Federal Democratic Republic of Ethiopia

Ministry of Health

Dec. 2014
Addis Ababa, Ethiopia
Federal Democratic Republic of Ethiopia
Ministry of Health

NATIONAL HMIS QUALITY IMPROVEMENT

MENTORSHIP GUIDE
Table of Content

Acknowledgement ...................................................................................................................... i
List of tables……………...……………………………………………………………………….ii
Acronyms ................................................................................................................................. iii
1. Introduction.............................................................................................................................1
1.1. Background ...................................................................................................................1
1.2. Definitions and overview of mentoring ..........................................................................2
1.3. Rationale and Purpose of HMIS mentorship ..................................................................3
1.4. Objective of HMIS mentorship guideline ......................................................................4
1.4.1. General objective.................................................................................................4
1.4.2. Specific objective ................................................................................................4
1.5. Expected Results ...........................................................................................................5
1.6. Scope ............................................................................................................................5
2. Methodology ...........................................................................................................................6
2.1. Approach ......................................................................................................................6
2.1.1. Site visits by mentors...........................................................................................6
2.1.2. ICT-based remote mentoring ...............................................................................6
2.2. Mentoring techniques and tools .....................................................................................7
2.2.1. Interview .............................................................................................................7
2.2.2. Document review ................................................................................................7
2.2.3. Observation .........................................................................................................7
2.2.4. Problem analysis/Bottle neck analysis .................................................................8
2.2.5. Coaching .............................................................................................................8
2.3. Recording, reporting and documentation .......................................................................9
2.4. Mentee/respondents and participants .............................................................................9
2.5. Mentors .........................................................................................................................9
2.6. Frequency of conduct of mentoring ............................................................................. 10
2.6.1. Intensive phase .................................................................................................. 10
2.6.2. Maintenance phase ............................................................................................ 10
3. Procedure and Steps .............................................................................................................. 12
3.1. Planning/Preparation ................................................................................................... 12
3.2. Conduct of the mentorship........................................................................................... 12
3.2.1. Introduction/Briefing meeting............................................................................ 12
3.2.2. Interview based on the checklist ........................................................................ 13
3.2.3. Observation based on the checklist .................................................................... 13
3.2.4. Problem Analysis/ Bottleneck analysis session .................................................. 13
3.2.5. Coaching sessions based on the gaps identified .................................................. 13
3.2.6. Completing mentoring logbook ......................................................................... 13
3.3. Feedback/report ........................................................................................................... 13
3.3.1. Debriefing meeting ............................................................................................ 13
3.3.2. Written report .................................................................................................... 13
4. Roles and Responsibilities ..................................................................................................... 15
4.1. All health service administrative.................................................................................. 15
4.1.1. Federal Ministry of Health ................................................................................. 15
4.1.2. Regional Health Bureau ..................................................................................... 15
4.1.3. Woreda Health Office ........................................................................................ 15
4.2. Partner......................................................................................................................... 15
4.3. Health facility.............................................................................................................. 16
5. Mentor .................................................................................................................................. 16
6. Resource ............................................................................................................................... 18
7. Accountability ....................................................................................................................... 18
8. M&E mentorship ................................................................................................................... 19
8.1. Monitoring and evaluation plan of HMIS mentoring program...................................... 19
8.2. Indicators to monitor and evaluate the mentoring program .......................................... 20
9. Annexes ................................................................................................................................ 22
9.1. Annex 1: Mentoring checklist for health facilities ........................................................ 22
9.2. Annex 2: Mentoring checklist for administrative units ................................................. 31
9.3. Annex 3: Mentoring log book...................................................................................... 34
9.4. Annex 4: Mentoring reporting format .......................................................................... 35
Acknowledgement

This mentorship guide is developed from adaptations of various mentorship documents and tools
from donors, implementing partners, as well as from policy and plan directorate guidelines.

Federal Ministry of Health (FMOH) has initiated and led the overall preparation and
development of this mentorship guide. Partners have took part in the drafting as well as critical
revision of the mentorship guide.

The Ministry of Health would like acknowledge HIQIP technical working group members along
with their organization for their unreserved commitment in the development of this important
mentorship guide. The organization also would to extend its gratitude to regional health bureau
plan heads and HMIS officers who provided valuable comments and suggestions to the
mentorship guide during HIQIP consultative workshop which was carried out at Adama town.

i
List of tables

Table 1: Supportive Supervision vs. mentoring ...........................................................................2

Table 2: Frequency of mentoring ............................................................................................... 11

Table 3: The M&E plan of the HMIS mentoring program ........................................................ 21

ii
Acronyms

ANC Antenatal Care

ART Anti Retroviral Therapy
eHMIS Electronic Health Management Information System
EMR Electronic Medical Record
EPI Expanded Program on Immunization
FMOH Federal Ministry of Health
FP Family Planning
HEW Health Extension Worker
HF Health Facility
HIQIP Health information Quality Improvement Plan
HIT Health Information Technician
HMIS Health Management Information System
HP Health Post
ICT Information Communication Technology
IPD In Patient Department
LQAS Lot Quality Assurance System
M&E Monitoring and Evaluation
MDR-TB Multi Drug Resistance Tuberculosis
MOU Memorandum of Understanding
MPI Master Patient Index
MRU Medical Recording Unit
NAC National Advisory Committee
OPD Out Patient Department
PITC Provider Initiated Testing and Counseling
PMT Performance Monitoring Team
PNC Post Natal Care
RDQA Routine Data Quality Assessment
RH Reproductive Health
RHB Regional Health Bureau
TB Tuberculosis
VCT Voluntary Counseling and Testing
WHO World Health Organization
WorHO Woreda Health Office
ZHD Zonal Health Department

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1. Introduction
1.1. Background
Reliable and timely health information is one of the foundations of effective health service
management and public health action. Well designed and managed health information systems
can generate quality health information which is crucial for monitoring and evaluation (M&E) of
health program performance and for developing appropriate policies, plans, and strategies to
ensure sound health care system.

