i

IMPROVING THE DATA MANAGEMENT

SYSTEM

OF THE RAKAI HEALTH SCIENCES PROGRAM

HIV CARE FIELD CLINICS

BY

MARIA MUKAKALISA

AND JOSEPH SSEKASANVU

CDC MEDIUM-TERM FELLOWS

2012

ii

IMPROVING THE DATA MANAGEMENT

SYSTEM

OF THE RAKAI HEALTH SCIENCES PROGRAM

HIV CARE FIELD CLINICS

BY

MARIA MUKAKALISA (MSc. HSM)

AND JOSEPH SSEKASANVU (BSc.QE)

CDC MEDIUM-TERM FELLOWS

OCTOBER 2012

i

Table of Contents Declaration ............................................................................................................................................. iii

Fellow’s role in project implementation ................................................................................................. iv

Acknowledgements ................................................................................................................................. v

Acronyms ............................................................................................................................................... vi

Executive Summary ............................................................................................................................... vii

1.0: CHAPTER ONE ................................................................................................................................... 8

1.1: Background to fellows’ project ...................................................................................................... 8

1.2: Background to the Institution ....................................................................................................... 2

1.3: Problem Statement ....................................................................................................................... 3

1.4: Justification of the project ............................................................................................................ 3

1.5: General objective .......................................................................................................................... 3

1.6: Specific objectives ........................................................................................................................ 4

2.0: CHAPTER TWO: METHODOLOGY ....................................................................................................... 5

2.1: Area of operation.......................................................................................................................... 5

2.2: Population served ......................................................................................................................... 5

2.3: Logical framework........................................................................................................................ 5

2.4: Project implementation ................................................................................................................ 6

2.4.1: Reviewed data collection and reporting tools to identify key similarities and gaps with MoH

recommended tools ............................................................................................................................ 6

2.4.2: Data entry screens designing ..................................................................................................... 7

2.4.3: M&E Fellows and MoH staff trained clinicians on the use of the new tools. ............................... 8

3.0: CHAPTER THREE.............................................................................................................................. 11

3.1: Project Outcomes ....................................................................................................................... 12

3.2: Lessons learnt ............................................................................................................................. 12

3.3: Challenges .................................................................................................................................. 12

3.4: Conclusions................................................................................................................................. 13

3.5: Recommendations ...................................................................................................................... 13

3.6: Next steps ................................................................................................................................... 13

3.6.1: Dissemination plan .................................................................................................................. 13

3.6.2: Follow-up/scale-up strategy ..................................................................................................... 13

Appendices............................................................................................................................................ 14

ii

Appendix 1: Logical framework for the project............................................................................... 14

Appendix 2: Rakai Districtmap indicating the sub-counties ................................................................ 15

Appendix 3: Work-Plan ...................................................................................................................... 16

Appendix 4: Budget for Improving the Data management system of the RHSPHIV care field clinics . 17

List of Tables

Table 1: Blueprint: Improving the data management system in the HIV care field clinics ......................................... 4

Table 2: Current status of RHSP data collection tools ............................................................................................. 7

List of Figures

Figure 1: Data Entry in HIV Care field clinics (Jan 2011 - March 2012)................................................................. 8

Figure 2: Clients in RHSP HIV care fields .............................................................................................................. 5

Figure 3: Review and revision of tools .................................................................................................................... 6

Figure 4: Data entry screens designing ................................................................................................................... 8

Figure 5: Training on paper based tools ................................................................................................................. 9

Figure 6: Training in data entry ........................................................................................................................... 10

Figure 7: Proportion of data entered in the RHSP HIV care field clinics ............................................................... 11

iii

Declaration We Ssekasanvu Joseph and Mukakalisa Maria do hereby declare that this end-of-project report

entitled Improving the data management system of the Rakai Health Sciences Program

HIV care field clinics, has been prepared and submitted in fulfillment of the requirements of the

Medium-term Fellowship Program at Makerere University School of Public Health and has not

been submitted for any academic or non-academic qualifications.

Signed ………………………………… Date…………………………………..

Ssekasanvu Joseph, Medium-term Fellow

Signed ………………………………… Date…………………………………….

