THE PHC MAP SERIES OF MODULES, GUIDES AND REFERENCE MATERIALS Each module includes: a User's guide a Facilitator's guide computer programs Module 1 Assessing information needs Module 2 Assessing community health needs and coverage Module 3 Planning and assessing health worker activities Module 4 Surveillance of morbidity and mortality Module 5 Monitoring and evaluating programmes Module 6 Assessing the quality of service Module 7 Assessing the quality of management Module 8 Cost analysis Module 9 Sustainability analysis Manager's guides and references Better management: 100 tips Problem-solving Computers The computerised PRICOR thesaurus Production Managers: Ronald Wilson, Aga Khan Foundation, Geneva and Thongchai Sapanuchart, Somboon Vacharotai Foundation, Bangkok, Thailand Co-Editors: Jennifer Sharples, Colin De'Ath, Bangkok, Thailand Design & Layout: Helene Sackstein, France Desktop Publishing: Marilyn J. Murphy, Suracha Suntarasut, Somboon Vacharotai Foundation, Bangkok, Thailand Printing: Thai Wattana Panich, Bangkok, Thailand Published in 1993 by the Aga Khan Foundation USA, Suite 700, 1901 L Street N.W., Washington DC and the Aga Khan Foundation, P.O. Box 6179, 1211 Geneva 6, Switzerland. Additional copies are available at the Aga Khan Foundation Canada in Toronto; Aga Khan Foundation (United Kingdom) in London; and AKF offices in Dhaka, Bangladesh; Delhi, India; Nairobi, Kenya; Karachi, Pakistan; Lisbon, Portugal; and Dar-es-Salaam, Tanzania; the Aga Khan University Faculty of Health Science in Karachi, Pakistan; the Somboon Vacharotai Foundation and the ASEAN Institute for Health Development in Thailand Dedicated to Dr. Duane L. Smith (1939-1992), Dr. William B. Steeler (1948-1992) and all other health leaders, managers and workers who follow their example in the effort to bring quality health care to all in need. The Primary Health Care Management Advancement Programme has been funded by the Aga Khan Foundation Canada, the Commission of the European Communities, the Aga Khan Foundation U.S.A., the Aga Khan Foundation's head office in Geneva, the Rockefeller Foundation, the Canadian International Development Agency, Alberta Aid, and the United States Agency for International Development under two matching grants to AKF USA. The first of these grants was "Strengthening the Management, Monitoring and Evaluation of PHC Programs in Selected Countries of Asia and Africa" (cooperative agreement no. OTR-0158-A-00-8161-00, 1988-1991); and the second was "Strengthening the Effectiveness, Management and Sustainability of PHC/Mother and Child Survival Programs in Asia and Africa" (cooperative agreement no. PCD-0158-A-00-1102-00, 1991-1994). The development of Modules 6 and 7 was partially funded through in-kind contributions from the Primary Health Care Operations Research project (PRICOR) of the Center for Human Services under its cooperative agreement with USAID (DSPE-6920-A-00-1048-00). This support is gratefully acknowledged. The views and opinions expressed in the PHC MAP materials are those of the authors and do not necessarily reflect those of the donors. All PHC MAP material (written and computer files) is in the public domain and may be freely copied and distributed to others. Contents FOREWORD 1 SESSION 1: INTRODUCTION AND OVERVIEW 7 Transparencies 5-1: Workshop objectives 14 5-2: Purposes of module 5 15 5-3: Monitoring 16 5-4: A systems diagram of management and service relationships17 5-5: An indicator is 18 5-6: Suggested indicators 19 5-7: Generic indicator categories for PHC services 20 5-8: Generic indicator categories for PHC management 21 5-9: Types of monitoring 22 5-10: Keep It Straightforward and Simple 23 5-11: The KISS approach 24 5-12: Steps in activity monitoring 25 SESSION 2: SPECIFY THE MONITORING OBJECTIVES(STEP 1) 27 Transparency 5-13: Session 2: Objective 30 SESSION 3: DECIDE ON THE SCOPE AND SELECT INDICATORS (STEPS 2 AND 3) 33 Transparencies 5-14: Session 3: Objectives 37 5-15: Planning the scope of monitoring 38 5-16: Common indicator modifications 40 5-17: Formulation of indicators 41 5-18: Frequency of data collection 43 SESSION 4: CHOOSE DATA SOURCES AND COLLECTION PROCEDURES (STEP 4) 45 Transparencies 5-19: Session 4: Objectives 48 5-20: Data sources 49 5-21: Data collection techniques 51 SESSION 5: COLLECT, TABULATE AND ANYALSE THE DATA (STEPS 5 AND 6) 53 Transparency 5-22: Session 5: Objectives 56 SESSION 6: PRESENT FINDINGS AND TAKE ACTION (STEPS 7, 8 AND 9) 59 Transparencies 5-23: Session 6: Objectives 63 5-24: Report findings 64 5-25: Take action 65 5-26: Monitoring review guidelines 67 Foreword What is the purpose of the Facilitator's guide? The Facilitator's guide contains a suggested workshop design for use by individuals who will help PHC managers and staff learn how to use the Primary Health Care Management Advancement Programme (PHC MAP) series. There is a Facilitator's guide for each module in the PHC MAP series. What information does it contain? Each Facilitator's guide contains instructions for conducting a workshop on one of the modules in the PHC MAP series using the information contained in the User's guide. The instructions are arranged