Quality of health facility data in the PMTCT cascade in Côte d'Ivoire

Purpose: Successful implementation of PMTCT programs requires accurate and timely data collection at the facility level and consistent reporting to higher levels to inform decision-making. 

Methods:  A retrospective national assessment of ‘Option A’ PMTCT programs in Côte d’Ivoire was carried out by USAID’s HIVCore project in March 2013, based on a nationwide sample of 30 PMTCT sites. We assessed PMTCT data collected from on-site registries and patient charts at each site for completeness and quality of data collection and reporting. 

Results: We observed sample-wide reporting errors, data inconsistencies, redundancies, and skewed data due to non-adherence to national protocols.  For example, we compared nine PMTCT indicators calculated from on-site data collected at each of the 30 sites (n=270) to nationally reported data and found 171 (63.3%) absolute discrepancies of >5%.  Moreover, data are infrequently analyzed or used for quality improvement at the facility level. The large quantity and complexity of PMTCT data requirements demand a significant allocation of provider time and enable data collection error.  Faulty conclusions drawn from inaccurate data serve as impediments to service improvement.  Data quality issues suggested that facility staff, health directors, and national policy makers may be misinformed regarding performance at all levels of the PMTCT cascade.

Recommendations:  Data systems should be designed to enable utilization of data both on-site and at higher levels. Suggested improvements include:  1) reduction of redundant or inconsistent data sources and indicators; 2) routine chart review to improve patient tracking; and 3) enhanced training and oversight of data collection and reporting.