i Improving Accuracy of District Coverage Estimates of Health Management Information System by Annealing it with Lot Quality Assurance Sampling Community Survey Data in Nepal (Improving Accuracy of HMIS District Coverage Estimates Using Annealing Technique in Nepal) Integrated Health Information Management Section Management Division Department of Health Services Ministry of Health and Population Technical Support DFID/Nepal Health Sector Programme 3 Monitoring, Evaluation and Operational Research Project Ministry of Health and Population Department of Health Services ii This study was carried out with the technical and financial support of the UK Department for International Development (DFID). DFID Nepal Health Sector Programme 3 (NHSP3), Monitoring, Evaluation and Operational Research (MEOR) project under the aegis of Integrated Health Information Management Section (IHIMS), Management Division, Department of Health Services (DoHS), Ministry of Health and Population (MoHP) provided technical assistance to complete the study. The views expressed are of those who contributed to carry out and complete the study and do not necessarily reflect the views of MoHP and DFID nor the Government of Nepal and UK Government. This primary research intended to improve the accuracy of district coverage estimates of health management information system (HMIS) by using a special statistical technique, the Annealing Technique (AT). This was done using lot quality assurance sampling data from a community survey blending it with the HMIS data of the same reference period to calculate a combined prevalence of selected indicators in three districts (Jumla, Arghakhanchi and Mahottari) of Nepal. To carry out the study NHSP3/MEOR project led by Abt Associates worked with Liverpool School of Tropical Medicine (LSTM) for overall research design, analysis and report writing as AT is a specialty of LSTM. Field work of the study was carried out by Rooster Logic Pvt. Ltd. Additional information about the study may be obtained from the IHIMS, Management Division, DoHS, MoHP, Teku Kathmandu; Telephone: +977-1-4257765; internet: http://www.mddohs.gov.np; or NHSP3/MEOR project, Lalitpur-10, Jwagal, Lalitpur, 44700, Nepal; telephone: +977-1-5544822; email: [email protected]. Cover photos courtesy of NHSP3/MEOR project © 2018. Recommended citation: Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Nepal; and Ne- pal Health Sector Programme 3/Monitoring, Evaluation and Operational Research (MEOR). 2019. Improving Accuracy of District Coverage Estimates of Health Management Information System by Annealing it with Lot Quality Assurance Sampling Community Survey Data in Nepal. Kathmandu, Nepal: DoHS, MoHP, Nepal. iii Contents Foreword ......................................................................................................................................... i Acknowledgements ........................................................................................................................ ii Study Monitoring Group .............................................................................................................. .iii Executive Summary........................................................................................................................ iv Acronyms ....................................................................................................................................... vi Chapter 1. Introduction ................................................................................................................... 1 1.1 Background ............................................................................................................................. 1 1.2 Statement of problem and rationale ........................................................................................ 1 Chapter 2. Study Objectives and Conceptual Framework.......................................................... 2 2.1 General objective .................................................................................................................... 2 2.2 Specific objectives .................................................................................................................. 2 2.3 Research questions .................................................................................................................. 2 2.4 Conceptual Framework ........................................................................................................... 2 Chapter 3. Methods ......................................................................................................................... 4 3.1 Study design and settings ........................................................................................................ 4 3.2 Survey data .............................................................................................................................. 4 3.3 Study population ..................................................................................................................... 4 3.4 Sampling ................................................................................................................................. 4 3.4.1 Sample size .................................................................................................................... 4 3.4.2 Sampling Process ........................................................................................................... 5 3.5 LQAS data collection training ................................................................................................ 7 3.6 Instruments .............................................................................................................................. 7 3.7 Data collection ........................................................................................................................ 7 3.7.1 Data collection procedure .............................................................................................. 7 3.7.2 LQAS survey back check ............................................................................................... 8 3.7.3 Study monitoring ........................................................................................................... 8 3.7.4 HMIS data ...................................................................................................................... 9 3.8 Indicators for annealing .......................................................................................................... 9 3.9 Safety Procedures .................................................................................................................. 11 3.9.1 Study participants ......................................................................................................... 11 3.9.2 Data collectors /district supervisors .............................................................................................. 11 3.10 Ethical Consideration .......................................................................................................... 11 3.10.1 Ethical approval ......................................................................................................... 11 3.10.2 Informed consent ....................................................................................................... 11 iv 3.10.3 Measures to protect privacy and confidentiality .....................................................................12 3.11 Data Management and Analysis .............................................................................................................12 3.11.1 Data management ....................................................................................................... 12 3.11.2 Data analysis ......................................................................................................................................12 3.12 Limitations .......................................................................................................................... 14 3.13 Community/Stakeholders in this Study .............................................................................. 14 Chapter 4. Results .......................................................................................................................... 16 4.1 Data characteristics and AT characteristics............................................................................ 16 4.2 ANC use ................................................................................................................................. 18 4.3 Safe delivery .......................................................................................................................... 21 4.4 New born care and postnatal care .......................................................................................... 24 4.5 Assessing variation in local-level data quality ...................................................................... 30 Chapter 5. Discussion .................................................................................................................... 33 Chapter 6. Dissemination and Utilisation .................................................................................... 35 6.1 Dissemination of Study Findings .......................................................................................... 35 6.2 Utilisation of Research Findings ..........................................................................................