in one to two hour sessions. The number of sessions depends on the amount of information and/or the number of steps contained in the User's guide. The first page of each session lists session objectives, major topic headings, time required, and materials and equipment. The following pages describe the instructional activities in outline form. The outline is divided into two columns. The right-hand column indicates what the facilitator says or does to conduct the session. The left-hand column lists the handouts, overhead transparencies, or other materials needed to support the activity. Copies of these materials, suitable for duplication, appear at the end of the session in which they are first used. Some transparencies are used in more than one session. How are the workshops organised? The first session of each workshop contains activities designed to introduce the PHC MAP series and explain its importance to PHC programmes, present an overview of the workshop, explain the purpose of the module, review specific terms or concepts used in the module, and acquaint the participants with the organisation and content of the User's guide. The final session of each workshop contains activities designed to review key points of the User's guide, if appropriate, help participants prepare an action plan, and brings the workshop to a formal conclusion. The sessions in between present the steps required to accomplish the purpose of the module and provide an opportunity for participants to apply those steps to their own programmes. Each workshop is designed to be given on consecutive days, uninterrupted except for breaks, meals, and rest, if the workshop is longer than one day. It is recognised, however, that situations vary and the PHC MAP modules will be used singly or in combination by individuals and organisations in the field and on university campuses. Therefore, it is expected that the workshops described in the Facilitator's guides will be adapted to fit a range of circumstances. Indeed, those who facilitate PHC MAP workshops are encouraged to make adaptations to meet the needs of participants and/or specific PHC programmes. Who can be a facilitator? Ideally, the person who serves as facilitator has training and experience in the fields of public health, management, planning, and evaluation, as well as sampling and survey design. It is recommended that this person also be skilful in working with small groups. The facilitator should be someone from outside the PHC programme, perhaps from another agency or a university. As a person with no direct interest in the programme, the facilitator can be neutral in disagreements that may arise and help the group members resolve an issue objectively. Having an outside person as facilitator also allows the programme director, who usually has a leadership role, to contribute his or her knowledge and experience as a full participant in the work of the group. It is also recommended that a facilitator have a full set of PHC MAP User's guides and Facilitator's guides. It is sometimes necessary, in the course of completing one module, to refer to information in another module. Who should participate in the workshop? The primary audience for the PHC MAP series is the team that manages PHC programmes or other population-based health programmes in either the public or private sector. An example of a PHC management team in the public sector is the core staff of a district ranging from 100,000 to 300,000 in size of population served. An example of a PHC management team in the private sector is the core staff of an NGO that provides PHC services to a specific population in a given geographic area. The average size of the service population may range from 40,000 to 60,000, but may be as small as 10,000 or more than 100,000. In either case, the management team should have: the knowledge and skills needed to complete the steps in the module the time and resources required to collect and analyse the required data the authority to plan and implement improvements in management systems and procedures based on this analysis. If feasible, teams from several districts or from several PHC programmes within a given NGO, may work simultaneously with one facilitator to complete a module. It is recommended that one facilitator work with no more than four teams or 20 people at one time. What does the facilitator do? Understands the needs of participants. If the facilitator is working with one PHC programme, the most efficient way to gather information about participants and the programme in which they work is to meet with the PHC director to determine: the nature of the PHC programme (services provided, size and description of area served, number and type of facilities, number and qualifications of staff, community involvement, computer capability, strengths, major problems, etc.) if information needs have been clearly identified previous staff training in management information systems or related topics resources available for training (time, space, equipment) possibility for subsequent technical assistance to workshop participants. Understands the content of Module 1. Read the