Tuesday, December 9, 2008
What I Do - Special Edition for Consulting Peeps
Now in my very first blog post I had mentioned what I was meant to do during my volunteer stint in Kenya. I just wanted to give an update on what I have done during these past 3-4 months. My consulting peeps might find this post a bit more interesting just because I jazzed it up with some consultant terms (sorry, I couldn't find a way to add "ping" in here). Just to recap, I am working with Voluntary Services Overseas (VSO) which has a business partnership with my company, Accenture. VSO placed me in Embu, Kenya where I work with AIDS, Population and Health Integrated Assistance Program (APHIA II) Eastern (A2E) which is a 5 year project funded by the US Agency for International Development (USAID). The project is managed by JHPIEGO, an affiliate of John Hopkins University and implemented by a consortium of 6 strategic partners that work closely with the Ministry of Health (MOH).Whew....ok. So I am based in APHIA's office in Embu (the very unsuspecting and small headquarters of the Eastern Province) where I work with the Monitoring and Evaluation (M&E) team. Essentially we collect health data (e.g. HIV/AIDs, TB, ARV, mortality rates, etc.) from the health facilities, dispensaries and district hospitals, etc. on a monthly basis, aggregate and analyze it, and send it to the national level for policy making and such. We also ensure the APHIA programs (HIV counseling and testing, outreaches to orphans, etc.) implemented in the communities are achieving its goals based on the data analysis. One of my tasks was to analyze how these health facilities were reporting their data to A2E ("as-is" data process flow) since reporting rates are rather low for some locations. From that, we identified key issues as to why reporting rates were so low (e.g. personnel not trained sufficiently, no computers available, extremely long distances or harsh terrains to traverse to send data, etc.) to make a "to-be" data process flow. Needless to say, it has been very interesting since the issues I see here are not even issues we consider in the U.S. For example, one of the biggest issues with receiving timely data submissions is because health facilities may be at least 3 hours from the nearest town and there is no transportation (or roads at that).You may recall from one of my previous blog posts where we visit Chalbi desert. The facility we visited there has no transportation to the nearest town and there are no official roads to that town AND there is no internet access and spotty cell phone connection. Thus, receiving data is no easy task from an area like this. Moreover, data records are not electronic; everything is still pen and paper! So you can imagine the risks of human errors, loss of data, etc. associated with the integrity of the data. Many health workers entrust their data to friends passing by their town to submit to their data since they don't know when they next vehicle will pass by the town (I've included a pic of the main means of transportation in Northern Kenya). So the more technical solutions I'm used to with consulting are a bit "out the window" but my knowledge of impact/needs assessments, stakeholder management, and training development have definitely been useful! Another issue that has been brought to my attention is with resource management/staff development at these facilities. There is a significant training need (not to mention staffing need) but you can imagine the obstacles with training staff when they're in remote locations and online training is not an option. Moreover, because some of these places are rather remote, staff can easily lose motivation when they lack the resources and management supervision they need. Thus, I could quickly see how one issue can lead to many other issues making them all interelated. So a great deal of my efforts have been in data gathering, observation, analysis, and proposing an action plan. At the same time, it can be rather overwhelming when you see so many issues that need to be tackled; but strategy comes into play here when you can see how targeting and addressing one issue can consequentially resolve other issues. I sometimes compare it to gears where when you set one in motion will ultimately cause the others to begin functioning.
In addition, my Excel and PowerPoint knowledge (thanks PPT Master, Nick) have been put to good use as of I've created many presentations for management and an Excel reporting tool to capture data submission by health facility and region and easily highlight those facilities/areas that are under-reporting (yay for conditional formatting!) and track trends over the quarters and the year. I've also been able to help capacity-build the M&E team by imparting some Excel and PPT skills to them.