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COMMUNITY – BASED INTEGRATED NUTRITION P.O. Box 4909,

Kampala, Uganda. TEL.: +256‐772‐502649.

E‐MAIL: cobin.ug@msn.com

PROJECT REPORT

Improving data management and quality of the outreach health and

nutrition systems of COBIN

By

Lillian Busingye Lisa (Fellow) E­mail: busingyell@hotmail.com

Institutional Supervisor Prof. John T. Kakitahi.

Academic Supervisor Ms Evelyne Akello

27 TH August 2010

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TABLE OF CONTENTS

Acronyms and Abbreviations……………………………………………………..3

Operational Definitions…………………………………………………………….4

Introduction …………………………………………………………………..……5

Background ………………………………………………......................................5

What was the problem/baseline……………………………………………………..6

Project objective; General objective……………………………………………7 Specific objectives……………………………….………….7

Implementation methods……………………………………………...……………..7

Project results as per objective………………………………………...……………..8

Challenges and solutions …………………………………………………………….13

Lessons learnt…………………………………………………………………………14

Way forward…………………………………………………..………………………15

Sustainability plan……………………………………….…………………………….15

Conclusion……………………………………….…………………………………….16

Appendices……………………………………………………………………………..17

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Acronyms and Abbreviations

COBIN…………………………………Community Based Integrated Nutrition Programme

FCW…………………………………….Family Care Workers

EW………………………………………..Extension Workers

HH……………………………………...House Hold

HIV………………………………………….Human Immune Virus

AIDS………………………………………Inhuman Deficiency Syndrome

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Operational Definitions

Family Care Worker: A person elected by the community and trained by COBIN to carry out COBIN activities at household/family level, particularly in her/his village.

Household: A group of people who normally live and eat together in one unit and share domestic functions and activities (UBOS 2002)

Caregiver: The individual, usually the mother or grandmother or grandfather who takes primary responsibility for the physical, mental and emotional needs and wellbeing of the child.

Vulnerability: A state of being in a risky situation, in this case, individuals who are prone to HIV/AIDS, sickness, hunger, and unable to meet basic needs for the family members.

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INTRODUCTION

It is increasingly recognized that information gathering and management is important not only in following up intended project activities but also in improving project performance and measuring impact. The ability to produce regular and reliable data, both qualitative and quantitative on the health, economy and the well being of the beneficiaries is an important indicator of good institutional strength. There is an old proverb in, management that says that; “if we cannot measure it, we cannot manage it”. Without good statistics the Government and other institutions cannot deliver efficient administration, good management of their programmes and evidence­ based policy making. The tool used in information management for the purposes of programme follow up is Monitoring and Evaluation. Monitoring and Evaluation in general terms refers to systems for programmes and project managers to verify where project activities are happening as planned, whether the objectives and intended outcomes are being achieved and whether resources are being used in a correct efficient manner.

Specifically, according to Phil Bartle, (www.philbartle.com) a Prof. in Sociology, Monitoring is the regular observation and recording of activities taking place in a project or programme. It is a process of routinely gathering information on all aspects of the project. To monitor is to check on how project activities are progressing. It is a systematic and purposeful observation. Monitoring also involves giving feedback about the progress of the project to the donors, implementers and beneficiaries of the project. He also defines Evaluation as a process of judging value on what a project or programme has achieved particularly in relation to activities planned and overall objectives.

Many programmes and projects are implemented in Uganda and other countries with varying success of information management for monitoring and evaluation. COBIN a local NGO is implementing a community based intervention, and part of the activities is information management to follow programme events.

BACKGROUND

COBIN (Community Based Integrated Nutrition) is an NGO operating in Lyantonde and Kiruhura Districts since 2004. It was started as a response to poor nutritional status of people in the cattle and dry corridor of Western Uganda It’s an integrated Nutrition program targeting mothers and children below 5 years. CoBIN is an integrated organization, where by its activities like offering HIV/AIDS nutrition education and support, establishment of kitchen gardens, provision of clean water by construction of rain water tanks, take part in national child days are incorporated into the districts health agricultural and education departments. Nutrition related interventions by CoBIN include carrying out food demonstrations both in the community and at hospitals/ health centers, advocating for proper sanitation, general hygiene Integrated Nutrition and Nutrition related interventions are carried out by Family Care Workers (FCW) at village level. FCWs are village volunteers recruited by the organization to implement COBIN programmes using a grass root approach.