User's guide and Facilitator's guide for Module 1 and consider options for workshop delivery. The purpose of Module 1 is to help participants select priority information needs and to review some basic concepts underlying management information systems. Depending on participant background, the amount of time available, and the need to establish priorities among management information needs, Module 1 can be presented in its entirety, limited to Level 1: Quick start, limited to the PHC MAP systems framework, or in summary form as contained in the first session of the Facilitator's guides for Modules 2 through 9. If information needs have not been clearly identified and participants have no background in systems, then Module 1 should be presented in full. The selection of the next module will depend upon priorities set by the participants as they complete the steps in Module 1. If information needs have been clearly identified and participants have no background in systems, then that portion of Module 1 can be added to the first session of the selected module. If information needs have been clearly identified and participants have a background in systems, then the overview of PHC MAP in the selected module will be sufficient. Understands the content of the selected module. Read the User's guide and Facilitator's guide for the selected module and consider options for workshop delivery. Depending upon the length of the module and the availability of staff for training, the workshop sessions may be presented as described in the Facilitator's guide, or workshop sessions may be delivered at intervals (for example, every morning for a certain number of days, one session per week, or one day per week for three or four weeks). If follow-on technical assistance is available, the content of the module could be presented in the workshop and the application of the procedure to the PHC programme could be conducted on the job. Participants could plan steps in the workshop, complete them on the job, and bring the results to the next workshop session. This approach is particularly applicable to Module 2 which requires development of a questionnaire, selection of a survey sample, training of data collectors, and data collection. These steps cannot actually be carried out within the time limits of the workshop as contained in the Module 2 Facilitator's guide. Other options are possible depending upon the circumstances of each situation. Determines what programme information, if any, is needed for completion of the module. For example, census data and lists of households are required to complete some of the steps in Module 3. Determines the most appropriate people to attend the workshop. For example, Module 7 is best completed by those responsible for planning, training, supervision, logistics, and other management services. Discusses the delivery options and participants with the PHC manager and make decisions regarding the most appropriate option and participant selection. Also determines if the needed information is available and if it is not, the alternatives for obtaining the information. Notifies participants of the date, time, and purpose of the workshop and confirms attendance. Initial notice of the meeting may come from the PHC manager, with follow-up by the facilitator. Prepares the agenda, using as a model the sample in Session 1 of the Facilitator's guide for the selected module. Inspects the room where the workshop will be held and answers these questions: Is the room large enough to seat all the participants? Can chairs and tables be arranged in a variety of ways; all participants around one table; participants in groups of three or four at smaller tables? Is the lighting adequate? Can temperature and humidity be controlled? Is there an electrical outlet for an overhead projector? Is a microphone necessary for everyone to hear and to be heard? Are toilets conveniently located? Is the site convenient to parking, restaurants and public transportation? Are supporting facilities available and convenient: duplication, word processing, computers? Prepares notes to conduct the workshop using the session outlines in the Facilitator's guide for the selected module, and makes the necessary adaptations. Refer to the appropriate User's guide for content. Duplicates the worksheets and other handouts as indicated in the Facilitator's guide and obtains the necessary equipment. Conducts the workshop as planned. Provides follow-on assistance, if appropriate. Session 1: Introduction and overview Objectives: Participants will be able to: Explain the purposes of Module 5. Distinguish between routine and short-term monitoring. Name at least two guidelines in the KISS approach to monitoring design. Explain the basic steps to planning monitoring procedures. Session outline: I. Introduction (10 minutes) II. Overview of workshop (5 minutes) III. Introduction to Module 5 (40 minutes) IV. Module 5 User's guide (20 minutes) Materials: Module 5 User's guide Handout 5-1: Agenda Transparency 5-1: Workshop objective Transparency 5-2: Purpose of Module 5 Transparency 5-3: Monitoring Transparency 5-4: A systems diagram of ma<->nagement