BPS IN ACTION: CASE STUDIES
ACCESS TO AND USE OF REAL-TIME DATA IMPROVES SERVICE TARGETING AND DELIVERY
The importance of access to current, accurate data cannot be overstated. Yet, effective data usage relies on a comprehensive, accessible, and usable information pipeline. BPS created the Prevention and Adaptive Learning Management System (PALMS) to pull existing and new data into user-friendly dashboards that support data-driven decision making at all levels in Malawi and Blantyre District: policy, technical leadership, implementation, and community. Enabling users to see both HIV prevention and related data, PALMS has become the foundational platform upon which the functionality of the district’s HIV prevention response and the BPS model rests. Most importantly, it is empowering District Coordinators and health management teams,
“After the coming of Blantyre Prevention Strategy, we started learning about how we can utilize our data to make sure that we know which areas we need to focus more and take our sources more... every month, we look at the data, and then we analyze the data, and then we take our activities there. …This has helped us to reduce or to have more outcomes based on where exactly the problem is. …PALMS and the BPS has helped Zingwangwa Health Center as a team to focus more on areas that we need to.”
Mirriam Hanjahanja
Senior Nursing officer, Zingwangwa Health Center
facilities, and communities to take ownership of Blantyre’s HIV response.
“BPS has really changed the tone within the district in terms of direct usage. And as for me, as an ICT person, yeah, I feel proud to be part of it, and also to see the fruits of the trainings that we did with the teams from the facilities bearing fruits in terms of the data review meetings that they're conducting.”
Gosten Njunga
ICT Programmer, Blantyre DHO
Suzike Likumbo
Former STI Coordinator, Current QI Coordinator, Blantyre District
Blantyre is the hub of Malawi’s Southern Region, which has been the epicenter of the country’s HIV epidemic for many years, but until recently District health coordinators like Suzike Likumbo had no access the data they needed to identify where new infections were happening and respond with targeted actions. The Blantyre Prevention Strategy-supported tools and training has allowed the coordinators not only to see these crucial statistics, but has also trained them on how to interpret the data and coordinate their response with partners in the community. In 2022, Likumbo and her colleaguesused this data to identify an alarming STI spike at Bangwe Health Centre - a concerning risk signal for HIV infections. Use of tools and capacities they developed with BPS support allowed them to zero in on the source of new infections, targeting their interventions for maximum impact. Working together with local organizations, they mounted a response that combined HIV testing; STI screenings, education, and treatment, and condom distribution. In subsequent quarters, STI infections decreased. This experience demonstrated for Likumbo and her district colleagues the power of data use for decision making.
WHAT IS PALMS?
Simon Ndira,
CEO of Compelling Works
Simon Ndira and his team focus on the data-related components of PALMS, which present dashboards with key indicators for HIV prevention.
What is QI Collaborative?
“With the coming of PALMS, we can say now we are using the data. We are implementing the activities basing on the evidence. Previously, we are just doing the activities somehow. But with the use of the data, we are now using the evidence and we are really targeting those people at risk. So after identifying the people at risk, it's when we deliver the core package of HIV interventions.”
Loncy Sajeni
Deputy District Environmental Health Officer, Blantyre District
Chimwewe Pinto,
Statistical Officer, Blantyre DHO
Dr. Gift Kawalazira,
Director of Health and Social Services,
Blantyre District Council
Before BPS coordinators were using data for decision making, but they were still asking for help from the Health Management Information System to analyze data. So BPS came with a system called PALMS that is supporting the district with HIV data for decision-making.
What is special about PALMS is that it pulls data from multiple resources automatically. It analyzes the data, gives you graphs, and red flags. If the data from a certain source or facility does not make sense, then the platform is able to point you towards the correct data source.
“I think PALMS, it's really good because the data is already there. You don't have to struggle to see how you're performing. You don't have to go through several registers.... You don't have to take a lot of time.... You just go in using your phone, check how your indicators are performing, check where you're not performing, check where you're performing well. So that also we aim to improve even more where we are performing well and where we're not performing well, we come up with change ideas. We come up with solutions. We come up with PDA circles and then we test the ideas. We see which one make better and we see which one can help us to improve the HFA outcomes in our district.”
Tamanda Nzima
Nurse, Quality Improvement Mentor,
HTS Coordinator, Blantyre DHO
Tamanda Nzima
Nurse, Quality Improvement Mentor, HTS Coordinator, Blantyre DHO
Using data available in PALMS, District Coordinators and facilities are able to identify which communities needs prevention services, such as condoms or PrEP, and make informed resource allocation decisions. With BPS, Tamanda Nzima says “power has been given to the people”. The district and city health teams and facilities are better able to engage with communities using the data. Likewise, community members access the same data and can advocate forthe resources they need for HIV prevention and other services.
WORKING ACROSS THE PREVENTION CASCADE: HOW ACTIONS INFORMED BY QI PrEP CONTINUATION SIGNALS LED TO INCREASED PrEP UPTAKE
The PrEPUp! Collaborative – the first quality improvement (QI) collaborative focused on pre-exposure prophylaxis (PrEP) – involves 23 PrEP providers in Blantyre and has built capacity at facilities and at the district and city health offices to implement QI approaches for HIV prevention.