Mukakalisa Maria, Medium-term Fellow

Signed ………………………………… Date…………………………………..

Dr. Kigozi Godfrey Institution Mentor

Signed ………………………………… Date…………………………………..

Dr. Nakigozi Gertrude Institution Mentor

Signed ………………………………… Date…………………………………..

Dr. Nampewo Solome Academic Mentor

iv

Fellow’s role in project implementation

The fellows participated in all the activities of this project from beginning to date.

Fellows developed the concept and shared it with the HIV care team for review and suggestions.

At the phase of problem identification, the fellows were key in this process but in constant

consultation with the HIV care team. Project proposal development was done by both fellows.

They presented the proposal to the team of supervisors and fellow trainees and this helped in the

modification of the proposal. Review of the indicators of the various stake holders in line with

MoH HIV care tools was done by one of the fellows (Maria Mukakalisa) and this resulted in

revision of the old tools. Designing of the new data collection tools was done by both fellows.

Designing data entry screens of the revised tools was done by the other fellow (Joseph

Ssekasanvu). Training clinicians on the revised tools and entry screens was done by both fellows,

with the help of MoH trainers. Mentorship (coaching) was done by the fellows and the MoH

supervisors.

Preparation of Power point presentation and final report was done by the fellows, in consultation

with the supervisors.

v

Acknowledgements

We wish to acknowledge the following for their contribution towards the successful

implementation of this project.

The Facilitators & staff of MakSPH-CDC Medium-Term Fellowship program; our academic

mentor, Dr Nampewo Solome; the institutional supervisors, Drs Kigozi Godfrey and Nakigozi

Gertrude; RHSP HIV care administrators, staff and the clients

vi

Acronyms

RHSP: Rakai Health Science Program

MoH: Ministry of Health

OpenMRS: Open Medical Records System

CME: Continuing Medical Education

vii

Executive Summary

Rakai Health Sciences Program provides HIV care services through 13 field based clinics. The

clinics are managed by clinicians who are supposed to do general clinic management in addition

to data management. This resulted in creation of data entry backlogs leading to late and poor

quality reports.

To solve this problem, the fellows took on the role of improving data management system of the

RHSP HIV care clinics. This was done by revision of RHSP data collection tools which included

size reduction, dropping and designing new tools. We also adopted the MoH HIV care data

collection tools. Data entry screens for the new RHSP tools were designed and adopted

OpenMRS for entry of MoH data collection tools. Training was done for the data collection tools

and data entry systems.

As a result, there was a remarkable improvement in data entry rate (50%) during the period July-

September 2012 as compared to the period April- June 2011 (23%), before project

implementation. Clinicians also reported that the new forms were easier to complete and to enter,

and this availed more time for review of clients and other clinic activities. There was noticeable

decrease in paper consumption in the HIV care program because of the reduced number and size

of some tools and use of HIV care cards that can handle multiple encounter data. Decrease in

storage space needs for patient files in the clinics. This intervention aimed at improving the

timeliness and quality of reports.

In conclusion, implementation of this project resulted in efficient data collection tools, improved

data entry rate, adoption of MoH HIV care tools, which would ease the process of integration of

RHSP HIV care services into MoH system.

viii

1.0: CHAPTER ONE 1.1: Background to fellows’ project

Recent changes to Rakai Health Sciences HIV Care program guidelines raised hope that the

national goal of increasing enrollment into HIV Care from 63% (RHSP rate - June 2011) to more

than 80% (one of the Millennium Development Goals) could be attained. The HIV Care program

relies on a sequence of diagnostic and treatment steps. Tracking each of these steps can

determine how well the system is performing; i.e. that eligible HIV infected clients are being

identified, and are receiving the appropriate care and treatment. While programmatic efforts to

reach this target are underway, obtaining complete data from RHSP HIV Care field clinics to

track progress presented a major challenge.

