Table 3

Challenges and strategies developed in response during the process of developing and implementing the KCH Paediatric Emergency and Acute Care Registry

ChallengeStrategies/Lessons Learnt
Need for integration into existing HMIS system
  • Multiple meetings with HMIS leadership were key to designing an integrated and complementary process

  • Inclusion of HMIS data clerks into PACHIMAKE data clerk trainings

  • Physical placement of PACHIMAKE data clerks next to the HMIS data clerks to encourage collaboration and teamwork

  • Frequent bidirectional communication with the HMIS staff

Multiple stakeholders with myriad interests
  • Multiple meetings with all groups of staff and learners in KCH Paediatric Department conducted early on in the planning process

  • Questionnaire to solicit variables of interest from stakeholders

Importance of local ownership of the project
  • Project designed to fulfil need identified by KCH Paediatric Department administration

  • Appointment of a clinician champion

  • Local project manager to supervise data clerks and troubleshoot day-to-day challenges

Multiple patient entry and exit points/paths
  • Data clerks perform ‘liwamba’ (Chichewa for a ‘hunt’) twice per shift to locate and follow admitted patients

  • Re-education of staff to direct patients to U5

  • Placement of data clerks at most common entry point (U5)

Ensuring data quality
  • Targeted trainings for data clerks

  • Periodic reassessment of vital sign and anthropometric measurement skills

  • Monthly audits of deaths and 10% of discharges with feedback to the clerks

  • Cross-checking of ward and database registers of discharged and deceased patients

  • HMIS, Health Management Information System; KCH, Kamuzu Central Hospital; PACHIMAKE, Paediatric Alliance for Child Health Improvement in Malawi at KCH and Environs; U5, Under 5 .