Pastoralist Community Health Information System (CHIS) TOT MOH September 2021 Jigjiga

PCHIS

1. Pastoralist Community Health Information System (CHIS) TOT MOH September 2021 Jigjiga

2. Objectives After this session, participants will understand: The basic concepts of Health Extension Program (2nd generation) The rural CHIS implementation Process in Health Extension Program Updated Pastoralist CHIS tools and how to use Data quality and information use

3. Outline Introduction Extension Program (HEP ) Context of pastoralist CHIS Overview Household Registration Kebele Profiling Integrated service recording tools Tallies and Reporting Formats Data Quality and Information Use

4. Introduction Millions of Ethiopians, especially those who live in rural areas, are exposed to a variety of preventable diseases. T he Ethiopian Government has formulated a series of Health Sector Development Programs, to avert the situation. Ethiopia has launched the Health Extension Program (HEP) in 2004, with aim to provide universal access to 16 packages of primary health care services

5. Introduction… The Extension Program (HEP) is a defined package of basic and essential health services targeting households. promotive, preventive and selected high impact curative

6. Introduction… 2nd Generation HEP Increased community demand and epidemiologic changes, the government of Ethiopia re-designed and introduced the second HEP at the end of 2017 The 2 nd generation HEP comprises of 18 packages (19 for pastoralist areas) The program is delivered at household, community, schools, youth centers and health post level by whom level IV HEWs community health workers who are 10 th grade complete and two years of clinical training (level I).

7. Introduction… The health Service packages of HEP for pastoralist are: Family Health Maternal & Child Health Adolescent & Youths Reproductive Health Family planning Immunization Nutrition Hygiene and Environmental Sanitation Personal hygiene Healthy housing construction & management Insects and rodents control Latrine construction and proper use Solid & liquid waste management & disposal Food & water hygiene

8. Introduction… Disease Prevention and control Malaria Prevention & control TB & HIV/AIDS prevention and control Zoonosis disease prevention & control Non-communicable diseases Prevention & control Mental Health NTD Prevention & Control First Aid Emergency measures Health Education &Communication

9. Context of pastoralist Pastoralists residing in Somali, Afar, Gambella , some areas of Oromia and SNNPR regions Mobility patterns are Static/Settled, Static base and transhumance (partial movement), Static-mobile (complete movement) Static-mobile and relocated after return, and Most likely out-migrant Introduction…

10. Overview of CHIS CHIS has been deployed as part of reformed HMIS since 2010 to monitor and evaluate the performances of HEP CHIS is designed to collect, analyze and use community level data for performance monitoring it was delayed in the pastoralist community due to mobile nature of the communities that determines the implementation of CHIS MOH designed simplified and integrated service recording tools based on the assessment findings and lessons learnt from the implementation of agrarian CHIS Introduction…

11. Customized basic formats/tools for Pastoralist areas : Introduction… 1. Household Register 2. Kebele profiling formats 2.1. Kebele demographic profile 2.2. Kebele resource mapping 2.3. Kebele household environmental sanitation profile 2.4. School Health profiling

12. Introduction… 3. Integrated service recording tools Family Planning Register Maternal and newborn care Register Expanded Program of Immunization (EPI) Register Developmental Nutrition Register Nutrition Screening and TFP Register Pregnant and Lactating Women Nutrition Screening Register Curative care service Register Neglected Tropical Diseases (NTDs) Screening Register Health Service Reminder Card

13. Introduction… 4. Tallies Service delivery tally Disease information tally Tracer drug availability tally Family planning method dispensed count 5. Reporting formats Monthly Service delivery report Monthly Diseases report Quarterly service delivery reports Annual reports Others Tickler file Box Field Book Shelf

14. Household Register PCHIS uses household register to record HH data that help the HEWs to identify preventive and promotive health service needs of a family Contents: Household Identification Household’s Movement Status Household members' description Hygiene and Sanitation Drinking water source Household’s possession of LLITN and CBHI membership status HEP packages practices & Household Model Status Show the Register with its contents

15. Household Register…Contents Household Identification Region :______ Zone:________ Woreda :______ Kebele :____ Gote /Village/other :______ Name of HH head :________________________________ Date of registration_________   Household’s Movement status recording part Household’s Movement status Ethiopian Fiscal Year Year: _______ Year: _______ Year: _______ Year: _______ Year :_____ Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 At residence place (√)                                         Moved (√)                                         Returned back (√)                                      