In an effort to strengthen the country health information system, Ethiopia has undertaken an
extensive reform and re-design of the health management information systems in 2007 to
enhance the existing health management information system (HMIS) at federal, regional, zonal,
woreda and health facility levels to produce reliable and timely information for planning
management and efficient decision-making. The reform has taken major steps in response to the
lack of accurate, timely and complete data that consequently affected the quality of care,
planning and management systems as well as the decision making by the managers at all levels
in the health sector. In addition, The FMOH has designed and implemented community health
information system as part of reformed HMIS to capture basic health and health related
information by Health Extension Workers (HEW) at household and individual level.

More recently the FMOH has revised the list of reformed HMIS indicators to make it more
comprehensive and strengthen the standardization process through incorporating new initiatives
and revising old indicators. Furthermore the ministry has recently implemented the reformed
HMIS in private health facilities in all regions.

High quality data is the prerequisite for better information, better decision-making and better
community health. Data quality is a complex construct, which encompasses multiple dimensions,
including accuracy, reliability, precision, completeness, timeliness, integrity, and confidentiality.
For good quality data to be produced by and flow through a data management system, key
functional components of HMIS needs to be in place at all levels of the health system.

The FMOH have done much work to improve data quality since the reformed HMIS. Through
the efforts made so far, the timeliness, completeness and reliability of data have improved over
the time and it has been possible to use the data for woreda based plan preparation and
performance monitoring purposes.

To further enhance data quality and health information use at each level in the country, the
FMOH give priority and prepare health information quality improvement plan (HIQIP).
Subsequently the ministry has revitalized National Advisory Committee (NAC HMIS) with a
focus in improving health data quality. The committee jointed donors, implementing partners and
stakeholders with FMOH to implement and support HIQP plan jointly.

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1.2. Definitions and Overview of Mentoring
According to WHO’s definition, Mentorship is a system of practical training and consultation
that fosters ongoing professional development to yield sustainable high-quality outcomes. It is a
process whereby an experienced, highly regarded, empathetic person (the Mentor), guides
another individual (the mentee) in the development and re-examination of their own ideas,
learning, and personal and professional development. The Mentor, who often but not necessarily
works in the same organization or fields as the mentee, achieves this by listening and talking in
confidence to the mentee.

Mentoring and supportive supervision are complementary activities that are necessary to build
the health service delivery systems. They both generally aim at a common set of outcomes but
differ in the emphasis and approach given by each.

Supervision tends to emphasize health facility management. It is often more hierarchical and
managerially oriented. Supervision is key in many organizational settings, and the goals are pre-
determined by the system. It may be more critical and evaluative than the more non-judgmental
approach associated with mentorship. While mentorship places more emphasis on the
enhancement of the professional skills and competencies of the healthcare provider (mentee).

Table 1: Supportive Supervision vs Mentoring

Supportive Supervision Mentoring
Also available through distance
Modality Physical presence is necessary
communication (ICT etc)
Primary Aim More of sharing Basically a teaching-learning process

Mentors needs to be very

Can be done by trained
Provider experienced and practicing
management/ program staff
individuals
Supervisors need training in areas
Mentors can function well because of
that are not directly part of a
their experience as a coach,
coaching skill development,
Rich in practical technical
Required skill Comprehensive knowledge on
knowledge and skills in a specific
and training health systems in totality,
program area,
Leadership, managing, coaching,
Coaching, negotiation and
negotiation, advocacy, facilitation
facilitation skills
and team building skills
Does have the scope and depth to Doesn’t have the scope and depth to
Emotional scope address the psychological/ address the psychological issues of
emotional issues of the Supervisee the Mentee

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Tends to be more sought at early
Is sought at all stages of a
stage in coaching career,
Timing coaching career,
Is required when technical
Is a regular activity
needs arise
Primarily on individual and at times
Target On individuals or groups
on small groups
Improving specific area of
Improving overall performance
intervention as part of continuous
Focus (On a systemic and programmatic
education and learning for
total improvement)
professional development

Though there are the above distinctions between mentoring and supportive supervision, both
have several areas of overlap. They are adjuncts to the development of capable coaches and they
share many skills and attributes. They both:
 Depend on powerful relationships with clients.
 Require experience and maturity from the person offering the service.
 Support the coach in becoming a better coach.
 Offer reflective questions and exploration of issues.
 Provide confidentiality and safety to explore.
 Are forms of accompanying the client (coach) on a learning journey

1.3. Rationale and Purpose of HMIS mentorship

The quality of data has shown a considerable improvement nationwide since the implementation
of the reformed HMIS. However, it is documented that FMoH still experiences a challenge to
generate the desired quality of data in the health system due to some constraints in maintaining
key functional components of reformed HMIS appropriately in place at each level of health
system. In the past few years the ministry and regional health bureau has recruited many trained
health information technicians and deployed at facility and district level. Regular in-service
trainings were also provided to HIT on improving their skills. However, limited human capacity
due to lack of continuous follow-up on the area of the field has been identified as one of the
major challenges.

The HMIS mentorship approach is among the helpful methods that allow workforce to enhance
their knowledge and skills in broad areas of content without moving outside of the work station
for theoretical and practical instruction. With mentorship, mentees place of employment is their
learning environment. This capacity building strategy provides greater continuity to ensure data
quality and utilization of data while data managers continue to practice and expand their skills on
health information system.

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The goal of HMIS mentoring is therefore to advance professional development in maintaining
health data quality and information use at each level of health service delivery. In addition to
imparting new skills and knowledge base, mentoring assists the mentee in establishing clear and
defined learning goals, fosters individual growth and development, and facilitates strong
professional relationships.

Previously, HMIS mentoring activities has been started and implemented by experts from the
FMOH, RHBs and different nongovernmental organizations. However, the mentoring activity
was done in a non-coordinated and fragmented manner. It was performed on an irregular basis
and there was no standard mentoring procedure and guideline which guides the activities of
mentors and the types of support provided to mentees. This consequently made the mentoring
program to be less effective. The FMOH has learnt many different lessons from the previous
mentoring programs. One of the major lessons learnt is the importance of availing a mentorship
guideline which will guide the mentors during their mentoring activity. Developing a mentorship
guideline will have a great effect towards the standardization and harmonization of the
mentoring program. Moreover, it will help improve accountability and consequently will lead to
a better quality of HMIS support during mentoring.

