Information is power: Improving health information systems to end HIV in South Africa

Trainees at an ESI-hosted District Health Information System workshop in Free State, South Africa.
Despite the relative strength and stability of its infrastructure and economy, South Africa reports one of the highest HIV prevalence rates in Africa, with nearly one in five people infected with the disease. The President’s Emergency Plan for AIDS Relief (PEPFAR) has responded to the crisis, providing resources to scale up sustainable and quality HIV and AIDS programs in the region. To achieve its objective of reducing the incidence of HIV, PEPFAR partners with international and South African NGOs, government entities, and private-sector health providers to extend HIV and AIDS treatment and prevention services and strategies to as many people as possible.

PEPFAR’s ambitious plan cast a wide net, the efficacy of which would require mending holes in the in-country health information system. In 2008, recognizing the need for improved and standardized methods of data collection and sharing, USAID enlisted JSI to manage the Enhancing Strategic Information (ESI) Project. One objective of the project was to build capacity among PEPFAR implementing partners to collect quality data, report it to a central database, and utilize it for evidence-based program planning.

Staff of a local PEPFAR partner organization in Pretoria receive DHIS training from the ESI project.
ESI was tasked with building the capacity of PEPFAR partners to utilize the Evidence-Based Health Management Framework—an organizational strategy based on using data for decision-making—to improve HIV services, including services for the prevention of mother-to-child transmission (PMTCT). Building capacity required the rigorous training of staff in effective employment of the new information system. ESI thus instituted a multi-level training system that taught data collectors how to routinely collect pertinent, accurate information and taught program managers how to better understand, manage, and apply the data to their program planning. In fact, the trainings were so successful and well-regarded that three ESI courses—Evidence-Based Health Management (EBHM); Facilitation and Mentoring; and Basic Monitoring and Evaluation—have gained accreditation from the University of Pretoria.

ESI trainers found that one of the major impediments to effective information management was a communication breakdown between data collectors and program administrators; data collectors did not fully understand the context or objectives for which they were collecting data, and program managers did not know how to synthesize the often incomplete data that was being collected for decision-making. To address this issue, JSI trained data collectors and program managers together to instill a shared understanding of program objectives and to ensure that accurate and appropriate data was being collected. This method of training proved invaluable to the adoption of the new systems and transformed the attitudes of health clinic and program staff members about the value of good data.

Trainees gather outside an ESI Monitoring and Evaluation and Pivot Table training for managers workshop in Limpopo.
“At first, we thought the trainings were a punishment!” explains one trainee. “But we realized very quickly that the information systems would greatly improve our work.” When ESI began, the team found it difficult to establish relationships and implement trainings. However, once the sessions began, word spread of the value and efficacy of ESI training and the demand grew continuously. Said another trainee, “I believe that this training will strengthen the relationship of our staff and will improve our communication in this fight against HIV.”

The strategic use of monitoring and evaluation and the application of the new skills in synthesizing and utilizing data revolutionized the way many who received the training thought about their work. After the trainings, organizational managers saw how accurate, up-to-date data and sound EBHM could be used for short- and long-term planning to extend HIV and AIDS services to more people that need them.

"I only really understood the power of monitoring and evaluation after taking the M&E and EBHM courses,” said one clinic manager. “The trainings were rigorous, but we didn’t burn out thanks to the passion and leadership of the ESI team. There isn’t a soul in this country that should go without attending those courses.”

The progress ESI has made in HIV and AIDS data quality and use in South Africa has paved the way for improved data quality and EBHM among PEPFAR partners and the National Department of Health. Quality data and EBHM are contributing to more effective HIV and AIDS health policies, which are meaningfully impacting the prevention and treatment strategies available to millions of at-risk and HIV-positive South Africans.