The origin of the problem started when RHSP had to change the mode of HIV care service

delivery from mobile to static clinics, as a result of decreased PEPFAR funding. Data entry

clerks who were doing data entry were laid off and clinicians who were the in-charges of the

field clinics were responsible for the review of the clients, general administration of the clinics,

drug stock management, data management, etc. This affected the completeness of data from the

field clinics. (See figure 1)

Figure 1: Data Entry in HIV Care field clinics (Jan 2011 - March 2012)

2

During the period Jan to Mar 2011, the new mode of HIV care service delivery was implemented

(mobile to static field clinics). This involved assigning clinicians to the various static clinics and

training of staff in the different roles they had to perform; which roles were originally handled by

other staff who had been laid off or re-located to other sections. One of the roles the clinicians

took on was data management, which they had never done before. All clinicians had basic

computer skills and were all trained in data entry and other data management tasks. The

clinicians were not able to enter any data in the period Jan-Mar 2011 because of unavailability of

computers and delay in electric power installation at the field hubs. In order to have data for

compilation of various reports, the RHSP contracted data entrants to enter the data as an

emergency.

Clinicians started on data entry in April 2011 and by the end of September 2011, a verification

exercise showed that clinicians had only entered 40% of the data collected for the two reporting

periods (April-June 2011 and July-September 2011) contracted data entrants had to completed

entry of the pending records to enable reporting.

Oct 2011- Mar 2012, Clinicians had gained experience but had reached a peak in data entry

(60%). Clinicians could not complete data entry despite the fact that they had gained speed and

experience. This was because of the many and lengthy forms used in data collection combined

with other clinic roles e.g. patient management and drug management.

1.2: Background to the Institution

Rakai Health Sciences Program is a research-based organization which started in 1988, as Rakai

Project; with the discovery of HIV (SLIM) disease in Kasensero-Rakai district. From 1988 to

2004, RHSP was providing HIV care in the “Suubi” (Hope) clinics but no provision of ARVs.

Since June 2004, with funding from the President’s Emergency Plan For AIDS Relief

(PEPFAR), the Rakai Health Sciences Program (RHSP) has cumulatively provided HIV care to

about 5500 individuals, including ART to approximately 2500 HIV-infected persons, with a

CD4≤250 cells/mm3 or WHO Stage IV disease. HIV care was formerly provided via 17 mobile

community-based out-patient clinics, called Suubi clinics, operated on a bi-weekly basis. These

clinics included; Kalisizo, Kabira, Nabigasa, Kasaali, Lwanda, Kasasa, Kakuuto, Kifamba,

Kibaale, Lwamaggwa, Buyamba, Kyebe, Kyabigondo, Kayanja, Nakatoogo, Kaleere and

Lyantonde. From the start of the HIV Care program in 2004 up to 31st December 2010, the

service component and data collection was solely the work of the field clinicians, Data entry and

validation was solely the work of the RHSP Data management section. At the beginning of 2011,

the 17 mobile clinics were reduced to 13 static clinics and all the clients in the closed 4 hubs

(Kyabigondo, Kayanja, Nakatoogo and Kaleere) were absorbed in the nearby clinics. In the new

system, all data entry and validation together with HIV-Care service provision became the work

of the clinicians based at the 13 RHSP designated rural health centers in Rakai.

3

1.3: Problem Statement

In order to have timely and good quality reports, there needs to be real time, accurate and

complete data entry. This makes it possible to have timely data cleaning, analysis, and generation

of timely and good quality reports. In the current situation, there is delayed, incomplete and

inaccurate data entry by the end of the reporting period. Clinicians first collect data on paper,

then enter the data later, which is double work. In addition, the many tasks performed by a

clinician in a day lead to data entry being given the last priority. There is thus creation of backlog

which leads to emergency data entry with its related problems, such as; incompleteness and

inaccuracy of data.

For example, in the period, April-June 2011, clinicians entered only 15% of the data collected

and an emergency team of data entry clerks entered 65%. However, the target has always been to

have all data entered by the field clinicians without the emergency data entry team. The accuracy

of the data entered for this reporting period was only 55%. This was because the data was

hurriedly entered by an emergency data entry team and no validation done because of the

approaching deadline for reporting. This led to late submission of the CDC-PEPFAR and MOH

reports.