Hence, development of HMIS mentoring guideline is given a due attention by the FMOH and it
will be used as a standard guide to the national HMIS mentorship program.

1.4. Objective of HMIS mentorship guideline

1.4.1. General objective

 To provide a standardized and uniform mentorship approach for HMIS quality improvement

1.4.2. Specific objective

 To maintain standard of mentoring in the HMIS activities by all stakeholders

 To harmonize health information quality improvement support
 To strengthen MOH and stakeholders integration in the implementation of HIQIP
 To enable and encourage stakeholders to integrate HMIS quality improvement support
 To provide guidance to mentors participating in mentorship program

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1.5. Expected Results

1. Health institutions get mentor’s support regularly according to guideline

2. Health workers and HITs gain knowledge and skills about routine health data collection and
reporting
3. Quality of HMIS data gets improved
4. Functional PMT in health institutions
5. Evidence based decisions making exercised at health institutions.

1.6. Scope

The scope of this guideline is to set standards and roles and responsibilities of stakeholders to
bring the desired quality improvement on HMIS at all level.

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2. Methodology
Broadly speaking, mentoring is conduct by site visit or physical presence of the mentors and
could be augmented using the available information technology infrastructure in the maintenance
phase of mentoring. Given the knowledge and skill transfer nature of mentoring and adult
learning theory of learning by doing, much emphasis has to be given to the physical presence of
the mentors than the use of information in distance.

Any consideration of the ICT based mentoring to augment the maintenance phase of depends on
the availability and functionality of ICT infrastructure and the presence of a particular ICT
literate mentee.

Whichever approach is utilized, two-way communication, emphasis to self-assessment, context

specific and supportive nature of mentoring should be maintained as guiding principles.

2.1. Approach

As described above, the following approaches could be utilized depending on the context

2.1.1. Site visit by mentors

This approach could allow more on-the-spot interaction and create opportunity to observe the
strength and weakness of HMIS implementation and data quality in the whole aspect. It is
considered as the best approach of mentoring due to the skill transfer nature of mentorship. It is
also helps to fulfill ICT related shortcoming / gaps in many aspects. Once the facility or the
administrative structure implemented standardized HMIS, generate quality data and graduate the
intensive phase, the remote-based approaches will be considered to augment the site visit and
maintain the change made.

2.1.2. ICT-based remote mentoring

The choice of ICT-based remote mentoring is contingent upon many conditions. The availability
and functionality of ICT infrastructure and the presence of a particular ICT literate mentee are
the major factors consider this approach. In any case, this approach should be reserved to
augment the site visit-based mentoring during the maintenance phase. It should be seriously
noted that an isolated ICT-based mentoring does not qualify a full-fledged mentoring and is not
reportable as such!

2.1.2.1. Telephone conference call mentoring

This is approach could be utilized to simultaneously mentor health facilities or health

administrations which are far apart using the current conference call service provided by ETC.

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Up to five facilities or administrative structures could be mentored at one go. It is cost and time
efficient. It only requires a single Smartphone capable of conference calling.

2.1.2.2. Video-conferencing mentoring

Video conferencing can be applied using ‘screen share’ feature of Skype. This requires PCs or
optimal size Smartphone with good internet connectivity at both the mentor and mentee side.
Whenever applicable, the Audio-visual material being prepared on HMIS by MOH could be
effectively utilized using this approach.

2.2. Mentoring techniques and tools

The technique of the mentorship program refer to the actual process of conduct of the mentorship
depending on the approach described above is employed. The following techniques could be
utilized:

2.2.1. Interview

Interview is utilized using a standardized checklist (Annex 1&2). The focus of interview should
be to gain broader understanding of the HMIS implementation and progress made after
mentorship in the facility/entity. Issues such as level of training, infrastructure, availability of
recording and reporting tools, data use, and challenges etc could be addressed using this method.
The challenges identified through the interview will serve the problem analysis step of the
mentoring process.

2.2.2. Document review

The mentor/mentors should review the monthly/quarterly/annual reports, data display, analyzed
data for management decision making, accuracy level based on RDQA and LQAS guidelines
using document review checklist (Annex 1&2).

2.2.3. Observation

Observation is a useful method as it provides on-the-spot insight to the practice of HMIS

implementation. Key aspects of the HMIS activity such as recording and tallying, database use
and skills, the status of integrated card room etc are observed. Observation is applicable to visit-
based mentoring. The results of observation are input for the problem analysis. Observation is
carried out using an independent semi-structured checklist or could be integrated with the
interview checklist (Annex 1&2)

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In addition to document review, the mentor/mentors should observe the actual practice of the
data management on-the-spot concentrating on the following four areas to enhance the
standardized checklist accordingly:
1) Way of data collection, aggregation, reporting, analysis and information use practice in the
regional health bureau
2) HMIS printing material need quantification, forecasting in the long terms, requesting,
distribution plan/report, utilization and follow-up practice
3) The mentoring skill of health care system HIT/M&E officers to their corresponding RHB,
Zones, Woreda and health facilities
4) The process of data quality assurances practice at all levels

2.2.4. Problem analysis/Bottle neck analysis

Once interview and observation have been conducted, it could be presumed that the HMIS
implementation status and major challenges have already been identified. However, as the bottle
neck analysis is an interactive process, more challenges and solutions could surface during the
analysis process. The results of the bottle neck analysis could drive further on-the-spot coaching
need, refresher training and other measures to be carried out by the mentee, the facility/entity or
higher levels and partners.
Many problems can be dealt with on the spot whilst others will have to be taken to the next level
of mentor/mentorship, regional forum, and NAC. A note will be made of problems requiring
solutions at higher level and actions taken will be reviewed at the subsequent mentorship.
At this stage,
 Both the mentor/mentors and RHB/M&E/HMIS unit should identify problems, listen,
discuss, give feedback, and solve problems together
 Identify areas of weakness and strength or best practices
 Prioritize problems
 Share responsibilities of solving problem between the two levels and analyze through
discussions the underlying causes for the identified problem/s.
 Set target for improvement. Identify appropriate strategy to solve the identified problems
according to their priorities. Draw upon identified local strengths to set practical solution.
Draw an agreed upon follow up mechanism and an action plan. Prepare an agreed upon action
plan.

