ENRS Quality Egypt

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ENRS Quality Egypt
E G Y P T
Dr. Amal Galal ENRS Focal PointNTP Egypt
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Introduction

• Egypt has more than 70 million population in 27
  governorates.
• Annual TB incidence of new positive cases is
  12/100000, with 5000 new positive TB cases and
  12000 TB cases all types notified to the NTP each
  year.

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ENRS in Egypt

• It is easy now for all levels to make recording
  and reporting of all data required for monitoring
  the Performance of TB activities
• It is also easy to check , recheck data and
  recall it to make all needed reports in
  appropriate time

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ENRS - Data and Information flow process
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Implementation of ENRS

• 2004, Two pilot governorates Cairo and Giza
• 2005 NTP started the first stage of expansion it
  was planed to work on 4 governorates, Ismaelia,
  Qaliubia, Port Saied.
• 2006 full expansion after distribution of about
  66 computers.
• 2 (Two) e-registers were introduced (district and
  lab).

Number of trainees
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ENRS coverage
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ENRS-Cost and resources

• The cost of developing the system was part of the
  staff salary, and the technical assistance from
  WHO was part of the training component through
  JPRM
• The main cost items in implementation were
• the hardware (60000 USD)
• the communication (5000 USD)
• the training (25000 USD)
• the supervision (3000 USD)
• Egypt example for full implementation covering
  153 chest clinics and 26 provinces plus 20 HI
  centers

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Implementation duration

• Total duration 2 years for full expansion (153
  BMU/district, 26 G, HIO 20)
• 6 months for pilot
• 3 months for expansion

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Quality Verification

• ENRS as a new system implements parameters of
  quality to ensure
• Accuracy (Proper item in the proper cell),
• Completeness (A zero blank cells),
• Consistency (Matching of different columns)
• Timeliness (availability of data in the assigned
  time).
• All these are done through electronic sheets
  which make it easy to fulfill all these
  parameters.

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Story of Quality Implementation
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Preparation of Quality training-step1

• Developing Q-tables
• Paper tables as a first step of piloting
• Electronic tables for evaluation

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Preparation of Quality training-step2

• Developing Q- Guideline

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Preparation of Quality training-step3

• Developing Exercises

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Preparation of Quality training-step 4

• Identify the trainees of each governorate
• The GCT of each governorate
• The HIO coordinator of each governorate
• Two from the governorate directorate information
  center (network manager data manager ).

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Preparation of Quality training-step 5

• Agenda
• Setting the three days training agenda

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Implementation of Quality training

• Started at August 2006 for provincial level
• Five groups and 73 trainees.
• 3 days of training on
• Data cleaning
• Quality tables
• Data compiling
• Data analysis and quarterly reporting

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Channels of Communications

• At BMU level Data is send on a (floppy disk,
  flash stick, CD..etc) to the District Information
  Centre/DIC.
• From DIC the data enter the governorate shared
  folder in the governorate information centre/GIC.
• At GCT level, the data is accessible through the
  shared folder at GIC.
• The Central Information Centre/CIC in the
  Ministry prepared an open channel directly to the
  Central NTP office.
• All communication channels are secured and
  protected by a password.

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Monitoring and Evaluation

• ME is done through supervisory visits to the
  chest units and District IT centers in all
  governorates to evaluate the field work and
  solve any technical obstacles.
• The supervisory team is formed from
• One of the Task Force Team
• One from the Central IT center in MOHP
• The GCT and the manager of the IT directorate
  center.

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• Quality Tables

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Completeness Tables-step1
At provincial level 1- Filter the files for
blanks or mistakes 2- Record them by using cell
index 3- Send feed back to chest clinic/TBMU 4-
Calculate number of mistakes in each column and
fill in the electronic form
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Completeness Tables-step2
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Completeness Tables
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Completeness Tables
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Completeness Tables
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Completeness Tables
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Accuracy Tables
Following the same steps to measure accuracy.
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Accuracy Tables
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Accuracy Tables
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Consistency Tables

• Some items revised for Consistency
• The patient with the chest clinic
• Registration date with Start of treatment
• Age group with sputum examination at diagnosis
• Patient diagnosis with Diagnosis Category
• Patient Category with treatment regimen
• Patient Category with Sputum examination at
  diagnosis

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Consistency Tables
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Consistency Tables
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Timeliness Tables
The GCT or the focal person in the information
centre receives the data from each clinic in an
assigned date, date is recorded in the electronic
sheets and a chart is drawn to notify the
timeliness of the process and the progress of
quality.
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• Governorates Outcomes
• Sohag Governorate in Upper Egypt

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Governorates OutcomeSohag governorate in upper
EgyptAccuracy - January 2006

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Governorates OutcomeSohag governorate in upper
EgyptAccuracy -March 2006

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Governorates OutcomeSohag governorate in upper
EgyptAccuracy - September 2006

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Governorates OutcomeSohag governorate in upper
EgyptAccuracy - October 2006

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Governorates OutcomeSohag governorate in upper
EgyptAccuracy - Quality

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Governorates OutcomeSohag governorate in upper
EgyptCompleteness- January 2006

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Governorates OutcomeSohag governorate in upper
EgyptCompleteness -February 2006

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Governorates OutcomeSohag governorate in upper
EgyptCompleteness -March 2006

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Governorates OutcomeSohag governorate in upper
EgyptAugust 2006

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Governorates OutcomeSohag governorate in upper
EgyptSeptember 2006

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Governorates OutcomeSohag governorate in upper
EgyptOctober 2006

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Governorates OutcomeSohag governorate in upper
EgyptCompleteness- Quality

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ENRS-Lessons Learned

• Improve accuracy, completeness consistency and
  timeliness of reporting and indicators
  calculation in NTP at all levels. (high quality)
• Save time for analysis, and facilitate feedback.
• Facilitate supervision and increase its
  efficiency
• Facilitate locating the patients as per their
  residency not only their place of diagnosis,
  which will give more accurate information about
  disease distribution, and access to services
  using GIS.

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ENRS-Next Step

• Produce comprehensive NTP database to be used in
  
• GIS for planning of treatment supporters (DOT)
  network.
• Operational research
• Evidence based planning and budgeting.
• Pilot the compiled package at the central to be
  expanded to the provincial level.

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Thank You