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District Health Information Systems

Oslo, April 2007

Topic 5

Data analysisData analysisturning data into informationturning data into information

João Carlos de Timóteo Mavimbe

&

Humberto Muquingue

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Collection

InputRaw data

PresentingInterpreting

USEANALYSIS Processing

Indicators

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By the end of this session, you should be able to:

Explain how data is converted into information

Explain basic epidemiological terms and concepts

Explain concepts of numerator and denominator

Explain the meaning and use of terms: count, rate, ratio and proportion

Make simple calculations

LEARNING OUTCOMES

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Data analysisData analysisturning data into informationturning data into information

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Data analysisData analysiswhatwhat, why and how, why and how??

WHAT ? (meaning)

turns raw data into useful information

is the process of producing indicators – most important step in data analysis

uses quality data – with the 3 C’s

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Data analysisData analysiswhat,what, why why and howand how??

WHY ? (purpose)

the aim of a DHIS - the improvement of coverage and quality of local health services - is facilitated by only collecting data that can be analyzed and used at the local level

allows comparisons – facilities / teams

favors self assessment (have I reached my target ?)

supports decision-making

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Data analysisData analysiswhat, whywhat, why and how? and how?

HOW ? (use)

calculates indicators

uses basic epidemiological concepts

Can you provide examples?

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Indicators Indicators - many definitions- many definitions

variables that help to measure changes, directly or indirectly (WHO, 1981)

indirect measures of an event or condition (Wilson and Sapanuchart, 1993)

variables that indicate or show a given situation and thus can be used to measure change (Green, 1992)

Occram’s rule

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IndicatorsIndicators measures of COVERAGE and QUALITY

variables used to measure CHANGE:

monitor progress towards defined targets

describe situations

measure trends over time

provide a yardstick whereby facilities / teams can compare themselves to others

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Indicators Indicators – there are many – there are many calculation calculation

typestypes

1. “Count” – no denominator

numerator - number of events, observations, individuals (frequency)

2. “Proportion” – numerator is part of denominator

expressed as per 100 (%), 1000, 10 000, 100 000

3. “Ratio” – numerator is not part of denominator comparing 2 different numerators

4. “Rate” – a detailed proportion

number of events during a specific period

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5. “Aggregated, composite or indexed indicators”

- DALY (disability-adjusted life years)

- HALE (health-adjusted life expectancy)

- QALE (quality-adjusted life years)

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There are about 1,500 indicators in the health sector

(World Bank inventory)!

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An ideal An ideal indicator indicator RAVES !!!RAVES !!!

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An ideal indicator An ideal indicator RAVESRAVES

RELIABLE it gives the same result if used by different people

APPROPRIATE it is the best way of measuring what we want to know

VALID it measures what you want to measure

EASY it is feasible to collect the data to produce this indicator (KISS)

SENSITIVE, SPECIFIC it reflects changes in events being measured

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Atop the line – Atop the line – numeratorsnumerators

(activities / interventions / events / (activities / interventions / events / observations / people)observations / people)

a count of the event being measured

How many occurrences are there:

morbidity (health problem, disease)

mortality (death)

resources (humanpower, money, materials)

Generally raw data (numbers)

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Under the line - denominators

(population at risk)(population at risk)

size of target population at risk of the event

What group do they belong to:

general population (total, catchment, target)

gender population (male / female)

age group population (<1, >18, 15-44)

cases / events – per (live births, TB case)

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I. Systems classificationI. Systems classification INPUT

monitors affordability of resources

measures availability / quality of resources

PROCESS

monitors activities that are carried out

measures accessibility of services – coverage and quality

OUTPUT

monitors results of activities

measures acceptability - use, change, performance, coverage and quality

OUTCOME

monitors changes in health status of populations IMPACT IMPACT

measures appropriateness - effectiveness, efficiency, equity, sustainability

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II. Functional classification

• Indicators can be grouped according to their function in plannning and monitoring:– Health status– Activities – Quality– Resources– Output / Efficiency – Efficacy– Impact / Outcome

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A. Health status indicators

• They inform about the causes of disease and death in a given population.

• Examples:– Morbility rates of measles– Death rates of TB– Incidence rates of diarrhea– Low birth weight rates

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B. Activity indicators

• They inform about of volumes of work.