2.2.5. Coaching

Coaching is a method which is employed on-the-spot and at every step of the above methods
such as interview, observation and problem analysis. It is the major knowledge and skill transfer
method for most cases of mentoring. Depending on the depth and breadth of the gap identified,
the mentor could recommend a refresher training to be conducted a relevant body/entity.

8
2.3. Recording, reporting and documentation

As much as possible, most aspect of the mentorship process ranging from preparation and
submission of a report should be documented using the available tools and in a proper manner.
This helps to monitor the track record of the given facility/entity and guide future mentoring
needs. Standard tools will be developed and pre-tested before become operational. In addition to
interview/observation checklist (Annex 1&2), the following tools are also used.

 Mentoring logbook (Annex 3): This logbook is placed at each facility/entity to be mentored
and used to record key variables of a particular mentoring visit such as data, mentors, key
gaps and key action points. It could serve as a reference for subsequent visits and also keeps
track of the mentoring activity conducted in the facility/entity.

 Mentoring reporting form (Annex 4): This is a standardized formal written reporting form
to be used after the mentoring activity is concluded. It will be a generic reporting form which
could be used for reporting to a health facility management, WorHO, ZHD, RHB or FMOH.

2.4. Mentee/respondents and participants

The HIT and HMIS officer are the primary mentees at the corresponding structures. In addition,
at least one person representing each type of recording and reporting tool should be mentored
during a given mentorship exercise. Members of a functional Performance Monitoring Team
(PMT) or the head or delegate of the facility or health administration, heads of senior posts
should be present during the briefing and debriefing sessions of the mentoring process.

2.5. Mentors

The mentors to be engaged in the mentorship exercise are mainly expected to be drawn from the
health management structure, key HMIS partners and other partners of the national and regional
HMIS Advisory Committees. Regardless of the source, the mentors need to fulfill all the
following criteria:
 A master or basic level training on the revised HMIS
 Training on HMIS quality improvement mentorship
 Practicing HMIS professional/focal person or currently supporting a health program actively
reporting using the revised HMIS or providing technical support on HMIS implementation.
Due to the comprehensive and wide nature of mentoring, a team approach composed of at least
two mentors is recommended so that task is shared without compromising the quality of the
mentorship. The mentors from the government, as the owner of the mentorship program, are
expected to lead the process. If resources don’t permit, a single mentor could conduct
mentorship with a prior notice and approval from the respective health administration.

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2.6. Frequency of conduct of mentoring

The frequency of mentorship differs depending on the level of health administration structure
and health facility and intensity of the mentoring. It is summarized as follows.

2.6.1. Intensive phase

Intensive phase should last a minimum of 4 month to health administrations and 6 months to
health institutions once the mentorship guideline is endorsed and the mentorship program is
officially launched. 4-6 months duration is an expert opinion to improve the long-standing data
quality problem in addition to the use of results-based financing mechanisms by major global
donors which has created more demand for timely and reliable data. A given health facility or
health administration will only graduate or transition to maintenance phase after a minimum of
6 and 4 months respectively and full implementation of integrated card room, use of standard
recording and reporting formats, reporting through single channel, practice & use of LQAS,
functional performance monitoring team and fully skilled & capacitated M&E/HIT/HMIS
officers which is sustained for six consecutive months and to be verified using RDQA by RHBs
and FMOH

2.6.2. Maintenance phase

The maintenance phase starts after 4-6 month of intensive phase for health administration and
health facilities respectively, fulfillment of the graduation criteria and sustenance of the result of
intensive phase for six months.

The maintenance approach also considered matured and expected to phase out when report
completeness, report timeliness and data accuracy of the health facilities or the health
administration is 90% and above for consecutive one year.

In general, after close to a minimum of two years of intensive and maintenance HMIS
mentorship program of the health administrations and health facilities, the M&E/HIT personnel
with an active support and monitoring from the PMT, are expected to take over the mentorship
and become internal mentors of their respective entities.

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Table 2: Frequency of mentoring
Maintenance
Mentoring Intensive phase
Mentee phase
No. entity
Frequency Duration Frequency
1 RHBs 2 days/month 4 month 3 days /Quarter
FMOH/Partner Specialized
2 3 days/month 6 month 6 days /Quarter
hospitals

3 ZHD 2 days/month 4 month 3 days /Quarter

4 WorHO 2 days/month 4 month 3 days /Quarter

RHB/Partner
General Hospitals/
5 3 days/month 6 month 6 days/Quarter
Specialty center

General Hospitals/
6 3 days/month 6 month 6 days /Quarter
Specialty center

7 ZHD/Partner WorHO 2 days/month 4 month 3 days /Quarter

Primary Hospitals/
8 3 days/month 6 month 3 days /Quarter
Specialty clinic

9 HCs/Medium clinic 2 days/month 6 month 6days /Quarter

WorHO/Partner
10 HPs/primary clinic 2 days/month 4 month 6 days /Quarter

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3. Procedure and Steps
The overall process of the mentorship activity could be broadly categorized into three parts as
described below.

3.1. Planning/Preparation

Good planning and preparation in advance is central to the success of the mentorship program.
The following activities should be carried out as part of a good preparation practice.
Mentorship plans should be integrated in the annual work plan at every level of the health care
system. This process should be the outcome of appropriate consultation with all health
institutions administrative offices that have stakes in mentorship system.
A well-articulated mentorship plan with implementation budget and incorporating it into the
federal annual work plan
Review areas of HMIS/data quality concerns from different source of information
(Mentorship report, supportive supervision report, RDQA, national HMIS review meeting,
regional HMIS review meeting, MTR report, JRM report).
Mentorship visit should be well planned and communicated in advance to ensure the
availability of responsible staff so that it could be possible to spend sufficient time for
support
All required logistics for the field visits should be secured
The preparation should be guided by the ‘preparation checklist’ which is to be filled by the
mentor(s) and to be reviewed and validated by the respective government structure which is
planning and leading the mentorship program.
The facilities/entities to be mentored should be communicated in advance to identify
shortages of HMIS related tools, job aids, guidelines…etc and plan the collection and
distribution of the materials during the mentoring visit

3.2. Conduct of the mentorship

The conduct of the mentorship is expected to follow a logical order with some flexibility
depending on the situation. In general, the process should follow the following steps. The HIT in
the facility/entity are focal persons of contact and are expected to facilitate the whole process.

