GOVERNMENT OF THE KINGDOM OF LESOTHO

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GOVERNMENT OF THE KINGDOM OF LESOTHO


MILLENNIUM CHALLENGE ACCOUNT












USE OF INFORMATION


-

MANUAL FOR HEALTH MA
NAGERS

-






Health

Systems

Strengthening

Technical

Assistance

HS
-
A
-
012
-
09


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ii
















































D
ocument

Use of Information

Version


Final

Date


October 15
, 2010


Prepared


Stiaan Byleveld


The Health Systems Trust


www.hst.org.za




THL National Institute for Health a
nd Welfare

International Affairs

Lintulahdenkuja 4, Helsinki

P.O.Box 30

FI
-
00271 Helsinki, Finland



HSS Technical Assistance office in Lesotho

Imperial Fleet Services Bldg

Corner Kingsway and Moshoeshoe Rd

Maseru 100, Lesotho

Office
Tel/Fax (+266) 2232596
9


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1















USE OF
INFORMATIO
N FOR
MANAGEMENT

FOR HEALTH MANAGERS



HSS TRAINING REF. HSS/
IM/00
2






















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2




Table of Contents


I
NTRODUCTION

................................
................................
................................
................................
.......

5

T
RAINING
O
BJECTIVES

................................
................................
................................
............................

6

L
EARNING
A
CTIVITIES
................................
................................
................................
..............................

6

T
ARGET
G
ROUP

................................
................................
................................
................................
......

7

T
IMETABLE AND
C
OURSE
O
UTLINE

................................
................................
................................
...........

8


MODULE 1: LESOTHO HE
ALTH MANAGEMENT INFO
RMATION SYSTEM (HMIS
)

......................

12

1.1 Defining
a health management information system

................................
................

12

1.2 Background and purpose of a HMIS in Lesotho

................................
.....................

13

1.3 Principles related to a well fu
nctioning HMIS in Lesotho

................................
........

14

1.4 The information cycle

................................
................................
.............................

16

1.5 The planning cycle

................................
................................
................................
.

18

1.5 Group exercise

................................
................................
................................
.......

23


MODULE 2: MANAGING H
MIS IN LESOTHO

................................
................................
....................

24

2.1 National Health Management Information Syst
em

................................
.................

24

2.2 Management of HMIS at Central level

................................
................................
....

25

2.3 Management of HMIS at District level

................................
................................
....

27

2.4 Management of HMIS at Facility level

................................
................................
....

36

2.5 Group exercise

................................
................................
................................
.......

37


MODULE 3: DATA AND I
NFORMATION

................................
................................
............................

38

3.1 Data types

................................
................................
................................
..............

38

3.2 Data sources

................................
................................
................................
..........

40

3.3 Data presentation

................................
................................
................................
...

41

3.4 Data quality

................................
................................
................................
............

41

3.5 What is an indicator

................................
................................
................................

44

3.6 Levels of i
ndicators

................................
................................
................................

45

3.7 Calculating indicators

................................
................................
.............................

47

3.8 Group exercise

................................
................................
................................
.......

48




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MODULE 4: PROCESS OF

ANALYSIS

................................
................................
..............................

49

4.1 Moving from data to information

................................
................................
.............

49

How to analyse the data

................................
................................
...............................

50

The collected data may be analysed according to the following lines:

..........................

50

4.2 Analysis

................................
................................
................................
.................

53

4.
3 Presentation

................................
................................
................................
...........

55

4.4 Interpretation

................................
................................
................................
..........

58

4.5 Use of information

................................
................................
................................
..

58

4.6 Group exercise

................................
................................
................................
.......

59


MODULE 5: MONITORING

AND EVALUATION
................................
................................
.................

60

5.1 What is Monitoring

................................
................................
................................
.

61

5.2 Designing a monitoring system

................................
................................
..............

61

5.3 What is Evaluation

................................
................................
................................
.

63

5.4 How to carry out an Evaluation
................................
................................
...............

64

5.5 Why a Monitoring and Evaluation System

................................
..............................

65

5.6 Overview of the Lesotho M&E system

................................
................................
....

68

5.7 Group exercise

................................
................................
................................
.......

70


ANNEXURE 1: CALCULAT
ING INDICATORS

................................
................................
...................

71

ANNEXURE 2: LESOTHO
M&E REPORT INDICATOR
S AN
D TEMPLATE

................................
.....

83

FURTHER READING

................................
................................
................................
...........................

92

EVALUATION OF TRAINI
NG EFFECTIVENESS

................................
................................
...............

