Chapter 14:Monitoring and Reporting

FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

MINISTRY OF HEALTH 1
 Section 1 Learning Objectives

 Section 2 Introduction
 Section 3 Operational Standards
 Section 4 Implementation Guidance
 Section 5 Implementation Monitoring

2
Learning Objectives
 At the end of this presentation participants will be
able to understand;

◦ the benefits of monitoring and reporting

◦ what Health Management Information means

◦ Data Quality Assurance techniques in hospitals

◦ How the Governing Board use HMIS/KPI data

3
Introduction
 Hospital management and Governing Boards are
responsible to monitor their hospital performance.
 Monitoring has a number of objectives including:
◦ To ensure that activities are proceeding as planned and on
schedule
◦ To maximize the quality, effectiveness and efficiency of
services
◦ To ensure financial viability of the hospital, and
◦ To ensure that the hospital is attaining of national targets.

 In addition to internal monitoring, hospitals are

required to report a core set of indicators defined in
HMIS and KPI.

4
Operational Standards
1. The hospital has an HMIS Monitoring Team (or
equivalent) which collaborates with the CG&QIU in
reviewing the HMIS indicators and takes action to
address any areas of concern.

2. The hospital conducts a self-assessment of its

own performance at a minimum every quarter,
using HMIS indicators and any additional local
indicators determined by hospital management.

3. The hospital submits monthly, quarterly and

annual HMIS reports to the relevant higher office
within the agreed timelines.

5
Operational Standards (cont’d)
4. The correspondence between data reported on
HMIS forms and data recorded in registers and
patient / client records, as measured by Data
Quality Assurance (DQA) and Lot Quality
Assurance Sample (LQAS) is ≥85%.
5. In collaboration with the Governing Board through
the CEO, the Clinical Governance and Quality
Improvement Unit have established performance
indicators for the hospital that are described in
hospital performance reports presented by the
CEO to the Governing Board as a minimum every
quarter.

6. . 6
Operational Standards (cont’d)
6. Indicators included in the hospital performance
monitoring system are a combination of
national/regional indicators and other local
indicators as determined by the Governing Board.

7. Hospital staff receive orientation on all

performance indicators and case
teams/departments determine indicators and
monitor their own performance using the process
improvement model.

7
Implementation Guidance

8
Health Management Information System

 HMIS refers to any system that captures, stores,

manages or transmits information to enhance
evidence based decision making at all levels and
improve the health system.
 HMIS defines 122 indicators in 8 main categories:
◦ Access to Health Services
◦ Community Ownership
◦ Resource Mobilization and Utilization
◦ Quality of health Services
◦ Pharmaceutical Supply and Services
◦ Evidence Based Decision Making
◦ Health Infrastructure
◦ Human Capital and leadership

9
Health Management Information System …

 Each HMIS Team should work with hospital’s

CG&QIU (or equivalent) to review the hospital data
and take action to address any areas of concern.
 Officer/team is responsible to ensure that:
◦ Data is collected and reported according to the HMIS
timeframe
◦ HMIS data is complete and valid before being used or
reported
◦ Data is reviewed by hospital management and used to
identify problems with service delivery
◦ Action is taken to address any problems identified using
HMIS data

10
 HMIS data aggregation and reporting
Latest date report
Frequency of
Health Facility Reporting level should be Comment
reporting
submitted

HP HC Monthly & Annual

Monthly, Quarterly
Health facility WoHOs 26th of the month
& Annual

Monthly, Quarterly Including private

WoHOs ZHD / RHB 2nd of the month
& Annual health facilities

Monthly, Quarterly Including private

ZHD RHB 7th of the month
& Annual health facilities

Monthly, Quarterly Including private

RHB FMOH 15th of the month
& Annual health facilities

NB: Registers are closed on the 20th of each month

11
Data Quality Assurance in hospitals
 Data quality can be defined as the state of
completeness, validity, consistency, timeliness,
accuracy, integrity and confidentiality that makes
the data appropriate for specific use
 Dimensions of Data Quality
◦ Accuracy: validity of data
◦ Timeliness: available on time
◦ Completeness: all data elements are registered
◦ Integrity: protected from deliberate bias or manipulation
◦ Reliability/Precision: not inconsistently
◦ Confidentiality:data maintained and not disclosed
inappropriately

12
Data quality assurance tools

 Lot Quality Assurance (LQAS)

and

 Routine Data Quality Assurance (RDQA)

13
Data quality assurance tools
 Lot quality assurance sampling (LQAS) is a
methodology that originated in manufacturing as a
low-cost way to assess and assure quality.

 Quality of HMIS data can be estimated using a

sample of 12 data elements and comparing the
results with a standard LQAS.

14
 Data quality assurance tools
LQAS Table: Decisions Rules for Sample Sizes of 12 and Coverage Targets/Average of 20-95%

Average Coverage (Baselines)/ Annual Coverage Targets (Monitoring and Evaluation)

Sample
Size Less
than 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%
20%

N/A
12 1 1 2 2 3 4 5 5 6 7 7 8 8 9 10 11

15
Role of the Governing Board to monitor hospital
performance
 Governing Board should review and monitor the selected set
of HMIS Indicators assure that the hospital is performing to a
high standard and quality services.

 The Balanced Scorecard is a tool that can be used by

Governing Boards to oversee the performance of the hospital

 The Governing Board should review each BSC report,

identifying areas of good performance and areas of concern

16
Balanced Scorecard
 The BSC is recommended by the FMOH as a management and
measurement tool for all levels of the health sector

 The Balanced Scorecard (BSC) is a planning, monitoring and

evaluation tool that considers performance in four key areas:
◦ Customer perspective
 Patient satisfaction score
◦ Finance perspective
 Revenue utilization
◦ Internal processes
 Healthcare acquired infection rate
 Stock out of tracer drugs
◦ Learning and growth of the organization
 Staff capacity building

17
Balanced Scorecard…
 Governing Boards should determine selected
indicators within each of the four key areas

 Act as a tool to orient staff to the objectives of the

hospital and strengthen staff engagement with
hospital improvement efforts.

18
Implementation monitoring

 Checklist & Indicators to measure attainment

of each Operational Standard.

19
Assessment Tool for Operational Standards
Yes No
1 An HMIS Monitoring Team (or equivalent) has been
established.
2 Self assessments of hospital performance are
conducted.
3 Monthly, quarterly and annual HMIS reports are
submitted to relevant bodies.
4 Lot Quality Assurance Samples have been done.
5 Lot Quality Assurance Samples show a result ≥80%.
6 The CEO and Governing Board have defined
performance indicators (that are a combination of
national, regional and other local indicators) in a
Balanced Scorecard
7 Performance indicators in a Balanced Scorecard (BSC)
have been reported to the Governing Board.
8 BSC orientations have been provided to staff. 20
 END

Thank You

21