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Among the key activities FCWs carry out is collecting information on all the activities they carry out, using Monthly Data Collection forms which they submit to the COBIN office for record purposes, data analysis and report writing. Other information on COBIN activities is generated and brought to COBIN office by health, agriculture, education and other sectural extension workers for the same purpose. More information is also collected during support supervisions. The population served by COBIN is very scattered and FCWs have got to cover long distances some times up to a kilometer to move from house to house, especially in Kiruhura district. The road network where it exists, and means of transport within the area, is also poor. There are no education requirements for these volunteers. The only requirement is the ability to read and write, and most of them are only literate in their local languages.

Overall Objective of COBIN To improve the Nutritional and Health status of people in the area especially Mothers and Children below 5years, and other vulnerable groups including those related to HIV/AIDS.

WHAT WAS THE PROBLEM/BASELINE

Information generated in the COBIN programme area does not conform with the principles of Monitoring and Evaluation. This is partly because of the low education level of the community volunteers who collect the data, little skills from programme staff on data management, and other factors as illustrated in the conceptual framework on the next page.

About 88 (65%) out of 136 FCWs, and extension workers report regularly. Also, the storage of data is scattered, where by only 35 (40%) of the 88 Family Care Workers who report regularly is in the computer as soft copy and 53 (60%) is in box files as hard copies. Data analysis is currently largely manual, laborious and incomplete. In General, data management skills are inadequate, even among program staff, but worse with FCW’s. FCW’s are expected to disseminate data back to their communities after it is analyzed by the program staff. What ever information generated, is disseminated by project staff to FCWs during quarterly meetings. However, the quality of this information given needs to be improved.

Because of the poor data collection, management and analysis, COBIN is not able to: 1. Truck properly its activities, 2. To measure the effect of the programme for evidence based planning, reporting and

dissemination. 3. Adequately quantify the programmes achievements.

The table below illustrates the percentages of data collected, stored and analyzed at CoBIN office. It also shows the gaps in data management in the programme.

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Monthly returns at CoBIN Actual reports/data forms to be dispatched

Data dispatched to CoBIN office.

Data entered in the computer at CoBIN office.

Data Analyzed in the computer at CoBIN office.

Data in hard copy

Data Analyzed as hard copy

136 (100%) 88 (65%) 35 (40%) 22 (30%) 53 (60%) 39 (45%)

PROJECT OBJECTIVES

General Objective To Improve Data quality and management of Outreach Health and Nutrition delivery systems in the COBIN area.

Specific Objectives 1) Improve data collection through re­training of 125 FCWs and 11 EWs within six months. 2) Increase the proportion of FCWs/EWs submitting monthly Reports on time from 65% to

95% . 3) Equip at least 3 staff with adequate knowledge and skills in Data entry and analysis using

SPSS programme. 4) Increase the proportion of data report forms entered in the electronic data base from 40%

to 80%.

IMPLEMENTATION METHODS

1. Review of already existing data collection tools. They are made easy and clear.

2. Re­trainings of: ­FCWS in proper methods of collecting and filling in data report forms. ­FCWs to improve skills of growth promotion and offering Nutrition education especially to HIV/AID patients and their families. ­CoBIN staff in data entry, analysis and management.

3. Support visits: COBIN used a combination of visits to the FCWs and extension workers to encourage them to bring their data report forms in time. Small rewards were given to centre heads to continue collecting reports and on time to meet the deadline of 5 th of a new month.

4. Data entry and analysis: When data was received at the office, it was be promptly entered in the computer and thereafter analyzed, by the programme staff. 12 FCWs were

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assigned a responsibility of collecting the data report forms and bringing them to the office on time, for entry and analysis.

PROJECT RESULTS AS PER OBJECTIVE

Objective One Improve data collection through re­training of 125 FCWs and 11 EWs within six months.

It was noticed that all the data report forms submitted were complete, accurate and consistent, hence, improving the quality.

Table below shows the consistency in reporting in the months of may June and July, for different villages. One village represents one Family Care Worker. For instance, the family care worker from Akakyenkye village reported continuously in May, June and July, reporting on different number of children. Farther analysis of this data would show the details of, for example, if the children weighed in these different months are the same or were always different. COBIN targets weight same children monthly, to monitor their growth, i.e improvement, stuntedness or set backs. There for, far other analysis would show that clearly.

Village

Total AKAKYENKYE AKANARA AKATONGORE AKENGOMA BIJUBWE

Month 5 20 11 12 10 16 69

6 10 11 10 10 12 53

7 9 10 9 10 6 44

Total 39 32 31 30 34 166

The above was achieved through the following activities; 1. Review of exiting data collection tools.

Two tools were reviewed, one for Family Care Workers, and another for Extension workers. Simplified the tool; reduced the no. of variables & made wording more clear and simple (Please see Appendix II)

2. Re­train FCWs and Field extension workers on how to use revised data collection tools. 136 (100%) FCWs and extension workers trained in 4 sub­counties. This activity was done to ensure accuracy when filling in the monthly forms. All are able to fill the monthly reports correctly.

