i

MAKERERE UNIVERSITY COLLEGE OF HEALTH

SCIENCES/ SCHOOL OF PUBLIC HEALTH

CQI MEDIUM TERM FELLOWSHIP

PROJECT: IMPROVING TIMELINESS IN HMIS 108 REPORTING

FROM HEALTH UNITS TO THE DISTRICT IN KYENJOJO DISTRICT.

By:

1. MUGABI SIMON PETER

(BACHELOR OF QUANTITAIVE ECONOMICS)

2. RUHWEZA FRANCIS

(BACHELOR OF HEALTH ADMINISTRATION)

MEDIUM TERM FELLOWS

NOVEMBER 2013.

i

Table of Contents

List of Abbreviations .............................................................................................................................. iii

Declaration ............................................................................................................................................. iv

Acknowledgement ................................................................................................................................... v

Executive Summary ............................................................................................................................... vi

1. Introduction/ Back ground ............................................................................................................... 1

2. Literature Review ............................................................................................................................ 1

3. Statement of the problem ................................................................................................................. 3

Conceptual Frame Work: FISH BONE” describing the Problem Analysis: ............................................... 4

4. Project Objectives ................................................................................................................................ 5

4.1 General Objectives ..................................................................................................................... 5

4.2. Specific Objectives. ...................................................................................................................... 5

5. Methodology ................................................................................................................................... 5

5.1. The outcome of multi voting by the District QI team ..................................................................... 6

5.2 Planned Activities .......................................................................................................................... 7

6. Project Outcomes/ Achievements. ...................................................................................................... 10

7. Lessons Learnt................................................................................................................................... 11

8. Challenges and how they were addressed ........................................................................................... 12

9. Recommendations/ Conclusions ........................................................................................................ 12

ii

Operational Definitions

Access: Easy reach to the next level of health services delivery in terms of distance/ transport costs.

Brainstorming: It is a group or individual creativity technique by which efforts are made to find a

conclusion for a specific problem by gathering a list of ideas spontaneously contributed by its member(s).

Efficiency: A level of performance that describes a process that uses the lowest amount of inputs to create

the greatest amount of outputs. Efficiency relates to the use of all inputs in producing any given output,

including personal time and energy.

Effectiveness: It is the capability of producing a desired result. When something is deemed effective, it

means it has an intended or expected outcome, or produces a deep, vivid impression

Feedback: Delivering information either forward to the next higher level or backward from higher to

lower level through written down journals, verbal, or through the media like radio stations, televisions or

through routine & non routine meetings.

HMIS 108: It’s a Ministry of Health monthly reporting tool for Health Facilities that offer Inpatient

Department Services/ Admissions.

Private for Profit Health Units: These are health units that are basically intended to generate profits

from the health services they render to the population and they do not benefit from the Primary Health

Care Funds from Ministry of Health.

Private not for Profit Health Units: These are health units that render health services to the population

at a subsidized fee and benefit from the Primary Health Care Funds.

Timeliness: Giving feedback in terms of reporting as in the stipulated required time; for HMIS 108

reports (In-patient Diagnostic Department monthly Reports), it’s by 7th of every month.

iii

List of Abbreviations:

ADHO- Assistant District Health Officer.

CQI- Continuous Quality Improvement.

DHO- District Health Officer.

HC- Health Centre.

HIA- Health Information Assistant.

HMIS- Health Management Information Systems.

HSSIP- Health Sector Strategic and Investment Plan.

MoH- Ministry of Health.

MRA’s- Medical Records Assistants.

MTRAC- Mobile/ Medicines Tracking System.

NMS- National Medical Stores.

Sms- Short Messaging System.

iv

Declaration:

I MUGABI Simon Peter and Ruhweza Francis do hereby declare that this end-of-project entitled

“Improving timeliness in reporting of HMIS 108 from Health Units to the District” has been prepared and

submitted in fulfillment of the requirements of the Continuous Quality Improvement 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……………………………….

Simon Peter MUGABI, Medium Term Fellow

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

Francis Ruhweza, Medium Term Fellow

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

Dr. William Mucunguzi, Institutional Mentor

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

Dr. Godfrey Kayita, Academic Supervisor.

v

Acknowledgement

This is to thank the following who made the training in Continuous Quality improvement (CQI)

techniques, application of concepts in project identification, implementation monitoring and

disseminations of outcomes; without whom it wouldn’t be a success. These were:

Makerere School of Public Health / CDC Fellowship for Technical, Administrative, Financial/

logistical support

Kyenjojo district local government for time off station and support during implementation of the

CQI project.