16. Household members’ description recording part Household Register…Contents S.NO Full Name DOB Age Sex (M/F Vital Reg. No *Occupation Educational status ** Marital status S/M/D/W/NA Date Relocated Reason of relocation Date Died Cause of death Y1 Y2 Y3 Y4 Y5      _/_/_                      _/_/__   __/_/_       _/_/_                   _/_/__   _/_/_       _/_/_                     _/_/__   _/_/__  

17. Hygiene, Sanitation, Drinking water and Housing Household Register…Contents Items Ethiopian Fiscal Year Year :_____ Year: _____ Year: ______ Year: _______ Year: _______ Q 1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Latrine Availability (Y/N)                                         Type (I/UI**)                                         proper use of latrine(Y/N)                                         Hand washing facility availability (Y/N)                                        

18. Household’s water Treatment, safe source and storage recording section Household Register…Contents Items Ethiopian Fiscal Year Year: _____ Year: ___ Year: _____ Year: ________ Year: __ Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Source of drinking water**                                         Water treatment technologies Used (Y/N)                                         Storing treated water with narrow necked containers/ separate clean dipping up (Y/N)                                        

19. Household liquid and solid waste disposal facility recording section Household Register…Contents   Ethiopian Fiscal Year Items Year: ______ Year: _____ Year: ________ Year: ________ Year: ______ Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Waste disposal facility Liquid (seepage pit) (Y/N)                                         Solid (refuse pit/ composting) (Y/N)                                        

20. Household Housing Status recording section of hygiene and sanitation card Items Ethiopian Fiscal Year Year: ___ Year: ____ Year: ____ Year:__ Year: ____ Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Having separate kitchen with smokeless stove (Y/N)                                         Having separate animal house (Y/N)                                         Having shelves for kitchen wares/Rack (Y/N)                                         Household well ventilated *(Y/N)                                         Household Register…Contents

21. Household’s Possession of LLITN and HDA & CBHI membership status Household Register…Contents Items Ethiopian Fiscal Year Year: ___ Year: __ Year: ___ Year: ___ Year: ____ Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Active WDA membership status                                         WDA leadership status (1:5/1:30/N)                                         Functionality of 1:5 network (for WDAs)                                         Number of LLITN (Protective****)           CBHI membership registration or renewal date          

22. HEP packages practices (P/NP/NA )   HEP packages Year: _ Year: ____ Year: _____ Year: ______ Year: ____ Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Hygiene and Environmental Sanitation                                         Personal hygiene                                         Healthy housing construction & management                                         Insects and rodent control                                         Latrine construction and proper use                                         Solid & liquid waste management & disposal                                         Food & water hygiene                                         Household Register…Contents

23. Kebele Profiling It is used to summarize data of kebele population, health resources, and status of households’ environmental sanitation situation of a kebele . The data is used as baseline to plan health activities The kebele profiling activities are: Kebele demographic profiling Kebele resource mapping Kebele household environmental sanitation profiling School health profiling Show the formats

24. Integrated service recording tools Family Planning Register Maternal and newborn Health Service Register Expanded Program of Immunization (EPI) Register Developmental Nutrition Register Nutrition Screening and TFP Register Pregnant and Lactating Women Nutrition Screening Register Curative care service (OPD) Register Neglected Tropical Diseases (NTDs) Register Health Service Reminder Card Show the Registers

25. Family Planning Register It captures data related to family planning services (Oral pills, Injectable, condom and Implanon as a contraceptive). A longitudinal register used to record FP information for one year for a single client After the fiscal year is completed, the client is registered again in the same registration book

26. New acceptors A client who has not received a contraceptive from a recognized FP program previously at the time of registration Repeat acceptors A client who has received a contraceptive method from a recognized FP program in previous year (EFY). Note: A client is counted only once as new or repeat in one fiscal year Family Planning Register…

27. Personal Information Category Family Planning Service TT Remark/ Appointment Serial No. Full Name Age Kebele New Acceptor (√) Repeat acceptor (√) Visit number Visit Date (DD/MM/YY) Blood pressure (mmHg) Type of contraceptive provided Amount given Reason for method switch TT provided (dose no) Date (DD/MM/YY) Sex Gote (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)                          1            2                      3                4               5               Family Planning Register… Use Abbrevation For col. 10 Inj = Injectabile C=Oral contraceptive Fec =Female condome Imp=Implant Oth =Others Mc=Male condom   Reason for method switch for col. 12 a) Side effect b) Misconception c) Wanted Short/long acting d ) Others (Specify)   others

