Table 3.

Proposed solutions for challenges with routine data

Identified M&E challenges	Proposed solutions
Inadequate tracking of referral forms	Standard filing system for referral forms agreed upon by health centre staff Weekly collection of referral forms by staff to further ensure secure storage Periodic trainings with health centre staff and VHWs to review referral and data collection protocols Mobile health applications [22] including text message reminders or real-time documentation of referral placement and completion via mobile devices
Discordance between multiple data sources	Unique patient identifiers to simplify monitoring across data sources [23] Continued triangulation of multiple data sources, as seen in this study among others [8]
Inconsistent monitoring and evaluation of the referral system	Referral indicators in the monthly M&E report Monthly dashboard to compare multiple data sources Community-based quality improvement approaches, whereby health care workers receive regular feedback from M&E data collection and are actively involved in subsequent programmatic decision making [24]