94





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Abbreviations


AIDS

Acute Immune Deficiency Syndrome

ART

Anti Retroviral Therapy

BAS

Basic Accounting System

CHC

Community Health Centre

DB

District

Barometer

DHMT

District

Health Management Team

DHP

District Health Package

DHP

District

Health Plan

DHS

District

Health System

DHIS

District Health Information System

DIO

District

Information Officer

DOH

Department of Health

ESP

Essential Service Package

FIC

Facility Information Co
-
ordinator

FIO

Facility Information Officer

HIS

Health Information Systems

HIV

Human Immunodeficiency Virus

HMIS

Health Management Information System

HTC

HIV Testing and Counselling

IHPF

Integrated Health Planning Framework

MDG

Millennium Development Goals

M&E

Monitoring

and Evaluation

MOHSW

Ministry of Health and Social Welfare

NDoH

National Department of Health

NHIC

National Health Information Committee

NHIS

National Health Information Systems

NHS

National Health System

NIDS

National Indicator

Data Set

PHC

Primary Health Care

PHIC

Provincial Health Information Committee

PQRS

Provincial Quarterly Reporting System

PTSSH

Patient Throughput Statistical System

SDIO

Sub

District

Information Officer

UN

United Nations

USAID

United States Agency for International Development

VCT

Voluntary Counselling and testing

WHO

World Health Organisation


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Introduction

Evaluation: not to prove, but to improve
(Stuffleb
eam et al.)


As early as 1981 the World Health Organisation emphasized the importance of health
information systems and related skills training in the implementation of an integrated primary
health care approach. While the quality of primary health care s
ervices stems from an
attitude that fosters service improvement, the measure of improved coverage and client
satisfaction lies in the judicious use of information. Key factors that contribute to the success
of services are decentralisation of authority fo
r decision making, training and strengthening
of managerial support for district
-
based initiatives.


The current era of rapidly changing technology and the abundance of information is here to
stay. The 1980‟s saw the “information age”, a time where inform
ation was a scarce resource
and its capture and distribution was a highly competitive business. Then in the 1990‟s came
the “Knowledge Economy”, when access to information grew rapidly. Now in the 2000‟s we
are in the age of “Intangible Economy”, relying

now on what people know and how they use
it and who people collaborate with, their commitment and how fast „value‟ is created.
(Wikipedia, the free encyclopaedia, 2007).


The course is delivered using a problem solving methodology structured around an ac
tual
district health management information dataset. Key concepts and principles of health
information systems are presented which are then discussed and debated in an inter
-
active
manner.
In addition, the users critically reflect on how they
get

and use i
nformation for
decision making in their operations. We all make decision at various levels and for different
reasons
. In delivery of health services, decisions are very important from use of resources
and how we treat or manage our clients. What do we base

the decision on?


The p
articipants then use the dataset in resolving common
real
-
life managerial dilemmas.
Teamwork is emphasised during problem solving sessions. In all of the above activities the
acquisition and refining of the skills required to effect
ively utilise an information system, are
concentrated upon.



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Training Objectives

This
s
ection gives the
overall
objectives of the training curriculum.



By the end of the training, the learners

should be able to
:

a)

U
nderstand a health management information
system (HMIS) with specific
reference to the Lesotho context

b)

U
nderstand management of HMIS at the different levels in the Lesotho MOHSW
and the various role players in the information system

c)

D
escribe the types of data and realise the importance of good qua
lity data.
P
articipants should also be able to describe indicators and understand the
difference between data and information

d)

F
ulfil the
ir

role within a facility or district team to
use information for management

e)

U
nderstand the link between information man
agement and monitoring and
evaluation (M&E)


Note:

1.

Th
e participants do not need to have previous academic qualifications or any
formal training in use of information

2.

Th
is course is not about computers and no

computer knowledge is required
.

3.

Participants sh
ould bring a calculator
.


Learning Activities

All modules in this course are

interactive in nature and its success is dependent on the full
participation of all participants. All
health managers

are invited to become informed, get
involved and learn whil
e they work by becoming part of a
district

information team and
participating in the creation of a locally relevant
d
istrict
h
ealth
i
nformation
s
ystem.