and service relationships Transparency 5-5: An indicator is... Transparency 5-6: Suggested indicators Transparency 5-7: Generic indicator categories for PHC services Transparency 5-8: Generic indicator categories for PHC management functions Transparency 5-9: Types of monitoring Transparency 5-10: KISS Transparency 5-11: The KISS approach Transparency 5-12: Steps in activity monitoring Equipment: Flip chart, stand, markers, masking tape, overhead projector and screen I. Introduction (10 minutes) Note: Omit Section I if you have presented Module 1, or some other module, immediately prior to the presentation of Module 5. A. OPENING REMARKS Introduce self and other staff, as necessary. Explain your role in the workshop. If you do not know the participants, ask each one to state his or her name, position title, and job location. Note: If the group is larger than 6 or 8, you may wish to have them wear name tags or place cards with their names at places where they are sitting. Ask each participant to complete this sentence: "As a result of attending this workshop, I expect ..." and write their responses on the flip chart. When all responses have been recorded, say that you will return to this list after giving an overview of the workshop. B. OVERVIEW OF PHC MAP Explain why information is important for PHC programmes. Summarise PHC MAP programme, including: Purpose of PHC MAP Title and purpose of each module and other materials. Make the following points about PHC MAP: Has been field tested and revised to ensure usefulness to PHC programme staff. Modules can be used in any sequence. Checklists and other materials can, and should, be adapted to fit a particular situation. The procedures outlined in the modules can be adopted as routine monitoring activities in a PHC programme. Explain why MAP is being introduced in this PHC programme. Note: The remarks here should be tailored to the specific programme and should provide the answers to these questions: Why are we doing this workshop? What do we expect to achieve? It may be appropriate for the PHC manager to make these remarks. II. Overview of workshop (5 minutes) Review the workshop objective. Distribute and review the workshop agenda describing the activities that will take place to accomplish the workshop objective. Review the expectations contributed by participants at the beginning of the session. Indicate which ones will be met and which ones will not and why. Suggest, if possible, alternatives for meeting the expectations that will not be met in this workshop. Ask for questions or comments. III. Introduction to Module 5 (40 minutes) Explain that the purposes of Module 5 are to help PHC programme managers to: Identify important PHC services and management functions they wish to monitor. Select key indicators for these services and functions. Design and implement a simple monitoring system using these indicators. Review the definition and purpose of monitoring. Review the systems framework for PHC programmes presented in Module 1, if necessary. Explain the three categories (inputs, processes and outcomes) and give an example of each. Distinguish among outputs, effects, and inputs. Discuss the relationship between the management system components and the service delivery system components. Review the definition of indicator. Explain that Module 5 suggests indicators for the inputs, outputs, and effects for PHC services and management functions. Present and explain the suggested indicator categories for PHC services. Present and explain the suggested indicator categories for management functions. Ask for questions and comments. Explain the two types of monitoring and give an example of each type. Routine Short-term Explain the relationship between routine and short-term monitoring. Review guidelines for designing a monitoring system: Select only key indicators. Keep data collection to a minimum. Provide timely feedback. Use a clear and convenient reporting format. Discuss the limitations of activity monitoring and give examples: Important information may be difficult to collect. Important information may not be feasible to collect. Discuss other options for assessing effects and impacts. Review the steps in activity monitoring. Ask for questions and comments. IV. Module 5 User's guide (20 minutes) Distribute a User's guide to each participant. Highlight key sections of the User's guide: The overview of PHC MAP with the description of modules and other materials, which they may wish to refer to for review of information needs met by other modules. Quick start provides a procedure for monitoring important performance indicators. An explanation of generic categories of indicators for PHC services and management functions. Step-by-step directions for designing and implementing a monitoring system. Appendices containing suggested indicators and blank worksheets. Ask for questions or comments. SAMPLE AGENDA MODULE 5* Session 1 (1 hr,, 15 mins), Introduction and overview Session 2 (1 hr), Specify the monitoring objectives (Step 1) Session 3 (1 hr,, 20 mins)<%0>, Decide on the scope and select indicators (Steps 2 and 3) Session 4 (1 hr), Develop data collection procedures (Step 4) Session 5 (1 hr,, 15 mins), Collect,, tabulate and analyse the data (Steps 5 and 6) Session 6 (1 hr,, 20 mins), Present findings and take action (Step 7,, 8 and 9) *For an actual presentation, substitute the appropriate clock hours in the first column. WORKSHOP OBJECTIVE Plan monitoring procedures for PHC and management services using the steps and worksheets contained in Module 5 PURPOSES OF MODULE 5 To help PHC programme managers to: 1. Identify important PHC services and management functions they wish to monitor. 