During a PrEPUP! collaborative “learning session” when all participating facilities in Blantyre came together to share PrEP implementation to experiences, the District Health Officer team and BPS partners noted a pattern of poor PrEP continuation across many facilities. In response:
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Four community labs were launched to gather insights on barriers to service uptake in low PrEP retention catchment areas
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Community insights on community misconceptions and stigmas led to change ideas in the facilities such as creating more targeted PrEP counseling based
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Network model committees that include community groups planned and implemented HIV prevention activities to provide health information and services
By using data, QI change ideas to improve service delivery, and the feedback loop between community insights and facilities, Blantyre has seen service delivery improvements, such as an increase in PrEP uptake.
Figure: Oral PrEP uptake among BPS PrEPUP! QI Collaborative sites compared to other sites in Blantyre and Lilongwe. Across all facilities participating in the BPS quality improvement (QI) collaborative in Blantyre, there was a rapid increase in PrEP uptake as compared to the non-QI collaborative sites in both Blantyre and Lilongwe.
Edward Moses
QI Consultant, UCSF HealthQual
BPS partner Edward Moses discusses BPS’s QI approach, which is unique in its focus on prevention. QI methodologies and application had been used almost exclusively for HIV care and treatment, not prevention, prior to BPS. Leveraging collaborative data and other prevention data from the PALMS platform under BPS's innovative approach has improved data access for decision making across the Blantyre health system and enhanced the QI collaborative facilities to share experiences and learn from each other.
MULTI-SECTORAL COLLABORATION IMPROVES COMMUNITY ENGAGEMENT, SERVICE DELIVERY, AND DATA-INFORMED DECISION MAKING
BPS’s innovative approach has created a more unified local health system that brings all partners and stakeholders together under city and district leadership — improving delivery of HIV prevention services in Blantyre. The Network Model approach aims to link and strengthen multiple, fragmented channels across sectors, bring community groups into program planning and implementation, leverage network resources, and ensure data-driven, coordinated HIV prevention activities are targeted.
The principal goal of the Network Model is to implement the core capabilities of the HIV prevention cascade through linked networks in local communities across the district. Network committees centered at public health facilities link together the facility with political and community leaders, local governance and public health structures, private (for-profit and not-for-profit) clinics and other service delivery, community-based and civil society organizations, and donor-supported implementing partners under the coordination of the district and city health offices. The linked networks in 15 district sub-geographies (as of July 2024) formed under the Network Model are working together through the committees to utilize data, experience, and community insights to address gaps in service delivery, health communication, and demand generation.
Ernest Takomana
Assistant Environmental Health Officer, Bangwe Health Center, Blantyre DHO
Ernest Takomana plays a key role at Bangwe Health Center - an urban public facility and one of the BPS proof-of-concept sites - supporting passive and active surveillance and community health. He discusses how the network model has helped with the prioritization and understanding of the data and increased collaboration and coordination across the Bangwe community on everything from resource allocation to data-based decision-making.
ENGAGING POLITICAL LEADERSHIP — WORK WITH CITY & DISTRICT COUNCILORS
Isaac Jomo Osman
City Councillor for Bangwe Nthandizi Ward
Through BPS-supported training for City and District Councilors and a working group on addressing structural risks of HIV in their communities, City Councillor Osman has utilized his newfound knowledge inform his community in the Bangwe Nthandizi Ward about HIV/AIDS, how they can protect themselves, and where to find services.
BPS SYSTEMS STRENGTHENING APPROACH HAS EXPANDING SERVICE DELIVERY FOR HIV PREVENTION TOOLS, INTRODUCTION OF INJECTABLE PrEP
The PathToScale Injectable PrEP Initiative in Malawi, launched on 1st September 2023, is leveraging BPS and Malawi’s HIV prevention clinical and implementation capacity, to test the delivery of long-acting injectable cabotegravir (CAB-LA) to prevent HIV as PrEP. The initiative, with implementation funding from The Bill & Melinda Gates Foundation and CAB-LA product through PEPFAR, aims to enroll 9,900 Malawians in an implementation science study in 36 public and private clinics and key population-focused drop-in centers across Lilongwe and Blantyre. The 6-month lead-in phase started in March 2024. What is particularly innovative about Malawi’s initiative is that it includes a focus on foundational systems and addressing policy and other barriers to full implementation of CAB-LA, creating a path to scale through the life of the initiative.
Chimwemwe Mablekisi
Director of Programmes, Malawi National AIDS Commission
The Ministry of Health disseminated the first national PrEP guidelines in December 2020. Initial scale up followed in early 2021. Chimwemwe Mablekisi, Director of Programmes for the National AIDS Commission, is a member of the BPS Project Management Team. She talks about the importance of understanding issues related to uptake of PrEP and continuation of its use by those who access it.. Collecting insights through the BPS-supported community labs has helped to increase uptake of PrEP by identifying community myths and other barriers to PrEP uptake and continuation and addressing them through quality improvement changes at facilities.