3.2.1. Introduction/Briefing meeting

The mentorship process should start with explanation of the objectives of the visit and expected
outcome of the mentorship. Both the Mentor/mentors and RHB M&E/HMIS unit should discuss
and agree on where and how to proceed the mentorship process. Along with the standardized
checklist, additional elements should be added as suggested by RHB /M&E/HMIS units. The

12
approach of communication during mentorship should be a two- way dialogue rather than
something imposed by the mentor/mentors.
This is the first step to be carried out in the presence of the head or delegate of the
facilities/entities, representatives from senior posts and HIT/M&E officers. It is also an
expression of good rapport and courtesy call.

3.2.2. Interview based on the checklist (Annex 1&2)

3.2.3. Observation based on the checklist (Annex 1&2)

3.2.4. Problem Analysis/ Bottleneck analysis session

3.2.5. Coaching sessions based on the gaps identified

3.2.6. Completing mentoring logbook (Annex 3)

3.3. Feedback/report

Although mentoring entails feedback and transfer of knowledge and skill at every step of the
process, additional two more structured feedback/reporting mechanisms are employed

3.3.1. Debriefing meeting

It is conducted at the end of the mentorship and before departing the facility/entity. This is done
in the presence of the representatives expected or who took part in the briefing meeting. This
should be considered as a preliminary verbal report until the formal written report is submitted.
Beyond a discussion on the process, gaps identified and actions taken during the process, role
and responsibility among stakeholder and particularly the role of the facility/entity to bridge the
identified gaps should be given emphasis during the debriefing meeting.

3.3.2. Written report

The mentor(s) will produce a report on the identified bottlenecks, coaching, problem solving and
result/changes because of the mentorship and share those reports to the RHB/M&E unit, regional
HMIS Advisory Committee/partner forum, HMIS-NAC and FMOH/PPD/M&E/HMIS monthly.
This is a more formal and structured report to be submitted to the next upper structure of the
mentored site or health administration as well as key partners expected to play a role in
improving the HMIS implementation. The report should be submitted not later than 5 days after
the conclusion of the mentoring exercise. Aggregation of data and preparation of a consolidated
report is based on the reporting hierarchy of the revised HMIS data flow.

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Fig.1 schematic description of the overall procedure of mentorship

Planning

Conducting
Mentoring

Feedback and
reporting

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4. Roles and Responsibilities
4.1. All health service administrative

4.1.1. Federal Ministry of Health

 Sign HMIS quality improvement MoUs with Stakeholders.
 Allocating Mobilizing needed resource to Strengthen HMIS quality improvement.
 Harmonizing teaming up the partner’s forum with the sector interest to bring the desired
HMIS quality improvement.
 Resource mapping and mobilizing the resource to the Regions
 Policy and Plan Directorate is in charge of supporting, facilitating and monitoring the HMIS
quality improvement mentoring.
 Organizing regular meeting to review the mentoring progress and address bottle neck.

4.1.2. Regional Health Bureau

 Establishing and own HMIS quality improvement partner’s forum.
 Sign HMIS quality improvement MoUs with stakeholders.
 Resource mapping and Mobilizing needed resource.
 Policy planning office should be in charge of supporting, facilitating and monitoring the
HMIS quality improvement mentoring.
 Set up a monitoring plan that starts from all heath service administrative level, through
Health facility.
 Build capacity of staffs to support all health administrative level and health facilities.
 Organize regular meeting to review the mentoring progress.
 Supporting, facilitating, monitoring and report the mentor activity against submitted plan.

4.1.3. Woreda Health Office

 Monitor and report the mentor activity against submitted plan.
 Resource mapping and mobilizing the resource to the health facility.
 Build capacity of staffs to improve quality of health information and support health facility.
 Arrange regular meeting to review HMIS quality improvement activity.

4.2. Partner

 Sign HMIS quality improvement MoUs with relevant health service administration or health
facility authority.
 All partners involved in supporting health service, public health administrative and health
facility hold each other to support the HMIS quality improvement.

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 Supposed to align HMIS quality improvement plan with their M&E plan and submit to
respected health service administrative level/ Health facility.
 Expected to discourage demands for parallel reporting and promote adherence to the
principles of the harmonization guide.
 Partners are expected to attend review meeting monthly, quarterly and at the end of the year.
 Commit for providing both technical, financial support and greater transparency in resource
availability and utilization.

4.3. Health facility

 CEO, Medical Directorate office and HMIS unit at each health facility is in charge of
supporting, facilitating and monitoring the HMIS quality improvement mentoring.
 Health facility should monitor and report the mentoring activity against submitted plan.
 Build capacity of health workers to utilize health information for decisions making.
 Each health facility should monitor and report the mentoring activity.

5. Mentor

Mentor’s knowledge, experience, encouragement and skills offer the growing leader guidance,
advice and small amounts of hands-on training. A mentor-mentee relationship focuses on
developing the mentee professionally and personally. As such, the mentor does not evaluate the
mentee with respect to his or her current job, does not conduct performance reviews of the
mentee, and does not provide input about salary increases and promotions.
This creates a safe learning environment, where the mentee feels free to discuss issues openly
and honestly, without worrying about negative consequences on the job. Therefore, establishing
basic roles and responsibilities can ensure a successful mentor-mentee relationship.