2. Select key indicators for these services and functions. 3. Design and implement a simple monitoring system using these indicators. MONITORING Definition: The periodic collection and analysis of selected indicators Purpose: Enables managers to determine whether key activities are carried out as planned and have expected effects on the target population Value: Identify problems;take corrective action; measure achievement of targets; assess trends in health status Management services PHC services A SYSTEMS DIAGRAM OF MANAGEMENT AND HEALTH SERVICE RELATIONSHIPS IMPACTS avoid dehydration and death of child OUTPUT CHWs trained in ORT OUTPUT ORS packet given INPUT trainers ORS packets INPUT trained CHWS & ORS packets EFFECTS CHWs skills in ORT EFFECTS mothers use ORT PROCESSES training (lectures, practices in ORT) PROCESSES CHWs diagnose & prescribe ORT AN INDICATOR IS... An indirect measure of an event or condition. Example: indicator: weight-for-age condition: nutritional status PHC services Outputs Effects Impacts Processes Inputs PHC management functions SUGGESTED INDICATORS, , , GENERIC INDICATOR CATEGORIES FOR PHC SERVICES EFFECTS Coverage (including behaviour) Knowledge and skills (of the target population) OUTPUTS Utilisation of services Quality of care Contacts, visits Access to services INPUTS Availability of personnel, supplies, equipment, funds GENERIC INDICATOR CATEGORIES FOR PHC MANAGEMENT EFFECTS PHC services available, accessible Staff performance Worker knowledge, skills, behaviour Community satisfaction with services Quality of PHC services OUTPUTS Services or activities completed Frequency of management activities Quality of management activities INPUTS Availability of trained personnel, supplies, information, guidelines/protocols TYPES OF MONITORING ROUTINE: regular, on-going core set of indicators tracks programme implementation SHORT-TERM: limited period of time tracks new activities or processes collects information to help solve a problem K EEP I T S TRAIGHTFORWARD AND S IMPLE THE KISS APPROACH Key indicators Minimum data collection Timely feedback Usable report format STEPS IN ACTIVITY MONITORING PLANNING: 1. Specify objectives 2. Decide on scope 3. Select the indicators and standards 4. Choose information sources; develop data collection procedures IMPLEMENTATION: 5. Collect the data 6. Tabulate and analyse the data 7. Present/report the findings 8. Take appropriate action ASSESSMENT: 9. Decide whether to continue monitoring Session 2: Specify the monitoring objectives (Step 1) Objectives: Participants will be able to follow the directions in the Module 5 User's guide to specify the monitoring objectives for their PHC programme. Session outline: I. Introduction (10 minutes) II. Specify the objectives (50 minutes) Materials: Module 5 User's guide Transparency 5-13: Session 2: Objective Handout 5-2: Worksheet for specifying the monitoring objectives Equipment: Flip chart, stand, markers, masking tape, overhead projector and screen I.Introduction (10 minutes) Review the session objective. Explain that the activity monitoring procedures can be applied to: short-term monitoring of selected indicators routine monitoring of all indicators improve upon an existing MIS II. Specify the objectives (50 minutes) Explain that specifying monitoring objectives involves determining: What is going to be monitored For what purpose For whom If Module 1 has been completed, instruct participants to review the PHC and management services they prioritised. If Module 1 has not been completed, instruct participants to review the list of the most common functions and services. Choose which services to monitor from the list in Appendix A. Choose which management services to monitor from the list in Appendix B. Rank services to be monitored on a scale of 1 to 10 (highest). Determine whether to monitor input, output or effect indicators for these services. Distribute the worksheet for specifying the monitoring objectives and explain what information goes in each column and how that information is determined. Note: This step assumes understanding of the terms numerator and denominator. You may need to review these terms, depending on the background of the participants. Direct participants to complete the worksheet for their own PHC programme using the model on page 22 in the User's guide as necessary. When participants have completed the worksheet ask them to: Explain the rationale for their choice of activities to monitor. Specify why information is needed for each purpose indicated. Explain the extent to which the users are involved in the selection