Daily diary analysis – An approach to strengthen information system at grass root level

Author(s):

Dr.Minal Mehta

Topics: Community health workers, Employee Engagement, Human Resources/Workforce Development, Supervision, Task shifting, Training

Region and Country: Asia, India

Organization: NGO in the Suburbs of Mumbai

The Report

Problem:

This improvement report refers to the period July -2007

Facilities which implemented HIV AIDS program for children were the subject of the report.

The facilities were NGO (Non-Government Organization) implementing Pediatric HIV AIDS program with the technical support from a Mother NGO. Author worked as the coordinator for the program.

Outreach Worker (ORW) daily diary is a primary source of a lot of data. The guidelines given by the donor agency for ORW daily diary is sufficient. However, in absence of analysis and feedback the data remains hidden, and crude. While interacting with ORW during Technical Support (TS) visits it was shared that they need inputs and guidance to write the ORW diary.

As the daily diary data was not used in the every day life, the gaps in the needs of the community and program widened, under reporting of the field work lead to inadequate planning for the region.. For example – the number of people reached by ORW were under reported, the emergency support given by the ORW under program was hardly reported, challenges in the outreach to remote areas in the rural parts of the district were overlooked.

This report aimed at improving the quality of the data at grass root level. This was done immediately by analysis of the ORW daily diary format and ensuring the training to ORW in documentation.

Intervention:

a) To make the data in the ORW diary more visible

b) To evolve a daily diary format in Marathi ( local language )

c) To enhance the quality of data at grass root level

The report presents the detail analysis of ORW diary and recommends a revised format to be made in the local language so that it can be computerized at a later stage and analyzed using software packages like NVIVO or Atlas TI.

This brief report also aimed at making documentation work by outreach worker very simple , and uniform across the program so that district wise field reality can be compared and outreach strategy can become area specific.

Methodology -

It was decided to use following protocol in content analysis of daily diary.

1) Sample Selection – photocopies of sample pages of ORW diary from the districts – Pune,Solapur,Satara,Miraj from five ORW zone were selected after preliminary reading

2) Arranging the data for content analysis- All the text data was arranged district wise and ORW zone wise for analysis/

3) Deciding coding units – example – word, concept, sentence, paragraph, theme, entire. We used daily report entire text as coding unit.

4) Deciding Categories- categories evolved after immersing oneself in the data instead of deriving from existing theories or previous related studies. The categories that immerged from intensive reading were – Home visits, Events Report, Office work, Networking visit, Accompanied referral, Awareness work done, Training received, Information giving. Each category was further coded with Nodes as shown in the following table.

5) Coding the text - All the selected sample text ( 10 ORW zone, Period Oct-Dec 07 – 20 days x 3 months x 5 zone x 3 districts. However the numbers of report were 300 daily text reports. ) were coded as per the above table. Test coding was done and the same method was followed for the entire sample size.

6) Checking coding consistency – for the time being the codes were limited in number so coding instructions and rules were listed in one page. As the data size increases the instruction dictionary will be prepared which will consist of categories names, definitions or rules for assigning codes. Human coders are subject to fatigue and are likely to make more mistakes as the coding proceeds. However, in the current study the sample size being very small these challenges were not seen.

7) Drawing conclusion from coded data - involved exploring properties and dimensions of categories, identifying relationships between categories, uncovering patterns and testing categories against full range of data. At this stage the findings are presented in this report. Conclusions can be drawn after analyzing the daily diary of all 9 districts.

Results:

a) Loss of data while transferring to INGO CMIS.

Example - one to one contact made per ORW zone per quarter in Rural area were 40( lower side)-80( higher side ) and Urban area were 324. However, additional indicator reported much less number by both the INGO in rural as well as urban INGO. These findings also confirm the distance related challenges in the rural area resulting into less number of 1-1 contacts.

Health care given – ORW visited a PLHA who had loose motion, vomiting . However, ORW has not mentioned the timely support given in terms of hospitalization. This is just randomly read and found. Details will follow in next quarter report after analyzing the daily diary.

Sensitization work done to motivate private doctors to refer children to CHAHA- one ORW diary revealed the number of doctors in private practice met by her to motivate them to refer children to CHAHA. This important work done by iNGO was not highlighted in the narrative report.

ORW felt helpless – One ORW met the family with 3 single orphans whose mother works throughout the day and has no time to look after the children. All three children are less than 10 years in age and left alone in the house which is a slum and non supportive neighbors.

b) Child Identification strategy in Rural and Urban setting are different. Example – In the rural setting primary source for CLHA identification was Gram Panchayat or Anganwadi whereas in the urban setting the district hospital or other NGOs were the source of CLHA identification. This also means that HIV AIDS awareness education for Anganwadi sevika and Gramsevak will increase their cooperation. PHC sub-centers are present in all the Gram-Panchayat but anganwadi sevika has better rapport with the rural community than PHC staff.

c) Issues faced by PLHA in the rural and urban setting

Stigma and Discrimination – is experienced by many PLHA. However, the manifestation varies in Urban and Rural setting. In cities loss of employment and workplace discrimination is common whereas face of discrimination in rural setting is denial of the reactive status, resistance to HIV testing, migration to city. Other examples – 1) one woman was thrown out of the job after the HIV reactivity was known. 2) Emotional violence by uncle in a family with single orphan where father died of HIV AIDS

School drop out – in both rural and urban area is reported but reason is more economic or need to take care of younger siblings while mother is out for earning livelihood. One ORW diary revealed very interesting details – “in one of CLHA registered under CHAHA used to get unwell if went to the school and would get better if remained at home” – reasoning could be peer rejection in the school. However, such cases need to be studied in details by the counselor.

Livelihood options – it was learnt that livelihood options are very limited for PLHA. This adds to the school drop out in double orphan family where older siblings can start working to take care of younger siblings. However, a detailed case study can be very useful to raise the issue. This is also a very helpful observation to seek more grant from GFATM under IGP.

Single orphan and double orphan - Under CHAHA we have more number of single orphan than double orphan, For examples in one ORW zone analyzed, 22 single orphan were met through and 8 double orphans were reached. Single orphan were left to take care of each other while mother was away for work and double orphan family looked after by grandparents were facing more financial crisis. Single orphan family lacked emotional support and warmth needed from mother and double orphans lacked the economic support needed for growth. Even relatives who cared for double orphan were limited in the financial resources. These findings confirm the need to change the guidelines for foster care and adding financial resources under Alternate care and IGP.

Lessons:

1) Grass root level staff needs training in planning, coordination and documentation work

2) Daily diary reporting format to be in line with the program reporting at district, state and national level.

3) Quality and Flow of information from grass root (daily diary ) needs to be improved.

4) Developing a reporting format for the grass root staff to surface syntactical and semantic information embedded in the ORW diary.

5) Qualitative data analysis and outcome needs to be taken seriously in developing future program strategy.

Year:

2007