District Health sector CQI Team and staff in the health facilities supporting the need for change.

CQI Medium term Fellows for team work/guidance.

In a special way we extend our heartfelt thanks go to Mr. Matovu Joseph and his unique team for

parental resilient guidance and support.

vi

Executive Summary

With support from Makerere College of Health Sciences School of Public Health under CDC

grant the District Health Management Team in Kyenjojo Local Government with the leadership

of the Continuous quality improvement Medium fellows was facilitated to identify a priority

health problem of improving HMIS 108 in timely reporting was identified; among many others

brain stormed below:

- Poor recording in the Unit TB registers in health units.

- Incomplete and untimely reporting of HMIS reports.

- Not using the standard national treatment guidelines.

- Lack of reporting tools especially HMIS 108.

- Monthly physical counts of medicines not done like updating of stock cards.

- Lack of HMIS 054 (Inpatient registers) tools in health units.

- Intended absenteeism of health workers from duty.

- Lack of feedback from health workers who move out for trainings/ meetings/ workshops.

- Lack of using data/ health facility performance when in routine meetings at health facility

level with the VHT’S, Health Units Management Committees.

Problem analysis using the why, why problem fish analysis to identify the causes to of late

reporting as (Flow diagram below)

A review of the existing HMIS 108 data from October 2012 to March 2013 ;34% was taken

as an average(Baseline) of these 6 months in addition to review of the other supporting

resources to facilitate improvement.

A proposal with a General project objective to Improve HMIS 108 timely reporting from

34%in April 2013 to 90% by the end of September 2013 and the Specific objectives to:

vii

Improve the capacity of health facilities staff through training and provision of logistics

to develop and submit their HMIS 108 in time to the district.

Develop HMIS monthly tracking system at District and health facility level to easily

track any reports submitted/ not submitted from 0-90% by August 2013.

Strengthen quarterly timely feedback to 30 health facilities to enhance data utilization

and timely reporting at health facility to the district level by August 2013 was

developed.

Some of the immediate outputs/comes included the following:

After meetings with and training of 30 DHT members incharges of health facilities and

Medical Records Assistants, sending sms reminder messages every 3rd

and 4th of every

month for timely reporting, support supervision where data validation, mentorship, coaching,

distribution of HMIS 108 reporting tools, reporting checklists, daily Inpatient Census Sheets

was done. 2 review meetings were also held and as a result, HMIS timeliness improved from

34% in April to 90% in September 2013.

Despite these, the following challenges remained:

Low prioritization of HMIS 108 and untimely reporting of some Health Facilities, network

challenges of some mobile phone numbers, Institutional mentor went for further studies.

• However the strong team work in the district, use of HMIS 108 report tracking checklist

held every body accountable both at facility level and district level which has improved

timely submission, improved capacity for data management and timely submission of

other reports like HMIS 105 and ARV’s Reports/ Orders.

• Continuous feedback on timeliness in reporting during routine review meetings,

integrated support supervision by HSD’s and DHT and inclusion of HMIS reporting tools

viii

in Health Facility plans by the Incharges are needed to sustain and improve the results

made.

• The CQI fellows together with the other district health team members will continue

supporting these gain.

1

1. Introduction/ Back ground.

Kyenjojo district has a population of 398,200 (UBOS 2012), an area of 2500KM2, with 2

constituencies of Mwenge North and Mwenge south, 2 HSDs (Kyenjojo and Kyarusozi), 16 sub

counties of which 4 are town councils, 36 health facilities (01 is a District General hospital, 01

HCIV; Out of these 30 health facilities, 16 are public, 9 PNFP and11 PFP (Kyenjojo Health

Facility Inventory 2012).

A health facility was considered to have reported timely for HMIS 108 if submission to the

District of the reports for the preceding month was within 7 days of the following Month. A

number of factors were responsible for untimely reporting from the Health Facilities to the

District which included: lack of prioritization of HMIS 108 reporting, lack of reporting tools,

lack of the report tracking checklist, inadequate knowledge/ skills in compiling and reporting,

and lack of reminder messages to health staff on reporting.

