Background

The Democratic Republic of Congo (DRC) is one of the sub-Saharan African countries that have not reached the Millennium Development Goals (MDGs) related to water and sanitation. 31% of the rural population has access to improved water services, while only 29% of the rural population has access to improved sanitation facilities (UNICEF/WHO, 2015). Due to these low access rates, diarrhoea is the cause of death for 14% of children under five years old (EDS, 2014).

To improve access to water, sanitation, and hygiene (WASH) in rural areas, the Ministry of Public Health (MoH), Ministry of Education (MoE), and UNICEF are implementing the national “Healthy Villages and Schools” programme (known as VEA in French, “Villages et Ecoles Assainis”). The programme was initiated in 2008 and has been rolled out in two phases: 2009-2012 and 2013-2017. The objective of Phase 1 was to ensure that 3,500,000 people and 240,000 school children receive access to improved WASH services. Phase 2 has been focused on scaling up operations to reach a total of 4,050,000 people in 6,000 villages and 475,000 students in 1,250 schools.

Implemented in the rural and peri-urban communities in 24 of the 26 provinces of DRC, the VEA programme provides a comprehensive package that includes water and sanitation interventions, hygiene promotion, behaviour change activities, and capacity development. The programme is based on a key concept: encouraging communities to become a “Healthy Village” by meeting or exceeding the minimum standards for water, sanitation, and hygiene. Using a community-driven and community-led approach, citizens are motivated to reach the goal of being recognized as a Healthy Village. For a village to be certified as healthy, a set of norms were developed and agreed upon by the government of DRC (Box 1). Similarly, norms were developed to describe Healthy Schools (Box 2).

Box 1: Norms for Healthy Villages

A village is certified as “healthy” when it meets the following standards:
1. The village has an active gender balanced health committee and/or an active WASH committee
2. At least 80% of the population has access to clean water
3. At least 80% of households have access to hygienic latrines
4. At least 80% of households dispose of their solid waste hygienically in a pit
5. At least 60% of the population washes their hands with soap or use ash before preparing food or eating and after latrine use
6. At least 70% of the population understands the faecal-oral route of disease transmission and how to prevent it
7. The village is cleaned at least once a month by the community

Box 2: Norms for Health Schools

The four standards for a school to be declared “healthy” are as follows:
1. At least 80% of schoolchildren have access to drinking water at school
2. At least 80% of boys and girls utilise hygienic toilets at school
3. At least 80% of schoolchildren wash their hands with soap/ash before eating and after using the toilet
4. The school has a clean environment

Once a village or school is certified as “healthy” per the established norms, they enter the post-certification cycle. Local Ministry of Health and Ministry of Education actors conduct regular external visits with post-certification Knowledge, Attitudes and Practices (KAP) surveys to determine whether villages or schools maintained their status. Each village and school must receive at least one post-certification visit per year to continuously monitor their WASH standards. For villages which have lost their “healthy” status, a catch-up plan is developed and put in place by the health zones team in order to regain WASH standards.

Knowledge, Attitude, and Practices (KAP) surveys are undertaken at the beginning and at the end of the project cycle and in post-certification to determine respectively the scope of the community work plan and fulfilment of the norms. Data are managed at four different levels: data collection at the village/School level by community focal points; validation at the health zones level; data entry at the provincial level by Monitoring & Evaluation (M&E) focal points and data quality at the national level.

The Challenges

For Phase 1 (2008 to 2012), the programme opted for an M&E solution based on Excel spreadsheets and an online database system. The Excel spreadsheets, while somewhat effective for collecting monitoring data, were prone to data quality issues and uploading them to the online database caused high administrative overhead due to a lack of centralised metadata management.

The Solution

In Phase 2 (end of 2013), the program opted to implement a DHIS 2 database, which tracks how a village/school progresses from the beginning of the intervention through the steps to certification as a healthy village or school. The DHIS 2 Tracker application has been used since 2015 to manage, collect, and analyse data collected at the village/school level. Within the Tracker module, each step in the process is represented as a program stage. The stages are self-contained and pre-defined with intervals between stages. The built-in messaging feature was configured to send reminders to relevant focal persons when a next step in the process is due and/or overdue. The data from the previous database was imported into the new DHIS 2 database in aggregate format.

Evaluation of the healthy village/health school norms continues even after a village or school has been certified. These post-certification assessments are represented in DHIS 2 Tracker, as well as repeatable stages in a separate post-certification program.

Results

Using DHIS 2 has resulted in a more robust management information system that allows users to access their data in a meaningful way. There are over 800 users registered on the system, 3 million data values, and about 60,000 events. In the most active period for viewing data reports such as pivot tables and charts, there were over 5,000 user views in one month (December 2016).

There are almost 300 thematic dashboards which were created for and by different users to allow them to manage their programme. For instance, complex program indicators were created to calculate each norm, and these are saved to tables, charts, and maps which are then added to dashboards. Capacity building plans and initiatives are underway to increase use of the system at local and provincial levels. Through workshops and academies, BAO has facilitated advanced capacity building of the national M&E and DHIS 2 teams in a training-of-trainers format. Training for data capturers is carried out by the UNICEF/MSP/ME team to strengthen the control of the system.

To further institutionalize the use of DHIS2, data quality control is maintained through a combination of business processes (such as spot checks and data quality) and technical design by limiting erroneous data in the database using validation and program rules.

Next Steps and Future Opportunities

  • Develop mobile data reporting to reduce delays in data capturing: actors conducting assessments will be able to capture and report data from the field using suitable mobile phone technology or other hand-held devices such as PDAs or tablets. A pilot project was developed in 2017.
  • Mobile applications for program managers
  • Automated reminders and alerts to stakeholders when the next certification step is almost due and when the next step is overdue, to improve data completeness and program implementation
  • Set up a public portal
  • Develop a data completion report
  • Develop a feedback report on the quality of the data
  • Mechanism for importing data values ​​of events