Events

Background

Ghana is among the 10 countries selected by AFRO for support to introduce Personal Digital Assistants (PDA) also known as palm held computers for supervision in 2007. As the preparations for the introduction progressed, AFRO supported the country with 18 pieces of PDAs and funds for the training. The main objective of introducing the technology is to enhance supervision of service delivery which has become very weak at all levels within the health sector. In addition to enhancing supervision, the introduction of the PDA is also seen as a tool to facilitate the ongoing process of integrating priority child health interventions such as EPI, Malaria, IMCI, Surveillance and HIV at all levels since the final checklist for the supervision after the training is to be an integrated one. This is the second time WHO is supporting Ghana to apply PDA in service management. The first support was for Service Availability Mapping (SAM) in 2005 during which 50 pieces of PDAs were distributed to regional teams for the required training and tasks in various regions.

Participants the training workshop

Participation

As part of efforts to facilitate the training process, the National Programme Managers of the child health interventions had a one-day session to harmonize all programme specific supervisory checklists into a draft integrated one for use with the introduction of the new technology. With coordination by the Planning Division of the Ministry of Health and WHO, the draft integrated checklist was ready for the actual training session held 14-17 January 2008 at Dodowa near Accra. The four-day intensive training brought together four national programme heads (EPI, Malaria, IMCI, Surveillance) and 18 Regional officers together with other national officers from the Planning Division and WHO (figure -1) Facilitators were from WHO (IST), CDC and Datadyne.

Participants at the PDA training workshop at Dodowa

Acquisition of knowledge and skills

The training was in two sessions. First was the acquisition of knowledge and skills session where participants learnt how to install the equipment and the software. This was a classroom learning situation (fig 2). In the picture arrowed is one of the facilitators from Datadyne explaining an issue to the group. Participants at this stage also learnt how to load the checklist onto the PDA and manipulated the equipment with practical exercises. The draft integrated checklist was revised and an initial 100 point checklist was reduced finally to 48 for field practice.

Participants on field practice, Agomedahealth centre

Practice of skills

Participants had practical training exercises in four health facilities. Picture-3 is one of the groups using the PDA to capture responses from the facility Attendant at the Agomeda Health Centre. The other practical exercises took place at Dodowa Health Centre, Kordiabe Catholic Clinic and Atua Hospital.

After the field work, participants shared experiences and refined the integrated checklist for use in the regions. The final checklist has been loaded on the PDAs for all the participants. Reports from the field suggested that participants appreciated the simple user friendly nature of the PDA for the field exercise.

Piloting in 6 regions

The programme managers at the training session decided to pilot the use of the PDA for supervision in 3 regions (Brong Ahafo, Eastern and Western regions) due to financial constraints. This is to provide lessons for future decision-making on scaling to other regions and districts. The Ministry of health then advanced some funds (for fuel) to the selected regions. The pilot regions are to visit at least 10 health facilities and submit reports on each visit from now to end of March. Every field visit report and data should be sent to the Health Information Management Unit of the Ministry of health for central collation and dissemination. Copies of such reports are to be forwarded to WHO-EPI for monitoring and additional coordination.

Upon debriefing WR by the Facilitators, the WR decided that the country office provides support to the three Northern regions (namely- Northern, Upper East and Upper West) to be part of the pilot scheme. He has directed the EPI team to advance the process of getting the three regions on board. He has further directed the EPI team to work together with the Coordinators of the Ministry of Health to locate the first pieces of PDAs provided for the Service Availability Mapping (SAM) in 2005. This is to harmonize the two projects and also to advance capacity building process in the country.

Project monitoring

As part of efforts to monitor and evaluate the effect implementation of the pilot scheme and be able to make informed decision on the rest of the regions and the districts in the whole country, the WHO-EPI has developed a monitoring checklist to be administered during supervisory visit to the pilot regions (see copy below).

Next Steps

• The 6 pilot regions (Northern, Upper East/West, Western, Brong Ahafo and Eastern) are to implement the integrated checklist using PDAs in at least 10 health facilities between January and March 2008 and submit regular reports and data to the national coordinator with copy to WHO.
• National Coordinator (Centre for Health Information Management) to collate all reports and data from the regions and share with national programme managers and key stake holders for decision-making.
• WHO to provide the following support to the pilot scheme:

• • Advance funds to the 3 Northern regions early to join the pilot scheme with the others
  • Work with the National Planning Coordinator to locate the 50 pieces of PDAs procured for the SAM project in order to harmonize the two projects effectively for further training.
  • Monitor use of the PDA by the pilot regions using the attached checklist.
  • Work together with National Coordinator to document the lessons and observations from the pilot project