community-based-servicesIn 2008, the provincial departments of Health and Social Development introduced integrated paper-based tools to provide monitoring and evaluation of the approximately 10,000 community care givers (CCGs) working in KwaZulu-Natal. Unfortunately, these tools had not been adequately field tested, and although they are still in use, they are widely held to be grossly unreliable and not suitable for their intended uses. In addition, as the roles of CCGs have expanded over the years, numerous other elements have been added to the existing tools in a non-systematic way, thus increasing confusion and further diminishing the usefulness of the tools.

When the tools were first introduced, Edzimkulu realized the problems when attempting to implement them at Ndawana. We modified the tools to better reflect the work flow of the CCGs, to increase ease of input, and to allow proper validation of data. Both the modified CCG data-capture tools and the supervisory reporting tools were entered into Excel spreadsheets, thus creating rudimentary electronic applications. At the district and provincial levels, reporting from Ndawana was seamless with the rest of the reports being received.

With the re-engineering of primary health care, community-based services have become increasingly complex and the resulting reporting requirements greater. While the provincial tools have not been changed in a systematic way, Edzimkulu has continued to modify its tools and directly link the input data to automatically generate reports for four different stakeholder groups.

In 2012, Edzimkulu was requested by the provincial government to implement the Ndawana tools in Sisonke on a pilot basis. The pilot proved so successful that approval was given to implement the Ndawana tools throughout the district in phases. To date, the tools have been installed at 10 of 36 sites in the district. Approximately 200 of 950 district CCGs have been trained, along with the data capturers and community health facilitators at the ten sites.