As of April 2013, HMIS 108 timeliness in reporting from Health Facilities to the District had

stood at 34%; which meant late submission/entry of the reports into District Health Information

Software 2 (DHIS2), late reporting to MoH and untimely utilization of representative HMIS Data

for Health Service Delivery.

2. Literature Review

According to the M&E plan for Health Sector 2010/2011-2014/2015, the HMIS was noted

during the HSSP I & II to have various weaknesses. The low and declining trends of timeliness

of monthly reporting by districts (68% end of HSSP II) were worrying. Factors associated to

cause the none timeliness in reporting to the district level included: Insufficient funds,

2

inadequate staff at all levels, inadequate numbers of HMIS tools and the inadequate trainings of

Health Information Assistants, prioritization of HMIS at all levels, and inadequate utilizations of

data were causes of concern. According to the HMIS Manual developed by MoH Resource

Centre, timeliness and completeness in reporting is mandatory for early informed decisions.

Timeliness has different levels; epidemic prone morbidities MUST be reported within 24 hours

of encountering a case, weekly surveillance reports MUST be reported by every Monday of the

following week, monthly reports (HMIS 105, HMIS 108, PMTCT) MUST be reported every 7th

of the following week, quarterly reports (HMIS 106a) MUST be reported every 21st of the 2

nd

month after the end of the quarter and the annual report MUST be reported every 7th

of the

August. All these timeliness and completeness is to the district level.

Timeliness in reporting is mandatory for early informed decisions to the HMIS (MoH/August

2010),. It is important for timely decision making at MoH, District and Health facility level to

direct planning and mobilization for resources, implementation and monitoring and evaluation

of health services including Inpatient services , failure of which can result in to patients having

poor quality services, delay them in seeking care, develop complications or even die from acute

conditions.

HMIS 108 reports are also used to portray the picture of the severity of health conditions in the

catchment area of a health facility and the overall proportion of clients that utilize these services

of which failure to report gives an unclear situation quite disadvantageous to both service

providers and users.

Like many health facilities in Uganda, Mpumude Health centre reported related similar

challenges (CQI Medium Report 2011).

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3. Statement of the problem

As of March 2013 only 66% of all health facilities proving these services reporting late with

majorly from Public Health Facilities (72%) contrary to the expectation of 100% from both the

Private and Public Health Facilities as required by Ministry of Health to improve evidence based

decision making and health service delivery in the district in general , allocation of resources

like equipment, equitable essential medicines and supplies currently relying on crude allocation

of these supplies by level of health care delivery, with the result of over and under stocking of

supplies and wastage and expiry of these essential items and denied access to safe efficacious

good quality supplies and build community confidence in the quality of health services.

This was not possible because many Health Workers had not been trained in data management

and reporting, lacked reporting tools especially inpatient summery sheets and registers in

addition to the district not sharing this information and providing timely feedback may not even

access them from other private facilities where the quality might also be below, hence

compromised the satisfaction of the reasonable expectations and needs of patients/ clients.

4

Conceptual Frame Work: FISH BONE” describing the Problem Analysis:

Inadequate Skills and Knowledge

Staff not trained/ mentored

Limited CME’s done in Facilities

No Focal Persons & not prioritized.

No tracking mechanism for reporting

Inadequate Collection & Reporting tools Tracking mechanism not developed

Not supplied by NMS/ District Not prioritized at District/ Health Unit level

No need identified

Daily Inpatient census not done.

No need identified

No follow up & feedback

Inadequate Supervision

Many HMIS reports to fill

Many activities implemented

Systems

Late

Reporting

of HMIS

108

reports

Skills

Supplies

5

4. Project Objectives

4.1 General Objectives

Improve HMIS 108 timely reporting from 34% to 90% by the end of September 2013.

4.2. Specific Objectives.

Improve the capacity of health facilities staff through training and provision of logistics

to develop and submit their HMIS 108 in time to the district.

Develop HMIS monthly tracking system at District and health facility level to easily

track any reports submitted/ not submitted from 0-90% by August 2013.

5. Methodology

With support from Makerere School of Public Health under the CDC grants as requirement for

fulfillment of award of a CQI Certificate of Attendance, the identified medium fellows led the

DHMT to identify and implement a project on Improving HMIS 108 timeliness in reporting

from Health Facilities to the District since April 2013.

