A data warehouse approach can manage multiple data sets

2010

Introduction A plethora of health indicators have been added into the District Health Information System (DHIS) since its adoption and implementation as the routine health information for South Africa in 1999. The growing demand for the production and dissemination of routine health information has not been equally matched by improvements in the quality of data. In the health sector the value of monitoring and evaluation is not simply the product of conducting monitoring and evaluation but, rather from discussing and using performance indicators to improve health service delivery. Aim The aim of this study was to classify health care indicators in the national health data sets used for planning, monitoring and evaluation and to review the data management practices of personnel at provincial and district level. Methods An observational, cross sectional study with a descriptive component was conducted, in 2009, using a finite sample population from district and provincial level across eight provinces. The study participants completed a self-administered questionnaire which was e-mailed to them. Results A total of 32 (52%) participants responded to the questionnaire and of this total 21 (65.5%) responses were from district level and 11 (34.4%) from provincial level. The National Indicator Data Set, the key source for primary health care and hospital data, was implemented in 1999 with approximately 60 indicators. In less than 10 years it has grown in size and presently contains 219 performance indicators that are used for monitoring and evaluating service delivery in the public health sector. Whilst both district and provincial level personnel have a high awareness (83%) of the DHIS data sets there is variability in the implementation of these data sets across provinces. The number of indicators collected in the DHIS data sets for management decisions are "enough", however a need was expressed for the collection of community health services data and district iii level mortality data. Similarities were noted with other studies that were conducted nationally with respect to data sharing, utilisation and feedback practices. Data utilisation for decision making was perceived by district level personnel to be adequate, whereas provincial level personnel indicated there is inadequate use of data for decision making. Whilst 87.1% of personnel indicated that they produce data analysis reports, 71.9% indicated that they never get feedback on the reports submitted. The top 4 data management constraints include: lack of human resources, lack of trained and competent staff, lack of understanding of data and information collected and the lack of financial and material resources. There was agreement by district and provincial level personnel for the need for additional capacity for data collection at health facility level. Discussion The increasing need for accurate, reliable and relevant health information for planning, monitoring and evaluation has highlighted critical areas where systems need to be developed in order to meet the information and reporting requirements of stakeholders at all levels in the health system Recommendations An overarching national policy for routine health information systems management needs to be developed which considers the following: emerging national and international reporting requirements, human resources requirements for health information and integration of systems for data collection. In the short-term a review of the National Indicator Data Set needs to be conducted.

Objective: To describe the status of health information systems in 14 sub-Saharan African countries of the World Health Organization African Region. Design: A questionnaire-based survey. Setting: Fourteen sub-Saharan African countries of the African Region. Participants: Key informants in the ministries of health, national statistics offices, health programmes, donors and technical agencies. Main outcome measures: State of resources, indicators, data sources, data management, information products, dissemination and use of health information. Results: The highest average score was in the identification and harmonisation of indicators (73%), reflecting successful efforts to identify priority indicators and reach international consensus on indicators for several diseases. This was followed by information products (63%), which indicated the availability of accurate and reliable data. The lowest score (41%) was in data management, the ability to collect, store, analyse and distribute data, followed by resources -policy and planning, human and financial resources, and infrastructure (53%). Data sources (e.g. censuses, surveys) were on average inadequate with a score of 56%. The average score for dissemination and use of health information was 57%, which indicated limited or inadequate use of data for advocacy, planning and decision-making. Conclusions: National health information systems are weak in the surveyed countries and much more needs to be done to improve the quality and relevance of data, and their management, sharing and use for policy-making and decision-making.

2010

Health services are increasingly under pressure to develop information systems that are responsive to changing health needs and appropriate to service objectives. Developing an essential data set provides managers with a clearly defined set of indicators for monitoring and evaluating services. This article describes a process that resulted in the creation of an essential data set at district level. This had a significant impact on neighbouring districts and resulted in the development of a regional essential data set, which in turn helped to influence the creation of a provincial and then national essential data set. Four key lessons may be drawn from the process. The development of an essential data set both requires and can contribute to a process that allows the reporting requirements to be adjusted over time in response to changing circumstances. In addition, it contributes to (and requires) the integration of programme reporting requirements into a coherent information system. While the case study describes a bottom-up approach, a top-down consultative process is advocated because it establishes a framework within which information needs can be reviewed. Lastly, the use of surveys can aid efforts to keep the essential elements to a minimum. In conclusion, the development of an essential data set contributes to strengthening health services because it necessitates dialogue between programme managers and defines indicators to be monitored by them.