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3. Sensitize the community/beneficiaries to appreciate more the importance of data collected. There was a target of meeting 800 community members from the four sub­ counties, and this was achieved even beyond the target, where by 815 members were sensitized about the importance of data.

4. Conduct on­site technical support supervision and follow up of FCW’s extension workers. This was done by the COBIN staff, to ensure proper filling in of the data monthly report forms. At least 10 FCWs were visited per sub­county (on average, a sub­ county has 20 FCWs/Villages), and these were selected according to their performance, specifically those who were thought to need more support. This is because there members who are very keen and always do it right. So due to limited time, those were not visited, and the time was dedicated more to those are kind of slow.

5. Replace Illiterate FCW with Literate ones. This is an exercise COBIN has always wanted to carry out. The illiterate FCWs were known but were being tolerated. They always had someone, like a relative or friend to step in for them when compiling reports and taking notes in workshops, so COBIN tolerated them. However, this affected the quality of data and reporting in general, so with this fellowship, they were requested to step down in favor of the programme. This did not go well with some of them, but it had to be done.

Objective two Increase the proportion of FCWs/EWs submitting monthly Reports on time from 65% to 95%

The above objective was achieved up to 81% (110/136), from 65% (88/136). The set target was 95%, and even if it was not met, the above results are still good, because there is a big

FCW and Extension workers being re­trained on how to use the revised data report forms.

Sensitizing the community to appreciate the importance of data collection.

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improvement in the monthly reporting. More so, the 81% is of only those who submitted reports before the set date which is 5 th of every month. Those who reported after that date were not considered.

1. Set a timeline for reporting. The deadline for reporting was set for the 5 th of every month.

2. Ensure timelines of reporting are adhered to. This had been a challenge with COBIN for some time, until during this fellowship programme, where staff agreed to set aside an incentive for centre heads responsible for getting the data report forms to the office from the communities. Twelve FCWs were selected to be responsible for collecting data report forms monthly to the office, and they were given 5,000 UGX as their transport. This is not enough, but it was some sort of encouragement, after introducing this system, the reporting improved greatly, as shown below.

% of FCWs/EWs reporting on time each month

0

20

40

60

80

100

March April May June July

Baseline

Current

Targets

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Objective three

Equip at least 3 staff with adequate knowledge and skills in Data management and analysis using SPSS program

1. On­job training of 3 COBIN staff in data analysis. This was an exciting exercise and it took place at the COBIN offices in Lyantonde. Three staff were trained and are able to enter the data. They are also able to analyzed, and below are some of the table graphs showing the data analyzed by staff.

2. Support supervision of COBIN staff by the trainer. The trainer supervised COBIN staff three times in the 6months of implementation. With that, the staff was able to produce the results shown in the tables below.

Graph showing the number of children weighed for three months by their sex.

Staff being trained in data entry and analysis at COBIN office.

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From the above graph, we are able to tell that there were more boys weighed compared to the girls. We are also able to know that the number of children weighed in the three different months (1, 2, 3 ) declined, and so COBIN staff should find out what the problem could have been. Far other analysis of this data will revile a lot of information relevant to COBIN as a programme.

Table showing number of children weighed in in different nonths in particular villages.

Village

Total AKAKYENK YE

AKANAR A

AKATONGO RE

AKENGOM A BIJUBWE

Month 5 20 11 12 10 16 69

6 10 11 10 10 12 53

7 9 10 9 10 6 44 Total 39 32 31 30 34 166

The above table is also another example of data analyzed by the trained staff. A lot of information can be got from the above table, which can help COBIN plan for the betterment of the beneficiaries, in this case, children who are five years and below.

Objective four Increase the proportion of data report forms entered in the electronic data base from 40% to 80%. The above % was very high, but it was achieved beyond, by 1%, which is a great improvement. It was achieved trough the following;

1. Purchased a computer and software for the database. This was meant to provide enough equipment for the data entrants, so as to avoid clashes hence delays in reporting.

2. Trained 03 staff in Epi­Data for entry. Targeted 80% (108/136) data report forms entered, but after the training and support supervision, we achieved 81% (110/136) of this activity.

3. Designated two staff to enter data. Data was entered by two staff, but was analyzed by three staff that are trained.

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The picture below show the data base screens where the collected data was being entered and analyzed.

CHALLENGES AND SOLUTIONS

High targets in a short time, there for some were not achieved as planned. E.g timely reporting which was set at 94%, but was achieved at 81% as average per month. COBIN will still work hard to meet and maintain the set targets after the project.