The District Health Sub District QI Members identified a problem and the causes to the

problem to work on and made a proposal for funding interventions following the training in

CQI and as a requirement from the training institution.

The District team underwent brainstorming, generated ideas / problems affecting the health

sector. This was guided by stimulating idea generation and increasing overall creativity and

consensus in problem and cost effective solutions and principles of “Focusing on Quality”,

“Withholding disapprovals” and “Welcoming unusual ideas”.

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Below is a summary of issues raised:

- Poor recording in the Unit TB registers in health units. (AA)

- Untimely reporting of HMIS 108 reports from health units to the district(AB)

- Not using the standard national treatment guidelines (AC)

- Lack of reporting tools especially HMIS 108 (AD)

- Monthly physical counts of medicines not done like updating of stock cards (AE)

- Lack of HMIS 054 (Inpatient registers) tools in health units (AF).

- Intended absenteeism of health workers from duty (AG).

- Lack of feedback from health workers who move out for trainings/ meetings/ workshops

(AH).

- Lack of using data/ health facility performance when in routine meetings at health facility

level with the VHT’S, Health Units Management Committee’s (AI).

5.1. The outcome of multi voting by the District QI team:

ITEM LETTER 1ST

VOTE 2ND

VOTE 3RD

VOTE

AA 5 4 1

AB 6 6 4

AC 3 2 1

AD 4 4 2

AE 3 2 2

AF 3 1

AG 5 3 2

AH 4 2

7

AI 6 4 1

Untimely reporting of HMIS 108 reports from the health units to the district was prioritized.

The team having identified and prioritized the problem to work on made a proposal with work

plan and budget that was presented to Makerere College of health sciences, School of public

health Fellowship programme for approval and funding under the CDC grant.

Integrated support supervision and meetings with DHT and sending sms went on prior

implementation of other activities that needed financial support as the project was not a new idea

but building and improving on the existing practices using available resources to foster

ownership, team work, motivation for improvement and sustainability of the achieved results.

The flow diagram in ANNEX 1 below shows the reporting process from the health facilities to

District.

5.2 Planned Activities

Annex 3 is a summary of counter measures developed to solve the problem.

Refresher training of 30 Health Facility In charges and Medical Records Assistant on

HMIS 108.

Supply of HMIS tools (HMIS 108 reporting forms, Daily Inpatient Census Forms and

Report Tracking Checklist) to 30Health Facilities.

Conduct integrated support supervision to all Health Facilities.

Conduct 2 District Level HMIS 108 review meetings with Incharges and Medical

Records Assistants on timely reporting.

Send sms reminders to all mTRAC registered health workers every 3rd

of the following

month to adhere to timely reporting.

8

The review meetings in addition to support supervision both from the district and MakSPH were

part of the monitoring system to track activity implementation and address/ correct challenges in

time. The final dissemination at national level was to report the project results and how the

district planned to sustain these as way of improving the quality service delivery in the district.

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6. Project Outcomes/ Achievements.

29 In charges, Medical Records Assistants and 1 DHT members were trained in HMIS

108 of which all the 29 were subjected to a Pre/Post Test where 72.4% improve in

Knowledge.

30 Health Facilities were supplied with HMIS 108 reporting tools, reporting checklist,

daily Inpatient Census Sheets which would run them for a complete Financial Year

2013/2014. This drastically improved on non-availability of the HMIS tools.

152 monthly sms reminders on timely reporting were sent to 152 registered health

workers using mTRAC system. This was done every 3rd

or 4th of every following month.

.

Support supervision was conducted in 30 Health Facilities offering Inpatient/ Maternity

services. Data validation/ auditing, mentorship, coaching and sharing any challenges that

were experienced in the quality of timely reporting.

2 review meetings were conducted with 76 District Health Team members, Incharges of

Health Facilities and Medical Records Assistants.

As a result of the above interventions implemented by the team, there was improvement

from 34% in April 2013 to 90% in September 2013 in HMIS 108 timely reporting from

Health Units to the District which is also improved other HMIS routine reports like the

ARV reports and orders

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0

10

20

30

40

50

60

70

80

90

100

Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13

% T

imel

y Re

port

s

KYENJOJO DISTRICT HMIS 108 TIMELINESS IN REPORTING TO THE DISTRICT LEVEL.

