health information system “ consumers’ perspective” gunnar bjune march 2013...
TRANSCRIPT
Three fundamental issues The health problem
Prevalence, incidence, ”disease burden” The service delivery
Facilities, strategies/programs, activities The resources
Man-power, skills, supplies, support
->Outcome / impact
Conflict of interest? Control: Global/national/local/personal
”Bottom-up strategy” (democratic) Rights: Needs/justice/legal/private
Data quality, data safety, integration Efficiency: Needs – resources
Analyses and research Safety: Epidemics/hazards/life-style
Surveillance
Example: Tuberculosis controlObjectives
Reduce mortality Detect and treat cases (morbidity) Cure sputum positive cases Reduce transmission
DOTS : 1. political commitment 2. diagnosis through microscopy 3. drugs supply 4. observed therapy 5. recording and reporting
Tuberculosis control“Information culture” Central management unit (in MoH) National standard formats TBMUs -> Province -> CU -> MoH Standards used as basis for
supervision Emphasis on treatment outcome Often functions in isolation from PHC
Tuberculosis controlWhat kind of data?
Classification New pulm. sm+ Pulm. sm – Extra pulm. Transfer in Retreatment Relapse
Treatment outcome Cured Treatm.
Completed Dead Transferred out Chronic (“failure”) Lost to follow-up
Tuberculosis controlWhat sources of data? Laboratory book
TB suspects, results of 2 smears, follow-ups Treatment card
Demographic data, classification, treatment, weight, regularity, lab.res.
Registration bookClassification, treatment outcome, comments
Supervision reportsProblems, solutions, data quality
Tuberculosis controlFlow / loss of information
Symptomatics
Laboratory TBM
Province
National
International (WHO)
PHC
Hospital serv.
”Symptomatics”
LaboratoryTBMU
PHC
Hospitals
Non-TB / TB
Private / public
DOTS centr.
Tuberculosis controlWhat we can learn from the laboratory book
External quality control Work load and in service training Suspect/positive ratio Quality of diagnostic microscopy
routine Quality of follow-up Transfer to treatment cards
Tuberculosis controlWhat we can learn from the treatment cards
Accuracy of diagnosis/classification Weight gain/loss Address* (and social background) Treatment regularity Regimen and drug reactions Treatment outcome Transfer to registration book
Tuberculosis controlWhat we can learn from the registration book
Incidence* and classification / PHC unit Treatment outcome / PHC unit Childhood TB (active transmission) Mortality (HIV etc) Extra pulmonary TB (HIV, M.bovis etc) Gender balance Transfer to CU/MoH reports
Tuberculosis controlThe problem of coverage WHO target: Detect 70% of estimated
new cases What is the basis for the estimate? The private sector? Double reporting? Alternatives:
1. Geographical and social accessibility (GIS/season/social strata/etc)
2. Diagnostic delay
Tuberculosis controlIntegration into PHC In principle, but often not in reality Resources (transport, pharmacy,
statistician, laboratory, supervision, data management)
Culture (treatment outcome, data quality, district management, health rights)
Power (supplies, supervision, staffing) Satisfaction (outcome data)
Challenge / solution Central control Quality of data Efficiency Reporting Local problems Success ”The big picture”
Peripheral analyses Used by ”producers” Training Supplies etc Documented needs Treatment outcome Local interactions