Ukraine Infectious Disease

Program

Health Information Systems and

Management Reform

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 Collaborating Agencies
 Started in 1997 as a collaboration between the
USAID, BASICS, CDC, MOH and PATH
 PATH became the lead organization with the
technical assistance provided by all partners
 Funded by USAID; the 2nd and 3rd years of
work supported through the Technologies for
Child Health (Health Tech) Cooperative
Agreement between USAID and PATH
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 Background:
• Grew from lessons learned from diphtheria campaigns in
Ukraine, which identified weakness of existing HIS

– Lack of reliable data on vaccine distribution, consumption,

coverage and wastage
– Confusion over target population definitions, campaign
strategies and contraindication criteria
– Non-standard statistical methods, contradictory reports and
statistics between oblasts
– Excessive record-keeping and reporting requirements
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 Program Goal:
Improve the public health management,
infectious disease prevention and control
activities through reform of the MOH's
health information system by improving
- the quality of the information collected, and
- the utilization of the information by and for
management

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 Program Activities (1):
Established multi-disciplinary, multi-level
working group
• assessed the current status of data collection,
processing and utilization;
 identified deficiencies in the system;
 established priorities and recommended changes
 monitored progress of the reform
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 Program Activities (2):
• Working group developed methods and
materials for the introduction of revised policies
and practices, and for training staff
• Three oblast wide workshops and National
conference on management information
conducted to introduce findings
• Establishment of the National level Working
Group to advise and coordinate country-wide
adoption of the program reforms

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 Program Activities (3):

 replication of previously developed management

and public health surveillance reforms in the all
country
 Series of regional training seminars for oblast
epidemiologists and pediatricians on the revised
reporting policies and procedures, forms and
monitoring tools

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Accomplishments:

• Every level of the public health service

delivery system, from the MoH, oblast SES
to the village ambulatory clinic, now has
the capability to accurately forecast needs
and monitor and evaluate their activities

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Accomplishments:
• Standardized internationally accepted definitions
and methods for calculating base populations for
surveillance statistics, annual work plans and
monitoring of program performance are in use

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Accomplishments:

• Immunization managers have the capacity

to accurately monitor supplies from existing
stores to the point of consumption, track
vaccine balances and rationalize
distribution.

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Accomplishments:
• Oblasts now have the ability to monitor and
respond to vaccine wastage. For the first
time, oblast and national authorities have
evidence of the extent of the problem, and
the information tools necessary to
effectively address it.

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Accomplishments:
The problem with excessively and
inconsistently applied contraindications to
immunization, which had been identified
and documented by the new HMIS, was
successfully addressed, and the number of
contraindications in the new immunization
schedule was radically reduced.

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Accomplishments:
Armed with the HMIS data demonstrating
inefficiency of the decentralized vaccine
procurement mechanism, with documented
evidence of frequent stockouts affecting
immunization coverage rates, the Ministry of
Health has succeeded in 2001 in re-establishing
central procurement of vaccines in Ukraine

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 Summary
This has resulted in:
• Identifying “problem” administrative
territories and health settings
• Targeted interventions to identify and
correct the source of program deficiencies
• More children being immunized with those
immunizations being more timely
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 for monitoring of immunization
at oblast and central level

Software application UKRVAC-01

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 PURPOSE

Ukrvac is a supplement to HMIS that helps

1) process big flow of quality data at oblast and central
level in a timely manner
2) quickly draw immunization manager’s attention to
regions with sub-optimal performance
3) present information in a suitable form to decision
makers and as a feedback to health workers at lower
levels
4) store the data electronically for future reference
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 DATA ENTRY

 WHO - assistant epidemiologist or PC operator (in oblasts)

 WHEN - every month
 HOW LONG - usually no more than 2-3 hours
----------
Accuracy verification and protection from accidental
mistakes of an operator during data entry:
- data validation
- automatic verification of totals
- conditional formatting of data entered

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 SYSTEM OUTPUT:

1. MONTHLY REPORTS ON
IMMUNIZATION PRACTICE
 number and types of immunizations given
 use of vaccines
 contraindications
 timeliness
All data are protected from changes
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 Number and types
of immunization
given,
Cumulative
numbers,
Coverage in %

Vaccine
flow
and
usage
data

Timeliness of
immunization and
contraindications

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 2. CONTRAINDICATIONS TO DTP
(tables and graphs)

 by type (short-term, long-term, permanent)

 by oblasts and rayons/towns
 by months
 structure (DTP-1,2,3)

All data are protected from changes

Conditional formatting function
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PERCENTAGE OF CHILDREN WITH CONTRAINDICATIONS TO DPT 1-3 UKRAINE 2000

16%
16%
The overall number of contraindications have reduced.
Proportion of children contraindicated to DTP 1-3 for a
14%
14% long term has dropped from 4% to 2.6%

12%
12%

10%
10%

8%
8%

6%

6%

4%

4%

2%

2%
0%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

0%
Jan Feb Mar Apr
Long-term and permanent
May Jun Jul
Temporary
Aug Sep Oct Nov
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Dec
 December
December

10%
12%
14%
16%

0%
2%
4%
6%
8%
Crimea

Vinnitsa

Volyn

Dnipropetrovsk

Donetsk

Zhitomir

Zakarpatie

Zaporizhzhia

Iv-Frankivsk

Kievska

Kirovograd

Lugansk

Lviv

Nikolaev

Odessa

Long-term and permanent

Poltava

Rivno

Sumy

Temporary
PERCENTAGE OF CHILDREN WITH CONTRAINDICATIONS TO DPT 1-3

Ternopil

Kharkiv

Kherson

Khmelnitsky

Cherkassy

Chernivtsi
UKRAINE

Chernigiv

Kiev City

Sebastopol

UKRAINE
The focus of attention should be on selected low compliance regions

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2000
3. TIMELINESS OF IMMUNIZATIONS
(table and graph)

 by oblasts and rayons/towns

 by months

All data are protected from changes

Conditional formatting function

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 TIMELINESS OF DPT-3 IMMUNIZATIONS
(at the age of 6mo 29d), UKRAINE, 2000

100

95

90
Coverage, %

85

80

75

70
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 24
Dec
Vaccine shortages result in delayed immunization

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 4. IMMUNIZATION COVERAGE
(tables and graphs)

• Breakdown by oblasts and towns/rayons

• Monthly and cumulative data in tables and
dynamically built graphs
• For all antigens: BCG, Polio (1-7), DTP (1-4),
DT, Td, d, Hep B, Measles, Mumps, Rubella

All data are protected from changes

Conditional formatting function

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Frequent stockouts

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 Decentralized procurement:
no mumps vaccine in 5 oblasts, whereas
other preparations might have been bought
in excessive quantity

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 5. USE OF VACCINES (tables and graphs)

 For each vaccine:

 vaccine flow in oblasts and rayons/towns every month
 monthly balances at oblast, rayon/town stores and in health
facilities
usage/wastage patterns by oblasts/rayons/towns and months

Graphical presentation of all vaccines usage patters in regions

Conditional formatting function
All data are protected from changes

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Reasons for high wastage need to be
investigated and customized action
plans developed

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 More than 6-month supply of DPT issued
Severe shortage of to health settings
basic vaccines

A lot of DPT in stock but no Mumps

vaccine

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