Using Data to Keep Clients on Path to Health

By Eric Kilongi | July 17, 2013

A rapid malaria test used at Rubuor Health Center, where a new data analysis program supported by EGPAF is helping the clinic better track clients and patients.

USAID

At a health clinic in Rabuor in Kisumu County in Kenya, what began as an effort to analyze data and measure the facility’s performance in the fight to eliminate mother-to-child transmission of HIV and other infectious diseases has resulted in an effective system that can trace clients to their homes.

By following patients who miss appointments through a community-based strategy, Rabuor Health Center can now account for all patients who visit the facility and determine which clients have sought treatment elsewhere, which have died, and which clients are being lost to follow up care. 

Using the new system – which uses telephone and home location details captured by health care workers during the patient’s first visit to the facility– the health center successfully traced 82 percent of clients who missed follow-up appointments in 2012, 93 percent of whom returned to the facility for treatment. Only 18 clients could not be traced. 

The system keeps track of patient visits to child welfare clinics, antenatal care clinics, and other health facilities, including HIV-exposed infants, people living with HIV, and those enrolled in HIV care and treatment. The system can also help the health center find clients who have failed to collect their HIV test results.

“We first call the clients to re-schedule their appointment (if they do not collect their test results),” Eric Openda, Rabuor Health Center Community Assistant, explained. “If the clients fail to come within three days, we send the community health worker (CHW) attached to their village (to the client) with the details they provided during registration.”

Initially, tracing “defaulters,” or people who have failed to continue follow-up care, used to happen only when new cases of HIV were reported in the area.

Monthly data review meetings incorporating the facility’s health workers and other supporting partners were initiated to share and analyze data in a way that would help measure performance and low retention rates. The facility decided to focus their efforts on people who had failed to return for follow-up care.

“Through this system, we are seeing more pregnant women coming early for antenatal care (ANC) and completing all four ANC visits before delivery,” said Edna Okombo, Rabuor Health Center Nursing Officer.

All of the Maisha-supported health care facilities have adopted the monthly district-based data review meetings, which health workers who record data in the maternal and child health (MCH) department attend on a rotating basis. At the meeting, each facility presents their data, using the elimination of mother-to-child HIV transmission (eMTCT) tracking tool as a guide.

This has helped to improve the accuracy and completeness of facility records, with fewer errors. All facilities submitted their data on time by the end of 2012, with a 95 percent improvement in accuracy– a 69 percent improvement since 2010.

“Now we come regularly to the clinic to check (on) the clients who are defaulting from our villages,” said Frida Olweny, a CHW attached to Kaloya and Kacholla villages.

The initiative began in 2012, when authorities realized that they were unable to determine the facility’s HIV retention rates, which are critical to evaluating the facility’s progress in the fight against HIV.

Using these and other tools, health care facilities have documented improved retention of HIV-exposed infants, with the Ministry of Health taking the lead in data management. Efforts like these are key to the fight to eliminate HIV.

Eric Kilongi is Senior Communications Officer for the Foundation, based in Kenya.