Cambodia has set goals in their national HIV Strategic Plan to reach the 90-90-90 targets by 2020, reduce HIV mortality, and eliminate new HIV infections by 2025. Development and scale-up of a robust strategic information system is one of 8 cross-cutting key strategic components in this strategy. A national strategy for monitoring and evaluation of the health sector HIV strategy has been developed, which states that the objective of the HIV strategic Information system is:
1. To provide the evidence basis for tracking progress and guiding implementation of the Strategic Plan through routine monitoring, operational research, surveillance, and evaluation.
2. To strengthen Boosted Integrated Case Management to improve HIV cascade outcomes towards the 90/90/90 targets.
One of the five requirements for B-IACM is the development of a linked database across the whole cascade. The SOP for B-IACM-PNTT (partner notification tracing and testing) states “This strategy should be divided into 2 phases: medium term and long term. Medium term: linking databases across the entire cascade and TB-HIV and PMTCT cascades; long term: integration into the PMRS system…..Critical for such linkages is a unique identification system.” In addition, NCHADS has outlined plans for Integrated Case Surveillance of HIV and STI (ICSHS). The goal of ICSHS is to identify and record all cases of HIV infection, both new and old. Strengthening of strategic information systems is necessary for robust ICSHS.
Several SI databases currently exist under NCHADS/ MOH to monitor key programmatic outputs and outcomes including the VCCT database, B-IACM database, pre-ART/ ART database, STI database, HEI (HIV Exposed Infant) database, pediatric database, viral Load, and an Exposed Infant Diagnoses (EID) lab database. Under the MCHC/ DPHI HMIS system, there is also a web-based application used for reporting aggregate data on HIV testing from health centers (including antenatal care) and outreach testing. NCHADS is also developing a database for key population prevention services that contains essential data from non-governmental organizations regarding their work with key populations (KP) that includes introduction and use of a unique identifier code (U-UIC) to allow tracking individuals through the cascade.
NCHADS has developed a vision for the HIV SI system which would facilitate tracking patients through the cascade through a patient lookup system. This system would serve as a master repository for all patient identifiers assigned to the patient, including identifiers used by HIV services, laboratory services, TB program, MCH program, or administrative systems such as Health Equity Fund (HEF), for example. This planned NCHADS HIV SI system would be based on electronic databases and internet connectivity to all 69 VCCT and OA/ART sites.
In 2017 NCHADS made great strides to link the existing NCHADS databases by developing and Electronic Master Patient Index System (EMPI) that could allow linkage of HIV patients not only between NCHADS clinical and laboratory databases, but also with databases used by other programs such as TB, inpatient care, clinical laboratories, and/or administrative systems such as HEF. In addition, they have worked with the Cambodian Communicable Disease Center to adapt a national 115 mobile phone disease reporting system to also facilitate identification of newly identified HIV infections for rapid mobilization of the B-IACM system (already deployed in Siem Reap and Battambang provinces). Additionally, NCHADS is exploring use of fingerprint technology to improve deduplication of ART clients, barcodes to streamline processing of viral load laboratory specimens, and line-listed VCCT and STI databases. NCHADS is also in the process of installing a system for remote cloud-based printing of viral load test results in order to decrease viral load result turnaround time.
In terms of data use, NCHADS has established an SOP for Continuous Quality Improvement (CQI) in which ART clinic staff meet quarterly to review measures of HIV clinical care. Quarterly review of data is an essential foundation for these meetings. In addition, NCHADS is strengthening use of data at the provincial and district level for B-IACM through routine Group of Champions meetings. Although some HIV staff members have been trained to do routine analyses for CQI and B-IACM meetings, use of dashboards is a way of facilitating analysis and increasing use of data by a much greater number of HIV program staff to ensure that decisions are evidence-based. Through a collaborative process with national stakeholders, NCHADS has designed dashboards for B-IACM and will also use a similar process to design CQI dashboards. However, these dashboards have not yet been fully programmed.
Furthermore, much of the care provided to patients throughout the cascade is still not tracked in line-listed electronic databases. Currently only approximately 54 of 69 ART facilities use electronic ART databases. Furthermore, although they are line-listed, these databases are not yet linked via internet to the central database. VCCT clinics do not have electronic, line-listed data, except for a handful participating in a pilot project in Battambang and Banteay Meanchey which uses a finger-print identification system. In addition, all referral hospitals now assign a unique health identification (UHID) number (the PMRS number, Patient Medical Registration System) to either all patients seen for general hospital services, or just those patients eligible for HEF patient benefits and provider compensation. But, there is not yet a routine process for ensuring all HIV patients have been assigned PMRS numbers, or that HIV service delivery for HEF patients is reimbursed.
Therefore, an independent assessment of the progress Cambodia has made in strengthening their HIV SI system is needed before full-scale up of the system is undertaken, to ensure the system is optimally fit for purpose, sustainable, and able to produce high quality, actionable data. Ideally this assessment would be led by an independent consultant who would be responsible for generating a full assessment report, with findings coming from not only the consultant, but also a team of international and national experts in key areas such as surveillance and health systems informatics. Such an assessment is essential for ensuring a clear roadmap for HIV SI system strengthening as Cambodia prepares for EMTCT of HIV and syphilis, as well as elimination of HIV by 2025.
Terms of reference:
The consultant is expected to lead a team of international and national experts in an assessment of the national HIV information system.
This will entail:
i) Finalizing a methodology for the assessment
ii) Coordinating and conducting the assessment jointly with an assessment team that involves NCHADS, WHO, UNAIDS, PEPFAR, and other key stakeholders
iii) Producing a roadmap summarizing key recommendations for strengthening and scale-up of HIV information systems for 2018 through 2025.
Expected output/deliverables: Finalized methodology and timeline for HIV SI system assessment based on existing WHO and UNAIDS guidance
- Report summarizing findings, and recommendations for the roadmap to strengthening and scale-up of HIV information systems to NCHADS and key partners over the short (2018), medium (2019-2020) and long term (2021-2025)
Education: At least a Master’s degree in related field is preferred
Experience and skills: At least 5-years of experience in working with HIV information systems in developing countries
Languages: Fluent written/spoken English
Interested applicants are strongly encouraged to send CV, letter of interest and the financial proposal via email to the WHO Representative Office before the deadline for submission on 20 April 2018 at WHO
email: [email protected]