• Examples:– Coverage rates of a programme– Achievement indexes– Use of services (OPD utilisation rates)– Admission rates per inhabitant

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C. Quality indicators

• They inform about the excellence of activities carried out.

• Examples:– Antenatal attendance rates– Direct obstetric death rates in the facility– Vaccine dropout rates

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D. Resource indicators

• They inform about the availability / quality of consummables, equipments, staff, health facilities and money.

• Examples:– Cost of drugs prescribed per consultation– Number of inhabitants per clinical officer– Percentage of health facilities with vehicle

for programme activities– Availability of vital drugs

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E. Efficiency indicators

• They refer to the volume of activities performed using a given resource. They inform whether the resources were well used, underused or overused the ratio of inputs needed per unit of output produced

• Examples: – Deliveries per nurse– Bed occupancy rates – Average length of stay

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F. Output or efficacy indicators

• They show to what extent the expected result was attained with the available resources “the degree to which outputs affect outcomes and impacts”

• Examples: – Reported new cases of acute flaccid paralysis– Incidence rates of EPI-targeted diseases– Percentage of fully immunised children

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G. Impact or outcome indicators

• The impact of a programme is the effect that programme induced on the overall health status and socio-economic conditions of the target population

• Examples: – Nutritional status of children– Percentage of new family planning acceptors– Incidence and mortality rates due to HIV– Infant mortality rates

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III. Classification according to indicator level

1. Local indicators

2. Indicators from censuses and surveys

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1. Local indicators

• Compiled from routine HMIS data

• Should follow principles of “minimum data set” and “information filter”

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Minimum or Essential Minimum or Essential DatasetDataset

► the minimum amount of data that needs to be collected

► for the effective management of services which allows them to make the greatest impact on the health needs of the community which they serve (thus improving coverage and quality)

► uses minimum number of data collection tools

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The Information filterThe Information filter

National Information Systems

Community Information Systems

District Information Systems

Provincial Information Systems

International IS

Indicators,proceduresand datasets:

Community

District

Province

National

International

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2. Indicators from censuses and surveys

• Infant mortality rate

• Crude death rates

• Crude birth rate

• Death rates of children aged 0-4 years

• Maternal mortality rates

• Seroprevalence of HIV or BHep

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Epidemiological questionsEpidemiological questions

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EpidemiologyEpidemiology: who, where, : who, where, when ?when ?

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Epidemiology:Epidemiology:what, why and how?what, why and how?

WHAT ? (meaning)

study of the distribution, frequency and determinants of health problems and disease in human populations

WHY ? (purpose)

obtain, interpret and use health information to promote health and reduce disease

HOW ? (outcome)

uses indicators to answer basic epidemiological questions

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Information cycle meets

Planning cycle

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Information Information CycleCycle

Data converted to information

What do we do with What do we do with it?it?

How do we present How do we present it?it?

How do we use it?How do we use it?

data sources & tools

analysis

Reports and graphs

Interpretation of information

Good quality data

What do we collect?What do we collect?Decision-making

for effective management

feedbackfeedback

Stages Tools Outputs

Quality at Quality at every stageevery stage

EDSEDS

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Planning CyclePlanning CycleWhere are we now?Where are we now?

Situation analysis

Where are we Where are we going?going?

Goals, Targets, Indicators

How will we get there?How will we get there?

Action Plans

How will we know How will we know when we arrive?when we arrive?

Monitoring and Evaluation

Quality Quality information at information at

every stageevery stage

EDSEDS

Priority problems

Key strategies

Key interventions

Review of plans

Stages Tools Outputs

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GOALSGOALS

broad policies and long term objectives

broad aims stated in general terms

represent future direction

Set at national level by political and health decision makers

general objectives (aims, long term objectives)

correlated with local context

set at provincial and district levels by health managers

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TARGETSTARGETS

they are a they are a subsetsubset of objectives of objectives

state exactly what has to be achieved, by whom and by when

a realistic point at which to aim to reach a goal

turning the goal into number terms

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TARGETSTARGETS should be SMART

Specific measurable based on changes in situation concerned

Measurable able to be easily quantified

Appropriate fit in to local needs, capacities and culture

Realistic can be reached with available resources

Time bound to be achieved by a certain time