of indicators and the use each user will make of the information. Ask for questions and comments. SESSION 2: OBJECTIVE Specify monitoring objectives for your PHC programme Managers Internal users Others External users What to monitor Purpose & routine(s)or short-term Management services PHC services Providers Donors WORKSHEET FOR SPECIFYING THE MONITORING OBJECTIVES Session 3: Decide on the scope and select indicators (Steps 2 and 3) Objectives: Participants will be able to follow the directions in the Module 5 User's guide to:Decide on the scope of the monitoring.Select the indicators and performance standards. Session outline: I. Introduction (5 minutes) II. Decide on the scope of the monitoring (30 minutes) III. Select the indicators and performance standards (45 minutes) Materials: Module 5 User's guide Transparency 5-14: Session 3: Objectives Transparency 5-15: Planning the scope of monitoring Transparency 5-16: Common indicator modifications Transparency 5-17: Formulation of indicators Transparency 5-18: Frequency of data collection Handout 5- 3: Worksheet for specifying the scope of monitoring Handout 5-4: Worksheet for selecting indicators and standards Equipment: Flip chart, stand, markers, masking tape, overhead projector and screen I. Introduction (5 minutes) Review objectives for Session 3. II. Decide on the scope of the monitoring (30 minutes) Discuss the four areas that need to be addressed in planning the scope of monitoring, and the factors involved in each: Geographic area Facilities or sub-projects Personnel involved Durationshort-term vs. routinedeadlines Distribute the worksheet and direct participants to complete Handout 5-3 using the model on page 23 in the User's guide as necessary. Ask for questions and comments. III. Select the indicators and performance standards (45 minutes) Refer participants to Appendices A and B, and explain that input, output, and effect indicators are suggested for each PHC and management service. Direct participants to review the indicators listed and the information contained in the footnotes. Explain that:Participants will probably need to modify the indicators to fit their own situations. The most common modifications are:the definition of the target group terminology Indicators can be expressed in different ways. Distribute Handout 5-4. Direct participants to select/modify indicators for their PHC programme and formulate each one. Direct participants to present the indicators they have formulated and to explain any modifications or additions. Note: Check selected indicators for consistency with monitoring objectives established in Session 2 and help participants make adjustments as needed. Explain that a performance standard, sometimes referred to as a target, is set for each indicator to establish a point at which it can be agreed that the target has been achieved. Demonstrate how those standards are used to calculate the effectiveness of performance. Direct participants to set standards for the indicators they have selected or modified and record them on the worksheet. Discuss some of the factors considered in establishing frequency of data collection. Direct participants to establish frequencies for their selected indicators and record them on the worksheet. Ask for question or comments on Steps 2 and 3. SESSION 3: OBJECTIVES Decide on the scope of monitoring Select the indicators and performance standards PLANNING THE SCOPE OF MONITORING Geographic area Facilities or sub-projects Personnel involved Duration Short-term vs. routine Deadlines WORKSHEET FOR SPECIFYING THE SCOPE OF MONITORING A. What geographic area will be covered? B. Which facilities or sub-projects will be monitored? C. Which personnel (managers, providers, and volunteers) will be selected? D. How long will the monitoring continue? COMMON INDICATOR MODIFICATIONS Definition of target group(s) Terminology Phrasing Addition or deletion of indicators FORMULATION OF INDICATORS Count: Simplest type of measure Rate: Measures frequency of events Ratio: A fraction or a decimal Proportion: Measures relationship between a part and the whole Percentage: A proportion multiplied by 100 Frequency Standards Formulations PHC services Indicators Management WORKSHEET FOR SELECTING INDICATORS AND STANDARDS FREQUENCY OF DATA COLLECTION Consider how often users want to examine results Establish the minimum frequency necessary Continuous data collection - exact number of times an event occurs Periodic data collection-determine if a procedure is being carried out as expected Session 4: Choose data sources and collection procedures (Step 4) Objectives: Participants will follow the directions in the Module 5 User's guide to: Choose information sources Select data collection techniques Session outline: I. Introduction (10 minutes) II. Identify existing data sources (10 minutes) III. Develop new data collection instruments (40 minutes) Materials: Module 5 User's guide Transparency 5-19: Session 4: Objectives Transparency 5-20: Data sources Transparency 5-21: Data collection techniques Handout 5-5: Worksheet to select data sources and techniques Equipment: Flip chart, stand, markers, masking