The following learning activities will be used

and is applicable to all modules in this course
:


Group
discussion:

The facilitator will prompt the participants through questions relevant
to the topic in order to facilitate a discussion on the link between the
topic and their day
-
to
-
day activities at the office


Facilitator presentation: The facilitator will

continue with an oral presentation on the topic
(PowerPoint presentation)


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Group
w
ork:

The facilitator will conclude the presentation by giving the participants
an assignment relevant to the topic to be done through working in
small groups of 3
-
5 participa
nts per group


Feedback in plenary: One group member will present the assignment in plenary where after
the rest of the participants will be giving comments on the presentation
made by the group


Feedback by facilitator: The facilitator will conclude the s
ession by summarising the key
learning, considering the training objective as well as the information
derived from the group discussions


Target Group

Although this
curriculum
is
aimed at health managers,
all health workers actively involved in
collectin
g,
processing and
analyzing or using information at facility or dist
rict level will also
benefit from this course.

A
dministrative

and clinical

health
managers who are responsible for
the use of information for management at facility or district level inclu
de:

a.

Information Officers/Managers

b.

Project/Programme Managers

c.

Statistician

d.

Pharmacy Technologist

e.

Laboratory Technologist

f.

Medical Officer

g.

Nursing Sister/Staff Nurse/Nurse Assistant

h.

Mental Health Nurse

i.

Dental Specialist/Officer

j.

Orthopaedic Technologist

k.

Physio
therapist

l.

Health Educator/Counsellor

m.

Environmental Health Inspector

n.

Occupational Health Practitioner

o.

Social Worker


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Timetable and Course Outline

The Use of Information for Management course for health managers is a 3
-
day course.


Day 1

Timeframe

Topic

Trai
ning Content

Learning Outcome

08:30


09:00

Registration

09:00


10:00

WelcomE

&
Introduction



Welcome all participants



Introduce participants to each
other



Determine participants
expectations of the training



Determine training norms



Provide an overview
of the course
content



Participants to complete the pre
-
knowledge questionnaire

The learners should
be able to realize the
strengths and
experiences that they
bring to the training

10:00


10:30

Morning Tea

10:30


12:30

HMIS



Defining a health management

information system



Background and purpose of HMIS



Principles related to a well
functioning HMIS



The information cycle



The planning cycle

The learners should
be able to understand
a health management
information system
(HMIS) with specific
reference to the

Lesotho context

12:30


13:30

Lunch

13:30


15:00




Group exercise


15:00


15:30

Afternoon Tea

15:30


17:00

Manage HMIS



National Health Management
Information System



Management of HMIS at Central
The learners should
be able to understand
management of HMIS

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level



Management of HMIS at District
level



Management
of HMIS at Facility
level

at the different levels
in the Lesotho
MOHSW and the
various role players in
the information system



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Day 2

Time Frame

Training Topic

Training Content

Learning Outcome

08:30


09:00

Recap of
previous day



09:00


10:00

Data and
information



Data types



Data sources



Data presentation



Data quality



What is an indicator



Levels of indicators



Calculating indicators

The learners should
be able to describe
the types of data and

realise the importance
of good quality data.
P
articipants should
also be able to
describe indicators
and understand the
difference between
data and information

10:00


10:30

Morning Tea

10:30


12:30




Group exercise


12:30


13:30

Lunch

13:30


15:00

Process of
analysis



From data to information



Analysis



Presentation



Interpretation



Use of information

The learners should
be able to fulfil their
role within a facility or
district team to use
information for
management

15:00


15:30

Afternoon Tea

15:30


17:00




Group exercise




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Day 3

Time Frame

Training Topic

Training Content

Learning Outcome

08:30


09:00

Recap of
previous day



09:00


10:00

M&E



What is monitoring



Monitoring system



What is evaluation



Carry out evaluation



Why a M&E system



Overview o
f the Lesotho
M&E

The learners should
be able to understand
the link between
information
management and
monitoring and
evaluation (M&E)

10:00


10:30

Morning Tea

10:30


12:30

Practical
exercise on the
contents of the
course (group
work)


The learners sh
ould
be able
to handle
locally generated data
in order to create
current and relevant
information for use in
the management of
district level health
programmes so as to
improve the coverage
and quality of PHC
services

12:30


13:30

Lunch

13:30


15:00

Fe
edback by
groups in plenary

Discussion and
closure





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Module 1:
Lesotho
Health Management
Information System

(HMIS)

AIM OF THE
MODULE
:

Module

1 introduces the principles of
a health management information system
in
relation to the
link between the
inform
ation cycle

and the planning cycle


LEARNING OUTCOME:

By the end of this module participants should be able to understand a health management
information system (HMIS) with specific reference to the Lesotho conte
xt


LEARNING CONTENTS:



Defining a health management information system



Background and purpose of HMIS



Principles related to a well functioning HMIS



The information cycle



The planning cycle


LEARNING ACTIVITY:



Facilitator presentation



Group exercise



Feedbac
k in plenary



Group discussion



1.1

Defining a Health Management I
nformation
S
ystem

A Health
Management
Information System (H
M
IS) can be defined as “a system that
integrates data collection, processing, reporting and use of the information necessary for
i
mproving health service effectiveness and efficiency through better management at all
levels of health services.”