28. Maternal and newborn Health Service Register It is a longitudinal register It is used to record data related to maternal and child health services provided to women and children during pregnancy, perinatal and postpartum periods One row is used to document follow up data for one pregnancy , delivery & Postnatal services

29. Personal Information Focused Antenatal Care Serial No. Name Age Kebele Last Menstrual Period Gestational Age (weeks) Visit number Date of ANC visit (DD/MM/YY) Weight ( Kg) BP MUAC (cm) HIV Test accepted (√)   HIV Test result (P/N) Client counseled and Referred for ART Iron supplementation (# of tablets) TT provided (dose no) Mebendazole provided (√) Advised on danger sign (√) Advised on birth preparation (√) Advised on maternal nutrition (√) Counseled on Breast feeding (√) ITN provided (√) Date (DD/MM/YY) Gote EDD (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22)             1                                 2                                       3                             4                           Maternal and newborn Health Service Register…

30. Maternal and newborn Health Service Register… Delivery Services Maternal status Neonate status Complication and referral New Born preventive service Postnatal Care Remark/     Place of delivery Attendant Received miso (√) Alive/ Stable (√) Died (√) Alive (√) Sex (M/F) Weight in grams Still birth (√) Neonatal death (age in days) If died, cause of death Maternal complication (√) Referred (√) TTC eye ointment (√) Chlorhexidine (√) Visit Number Date of Visit (DD/MM/YY) PNC visit Time Advised on maternal care (√) Advised on newborn care (√) Place where PNC provided Newborn Complication (√) (24) (25) (26) (27) (28) (29) (30) (31) (32) (33) (34) (35) (36) (37) (38) (39) (40) (41) (42) (43) (44) (45)                               1             2                 3               4             Note: PNC visit time: 48 hours, 7 days, 42 days

31. Expanded Program of Immunization (EPI) Register EPI register is longitudinal register designed to record data to monitor vaccination of children and related services   Personal Information Antigens received Date (DD/MM/YY) PAB Remarks/Appoints Serial No. Name of Infant DOB Name of Mother Woreda Dose number BCG OPV DPT-HepB-Hib (Pentavalent) PCV Rota IPV Measles Fully immunized by first birthday (√) Mother received TT 2+ in last pregnancy (√) Mother received TT 3+ in her life(√) Protected at birth (PAB)(√) Reg. Date (DD/MM/YY) Sex (M/F) Kebele Gote (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18)              0                                 1              2              3            

32. Developmental Nutrition register It is used to record data on Growth Monitoring service for under two children and Micronutrient supplementation services for children age 6 months to 59 months. It has three parts: Personal Information, Growth Monitoring and Promotion, and Micronutrient supplementation and Deworming

33. Developmental Nutrition register… S.No Personal Information GMP for under 2 years children Year: _________________ Micronutrient supplementation Remarks Date (DD/MM/YY) Visit Date (DD/MM)                         Vitamin A (DD/MM/YY) Deworming (DD/MM/YY)   Name   Woreda   Weight (kg)                             Age (MM)   Kebele   Height (cm)                         Z-score of WFA                                 Sex (M/F)   Mother/Guardian   Gote   Nutritional status (N, MU, SU)*                      

34. Nutrition Screening and TFP Register It is used to record data on services given nutrition screening, admission of severe malnutrition and referral activities. It focuses on: Nutrition screening for children under-five years of age OTP admission and discharge services Personal Information Nutrition Screening Admission Serial No. Name of Child Age (MM) Name of Mother/Guardian Woreda Kebele MUAC (cm) Oedema (+,++,+++) Classification (N,MAM, SAM)** If SAM, action taken (Admitted or Referred) Unique SAM No New admission (Y/N) Date (DD/MM/YY) Sex (M/F) Gote Transfer/ Readmission(Y/N) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)                                     NB: N:- Normal; MAM:- Moderate Acute malnutrition; SAM:- Sever Acute malnutrition

35. Nutrition Screening and TFP Register… OTP start date Classification (N, MAM, SAM) Discharge *Outcome Remark Visit # Date (DD/MM/YY) Weight (kg) Height (cm) Z-Score Oedema (+,++,+++) MUAC (cm) Date (DD/MM/YY) Weight (kg) Height (cm) Z-Score Oedema (+,++,+++) MUAC (cm) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28)  1                                2                                3                                4                               Nutritional Status: N=Normal, MU=moderately underweight, SU=severely undernourished *Outcome: Cured, Defaulted, Transferred out, Non-respondent, Died

