIS functions and how it can be extended to make it more functional in managing the HIV programmes in maternal, newborn and child health, hence enhancing accurate information flow from health facilities to the district level.

Secondary objectives

1. To review various data sources and frameworks used in monitoring and evaluating HIV interventions;
2. To establish a system of tracking progress on these HIV interventions at both the provincial and district levels;
3. To evaluate the district health information systems and investigate what is currently being used in monitoring progress on these HIV indicators; and
4. To investigate barriers to the use of health information and to analyse information flow from health facilities to the district level.

• The expected outcome is the improvement in the ability to monitor high impact HIV interventions.
• The secondary outcome is the improvement in the district health information system to monitor maternal, newborn and child health programmes performance.

Supervisors: Prof Lilian Dudley, Health System Research, Faculty of Health Sciences, University of Stellenbosch; Prof Debbie Bradshaw, Burden of Disease research Unit, MRC
Study Institution: Stellenbosch University
MRC Unit: Burden of Disease Research Unit