Change of a Data trainer in the middle of the project implantation (May 2010). A new template had to be designed according to the new trainer, for easy analysis. This required starting data entry afresh, which consumed much time. COBIN staff had to invest in extra, time and hard work to cope and meet deadline.

Big sample size for this study, for instance, data from 136 respondents was collected and enter, monthly, and each form has 2pages, which ask for many details about a particular child, in 4 sub­ counties, 136 villages. Because of this, data from some FCWS and Extension workers was not considered for the sake of completing this project in time.

In the middle of the project, a new strategy had to be introduced, that is, giving an incentive in form of money to individuals who we called centre heads, to collect and submit data report forms on time, for data entry. This was due to low reporting even after the refresher trainings and

Data entry screen in EpiData programme

Data analysis screen in SPSS programme.

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replacing illiterate FCWs. To solve this challenge, COBIN invested in the extra funds required (5,000 per month per centre head). This improved the report submit ion and the objective was achieved from 65% to 81%.

LESSONS LEARNT

Projects like COBIN who use community volunteers to collect data using data collection tools, should have those tools in the local languages, simplified and made clear for the data collectors to understand so as to collect the right information. Otherwise, this may lead to incorrect, inconsistency and irrelevant information, which will definitely hinder the planning and performance of the project.

For project which collects a lot of data using volunteers should motivate them, through giving incentives like availability and reliability of data collection tools, transport/communication facility, feedback etc. These act as fuel and give encouragement to these volunteers to work hard with enthusiasm, and will result into the project successes. However, the project should try to design sustainable incentives, so that even if the project it closed, what it put in place will still remain.

In effective data management, timely reporting is important, so that data is entered and analyzed at the same time to avoid errors. Delays in reporting will lead to delays in planning and solving the problems at hand.

Participatory approach increases involvement, ownership and sustainability. Every one should be involved in the project right from the beginning. These include the beneficiaries, the project staff, the donors and the rest of the community. This will lessen the unnecessary questions in the implementation, and other hiccups. It will increase ownership and sustainability.

Building capacity of communities is an assurance to success of a project and its sustainability. At the beginning of the project, everyone concerned should be clear about the project, so that they know what to expect.

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WAY FOWARD

q Include manageable and sustainable incentives for community volunteers in COBIN project. The project staff will have to sit, discuss and agree on sustainable incentives which will motivate and benefit the FCWs and their communities. The incentives will target all FCWs and extension workers.

q To ensure all FCWs and EWs submit data report forms on time. The set target for monthly reporting must be attained and maintained. The incentive of 5,000shs given to centre heads will still be, until sustainable and manageable incentives are designed by the project.

q Ensure all data report forms submitted are entered in and analyzed by the database. Incase the trained staff gets very busy, a data entrant will be hired, and the staff will be entirely responsible for supervision, and analysis.

q Develop reports from the data analyzed for M&E. COBIN staff will generate reports from the data analyzed. These reports will be submitted to stakeholders, donors and used for feedback to the community. They will also help in the future planning and improvement of the project.

q Scale up improved data management and quality to all the other COBIN activities. These include, Food demonstrations, home visits, health education talks, sanitary pads distribution, rain water harvesting, vegetable seeds distribution, etc.

SUSTAINABILITY PLAN

CoBIN will ensure continuous on­job trainings of project staff and community volunteers, both old and new during its life span. There will be scale up of this intervention by applying the same approach to other programme activities. The data analysis and management soft ware CoBIN chooses to use will be installed on all computers, and also have a backup system. In addition, there will be continuous meetings for example quarterly meetings which involve all stakeholders and end month meetings which are only for programme staff unless otherwise.

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CONCLUSION

The project has been a great lesson and will help COBIN realized and tack its changes in its work. COBIN is happy to learn the Data management process, and finds it a amazing how easy it can be to analyze the collected data in the computer by just click of a button. We are grateful to CDC­MUSPH Fellowship program, because of the good practices COBIN has been able to acquire from the projects. The data management process of COBIN will continue to improve given the capacity built.

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APPENDICES

Appendix I

Reference

Fisher A. A et al. “Designing HIV/AIDS Intervention studies: An operations research handbook” 2002 The population Council

“Monitoring and Evaluation: Some tools, Methods & Approaches” The world Bank Evaluation Dept, 2004

Phil Bartle, (www.philbartle.com)

Nina F. et al. “M&E fundamentals: A Self­Guided Mini­course. Measure Evaluation, 2007

CoBIN activity and monthly reports and end of year reports.

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Appendix II

Revised Monthly data report forms