Table 4.

DPREM—bringing together the different implementation practices—with inserted key feature indications in italics (Source: synthesized interview transcripts, authors’ emphasis)

For Malaria, DPREM began in 2013 when the Provincial Malaria Programme Manager took it on board, focussing on improved data use for the malaria programme [integration]. The activity proved useful and became part of the system [integration/working with the system]. The initial idea was that an integrated PDoH-HAI team would visit each district twice per annum [integration/trust] complemented by more frequent supervision activities. However, implementation scope was limited by factors such as the remoteness of some districts and civil unrest in Sofala during the implementation period, which required some re-planning [flexibility].

DPREM centred around a 2-day workshop where health workers from primary healthcare facilities presented secular trends in their programme data and were provided with refresher training. Each DPREM included pre-planning and add-on activities; all implemented through an integrated approach. Annually, HAI and PDoH staff constructed a timetable for the DPREMs [integration/trust]. Before the scheduled meeting dates, a HAI-PDoH joint meeting planned schedules, logistics, and budgets [integration/trust]. These plans were communicated to district officials. One month in advance, a printed PowerPoint template was sent to each health facility in the district [working with the system] for staff to review their facility registers, extract relevant data, and transfer these onto printed slides. A week before the meeting, members of the HAI-PDoH team travelled to the district capital to prepare the logistics for the meeting [integration/trust]. Before the workshop, one or two health workers from each facility travelled to the district capital where they were assisted by HAI-PDoH staff to enter the data from the template into the electronic PowerPoint version [integration/trust/working with the system]. They also received coaching in presentation skills if necessary [working with the system/trust]. Before or after the workshop, joint district and provincial teams travelled to health facilities to conduct supervisory visits for that particular programme.

Typically, during the first day of the workshop, a health worker from each facility presented the PowerPoint slides—including summarized data, ideas for health service improvements in response to the data, and a comparison between the data and the existing electronic health information system data to allow for an assessment of data quality. There were usually three to four presentations, followed by questions and suggestions for each health facility. Health workers therefore learnt by example and by doing. Once the presentations were complete, other workshop activities included refresher training on clinical protocols, group-based reviews of patient charts from complicated or fatal cases, and group-based data concordance exercises where a variety of data sources were compared with enable a deeper understanding of data processes and data quality issues. The workshop culminated in an action plan for improvement in each health facility. Post-workshop, a report and agreed action plans were drafted.

It was observed that participants understood this to be an activity run by their own public health system managers, not an external organization [integration].