Trend (%) Target

Review Meetings & Supervision Conducted

Sms’ sent, Support Supervision conducted

Training done, logistics supplied, sms’

sent

7. Lessons Learnt.

The use of report tracking checklist held each and every body accountable both at facility

level and district level.

Team work was key in identification, implementation and review of the interventions for

ownership and sustainability.

Health facilities having realized the need for timely reporting are now committed,

enthusiastic and reporting in time.

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8. Challenges and how they were addressed.

S/N Challenge Addressed

1 Prioritization of HMIS 108 Timely

Reporting of some Health

Facilities.

- Sharing of reports during the review meetings

and support supervision

- Development of Standard Operating

procedure on Reporting.

2 Network challenges of some

mobile phone numbers.

- Encouraging other registered staff to inform

the concerned after getting the reminder sms’

since more than one member from the health

facilities are registered.

3 Busy schedules Integration of CQI activities into the routine work.

9. Recommendations/ Conclusions.

Train new staff and reorient existing staff in HMIS reporting and use including new

reporting formats/ MoH guidelines.

Feedback on timely reporting.

Integrate HMIS 108 into support supervision activities to the health facilities.

Sustain the District HMIS and health facility tracking tools to monitor performance.

Inclusion of HMIS reporting tools in Health Facility and District Health Plans and

budgets.

Lobby for more support for data management from stakeholders.

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Include timeliness in reporting in the Health Facilities Quarterly League Tables so

that the district remains in the know of which facilities are doing well or have

challenges.

As a result of implementation of this project through training of health workers, quarterly

data reviews, logistical support and sending sms reminders the HMIS 108 from 34% to

90% with more team work, health workers are now motivated to routinely report,

manage data and improve planning, decision making and health service delivery in the

district.

The CQI medium term fellows will work with the district to sustain/ improve gains

made.

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References

Kyenjojo District local government health sector inventory (2012).

Ministry of Health (2010) Health Sector Strategic Plan III 2010/11- 2013/14 page 94.

Nankanja R and Kayizzi J B (2012) Improving records and data management in the ART clinic

at Mpumudde HCIV: Makerere School of Public Health page 3

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Appendices

Annex 1. Flow of reports from Health Unit to the District.

No No

Yes

No

Yes

Should report

be delivered

to District or

HSD

In charge-

endorses the

report for

submission

Is the report

Timely?

Compile

HMIS 108

report.

HMIS Report submitted to

District

Report submitted

at HSD level.

Submit report to

the District.

Enter the

report in

DHIS2

Enter the

report in

DHIS2

Fill the reporting

checklist, Advice &

File the report in

database.

Fill the monthly monitoring

checklist. Maintain good

practice & File the report in

database.

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Annex 2. Continuous Quality Improvement District Team.

i. Dr. Mucunguzi William- Ag DHO

ii. Babukika Anita- ADHO (MCH)

iii. Bwerere G.W.- District Health Educator

iv. Mwesige David- MRA/ DHO’s Office

v. Birungi Margie- Health Information Assistant/ Kyenjojo Hospital

vi. Mugabi Simon Peter- Bio-statistician

vii. Ruhweza Francis- District TB and Leprosy Supervisor.

viii. Kabajuma Felister- Office Attendant/ DHO’s Office

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ANNEX 3: Counter measures matrix

Staff not trained/

mentored

Lack of Data

Collection Tools Untimely reporting

of HMIS 108

Reporting

No tracking

system at all levels

No feedback on

Reporting to

Health Units

Procurement

of HMIS

Tools

- Training

- Supervision

Develop a

Tracking

System

Provide

Feedback

- Sms’ using mTRAC

saying “Thank You

for Reporting”

PROBLEM ROOT CAUSES COUNTER MEASURES PRACTICAL METHODS

Photocopying

Training of I/C’s & HIA’s

On Job Mentorships

Support supervision

Follow up from NMS

Ordering from NMS

Sms reminders (mTRAC)

Reporting trends

4 4 16 Y

5 4 20 Y

4 5 20 Y

4 4 16 Y

4 3 12 N

3 2 6 N

5 4 20 Y

4 4 16 Y

5 5 2

5

Y

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Annex 4 Work plan to improve HMIS reporting- Kyenjojo 2013.

