title: How do we know? An assessment of integrated community case management data quality in four districts of Malawi.
abstract: The World Health Organization contracted annual data quality assessments of Rapid Access Expansion (RAcE) projects to review integrated community case management (iCCM) data quality and the monitoring and evaluation (M&E) system for iCCM, and to suggest ways to improve data quality. The first RAcE data quality assessment was conducted in Malawi in January 2014 and we present findings pertaining to data from the health management information system at the community, facility and other sub-national levels because RAcE grantees rely on that for most of their monitoring data. We randomly selected 10 health facilities (10% of eligible facilities) from the four RAcE project districts, and collected quantitative data with an adapted and comprehensive tool that included an assessment of Malawi's M&E system for iCCM data and a data verification exercise that traced selected indicators through the reporting system. We rated the iCCM M&E system across five function areas based on interviews and observations, and calculated verification ratios for each data reporting level. We also conducted key informant interviews with Health Surveillance Assistants and facility, district and central Ministry of Health staff. Scores show a high-functioning M&E system for iCCM with some deficiencies in data management processes. The system lacks quality controls, including data entry verification, a protocol for addressing errors, and written procedures for data collection, entry, analysis and management. Data availability was generally high except for supervision data. The data verification process identified gaps in completeness and consistency, particularly in Health Surveillance Assistants' record keeping. Staff at all levels would like more training in data management. This data quality assessment illuminates where an otherwise strong M&E system for iCCM fails to ensure some aspects of data quality. Prioritizing data management with documented protocols, additional training and approaches to create efficient supervision practices may improve iCCM data quality.
authors.affiliation: ICF International, International Health and Development Division; 530 Gaither Road, Suite 500, Rockville Maryland, 20850 USA jennifer.yourkavitch@icfi.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yourkavitch
authors.affiliation: ICF International, International Health and Development Division; 530 Gaither Road, Suite 500, Rockville Maryland, 20850 USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Zalisk
authors.affiliation: ICF International, International Health and Development Division; 530 Gaither Road, Suite 500, Rockville Maryland, 20850 USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Prosnitz
authors.affiliation: Independent consultant contracted by ICF International, International Health and Development Division; 530 Gaither Road, Suite 500, Rockville Maryland, 20850 USA.
authors.forename: Misheck
authors.initials: M
authors.lastname: Luhanga
authors.affiliation: IMCI Unit, Community Health Sciences Unit, Ministry of Health; Tsiranana Drive, Mtunthama Road, Lilongwe, Central Region, Malawi.
authors.forename: Humphreys
authors.initials: H
authors.lastname: Nsona
mesh_terms: D019090:Case Management / Q000458:organization & administration*; D002662:Child Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000193:education; D000068598:Data Accuracy; D003906:Developing Countries; D063005:Health Information Systems; D006801:Humans; D008295:Malawi
keywords: Assessment; child health; community care; decision making; developing countries; health information system; health systems research; quality