SSA - National NCD HeartCare Outreach and Data Focal Person

The NCD HeartCare Outreach and Data Focal Person supports the Ministry of Health NCD team in planning and coordinating NCD outreach activities, analyzing and presenting HeartCare data, strengthening data quality, supporting follow-up of high-risk patients, and promoting routine use of HeartCare data for programme management and decision-making. The role focuses on outreach coordination, data analysis, data quality, patient follow-up tracking, user support, and routine programme reporting.

Responsibilities

• Support NCD outreach planning and coordination including preparation of routine outreach plans, schedules, and activity trackers.
• Liaise with the NCD National Coordinator and provincial, facility, and outreach teams to confirm dates, locations, staffing, equipment readiness, and reporting expectations.
• Use HeartCare data to identify priority communities, facilities, or patient groups for outreach planning and NCD Coordinator endorsement.
• Prepare available patient lists for outreach, including screening, reassessment, follow-up, or referral review.
• Support outreach teams to use HeartCare for registration, CVD risk assessment, scheduling, and follow-up documentation.
• Track outreach completion and promptly report delays, cancellations, or incomplete activities to the NCD Coordinator.
• Maintain an outreach tracker covering planned and completed activities, pending actions, responsibilities, and follow-up needs, with quarterly updates to the NCD Coordinator.
• Extract, analyze, and summarize HeartCare web and mobile data for the NCD team.
• Provide routine summaries on screening, registration, risk categories, facility performance, outreach, follow-up, and referrals.
• Prepare simple charts, tables, dashboards, maps, and briefing slides for NCD review and decision-making.
• Support monthly or quarterly data reviews by preparing HeartCare summaries and highlighting issues for management action.
• Identify trends, gaps, and priority areas, including low reporting, incomplete records, high-risk patients, and weak follow-up documentation.
• Contribute to routine reports for MoH management, provincial teams, WHO, and partners.
• Generate and maintain approved lists of high-risk patients or those requiring follow-up.
• Work with the NCD team and facilities to track follow-up, referral, counseling, or reassessment for high-risk patients.
• Promptly flag overdue follow-up, missed appointments, incomplete referrals, and cases needing clinical or programme review.
• Support communication between NCD, provincial, and facility teams to improve high-risk patient follow-up.
• Maintain a confidential high-risk patient follow-up tracker for authorized personnel only.
• Document follow-up gaps and recurring barriers for quarterly NCD and provincial team discussion.
• Conduct routine HeartCare data quality checks on completeness, timeliness, consistency, missing values, duplicates, and unusual patterns.
• Review key patient and assessment fields, including demographics, facility, clinical measures, CVD risk, referral, and follow-up data.
• Identify facilities or users needing support for incomplete, inconsistent, or delayed data entry and report to the NCD Coordinator.
• Provide feedback on common data quality issues and agree timely interventions with the NCD Coordinator.
• Support simple checklists, job aids, and SOPs for HeartCare data entry and review.
• Work with the NCD Coordinator and Digital Health team to align HeartCare data quality with MoH processes.
• Prepare user support plans for NCD Coordinator endorsement before engaging health workers and outreach teams.
• Help users with core HeartCare workflows, including search, registration, scheduling, risk assessment, referrals, appointments, and follow-up.
• Document user issues, workflow challenges, training needs, and usability concerns for monthly submission to the NCD Coordinator.
• Maintain a HeartCare issue log and coordinate escalation of unresolved system or technical issues.
• Support refresher training, coaching, and mentoring for users with low usage, frequent errors, or data quality issues.
• Prepare user guidance, job aids, FAQs, and orientation materials for NCD Coordinator review and endorsement.
• Submit regular reports on outreach, HeartCare use, data quality, high-risk follow-up, user support, and unresolved risks.
• Maintain coordination documents, including plans, trackers, meeting notes, issue logs, follow-up trackers, and templates.
• Document lessons learned from outreach and HeartCare use for submission to the NCD Coordinator.
• Recommend improvements to outreach planning, patient follow-up, data quality, and HeartCare use.
• Contribute to NCD updates, Digital Health meetings, partner briefings, and MoH reporting.
• Work with MoH NCD, provincial, facility, and outreach teams.
• Coordinate with Digital Health on HeartCare use, data access, reporting, user issues, and governance.
• Coordinate with WHO, NGOs, and partners on NCD monitoring, data analysis, and capacity building.
• Escalate technical issues, system defects, access problems, and data concerns through proper channels.
• Ensure activities align with MoH priorities, approved NCD guidance, and responsible handling of patient-level information.

Requirements

• University degree in public health, health information systems, health sciences, nursing, data management, statistics, information systems, programme management, or related discipline.
• Postgraduate qualification (master’s degree) in public health, health information systems, digital health, monitoring and evaluation, epidemiology, health management, or related discipline is desirable.
• At least five years of demonstrated experience supporting health programme coordination, outreach activities, public health services, health facility support, or community-based health activities.
• Demonstrated experience working with routine health data, programme data, monitoring tools, reporting systems, or health information systems.
• Experience working with NCD programmes, CVD risk screening, WHO PEN, HEARTS, diabetes, hypertension, or primary health care services is desirable.
• Experience supporting digital health systems, mobile data collection tools, electronic medical records, DHIS2, KoboToolbox, CommCare, ODK, or similar systems is desirable.
• Experience using Microsoft Excel or similar tools for data review, data cleaning, analysis, tables, charts, and reporting is desirable.
• Experience preparing activity reports, briefing notes, dashboards, presentations, or programme summaries for managers or technical teams is desirable.
• Experience coordinating with multiple stakeholders, including national staff, provincial teams, health facilities, or community-level service providers is desirable.
• Experience supporting users with different levels of digital literacy, including explaining system or data issues in simple and practical language is desirable.
• Experience handling sensitive health or personal information responsibly and confidentially is desirable.
• Good understanding of public health programme implementation, preferably in NCDs, primary health care, outreach services, or chronic disease follow-up.
• Good understanding of basic data quality principles, including completeness, timeliness, consistency, missing values, duplicate records, and unusual data patterns.
• Ability to analyze routine health data and present findings clearly using tables, charts, dashboards, and short written summaries.
• Ability to coordinate activities, track actions, follow up with stakeholders, and maintain organized records.
• Ability to support health workers and programme staff in the practical use of digital tools.
• Good communication, problem-solving, and teamwork skills.
• Ability to work respectfully with national, provincial, facility, and partner teams.
• Understanding of responsible data handling, confidentiality, user access control, and safe management of patient-level health information.
• Basic understanding of NCD service delivery, CVD risk assessment, patient follow-up, referral pathways, and health facility workflows.
• Fluency in the English and Bislama language.

Skills

• Public Health
• Health Information Systems
• Data Management
• Statistics
• Programme Management
• Public Health Programme Coordination
• Outreach Activities
• Routine Health Data Analysis
• Monitoring Tools Development
• Reporting Systems
• Health Information Systems Support
• NCD Programmes
• CVD Risk Screening
• WHO PEN
• HEARTS
• Digital Health Systems
• Mobile Data Collection
• Electronic Medical Records
• DHIS2 Knowledge
• KoboToolbox
• CommCare
• ODK
• MS Excel
• Data Cleaning
• Data Analysis
• Data Quality Principles
• Activity Reporting
• Dashboard Preparation
• Stakeholder Coordination
• User Support Management
• Confidential Information Handling
• Patient Follow-up Tracking
• Referral Pathways Development
• Health Facility Workflows

Languages

English, Bislama