Delay in submission of reports will not only lead to late and poor feedback to field data

managers, late and poor planning for supplies but may also lead to frustration/ disappointment to

funders who can decide to reduce or completely stop funding the program.

As a result of the delay in submission of reports to stakeholders, the M&E team embarked on a

project of improving on the existing data management system in the RHSP HIV care clinics with

a major aim of improving on the timeliness and quality of reports generated for submission.

1.4: Justification of the project

Generation and submission of timely and good quality reports on activities carried out by any

institution/ individual is a standard practice and a requirement.

In order to keep up with timely reporting as required by funders, there was a need to find ways

of improving and strengthening the current monitoring system of the HIV Care program; with

focus on data collection and capture by the clinicians.

Thus, the project focused on the modification of the data collection tools and data entry system;

and equipping the staff with the data management skills to do timely and efficient data entry.

1.5: General objective

To improve the data collection and reporting system in order to be able to submit quality HIV

care reports to different stakeholders in a timely manner.

4

1.6: Specific objectives

To review data collection and reporting tools in reference to the national MoH guidelines

on comprehensive HIV care.

To review and redesign the computerized database

To strengthen capacity through training and mentoring staff on the revised data collection

and reporting system

The detailed information on the priority given to accomplishment of the various objectives and

their time allocation is given in table 1.

Table 1: Blueprint: Improving the data management system in the HIV care field clinics

PRIORITY % ASPECT

1 40 M&E Fellows revised the RHSP data collection tools with reference to

MoH tools in order to collect data on only the needed indicators

(reduced to shorter forms).

2 25 M&E Fellows redesigned data entry screens for the revised data

collection tools

3 35 M&E fellows trained clinicians on the use of the revised tools and data

entry screens. MoH trainers trained staff on the use of the MoH tools

5

2.0: CHAPTER TWO: METHODOLOGY 2.1: Area of operation

This project was conducted in RHSP HIV field clinics located at some of the sub-county

headquarters in Rakai district. These clinics include: Kasasa, Kasaali, Kyebe, Kasensero,

Buyamba, Lwanda, Nabigasa, Kabira, Lwamaggwa, Kakuuto, Kifamba and Kalisizo clinic that

is located at the RHSP Kalisizo office. Refer to the Map of Rakai district and the sub counties

(See appendix 2).

2.2: Population served

The clients served in the RHSP HIV care program by March 2012 were 6,024.

During the period April-June 2011, the total number of clients in all the HIV care clinics was

5358, 44.8% (2401/5358) of those were on ART. The client population in the various RHSP

clinics and their ART status is indicated in Figure 2.

Figure 2: Clients in RHSP HIV care fields

2.3: Logical framework

The logical framework for implementation of this project is detailed in appendix 1.

6

2.4: Project implementation

2.4.1: Reviewed data collection and reporting tools to identify key similarities

and gaps with MoH recommende d tools

During the month of January 2012, the fellows reviewed all the RHSP data collection tools and

highlighted the duplicated indicators on the various forms. The fellows then reviewed indicators

for reporting to the various stakeholders (e.g. CDC, MEEPP, and RHSP) in relation to the MoH

HIV care tools, since it was a requirement for RHSP to adopt the MoH HIV care tools (see figure

3). This was meant to prepare for integration of the HIV care services into the MoH system. The

review of indicators was done in consultation with the RHSP HIV care program coordinators, to

take into account the research and service interests.

Figure 3: Review and revision of tools

7

During this review, we identified indicators required by other stake holders but not addressed by

MoH HIV care tools. A new tool, the RHSP HIV Care Card (Addendum) was designed (March

2012), to address the desired indicators. This form (the addendum) was designed in a format

similar to the MoH HIV Care/ ART card; having many encounters and used by both Pre-ART

and ART clients. . Redundant and duplicated indicators were removed from the forms and this

resulted in re-designing or modification of the RHSP forms to come up with shorter and more

user friendly forms. Other forms were dropped completely (see table 2 for details).

