Roll Out of RDQA in Provincial and Federal Hospitals

Overview

The Federal Ministry of Health and Population (FMoHP) initiated the Routine Data Quality Assessment (RDQA) in six secondary and tertiary hospitals managed by the federal and provincial governments in Province 2 and Lumbini Province. Gajendra Narayan Singh Hospital, Bheri Hospital, Narayani Hospital, Rapti Provincial Hospital, Lumbini Provincial Hospital, and Provincial Hospital Janakpur were selected to conduct the RDQA.

The RDQA tool consists of two domains: data verification and system assessment. The data verification domain of the RDQA tool helps assess whether service delivery sites (health facilities) at different levels and the national M&E system are collecting, consolidating, and reporting data to measure the selected indicator(s) accurately and on time. It also crosschecks the reported results with other data sources.

The system assessment domain of the RDQA tool identifies strengths and potential threats to data quality posed by the design and implementation of the data management and reporting system at different levels of the M&E and service delivery sites. System assessment has five functional areas: M&E structure, functions and capabilities; indicator definitions and reporting guidelines; data collection and reporting forms and tools; data management processes; and use of data for decision making.

Recommendations

For health facilities

Institutionalize the RDQA
The RDQA tool should be routinely carried out by the health facilities, and should take place at least twice a year. It should be institutionalized within the hospital system. The assessment should be executed in the presence of ward in charges to understand the issues faced by each ward, and to learn about transformative errors and methods of ensuring data quality. Consequently, the action plans that will be identified may also be easier to implement as they will be relatable to each ward.

On human resources for health (HRH) and their capacity

Prioritize HRH in record units: One of the prominent issues that emerged during the implementation of the RDQA was the lack of medical record unit personnel. For that reason, health facilities should strengthen and prioritize human resources in their medical record units. In addition, focal and co-focal persons should be in place to deal with HMIS reporting and public health analytics.

Make data available to all personnel: Data should never be confined to a single unit. All health staff should be able to access, with proper authorization, the data and use it to improve their performance and quality of services. It is important to train as many personnel as possible on data use, HMIS reporting, and public health analytics, among
others. To begin with, ward in-charges can undergo training and the programme can be expanded gradually.

For the Ministries of Social Development and Provincial Health Directorates

Build capacity to prioritize data and record management: Training, along with refresher courses, should be conducted on HMIS reporting and data and record management. They should focus on medical record unit personnel but should also include human resources from other units. This should be done at least once a year, and should be part of the routine training programme run by the institutions. These capacity building programmes should be mandated by the MoSD and PHDs.

Enforce the use of the RDQA: While the guideline on the use of the RDQA states that the tool can be used twice a year to understand the quality of data produced by health facilities, it has not been met with total compliance. Therefore,
the MoSD/PHDs should work on reinforcing the RDQA tool and its usage among the health facilities.

For the Federal Ministry of Health and Population

Address logistical issues related to data management: Almost all health facilities that were part of this study pointed out logistical challenges, such as delayed delivery of reporting forms and updated guidelines. The MoHP should ensure that these logistical challenges are addressed on time.

Establish quick troubleshooting mechanisms: Quick troubleshooting mechanisms should be installed within the IHMIS units so that issues that arise during the data management processes can be addressed immediately.

Review set of indicators: There were numerous indicators for the hospital-level that were irrelevant. On that account, the MoHP should update the RDQA tool and create a filter in the system so that only relevant sets of indicators are displayed. These should be based on the institutional hierarchy of the health institutes.

For agencies regarding technical assistance

Support the federal and provincial ministries on RDQA implementation: Technical assistance should be provided to the FMoHP and MoSDs in addressing the barriers to improving data quality. Support should also be given for the nationwide implementation and use of the RDQA.

Research low data use: As part of their support to the FMoHP, agencies should initiate research and analysis on the reasons behind the low use of data in health facilities. This research will guide further programmes on data use and quality improvement efforts.