36. Pregnant and Lactating Women Nutrition Screening Register This register is used to record data related to nutritional screening services given for pregnant and lactating women . Personal Information Nutritional Screening Counseling & Action taken Remarks S.No Name of the Mother Age Woreda PSNP* beneficiary (Y/N) Visit No. Date of visit (Write day DD/MM/YY) Status (P/L) Weight (kg) MUAC (cm) Classification (N or Malnourished) If all Nutrition Counseling Provided(✔) (1,2,3,4,5,6) Action taken (A,B,C,D) Kebele Gote                                           1                   2                       3                   4                     5                   Nutrition Counseling For Pregnant Women eat one extra meal every day For Lactating Women eat two extra meal every day Eat variety & diversified food Deworming at 2 nd or third trimester (PW) IFA every day minimum at least 90 days plus Sleep under insecticide treated net Action Taken Counseling provided Referred to TSFP Referred to PSNP Referred to other (specify) N: Normal; MUAC>23 cm; Malnourished : MUAC <23 cm

37. Curative care service Register It is a case register used at OPD to record disease information during treating and counseling patients Identification Sign & Symptom (C/C) Malaria related info Disease Classification (If Patient referred, write " referred") Type of visit TB Screening Provider Initiated HIV Counseling & Testing (PIHCT) Action taken (Treatment given) If referred, Reason for Referral   Remark/ Appointment (referral site) Serial No. Service Date (DD/MM/YY) Full Name Age Sex (M/F) Woreda Kebele Gote Travel History (Yes/No)   RDT result (N, PF,PV, Mixed) New (√) Repeat (√) Screened for TB (√) TB screening result (P/N) HIV Test Offered (√) HIV Test performed (√) HIV Test result (P or N) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22)                                                                                  

38. Neglected Tropical Diseases (NTDs) Screening Register NTD Screening register is used to record data related to targeted neglected tropical diseases while screening and diagnosing the household members for & with the neglected tropical diseases. S.No Full Name Age Sex Address Screening date (DD/MM/YY) NTD Cases screened (1, 2,3,4,5,6,7,8 or 9) Linked / Referred for treatment (yes/No) Treatment outcome (Improved, the same, dead) Remarks Woreda Kebele Gote                                                                         Trachomatous trichiasis (TT), Lymphedema , Hydrocele, Cutaneous Leishmaniasis , Visceral Leishmaniasis , 6. Dracunculiasis , 7 . Schistosomiasis (SCH ), 8. Soil Transmitted Helminthiasis (STH), and 9. Onchocerciasis ( Oncho )

39. Health Service Reminder Card The only card for PCHIS It is issued to the client during service provision that has continuity, and they keep with them and show up with it during consecutive services where they go to any facility . A copy of this Health Service Reminder card is kept in Tickler file box to follow the client to trace for the next appointment. It has two parts: Maternal Health Service on front page and Child Health service on backside of the card.

40. Health Service Reminder Card… Health Service Reminder Card for Maternal Health: Obstetric History Pregnancy follow up (Antenatal care) Delivery Postnatal care Family planning Services Tetanus Toxoid (TT) vaccination Health Service Reminder Card for Child Health: Vaccination Growth Monitoring

41. Tallies and Reporting Formats Types of tally sheets used in CHIS Service delivery tally Disease information tally Family planning method dispensed count Quarterly reportable data elements tally The CHIS reporting formats Monthly service delivery reporting form Monthly disease reporting form Quarterly service delivery reporting form Annual reporting form Immediately/weekly PHEM Reporting form Show the tallies & report formats

42. Other Tools or materials Tickler file Box Tickler file system is a system that used to assure service continuity through follow up client appointment using the Tickler file. It consists of 12 boxes arranged serially and each box representing a month of the year. 4 2 3 1 5 6 7 8 9 10 11 12

43. Field Book is a register used to record the identification details and service data of clients receiving service at household or outreach sites and for whom the HEW did not carry the household and service register. It is used to record household data/service given and update the household register or record the service given in service register. Other Tools or materials… Date of visit Name of the client Service provided (detail) Name of Head of Household Address: Woreda, Kebele, Gote)                              

44. What is data Quality? Data quality is a perception or an assessment of data's fitness to serve its purpose in a given context.  It refers to whether data is properly collected, accurate and fit for its intended purpose. Data quality is not linear and has many dimensions like Accuracy, Completeness, Consistency, Timeliness, Relevance and data confidentiality. Data Quality

