February 26, 2019

Digitizing Data to Improve Diagnosis in Guinea

Health workers in Guinea being trained on the use Rapid Diagnostic Tests (RDTs) for malaria through the StopPalu+ project. RDT supervision is a component of Outreach, Training and Supportive Supervision (OTSS).

Ensuring the quality of diagnosis at health facilities is key in fighting the spread of disease, including malaria. With health centers that are well-equipped, safe, and have personnel able to properly diagnose and treat malaria, patients are more likely to recover from their illness, and data can be collected in an effort to improve processes and combat the disease at a larger scale. In Guinea, the USAID/President's Malaria Initiative StopPalu+ project trains health workers on malaria diagnosis through laboratory testing, the most accurate and precise way to diagnose malaria and the most useful in terms of tracking the spread of different species of malaria parasite.

Training of health professionals in diagnosing malaria is a complex and important task that MCDI has taken on in Guinea - a country still dealing with the ramifications of the 2014 Ebola outbreak. Trainings need to be measured in terms of their effectiveness at ensuring trainees reach important benchmarks. With the StopPalu+ project, led by RTI International with MCDI as the diagnostic partner, MCDI is using an innovative and helpful tool adapted from past experiences to support Outreach, Training and Supportive Supervision (OTSS) activities that are conducted four to six weeks after each training session to ensure the quality of malaria diagnosis at health facilities in Guinea. With a tablet-based questionnaire completed through mobile-based platform SurveyCTO, StopPalu+ is working to improve the case management of malaria in selected regions of Guinea.

The supervision tool, used by MCDI in other countries where it conducts OTSS visits, has been adapted in collaboration with RTI to specifically match the Guinean context, and it was piloted in Guinea for the first time in 2018 in four regions. While other components of the StopPalu+ project had already begun using electronic data collection, previous rounds of OTSS had been completed using paper forms, so 2018 was the first time that laboratory data from all StopPalu+ health facilities were collected electronically. The move to digitizing data entry at the health-facility level is one way in which MCDI seeks to help RTI put the "plus" in StopPalu+, which follows a previous five-year malaria control project funded by the US President's Malaria Initiative.

OTSS in Guinea entails project staff and regional health officials to visiting health facilities and go through a checklist of requirements that the facilities must meet in order to pass the supervision visit. This list includes markers such as the availability of reagents and other laboratory supplies, the proper preparation of blood slides for diagnosis of patients, the proper management of hazardous waste, and the accuracy of test results.

For external quality control during OTSS, laboratory technicians at health facilities are routinely tested on accurate microscopic diagnosis using sample blood slides whose results have been validated by PCR. These blood slides represent all species and parasite densities to help keep skills fresh. To ensure internal quality control, the laboratory technicians at each facility are also tested on their diagnoses of a sample of malaria blood slides collected from regular operations at the lab itself, and compared to the supervisors' results.

The OTSS survey allows for more timely data analysis, with electronic data entry of forms from health facilities in rural or remote areas done offline and uploaded when in an area with an internet connection. The fields on the OTSS forms are standardized and more concise for faster, easier analysis of the aggregated data. Moving away from paper surveys also allows for data to be accessible for analysis almost immediately, and valuable data are less likely to be lost.

Mamady Sidibe, an OTSS supervisor for StopPalu+ for health faciltiies in Conakry, says of the OTSS tool, "The tool is great, it has allowed staff to access supervision data on time. Thanks to the tool, we are able to point out the strengths and weaknesses of facilities and proceed to recommendations for better quality diagnostic of malaria. Applying recommendations issued from supervisions is a great benefit for laboratory service delivery."

As an organization, MCDI aims to strengthen access to data for decision-making across all of its projects around the world. With a goal of 100% electronic data collection through the StopPalu+ project, Guinea is moving towards a system where it can analyze its health facility data more quickly and comprehensively.

Surveyors being trained in the OTSS SurveyCTO tool.

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