The following points are roles and responsibilities of the mentor and things that mentor should
do together with the mentee.
 Mentor should provide guidance based on past experiences. Guidance should always be as
straight forward as possible, and lead directly from stated concerns of the mentee.
 Increase mentee’s ability to communicate with quality data;
 Introduce mentee with data utilization at different processes ( departments) or
institutions; and
 Strengthen feedback mechanism inter and intra health institutions.
 Mentor should help the mentee identify problems and guide them towards solutions.
 Help mentee to develop HMIS skills:
 Identify gaps, solve problems at the spot if possible , coach facility staff and develop an
action plan for quality implementation;

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 Strengthen PMT (Performance Monitoring Team) at every level to improve data quality;
and
 Guide in developing information use skills for decision-making.
 Mentor should establish a positive personal relationship with mentee:
 Establish mutual trust and respect;
 Maintain regular interaction and consistent support; and
 Make your meetings enjoyable and fun
 Mentor should submit HMIS quality improvement plan with detailed activates and progress
report on monthly basis to the unit head
 Mentor should review activity progress and put feedback and reflection on monthly bases.
 Mentor should avoid setting up a situation where by the mentor is seen to be “checking up”
on the mentee
 Mentor should offer constructive criticism in a supportive way
 Mentor should solicit feedback from the mentee
 Mentor should be careful to not do mentee’s job
 Mentor should look after mentee’s needs, but consider his/her own as well
 Mentor should not give up right away if the mentee resists help at first
 Mentor should not try to force the mentee to follow his/her footsteps

Mentor and mentee together should:

 Identify roles the mentor can play to help the mentee to achieve certain goal
 Communicate on a regular basis
 Refer back to pervious conversations to make sure that things have been done properly

The following are among the mentor’s functions:

 Teaches the mentee about a HMIS related issues
 Coaches the mentee on a HMIS related skills
 Facilitates the mentee’s growth by sharing resources and networks
 Challenges the mentee to move beyond his or her comfort zone
 Creates a safe learning environment for taking risks
 Focuses on the mentee’s total development

Quality of a good mentor

 Good motivator: He / she motivate staff to work efficiently in spite of the circumstances,
whatever they are. He or she can generate the commitment and confidence of his external and
internal clients.
 Adaptable: Change is a constant theme in any workplace. A mentor is open to new ideas,
positive, flexible, and cooperative. S/he is ready to manage change efficiently when it occurs.
 Excellent communicator: Mentors need to convey information very clearly so that each part
is well understood to avoid mistakes. Excellent communication skills also entail not only

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conveying information but also receiving information. Mentors listen carefully to what health
workers and health managers say.
 Efficient – A mentor should be efficient. He/ she should know the steps of the work process,
and is always ready to have the next task ready for implementation by the staff. He or she is
time and cost conscious, thus, no time is wasted on the job.
 Social skills – A mentor has social skills that encourage staff to do good work all the time.
He or she is polite and is respectful of other people’s rights and dignity. He or she does not
humiliate staff when they commit mistakes, but gently helps them to correct mistakes
 Self-disciplined – A mentor has self-discipline. He / she follow rules, regulations and
deadlines.

6. Resource

 All HMIS quality improvement stakeholders promote the importance of strengthen resources
mapping and mobilization at all levels to improve infrastructure, supplies, training, review
meetings and supportive supervision,
 Stakeholders (all level health service administration, partners and health facility) out to
allocating mobilizing needed resource to strengthen training and capacity building at all
health sectors by tailor trainings to the level and experience of different categories of staff.

7. Accountability
Mutual accountability can push all level health service administration and partners to deliver on
their commitments and responsibilities, demonstrate how actions and investment translate into
tangible results and better long term outcomes, and tell us what works, what needs to be
improved and what requires more attention.
Partner’s forum should set roles and responsibilities of each actor and harmonies efforts in
supervision, budgeting, planning, and support of HMIS quality improvement.
Partners will sign HMIS quality improvement MoUs with relevant health service administration
or health facility authorities.

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8. M&E mentorship
8.1. Monitoring and evaluation Plan of HMIS mentoring program

In order to track the effectiveness of the HMIS mentoring program and hence improve HMIS
implementation, developing a monitoring and evaluation plan is an important step. The M&E
plan of HMIS mentoring is based on the objectives and expected result of the mentoring program
which is listed on the above section.

Frequency of mentoring: Mentors should provide HMIS mentoring support to health facilities
and institutions in their respective catchment area. The frequency of mentoring for each type of
facility and institution should be based on the number of days mentioned in the previous section
of this manual. Especially in the intensive phase of the mentoring program, each facility and
institution should be mentored at least once every month. At health facilities, the mentoring
activity should include support to each department’s recording procedures and tools (MRU,
review of all registers, tally sheets and reporting formats). Data quality assurance and
information use related practices should be performed for all types of facilities and institutions.
The mentor should arrange a discussion session with the HIT, PM team and health institution’s
manger/head.

Who to be monitored: Mentors are expected to provide HMIS support at all levels of the health
system. They should support RHB, ZHDs, WorHOs, Health centers, hospitals and health posts.
During mentoring, the HMIS mentoring checklist (Annex 1&2) should strictly be used and each
component of the checklist has to be completed. At the end of each mentoring session, the
mentor should arrange a briefing session to the institution’s head, HMIS officer and/or PM team.

Reporting: Each mentor is expected to prepare a comprehensive HMIS mentoring report and
should submit to the next health administration unit where the mentoring is performed (Report to
WorHOs, ZHDs or RHBs). Moreover, the mentors are expected to submit the HMIS mentoring
checklist that they completed during the mentoring program. In addition to submitting a
comprehensive mentoring report and filled mentoring checklist, the mentors are expected to
document the findings and the support provided at each mentored site. The recording should be
made on a dedicated HMIS mentorship recording logbook, which should be available at all
health institutions.

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8.2. Indicators to monitor and evaluate the mentoring program

The following indicators will be used to track and assess the effectiveness of the mentoring
program:
1. Number of health facilities/institutions mentored per month (Disaggregated by type of
facility and institution)
2. Proportion of institutions mentored once every month (Disaggregated by type of facility
and institution)
3. Number of monthly mentor’s feedbacks and reports submitted to the next administrative
level
4. Number of institutions with mentor’s feedback documented on HMIS mentoring
logbook.
5. Number of review meetings held to assess the progress and challenges of the HMIS
mentoring program
6. Proportion of institutions which established PM team after the mentoring program
7. Proportion of facilities with improved LQAS score after the mentoring program
8. Proportion of facilities with improved timeliness and completeness of HMIS reports

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Table 3: The M&E plan of the HMIS mentoring program
Frequency
Activity or output Indicator Data source of
collection

Number of health facilities/institutions

mentored per month
Facility HMIS
Proportion of institutions mentored logbook review Monthly
Health facilities once every month or
receive regular HMIS Mentors
Proportion of institutions with mentoring
mentoring
mentor’s feedback documented on report
HMIS mentoring logbook.