45. Common Elements of Data Quality Accuracy Timeliness Data is collected, transmitted and processed according to the prescribed time and available for making timely decisions Data that is compiled in reporting forms is accurate and reflect no inconsistency between what is in the registers and what is in the reporting forms at facility level . Data Completeness: At service delivery point, it refers to all the relevant data elements in a patient/client register are filled At Health Administrative unit All the data elements in a report or database are filled

46. How to Check data quality HEWs should Check monthly/quarterly/yearly report for content completeness before sending to Health Center Visual scanning (eyeballing): Look across each line and then from top to bottom; it is important to look for missing data values, unexpected fluctuations beyond maximum/minimum values, inconsistencies between linked data elements, and for mathematical errors. HEWs should perform LQAS monthly to check data accuracy level of the report of that specific month Data accuracy check using Lot Quality Assurance Sampling (LQAS) technique follows steps to perform

47. Steps in Data Quality Check using LQAS method (Steps 1-3) Prepare your draft report. Pre-fix the level of data accuracy that you are expecting to 90% Put serial numbers against the data elements in the Service Delivery Report (include aggregated data only). if the reporting period is quarter include both monthly and quarterly data elements 49 9/26/2021

48. 4. Generate twelve random numbers using lottery method or Excel program. These random numbers represent the serial numbers of the data elements included in the data accuracy check. Write them in 1 st Column of the Data Accuracy Check Sheet . This is to ensure representation of all data elements by giving equal chance to all data elements. 5 . List down the selected data elements from the report on to the Data Accuracy Check Sheet in Column 2 50 Steps in Data Quality Check using LQAS method (Steps 4-5) 9/26/2021

49. Random # (1) Selected data elements (2) Value in Consistent Register (3) Tally sheet(4 ) Report (5) Yes (6) No (7)   Total (YES or NO)  Data Accuracy Check Sheet (HPs ) 51 Month/Quarter/Year: --------------

50. Steps in Data Quality Check using …(Steps 6-10) Recount the figure from register, and tally sheets and record in the corresponding column 3 & 4 of the Data Accuracy Check Sheet respectively. Write down the reported figures from the Monthly/Quarterly Report for the selected data elements in the Column 5 of the Data Accuracy Check Sheet. If the figures for a particular data element match or do not match put “yes” or “no” accordingly in Column 6 or Column 7 respectively. Count the total number of “yes” and “no” at the end of the table Match the total number of “yes” with the LQAS Decision Rule table and determine the level of data accuracy achieving the expected target or not. 52

51. Random # Reporting elements Value in Consistent Register Tally sheet Report Yes No 14 Number of postnatal visits within 7 days of delivery 5 4 5 ü 91 Functional  1 to 5 networks 56 56 56 ü 94 Number of outpatient visits 18 18 18 ü 83 Total number of children aged 24 – 59 months dewormed 56 45 60 ü 10 Number of pregnant women that received ANC First visit 10 10 10 ü 89 Number of slides or RDT positive for malaria 7 7 7 ü 55 Number of under 5 children treated for pneumonia 4 4 4 ü 3 New acceptors by methods 5 2 5 ü 47 Early neonatal death  at community ü 26 Number of children <1yr of age who have received first dose of measles vaccine 10 10 10 ü 101 Ferrous sulphate + folic acid 1 * 1 ü 70 Number of weights recorded with severe acute malnutrition 12 8 13 ü   Total (YES or NO)  8 4 Data Accuracy Check Sheet 53 Month/Quarter/Year: September 2013E.C 

52. The “Decision Rule” Decision Rules for sample Sizes of 12 and Coverage Targets /Average of 20-95% Sample size Average Coverage (baselines)/Annual Coverage Targets (monitoring and Evaluations) Less than 20% 20% 25% 30% 35% 40% 45% 55% 60% 65% 70% 75% 80% 85% 90% 95% 12 N/A 1 1 2 2 3 4 5 6 7 7 8 8 9 10 11 Is a slide on LQAS Table for sample size of 12 used to know for deciding whether we have achieved the desired level of data quality or not . Data quality LQAS score: the total number in the “Yes” column corresponds to the percentage in decision rule table (LQAS table). For example, if total “yes” number is 2, the accuracy level is between 30-35%; if total number in the “yes” column is 9, the accuracy level is 85%

53. Information use is a practice where an organization experienced the use of data/information as basis for building a knowledge , which can then be used for different purposes, and it is the process of making decision based on synthesized information, and reached conclusion. Information Use