Table 2: Current status of RHSP data collection tools

Forms # of Pages

A) Re-designed (3) Original Current

Screening form 3 1

Clinical assessment 8 5

Lab monitoring card 1 1

B) New (1)

HIV Care card-Addendum 1

C) Adopted

MoH HIV Care tools

D) Dropped (7)

Clinical Follow Up

Patient Medical List

PMTCT

Pre-ART summary card

ART summary card

Information sheet for ART initiation

Drug tracking form for children

2.4.2: Data entry screens designing

As far as data entry was concerned, we designed and tested the data entry screens for the RHSP

revised tools in Visual FoxPro (see figure 4) and adopted the OpenMRS entry system for the

MoH data collection tools.

8

Figure 4: Data entry screens designing

2.4.3: M&E Fellows and MoH staff trained clinicians on the use of the new tools.

At the beginning of April 2012, we organized a 4-day staff training on the Paper based tools; the

revised RHSP and adopted MoH tools. We invited MoH trainers to train the team on the MoH

tools and the fellows trained the team on the RHSP revised tools. The training was well attended

and it went on successfully. We started collection of data on the new tools the day after end of

training. Figure 6 shows HIV care staff in a training session on paper-based tools (RHSP and

MoH HIV tools), facilitated by the fellows and MoH training team.

9

Figure 5: Training on paper based tools

The fellows then started on the mentorship (coaching) exercise and monitoring on the

progress of the use of the new forms. As the field team used the forms, we received

feedback on the forms which we acted upon. A month later, (May 2012), we invited the

MoH trainers to join the fellows for a 4-day mentorship visit to all the RHSP HIV care

clinics. The MoH mentorship team gave immediate feedback to the staff and also gave a

de-brief and a written report to the RHSP HIV Care coordination team.

In June 2012, training on the data entry screens was conducted (see figure 6). We invited

the MoH team to train the staff in the OpenMRS while the fellows trained the staff on the

Visual Foxpro entry screens for the revised RHSP forms. During the training, we

experienced challenges with OpenMRS software compatibility with the laptops’

operating system. This disorganized the training and delayed the entry of the data in the

OpenMRS system after the training.

10

Figure 6: Training in data entry

Data entry started late July 2012 in some few clinics where the OpenMRS software was

successfully installed. As the clinicians started on data entry, the fellows and the HIV care data

manager went to the field for mentoring and coaching.

In August 2012 we received a mentor from MoH who joined the fellows in the mentorship

exercise.

11

3.0: CHAPTER THREE During the mentorship visits, inconsistencies identified on the forms by the mentorship team

were worked upon by the staff. Data entry gaps identified by the mentorship team were also

discussed and worked upon by the staff.

The team then assessed the progress of data entry for the July-Sept 2012 quarter. The details of

the data entry assessment are shown in Figure 7.

Figure 7: Proportion of data entered in the RHSP HIV care field clinics

During the period, Apr-Jun 2011, clinicians started on data entry on old tools. This progressed at

a slow rate and by the end of the quarter, only 23% of the data collected during this period was

entered. In the next quarter, July-Sept 2011, the rate of data entry increased to 40%. For the next

two reporting periods (Oct-Dec 2011 and Jan-Mar 2012), despite the data management skills

attained by the clinicians, data entry rate stagnated at 60%. This data entry stagnation prompted

the fellows to hold a discussion with the clinic team. The discussion revealed that the data

collection tools were many and lengthy resulting in spending a lot of time on patients and entry

as well. The fellows then took up the task to review and develop efficient data collection tools.

In the period Apr- June 2012, clinicians were trained on the use of the new data collection tools

12

and data entry. Thus clinicians could not enter any data during this period because after training

on paper based forms, they had to complete the MoH HIV care card for every client under RHSP

HIV care. Data entry was further delayed by the OpenMRS software incompatibility with many

of the field clinic laptops.

Data entry on the new tools started late July 2012 and by Sept 2012, 50% of the data collected in

the quarter had been entered, which was a remarkable improvement in data entry rate. Clinicians

reported that the new forms were easier to complete and enter and this availed more time for

review of clients and other clinic activities. Basing on the remarkable improvement in data entry

rate, fellows project that by March 2013, clinicians would be in position to enter all the data

collected in a quarter.

