EE ENRS Quality GG Egypt YY Dr. Amal Galal PP ENRS Focal Point NT P Egypt TT Introduction •Egypt has m ore than 70 m illion population in 27 governorates. •A nnual T B incidence of new positive cases is 12/100000, w ith 5000 new positive T B cases and 12000 T B cases all types notified to the NT P each year. ENRS in Egypt • It is easy now for all levels to m ake recording and reporting of all data required for m onitoring the Perform ance of T B activities • It is also easy to check , recheck data and recall it to m ake all needed reports in appropriate tim e ENRS - D ata and Inform ation flow process Im plem entation of ENRS • 2004, T w o pilot governorates Cairo and G iza • 2005 NT P started the first stage of expansion it w as planed to w ork on 4 governorates, Ism aelia, Q aliubia, Port Saied. • 2006 full expansion after distribution of about 66 com puters. • 2 (T w o) e-registers w ere introduced (district and lab). Num ber of trainees Stages Trainees GCT Directorate IT center Total Pilot 38 2 2 42 First 16 2 - 18 Second 254 23 60 337 Total 308 27 62 397 ENRS-Cost and resources • T he cost of developing the system w as part of the staff salary, and the technical assistance from W H O w as part of the training com ponent through J PRM • T he m ain cost item s in im plem entation w ere: – the hardw are (60000 U SD )* – the com m unication (5000 U SD )* – the training (25000 U SD )* – the supervision (3000 U SD )* *[Egypt example for full implementation covering 153 chest clinics and 26 provinces plus 20 HI centers] Im plem entation duration T otal duration: 2 years for full expansion (153 BM U /district, 26 G , H IO 20) • 6 m onths for pilot • 3 m onths for expansion 15 months computers procurement !!!!! ' uality V erification • ENRS as a new system im plem ents param eters of quality to ensure • A ccuracy (Proper item in the proper cell), • Com pleteness (A zero blank cells), • Consistency (Matching of different columns)& • T im eliness (availability of data in the assigned tim e). • A ll these are done through electronic sheets w hich m ake it easy to fulfill all these param eters. Story of Q uality Im plem entation Preparation of Q uality training-step1 D eveloping Q -tables • Paper tables as a first step of piloting • Electronic tables for evaluation Preparation of Q uality training-step2 D eveloping Q - G uideline Preparation of Q uality training-step3 D eveloping Exercises Preparation of Q uality training-step 4 Identify the trainees of each governorate •T he G CT of each governorate •T he H IO coordinator of each governorate •T w o from the governorate directorate inform ation center (netw ork m anager & data m anager ). Preparation of Q uality training-step 5 A genda: Setting the three days training agenda Im plem entation of Q uality training Started at A ugust 2006 for provincial level Five groups and 73 trainees. 3 days of training on: •D ata cleaning •Q uality tables •D ata com piling •D ata analysis and quarterly reporting Channels of Com m unications •A t B M U level: D ata is send on a CIC (floppy disk, flash stick, CD ..etc) to the D istrict Inform ation Centre/D IC. Shared folder •From D IC the data enter the governorate shared folder in the governorate inform ation centre/G IC. GIC GIC •A t G CT level, the data is accessible through the shared folder at G IC. Shared folder •T he Central Inform ation Centre/CIC in the M inistry prepared an open DIC DIC DIC DIC channel directly to the Central NT P office. BMUs •A ll com m unication channels are secured and protected by a passw ord. , onitoring and Evaluation M & E is done through supervisory visits to the chest units and D istrict IT centers in all governorates to evaluate the field w ork and solve any technical obstacles. T he supervisory team is form ed from : •O ne of the T ask Force T eam •O ne from the Central IT center in M O H P •T he G CT and the m anager of the IT directorate center. $uality Tables Com pleteness T ables-step1 A t provincial level 1- Filter the files for blanks or m istakes 2- Record them by using cell index 3- Send feed back to chest clinic/T B M U 4- Calculate num ber of m istakes in each colum n and fill in the electronic form Filtering Com pleteness T ables-step2 $anuary Com pleteness T ables February Com pleteness T ables March Com pleteness T ables April Com pleteness T ables Quality A ccuracy T ables Follow ing the sam e steps to m easure accuracy. A ccuracy T ables A ccuracy T ables ConsistencyT ables Som e item s revised for Consistency •T he patient w ith the chest clinic •Registration date w ith Start of treatm ent •A ge group w ith sputum exam ination at diagnosis •Patient diagnosis w ith D iagnosis Category •Patient Category w ith treatm ent regim en •Patient Category w ith Sputum exam ination at diagnosis ConsistencyT ables ConsistencyT ables T im elinessT ables T he G CT or the focal person in the inform ation centre receives the data from each clinic in an assigned date, date is recorded in the electronic sheets and a chart is draw n to notify the tim eliness of the process and the progress of quality. 5th Day of each m onth Governorates Outcomes SohagGovernorate in Upper Egypt 0 overnorates O utcom e Sohag governorate in upper Egypt A ccuracy - J anuary 2006 0 overnorates O utcom e Sohag governorate in upper Egypt A ccuracy -M arch 2006 0 overnorates O utcom e Sohag governorate in upper Egypt A ccuracy - Septem ber 2006 0 overnorates O utcom e Sohag governorate in upper Egypt A ccuracy - O ctober 2006 0 overnorates O utcom e Sohag governorate in upper Egypt A ccuracy - Q uality 0 overnorates O utcom e Sohag governorate in upper Egypt Com pleteness- J anuary 2006 0 overnorates O utcom e Sohag governorate in upper Egypt Com pleteness -February 2006 0 overnorates O utcom e Sohag governorate in upper Egypt Com pleteness -M arch 2006 0 overnorates O utcom e Sohag governorate in upper Egypt A ugust 2006 0 overnorates O utcom e Sohag governorate in upper Egypt Septem ber 2006 0 overnorates O utcom e Sohag governorate in upper Egypt O ctober 2006 0 overnorates O utcom e Sohag governorate in upper Egypt Com pleteness- Q uality ENRS-Lessons Learned - Im prove accuracy, com pleteness consistency and tim eliness of reporting and indicators calculation in NT P at all levels. (high quality) - Save tim e for analysis, and facilitate feedback. - Facilitate supervision and increase it.s efficiency - Facilitate locating the patients as per their residency not only their place of diagnosis, w hich w ill give m ore accurate inform ation about disease distribution, and access to services using G IS. ENRS-Next Step - Produce com prehensive NT P database to be used in: V G IS for planning of treatm ent supporters (D O T ) netw ork. V O perational research V Evidence based planning and budgeting. - Pilot the com piled package at the central to be expanded to the provincial level. T hank Y ou.