54. Purposes of Information Use at Community level Improve evidence based practice and culture Planning the delivery of health services Knowing service delivery coverage Identifying current state of health status Identifying leading causes of morbidity and mortality Increase health service efficiency and effectiveness. Increase financial investments for service delivery Increase accountability and responsibility requirements Achieve quality and equity

55. Minimum Wall charts at HP S.No Description Form of presentation Frequency of Update Map of Kebele Map Annually 1 Population Profile Table Annually 2 Sanitation Profile Table/Bar Graph Annually 3 Outreach Locations and Schedule table (also on Catchment Area Map) As locations or schedule change 4 Immunization Monitoring For < 1 Children (Penta3, PCV, Measles) line graph: achievement vs eligible Monthly 5 Kebele resource profile table Annually 6 Plan Performance Monitoring Table Monthly&/Quarterly 7 CBNC Monitoring Line graph Monthly 8 Malaria Monitoring(For Malaria's kebele only) Line graph weekly

56. Population Profile Gedeb HP S.NO Description Number 1 No of HH 1,115 2 Total Population 5,464 3 Female Population 2,677 4 Male Population 2,787 5 15-49 Reproductive Age Group 1,270 6 Under five Children 852 7 Under three children 454 8 Under One Infants 174 Total New birth 152 Total Death 8 Sanitation Profile of Gedeb HP  Description 2007 Data HH with Latrine(Both Type) 1270 HH with Improved type of Latrine 325 HH with Unimproved Latrine 945 HH with Hand washing facility with Soap 300 HH with Hand washing facility with Sand/Ash 600 Source: HH Register

57. Templates Two templates used to enhance information use at health post level. Basic health indicators template Top Ten Causes of Morbidity and Mortality template

58. Basic health indicators template Shows the overall health performance of kebele /health post Displayed in a different chart in a place where it is visible Updated quarterly

59. Basic health indicators template The percentage could be written in different colors based on the performance as green, yellow and red. Used to identify the priority area Easily communicate with Kebele council members and PHCU staff

60. How to develop action Plan Step 1: Do Analysis for each indicator you want to look Step 2 : Identify possible cause for low/unlikely high performed indicator Step 3 :Prioritize your area of intervention Step 4 : Develop action Plan

61. Potential Solutions Magnitude Large scale = 4 Medium scale = 3 Low Scale = 2 Very Low Scale = 1 Feasibility Highly feasible = 4 Good feasibility = 3 Low feasibility = 2 Not at all feasible = 1 Cost Low Cost = 4 Medium Cost = 3 High Cost = 2 Very High = 1 Other Resources Needed Minimal = 4 Few = 3 Several = 2 Significant = 1 Capacity Excellent Capacity Exists = 4 Good Capacity Exists = 3 Fair Capacity Exists = 2 Little Capacity Exists = 1 Total Tracing Defaulter by using Tickler box &HDA 4 3 4 4 4 19 Providing Out Reach Service for far villages 4 2 3 3 3 15 Mobilizing clients ahead of EPI Due date 4 3 3 3 4 17

62. Action Plan Problem Identified Solution Responsible Body Time Frame Resource needed Remark High DOR of P1 to Measles Tracing Defaulter by using Tickler box & WDA Leader HEW WDA Leaders Tir 20-25,2009

63. Thank You!!

64. MUAC classification and recommended actions Color Nutritional status MUAC (cm) MUAC (mm Action Red Sever (SAM) 11.5cm <115 mm Refer to the nearest health facility that provides therapeutic feeding Yellow MAM 11.5- 12.4 cm 115- 124 mm Refer to the nearest health or nutrition center that provides supplementary feeding (if available) Green Healthy >12.5 cm >125 cm Encourage the care giver to continue with healthy hygienic care and feeding practices, and to return if the child becomes sick or weaker

65. WHO Growth monitoring chart z-scores Classification Recommendations/action Above 3   Obese Consult the mother impact of overweight like possible for having chronic diseases Between +2 and +3 Over weight counsel to feed diversified food not nutrient dense food age appropriate feeding/CF/ together with breastfeeding Between +1 and -1 Normal Appreciate the mother, counsel to continue age appropriate feeding/CF/ together with breastfeeding Between -2 and -3 Underweight Tell the mother the child is growing below the standard or what it expected. If the TSFP intervention available link the child to the program Then counsel her on age appropriate Complementary feeding together with breastfeeding Below -3 Severely underweight Enroll the child with OTP program If the child shows a danger sign/complicated refer to stabilization center for better treatment Then counsel her on age appropriate Complementary feeding together with breastfeeding