The 14th International Conference on Social Implications of Computers in Developing Countries (IFIP9.4)

Indicators are foundational for planning, monitoring and evaluating of health services in developing countries. Most health indicators use popua-tion-based data, to enable comparison across geographical areas and over time. This paper is based on an interpretative case study on health indicators and how they are calculated and used at health facilities in Cameroon. We found that health managers at different levels of health systems do not share the same understanding of health indicators and we observed a widespread absence of population data. We further observed that health managers derive alternative ways of calculating indicators in the absence of population data. This paper contributes by discussing the implications of a lack of a common understanding of health indicators and the absence of population data to calculate health coverage indicators. Though this study was limited to data and program managers at district and regional levels, the findings raise issues that have wider applicability in the implementation of electronic health information system as well as how indicators such as UHC goals are calculated.

East African Medical Journal, 2010

Objectives: this paper reviews the adequacy of inputs and processes at district level to support outputs and outcomes of service delivery at district level using a rapid assessment. the outputs included in this study are those considered essential for the attainment of the Health related Millennium development Goals(MdGs). Data sources: a questionnaire based rapid district Health systems assessment was conducted among six african countries during the year 2007. Study selections: the study took place in a random sample of six out of 19 English speaking countries of the wHo african region. these countries are Ghana, liberia, Namibia, Nigeria, sierra leone and Uganda. Data extraction: the data was extracted from the questionnaires, entered and analysed in Excel spreadsheet. Data synthesis: in spite of the variability in quality and completeness of reporting on the selected parameters, this paper does indicate that according to country norms and standards, the inputs and processes are insufficient to lead to acceptable outputs and outcomes, especially those related to the MdGs. an important point to note is that comparability across countries is made on the basis of individual country norms and standards. implicit in this assessment is that country norms and standards are reasonable and are appropriate for the attainment of the MdGs. However reasonable the country norms and standard are, it is unlikely that the low resource base as well as weak organisational and managerial capacities in most countries will support effectively the attainment of the MdGs. Conclusion: Most countries manage to offer the essential health services at all levels of care despite the relatively low level of inputs. However, their level of quality and equity is debatable. the general trend is that provision of the essential health services is more at the higher levels of care prompting concerns for the populations served at lower levels of care. there is also a tendency to have wide variations in the performance of service delivery geographically as well as at the different levels of the health systems. this paper recommends further exploration of the impact of focusing on improving quality of existing health services while increasing quantity of service delivery points to achieve higher coverage of essential health services.

Health services are increasingly under pressure to develop information systems that are responsive to changing health needs and appropriate to service objectives. Developing an essential data set provides managers with a clearly defined set of indicators for monitoring and evaluating services. This article describes a process that resulted in the creation of an essential data set at district level. This had a significant impact on neighbouring districts and resulted in the development of a regional essential data set, which in turn helped to influence the creation of a provincial and then national essential data set. Four key lessons may be drawn from the process. The development of an essential data set both requires and can contribute to a process that allows the reporting requirements to be adjusted over time in response to changing circumstances. In addition, it contributes to (and requires) the integration of programme reporting requirements into a coherent information system. ...

Tropical Medicine & International Health, 2008

Presupuesto y Gasto Público, 2007

El documento examina las cuestiones metodológicas relacionadas con el funcionamiento de los sistemas sanitarios. Se examinan los conceptos relevantes; se presentan ejemplos sobre la medición del desempeño de los sistemas de salud en varios países; se identifica las cuestiones metodológicas de los indicadores de desempeño y se presentan algunas implicaciones políticas. Los principales retos metodológicos están relacionados con la definición de indicadores y el control de su variabilidad, así como con la integración de los indicadores en un indicador compuesto y establecer puntos de referencia. El empleo de indicadores de desempeño requiere la consideración de diferentes enfoques con efectos complementarios a fin de evaluar si el sistema de salud logra objetivos establecidos.