ACTIVITY LOCATION TAR

GET

TIME FRAME INDICATORS MEANS OF

VERIFICATIO

N

RESP

ONSI

BLE

PERS

ON

COMMENTS

M A M J J A S

1. District feedback

meeting

District 1 No. of

participants

attending.

Report and

attendance lists

CQI

Fellow

s

Done in late

March 2013

2. Selection of CQI

team

District 8 No. CQI team

members active.

DHT Done in late

March 2013

3. Proposal presentation Kampala 1 Developed and

approved

proposal.

CQI

Fellow

s

4. Meeting DHT and

Incharges

District 40 No. of

participants

Report and

attendance lists

CQI

Fellow

19

attending. s

5. Training of health

workers on HMIS 108

District 30 No. of

participants

trained, No of

participants

reporting on

time.

Training reports CQI

Fellow

s

6. Provision of HMIS

tools

Health Units No. of health

facilities

receiving HMIS

tools.

Receipts CQI

Fellow

s

7. Development of

tracking checklist

District HMIS 108

monitoring tool

in use.

CQI

Team

8. Bimonthly feedback

meetings

District No. of

participants

Minutes/ reports CQI

Fellow

20

attending. s

9. Quarterly review

meeting

District 1 No. of

participants

attending.

Minutes/ reports CQI

Fellow

s

10. Feedback using

mTRACsms'

District No. of sms' sent

using mTRAC.

Bio-

statistic

ian

21

Annex 6

KYENJOJO DISTRICT HEALTH FACILITY REPORTING CHECKLIST (FY 2013/2014)

HEALTH UNIT NAME:………………………………………………………… LEVEL……..

ROUTINE REPORT

DATE SUBMITTED TO THE DISTRICT (Fill in for the different reports & Respective Month)

AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN JUL

HMIS 009a

HMIS 105

HMIS 108

HMIS 106a

ARV'S/PMTCT Orders

Reports Not Submitted to the HSD/District:………………………………………………………………………………………..

Reason for Not Submitting:………………………………………………………………………………………………………….

Verified by Incharge/ Name:………………………..……………………………Date:………………..Sign:………………………

Delivered to HSD/District By:………………………………………………..…..Date:………...…..Sign:…………………………..

Received at HSD/District By:…………………………………………………….Date:………….….Sign:…………………………

Note: Timeliness for Reporting to HSD/District is by 7th of the following month except HMIS 106a which is by 14th of the following month.

22

Annex 7

KYENJOJO DISTRICT HMIS 108 REPORT TRACKING CHECKLIST.

S/N HEALTH UNIT BY

MONTH

REPORT SUBMITTED ON TIME – Y for Yes/N for No

i.e. (7th

of Following Month 2013/2014)

Aug. Sept Oct. Nov. Dec. Jan Feb. Mar. Apr.

1 Kyenjojo Hospital

2 Butiiti HCIII

3 St. Adolf HCII

4 Villa Maria-Kaihura HCII

5 Nyakarongo HCII

6 Mbale HCII

7 Kigarale HCII

8 Butunduzi HCIII

9 Rwibaale HCII

10 Kisojo HCIII

11 Rwaitengya HCII

12 Kyankaramata HCII

13 St. Edwards HCII

14 McFarland MC

15 Katooke HCIII

16 Myeri HCII

17 Bufunjo HCIII

18 MukamaAsiimweCl

19 Midas Torch Clinic

20 Kyarusozi KCIV

21 Kyembogo Holy Cross

22 Mwenge Clinic HCIII

23 Kigoyera HCII

24 Nyamabuga HCIII

25 Kyakatara HCIII

26 Nyankwanzi HCIII

27 St. Martins-Mabiira

28 Kagorogoro SDA HCII

29 Mabale Clinic HCII

30 Katooke Clinic Centre

23

Annex 8:

A CQI Fellow Discussing during a Review Meeting

24

Annex 9:

MAKERERE SCHOOL OF PUBLIC HEALTH CDC FELLOWSHIP SUPERVISORS WITH

MEDIUM TERM CQI FELLOWS AND DHT AT KYENJOJO

DISTRICT

Supervisors Visit

25

Annex 9

2 Review Meetings with (76)-DHT, Incharges of HU’s, Medical

Records Assistants were held, shared Best Practices and Challenges