Proportion of facilities with improved

LQAS score after the mentoring
program (LQAS score >90%)
Health workers and
HITs demonstrate Proportion of facilities with improved
HMIS report Monthly
improvement in quality timeliness HMIS reports (Timeliness
>90%)
data collection and
reporting Proportion of facilities with improved
completeness of HMIS reports
(Representative completeness >90%)

Number of review meetings held on

Document
HMIS mentoring program
review (HMIS
minute review)
Improved information Proportion of institutions which Quarterly
use culture of health established PM team after the Mentors
mentoring program checklist
institutions
review

Proportion of institutions which Review Quarterly

perform monthly self-assessment meeting report

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9. Annexes
9.1. Annex 1: Mentoring Checklist for Health Facilities

Name of mentored health facility: Woreda:

Zone: Region:
Name of Mentor (s):
1.
2. ____________________________________
3. ____________________________________
Date (s) of Mentoring:
If No, write reason(s) and
Checklist questions Yes/No
suggestions

Section 1: Recording on individual medical records, registers and Tally sheets

1. Medical Record Unit: The mentor should visit the MRU, randomly check some folders in the
MRU, and discuss with MRU staffs

1.1 . MRU Space and materials

Does the MRU have:

1. Adequate space (Minimum 24 sq. m for health
center and 60 sq. m for hospitals)?
2. Adequate shelves (Are free shelves available
for new folders)?
3. Functional MPI box?
4. Does the MRU serve for 24 hrs?
Does the facility have adequate amount of each
HMIS format? (At least for the next 2 month)
1. Individual medical records
2. Tallies
3. Registers
4. Report forms

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1.2 . MRU working procedures
Do they set folder with appropriate format for a
visit: e.g. Folder with only RH card for ANC client
etc
Document review: Take randomly selected 10
patient folders in the MRU& check if appropriate
formats are available in the folder
Do they follow appropriate individual medical
recording procedure for each client/patient? (folder,
MPI, service ID etc)
Observation: Observe the working procedure in the
MRU and check whether they followed the correct
procedure. Make a discussion on how they
overcome their challenges.
Do they collect & shelve folders back daily to
MRU?
Do they use tracer card system?
Are all patient records (patient card, ART forms,
etc) integrated in an individual folder?
Is MRN provided to each client/patient?
Are summary sheets filled correctly for each
folder?
Are all cards (IMR) in one central card room
Document review: - Take randomly selected 10
patient folders and check the above points

2. Recording on registers and tally sheets

2.1. OPD Register

Do they use HMIS disease classification while
completing the OPD register?
Do they record all required data on the Register?

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Are the data on the register consistent with the
individual patient cards?
Document review: Take randomly selected 5
patient folders and check consistency of data with
OPD register.
Do they understand the definition of ‘New’ and
‘Repeat’ visits?
Do they understand each data element on the OPD
register?
Interview: Make a discussion with staffs who work
in OPD and assess the level of their understanding
Do they use the OPD diagnosis and attendance
tally, correctly and daily?
Do they complete the PITC tally from the OPD
abstract Register?
Document review: Select some data elements and
make consistency check between the register and
tally sheet
2.2. IPD Register
Do they record all the required data on the register?
Do they understand each data element on the IPD
register?
Are data elements on the register consistent with
patient cards?
Do they sum up the number of 'admissions',
'discharges' and 'length of stay' at the end of each
completed pages on the register?
Do they complete the inpatient morbidity &
mortality tally sheet?
Do they complete PITC tally from IPD register?
Document review: Review the IPD register and

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check whether the data elements are correctly
completed

2.3. ANC Register

Do they record all the required data correctly?
Are data on the register consistent with individual
integrated RH cards?
Do they complete FP tally sheet correctly and
daily?
Document review: Take randomly selected
integrated RH cards for verification with the FP
register; Check the FP register

2.4. Delivery Register

Do they record all the required data correctly?
Are the data elements on the register consistent
with data on the integrated RH card?
Do they sum up the required data elements at the
end of each page?
Document review: take randomly selected
integrated RH cards for verification; Check the
data elements on the delivery register).
2.5. PNC register
Do they record the required data correctly?
Do they sum-up data elements at the end of
each page?
Document review: Make data consistency check
with randomly selected RH (ANC) cards in the
PNC room.

2.6. Abortion Register

Do they record the required data correctly?
Do they sum-up data elements at the end of

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each page?
Document review: Make data consistency check
with randomly selected woman’s cards in the
abortion care room.
2.7. Family Planning Register
Do they fill all required data on the register?
Do they understand ‘new’ and ‘repeat’ FP
acceptors definitions?
Do they record the right abbreviation for
contraceptives they have provided?
Do they understand what to do on the register if a
client comes more than 5 times in a year?
Do they properly complete the FP tally sheet?
Document Review: Make data consistency check
with selected data elements.
2.8. Immunization Register
Do they open individual folder for child
immunization?
Is the summary sheet filled appropriately?
Do they understand the definition of PAB?
Do they record all the required data elements?
Do they complete EPI tally sheet daily?
2.9. TB Register
Do they record all the required data elements?
Do they understand the different Rx outcome
categories?
Do they understand and correctly complete cohort
report?

2.10. Leprosy Register

Do they record all the required data elements?
Do they understand the different Rx outcome

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categories?
2.11. VCT register
Do they record all the required data elements?
Do they properly use VCT tally?
2.12. Growth Monitoring Register
Do they record all the required data elements?
Do they properly use GM tally?
2.13. TT register
Do they record all the required data elements?
Do they properly use the tally?
2.14. Pre-ART Register
Do they record all the required data elements?
Do they record all the required data elements?
Do they use all the tallies that are required for Pre-
ART service?