3.1: Project Outcomes

There was noticeable decrease in paper consumption in the HIV care program because of the

reduced number and size of some tools and use of HIV care cards that can handle multiple

encounter data.

There was a remarkable improvement in data entry rate (50%) during the period July-September

2012 as compared to the period April- June 2011 (23%), before project implementation.

3.2: Lessons learnt

Advocacy skills are essential for acceptability of the project

Constant consultation with different stakeholders is essential for the success of the project

Having a positive attitude towards project implementation is key for success of the project

For the success of the project, there is need to dedicate ample time from start to end.

3.3: Challenges

The conflict between research and service component presented a problem in review of

indicators. This was overcome by the constant consultation with RHSP HIV Care service team

and staff from other RHSP departments.

We also experienced limited time for this project due to other RHSP commitments. This was

overcome by working overtime to accomplish both RHSP and fellows’ project demands.

At the period of training in the OpenMRS data entry system, we faced a challenge of the

incompatibility of the OpenMRS software with many of the field laptops’ operating systems

which disorganized the training and delayed the implementation of OpenMRS data entry in the

field clinics. We overcame this by constant consultation with RHSP IT experts and continuous

field support supervision visits by the HIV care data manager and the fellows. .

13

3.4: Conclusions

In the implementation of this project, we managed to accomplish the following: Data collection

tools were revised which resulted in the development of efficient data collection tools.

We also adopted the MoH HIV care tools, which was a requirement by MoH, in preparation for

integration.

3.5: Recommendations

To RHSP

Fellows recommend that more staff should be sent for the M&E course in order to

strengthen the M&E system at RHSP and also to ensure continuity in case the current

M&E staff leave or are assigned other duties

To assign a budget to M&E activities since M&E is an essential component in the

implementation of any project.

To MakSPH-CDC Fellowship Program:

To Increase the number of trainees admitted to the fellowship program so that more people get

the chance of gaining these very essential skills

3.6: Next steps

3.6.1: Dissemination plan

Final dissemination workshop on 5th Oct 2012 at Imperial Royal Hotel to the facilitators,

funders, administrators and supervisors at RHSP, other implementing partners, MoH, the

alumni MakSPH fellows and other interested partners

3.6.2: Follow-up/scale-up strategy

We plan to continue with the following:

• To provide continuous monitoring and support supervision to all field clinics.

• To have data management officers train further on OpenMRS (e.g screen

designing )

• To evaluate the effect of the project on timeliness and quality of reports

• To design an automated data capture (ADC) system on RHSP revised forms and

pilot it in 3 of the 13 hubs

14

Appendices Appendix 1: Logical framework for the project

Summary OVIs MOVs Assumptions/Risks

Goal Timely and

improved

quality in HIV

Care reporting

Late submissions of HIV

Care reports reduced to

0% by the end of

December 2012

Date of submission of

reports to stakeholder

(RHSP, MoH,

CDC/PEPFAR, and

MEEPP) in comparison

to submission deadlines

Purpose/

Objective

Increased good

quality data

capture by 95%

HIV Care clinicians to

have all current reporting

period data entered and

validated one week after

end of reporting period

Data authenticity checks

and reports from staff on

backlogs.