tape, overhead projector and screen I. Introduction (10 minutes) Summarise the outcomes of Steps 1, 2, and 3. Discuss the objectives for Session 4. II. Choose information sources (10 minutes) Provide examples of possible information sources. Distribute Handout 5-5 and direct participants to list the indicators they have selected in Step 3 and enter appropriate source of data for each. III. Develop data collection techniques (40 minutes) Define and give examples of techniques for gathering monitoring data. Explain that instruments to collect data by methods other than record review can be found in other MAP modules. Module 2 contains rapid surveys to identify health needs. Module 5 contains checklists for assessing quality of PHC services delivered to meet those needs. Module 6 contains checklists for assessing the quality of management functions that support service delivery. Explain that if existing records do not supply necessary data for monitoring, forms can often be modified so that staff can record the information needed. Direct participants to complete Handout 5-6 by writing in the techniques appropriate for each indicator and have them highlight those techniques that will require either modification of existing forms or development of new instruments. Ask for questions and comments. Remind participants that this is the final step in the planning phase. The next phase to be discussed is implementation. SESSION 4: OBJECTIVES: Choose information sources Select data collection techniques DATA SOURCES Existing sources Routine records Logistics records Treatment registers Patient records Activity reports Population-based records Modification of current forms Develop new instruments Management service indicators PHC service indicator Data Source: DC Technique: Survey/ interview Client Review Records Interview Health worker Observation Provider- client interface WORKSHEET TO SELECT DATA SOURCES AND TECHNIQUES, , , DATA COLLECTION TECHNIQUES Record review Observation Rapid surveys Exit interviews Health worker interviews Session 5: Collect, tabulate and analyse the data (Steps 5 and 6) Objectives: Participants will follow the directions in the Module 5 User's guide to: Collect the data needed to monitor selected activities. Tabulate and analyse the collected data. Session outline: I. Introduction (5 minutes) II. Collect the data (25 minutes) III. Tabulate and analyse the data (45 minutes) Materials: Module 5 User's guide Transparency 5-22: Session 5: Objectives Handout 5-6: Worksheet for specifying data collection, supervision and processing Handout 5-7: Worksheet for comparing actual with its standard of performance Equipment: Flip chart, stand, markers, masking tape, overhead projector and screen I. Introduction (5 minutes) Review session objectives. II. Collect the data (25 minutes) Describe steps that are recommended when using new monitoring forms or instruments, before actual data collection begins. Pretest new instruments and revise as needed. Select and train data collection personnel. Establish procedures for supervising data collection and processing forms and data. Explain the information contained in Modules 2, 4, 6, and 7 that can be guidelines for setting up data collection procedures. Distribute Handout 5-6 and instruct participants to complete it for one of the techniques identified on the preceding worksheet, such as a rapid survey, using actual names, if they can. Ask for questions and comments. Note: If data collection will take place after the workshop, be sure that participants anticipate problems that might occur and identify tentative solutions. III. Tabulate and analyse the data (45 minutes) Explain that data should be tabulated and analysed to meet the objectives and scope specified in Steps 1 and 2. Review the procedure for calculating percent of standard achieved. Distribute Handout 5-7 and direct participants to complete it and verify the percent achieved using the formulas. Note: If data collection will take place after the workshop, provide them with sample data with which to practice calculating percent achieved of standard. Explain that the worksheet shows one way of displaying data for interpretation: comparing actual performance to standards. Other ways are: Comparing indicators over time. Comparing performance between health units or administrative districts. Explain that data are most commonly displayed as lists, tables, and graphs. Refer participants to the examples provided and explain the information in each. Ask participants to discuss what conclusions they might draw from these tables and graphs or what problems might be indicated by the data displayed. Ask for questions and comments. SESSION 5: OBJECTIVES Collect the data needed to monitor selected activities Tabulate and analyse the collected data Responsibility Staff Supervision Processing Collection WORKSHEET FOR SPECIFYING DATA COLLECTION,, SUPERVISION AND PROCESSING, % Achieved of standard Action to be taken Standard performance Actual performance Components PHC service (indicators) Management service (indicators) WORKSHEET FOR COMPARING ACTUAL PERFORMANCE WITH ITS STANDARD OF PERFORMANCE,