2.15. ART Register

Do they record all the required data elements?
Do they understand the definition of cohort?
Do they understand the definition of survival
analysis?
Do they use all the tallies that are required for ART
service?
2.16. MDR TB Register
Do they record all the required data elements?
Do they understand the definition of each treatment
outcome?
Do they use integrated folder for these patients?

2.17. MDR Follow up Register

Do they record all the required data elements?
Do they understand the definition of each treatment

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outcome?
Do they use integrated folder for these patients?

2.18. PEP Register

Do they correctly record all the required data
elements?

2.19. Other registers (OR, Referral…)

Check whether the registers are properly completed
Note: Check each register

Section 2: Performance Monitoring and Data quality assurance

1. Establishment of performance monitoring (PM) team
Does the institution established performance
monitoring team (PM)?
When is it established?
Is PM team appropriately represented-as per the
information use manual?
Roles and responsibilities assigned to individual PM
team member?

2. Performance Monitoring

Does the institution have a strategic plan?

Does the institution have an annual plan?

Was performance versus plan compared for Key

indicators?
Are best performances recognized / outlined?

Are Weak performances (low achievements)

identified and listed?
Are problems associated with weak performance
identified?

Were causes of problems identified?

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Are proposed solutions to address problems
outlined?
Are agreed preferred solutions identified and listed
in priority order?

Are activities to implement solutions identified and

outlined (what to do)?

Are those activities assigned to individual member,

unit, department etc. with set time frame?
Was the last performance review meeting’s minute
documented?
Interview and document review: Discuss with the
HMIS focal person and other PMT members. Check
the PM minute book
Are display charts available? What types and are
they properly labeled?

3. Data Quality Assurance

Are PM team members aware of all new HMIS
implementation tools/ recording & reporting
procedures?

Completeness of data checked?

Was consistency of data assessed?

Did they do LQAS for the last month?

What is the value of LQAS score (%)

Document review: Check the LQAS checking table

Section 3. eHMIS and EMR-MRU implementation

Is the facility/institution using eHMIS? When did it
start?

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Do you send data using internet or external devices?
What challenges do you have in implementing
eHMIS?

Does the facility use EMR-MRU at the MRU

What challenges do you have in implementing

EMR-MRU?

Section 4. General Questions

Are staffs trained on HMIS? How many?
Does the institution have HIT? Is he/she trained on
HMIS and eHMIS?

Major challenges faced at the facility during the

implementation of the revised HMIS

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9.2. Annex 2: Mentoring Checklist for Administrative Units (WorHOs,
ZHDs, RHBs)

Name of mentored institution: _____________________________

Type (WorHO, ZHD/Sub city/RHB):_______________________
Name of Mentor(s):
1.
2.
3.

Date of Mentoring:
Questions Yes/No If No, write reason(s) and suggestions
1. General questions
Is there HMIS focal person (s) for the
institution?
Qualification of the HMIS focal person?
Number of M&E experts
Qualification of the M&E experts?
Number of health facilities in the woreda:
 Public hospitals:
 Health Centers:
 Health Posts:
 Private health facilities, by type:
2. Establishment of performance monitoring (PM ) team
Does the institution established
performance monitoring team (PM)?
When was it established?
Is PM team appropriately represented-as
per the information use manual?
Are roles and responsibilities assigned to
individual PM team member?

Does the PMT meet on a regular basis? If

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yes, How frequent?

3. Performance Monitoring

Does the institution have a strategic plan?

Does the institution have an annual plan?

Was performance versus plan compared

for Key indicators?
Are best performances recognized /
outlined?
Are Weak performances (low
achievements) identified and listed?
Are problems associated with weak
performance identified?
Were causes of problems identified?
Are proposed solutions to address
problems outlined?
Are agreed preferred solutions identified
and listed in priority order?

Are activities to implement solutions

identified and outlined (what to do)?

Are those activities assigned to individual

member, unit, department etc. with set
time frame?
Was the last performance review
meeting’s minute documented?
Interview and document review: Discuss
with the HMIS focal person and other
PMT members. Check the PM minute
book

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Are display charts available? What types
and are they properly labeled?

4. Data Quality Assurance

Did the institution conduct RDQA?

When was the last RDQA conducted?

What was the RDQA result?

If RDQA was not conducted, why?

Document review: Check the RDQA
report, if any and discuss on how to
assure data quality in the woreda.

5. Reporting
Is the institution using eHMIS to
aggregate data for reporting?
Are all the public facilities sending report
by eHMIS system? Are they sending by
internet or external devices?
If there are facilities that report manually,
why they are not using eHMIS?
Do you get report from all private
facilities? If no, why? And what do you
plan to receive reports from them?

Any challenges related with reporting?

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9.3. Annex 3: Mentoring Log book

Note: This log book is used to document the major findings, solutions and recommendations
provided by mentors during mentoring. Every mentor should document on this log book at the
end of each mentoring session.
Mentoring date (s): _______________________
Mentor (s) name:
1. ______________________________________ Signature______________
2. ______________________________________ Signature______________
3.______________________________________ Signature______________

Solutions Recommendations
Major HMIS related problems identified provided to the
provided on site
facility/institution
Problems identified in the
MRU (For health facilities
only)
Problems related to
recording on registers and
tally sheets (For health
facilities only)

Problems related to reporting

Problems related to data

quality assurance

Problems related to
performance monitoring

Other issues identified

during the mentoring session
9.4. Annex 4: Mentoring reporting format

Note: This reporting format is to report the activities of mentors. It should be completed every
month and be reported to each administrative level (Health center’s mentoring report should be
submitted to WoHOs; mentoring of WoHOs should be submitted to the ZHDs, Mentoring of
ZHDs should be submitted to the RHB and mentoring of RHBs should be reported to the
FMOH).
Reporting date: __________________________________________
Reporting period: ________________________________________
Reported by (Name):______________________________________

Monthly Mentoring reporting format

Number of mentors involved in the

mentoring program (Specify their name,
organization and qualification)

Number of health centers mentored in this

month

Number of hospitals mentored

Main findings during mentoring

Types of support provided during mentoring

Types of support needed from the

administrative unit( WoHOs, ZHDs, or
RHB)

Challenges faced during mentoring

Conclusion and recommendations

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