No power charging

problems and no

breakdown of

laptops

Outputs Revised and

simplified HIV

Care data

collection forms

All HIV Care data

collection forms to be

reviewed and ready for

use by end of March 2012

Presence of modified

tools

Authentic technical

expertise

Designed data

entry screens for

the new forms

Entry screen application

to be developed and ready

for use by end of March

2012

Presence and use of an

the new data entry

application in all clinics

Authentic technical

expertise

Strategies

/Activities

Train and

retrain

clinicians on the

revised data

collection tools

and data entry

screens

All HIV Care field

clinicians trained by end

of March 2012

Training schedule,

attendance lists and

training reports

Assume complete

attendance

15

KYEBE

L a k e V i c t o r i a

KABIRA

KAKUUTO

KIBANDA

KYALULANGIRA

KACHEERA

LWAMAGGWA

LWANDA

KASASA

KASAALI

KALISIZO

DDWANIRO

KIRUMBA

NABIGASA

KIFAMBA

BYAKABANDA

LWANKONI

KAGAMBA

RAKAI TC

KYOTERA TC

¯

KM0 10 20

Population Density

Persons per Sq Km

16 - 84

85 - 181

182 - 289

290 - 1728

Water Body

Appendix 2: Rakai Districtmap indicating the sub-counties

16

Appendix 3: Work-Plan

Activity Oct

2011

Nov

2011

Dec

2011

Jan

2012

Feb

2012

Mar

2012

Apr

2012

May

2012

Jun

2012

Jul

2012

Aug

2012

Sept

2012

Oct

2012

Revision of

tools

X X

Automated

application

development

X X

Revision of

SOPs

X X

Training X

Pilot X X X

Evaluation

of the

intervention

X

Reporting

writing

X X

17

Appendix 4: Budget for Improving the Data management system of the RHSPHIV care field clinics

ITEM

QUANTIT

Y

UNIT

COST

TOTAL

COST

SOURCE OF FUNDS

BUDGET JUSTIFICATION

COMBINED CDC RHSP

A STATIONERY

1 REAMS OF PAPERS 6 20,000 120,000 RHSP - 120,000 For printing forms used in clincs and training

2 FLASH DISCS (8GB) 2 50,000 100,000 RHSP - 100,000 For data storage and transfer, to be used by any staff

3 PENS (BOX-BLACK) 1 15,000 15,000 RHSP - 15,000 For use by trainees and fellows

4 NOTEBOOKS 40 3,000 120,000 RHSP - 120,000 For use by trainees and fellows

5 MARKERS(BOX) 2 15,000 30,000 RHSP - 30,000 For use in training and marking files

6 FLIPCHARTS(ROLLS) 3 20,000 60,000 RHSP - 60,000 For use in training

7 SPIRAL BINDERS 40 2,000 80,000 RHSP - 80,000 For binding training material and SOPs

8 SPIRAL BINDER COVERS 80 2,000 160,000

RHSP

- 160,000 For binding training material and SOPs

9 LAPTOPS 2 1,600,000 3,200,000 CDC 3,200,000 - For the fellows/ M&E staff

10 PRINTER Catridge 1 600,000 600,000

CDC

600,000 - For printing forms and training material

11

APPLICATION

DEVELOPMENT FOR

DATA ENTRY 1 1,000,000 1,000,000

CDC

1,000,000 - To be out-sourced from private providers

SUBTOTAL 5,485,000 CDC/RHSP 4,800,000 685,000

B STAFF TRAINING

1 TRANSPORT REFUND 20 20,000 400,000 CDC 400,000 - For trainees , their field stations are far from Kalisizo

2 PERDIEM 20 30,000 600,000 CDC 600,000 - For trainees , their field stations are far from Kalisizo

3 ACCOMODATION 20 40,000 800,000 CDC 800,000 - For trainees , their field stations are far from Kalisizo

4 MEALS/REFRESHMENTS 40 5,000 200,000 CDC 200,000 - For trainees , their field stations are far from Kalisizo

SUBTOTAL 2,000,000 CDC 2,000,000 -

C

COMMUNICATION AND

TRANSPORT

1 AIRTIME (5 MONTHS) 10 50,000 500,000 CDC 500,000 - To communicate to trainees, fellow staff and mentors

2

TRANSPORT-FOR

FELLOWS 1000 3,500 3,500,000

RHSP

3,500,000 To visit field clinics for implementation and support supervision

3 INTERNET MODEM 2 100,000 200,000

CDC

200,000 -

For use outside office premises, likely to work off station most

of the times

18

4

SERVICE FEE FOR

MODEMS(6 months) 2 150,000 300,000

CDC

300,000 - service fee for modems for at least 6 months

SUB TOTAL 4,500,000 CDC/ RHSP 1,000,000 3,500,000

SUBTOTAL (all items/

activities) 11,985,000

7,800,000 4,185,000

D Contingency 5% 599,250

CDC/RHSP

390,000 209,250

GRAND TOTAL(all items/

activities) 12,584,250

CDC/RHSP

8,190,000 4,394,250