Lack of data highlighted
The lack of data collection by the National Health Services Laboratory was highlighted in the first H.I.V, A.I.D.S, Sexual Transmitted Infection and Tuberculosis Reference Manual launched by the Ministry of Health.
Obtained by the Samoa Observer, the 77 page report released 20 July 2017 indicated the first manual and framework aims to develop for a programmatic disease area outside of the broader health sector framework, which it links to.
Chief Executive Officer, Leausa Dr Take Naseri in the report emphasized the importance of monitoring and evaluation of the said diseases.
“It is a powerful management tool as well as one of the core functions of the Ministry of Health,” he said.
“The Ministry of Health as government’s lead agency in the Health Sector is mandated in the M.O.H. Act 2006 to monitor and regulate health sector performance.”
“The manual consists of sexual health indicators that will enable tracking of progress and impact; as well as to allow informed decisions along the implementation of the current Health Sector Plan 2008-2018 and the new plan set to be operational in 2019.”
“The application of this manual will also serve to further the Ministry of Health endeavour to create integrated M&E systems for each disease and programmatic area within the health sector.”
“Crucial to this effort is the continued invaluable partnership of all stakeholders, partners, N.G.O’s, and international development partners involved in the Samoa’s national response to H.I.V, S.T.I, and T.B.
“I present this H.I.V, A.I.D.S, S.T.I. and T.B. M&E Reference Manual with great enthusiasm that it will make a change to the health of our people and overall performance of our Samoa Health Sector.”
“Working towards combating these diseases will involve improving health information, accountability, and evidence based management of H.I.V, A.I.D.S, S.T.I’s and T.B. I invite all partners and stakeholders to use this manual to guide the way forward,” Leausa stated in the report.
As of 2016 there were 24 cumulative cases of H.I.V. in Samoa according to surveillance data and 11 of these cases are currently living. “The primary mode of transmission of H.I.V. in Samoa is heterosexual sex.” “Results from the 2008 Second Generation Surveillance Survey reveal that H.I.V. in Samoa occurs at a rate of 10.4 cases per 100,000 with a male to female ratio of 2:1.”
“Surveillance data is currently gathered from hospital records on Upolu and Savaii, Private provider offices, health clinics, Immigration, various N.G.O’s, Samoa Family Health Association, and from blood donors.”
“However funding and staffing shortages at all of these organizations has limited the amount and frequency of data that can be collected for H.I.V. and other S.T.I’s. Thirteen out of the 24 cumulative cases are deceased.” Between 2009-2016 there were three females; eight males; 11 total living cases of people living with H.I.V.
“All living cases receiving treatments and nine are receiving antiretroviral from the national health services; two are receiving antiretroviral from private providers.”
There are five incidences of mother to child transmissions and currently, 3 living mothers and 2 living children,” says the report.
According to the report Samoa’s H.I.V, A.I.D.S, S.T.I. and T.B. data came from three main sources, surveillance data from National Health Services laboratory and S.T.I. Clinic that process samples from hospitals, health clinics, and reports from private providers; behavioural surveillance survey (B.S.S.) conducted by W.H.O. (2008) and behavioural and risk factor data from the Demographic Health Survey (2014).
The report further indicates there are however issues with data from these sources.
While the issues were not identified, the report points to the N.H.S. laboratory surveillance data, there are delays in receiving and testing specimens with produces late results, especially for antenatal women who may have already given birth by the time the results are processed.
“Private providers are required to report testing results back to M.O.H. but not treatment, and funding issues have made it difficult for M.O.H. to enforce this mandate.”
“Additionally, the facility is underfunded and therefore understaffed, which limits the quantity and frequency of how much and when surveillance data can be reported to M.O.H.”
As for the B.S.S. survey, collected important data on behaviour and risk perception of H.I.V, these data are now outdated.
The Demographic Health Survey, completed in 2014 also captures important data on risks behaviours, knowledge, and attitudes relating to H.I.V.
However, for current M.O.H. planning and implementation purposes, more behavioural indicators need to be collected in addition to more comprehensive surveillance data.
These separate sources need to be integrated so that clinical data can be linked with behavioural data for M&E.
Information gathered the current Health Sector M&E framework only records prevalence and incidence of Chlamydia, syphilis, and gonorrhea. More indicators pertinent to these STI’s and additionally H.I.V. need to be collected for planning purposes of the programme.
The report indicates the primary purpose of this document is to provide a data collection reference manual for the health sector with regards to M&E.
“It is meant to identify what data the health sector has, what it needs to collect, and for what purposes.”
“The M&E framework models the chain of results i.e. what indicators produce results at what level.”
“The indicator glossary provides a detailed list of each indicator, its calculation, data source, and required disaggregation.”