This means that an information system must provide the policy

maker, manager, doctor,
nurse or field worker with the right in
formation in the right place at the right time in order to
assist with their policy

making, decisions, treatment, or whatever support that is possible with
the use of information.



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The important components of a H
M
IS are hardware, software
, people, data and processes,
all working together. People need the skills and knowledge to use and manage information
technology, processes must be in place to effectively get the data and there must be the
relevant and appropriate hardware
and software

programmes to support the process and
people.


T
he

HMIS

in Lesotho serves to capture relevant data on the MOHSW core business thereby
generating necessary information for performance measurement and accountability to
stakehold
ers. In addition the information sets a learning framework defining what is working
and what is not working. Furthermore the information is expected to indicate the efficiency
with which resources are being transformed to service, how results compare with
national
objectives and the effectiveness of organizational activities over time.


The HMIS therefore maintains follow
-
ups to ascertain conformity to priorities and monitor the
extent to which the MOHSW objectives are being achieved. It is in this contex
t that Ministry
is in the process of strengthening the health information system to inform progress and guide
performance measurement in the course of implementing the health sector reforms.


The long term goal is a decentralized, integrated and unified da
ta management system
based on a sound database and appropriate technology capable of addressing the
information needs for all stakeholders in health development. In such settings, districts will
constitute data and information hubs for performance manageme
nt.


1.2

Background and purpose of a HMIS in Lesotho

The health managers need t
ools and systems to obtain, organize and share information
. The
information is needed in order to ensure

health programmes are reaching the intended
targets, measure effects of
programmes or interventions, monitor

health care
and improve
decision making and management of health services. The information is also used for
accountability at various
levels. The

accountability is needed at community, health facility,
district, nationa
l and international levels.


Lesotho, is a member of various international institutions and therefore accountable to
various global initiatives.

T
he government needs to be able to reflect its achievements in
relation to these global goals and therefore mu
st be able to monitor
and report
with accuracy
its performance.



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The

National Health Information System (NHIS
) that

is data and information

is
guided by
t
he

following
principles:



Data to be collected at the point of its generation



Data collection
and anal
ysis
enable
s

service assessment as well as self
-
assessment



Service delivery personnel have

the

responsibility for the collection of
relevant
data
in
their
specific duties


Where feasible, the basic analysis of the data would be carried out at the point of
collection
.
This could enable timely decision making at the point of data collection. However, thorough
data analysis
in Lesotho
is done at district and central level
.
Collection, aggregation and
analysis of data would follow the organisational structure o
f health services; national data
would comprise of the sum of the districts, districts data of the sum of its health facilities.


1.
3

Principles related to a well functioning HMIS

in Lesotho

The decentralised H
M
IS enables
Lesotho
districts to assess whethe
r the goals, objectives
,
indicators

and targets
, based on
annual
operational plans are being achieved.


It has a number of basic principles:



Supports the district based PHC approach



Services are monitor
ed through coherent information



Collects essential data

based on indicators




Collects only the “must know” information needed by the health facilities to monitor
and evaluate local priority PHC programs. User frien
dly, locally relevant, data
collection tools should be provided that can easily be generated by the HMIS
software

at district level. Data quality must also be assured by a number of built
-
in
computer tools and techniques designed to check

the reliability and accuracy of data.



Encourages decentralised planning

and management



Designed to encourage all health workers and local managers to use the information
collected at facilities to monitor progress towards the targets

they themselves have
set.



Includes all service providers at all levels



Information from all health care services, whether they are from local government,
private or government facilities, the community and its various health related
organisation
s, the proper collection of this information, timely analysis and regular
display and use thereof is the “brain” of a district health system

(DHS)



Integrated with and supports other information systems


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Decentralization of HM
IS to the 10
Lesotho
districts is the mainstay of the Ministry‟s attempt
to strengthen the HMIS system. The process take
s

time and resource
s

and

the main
components include;




Development of strong central support system to provide professional back
-
up,
q
uality control and stewardship. So far, an HIMS Unit, ICT Unit and Epidemiology
and Research Units have been established and are being strengthened. To enhance
data use and create demand an M&E unit has also been established.




Draft policies, strategic pla
ns, key indicators, district indicators and data collection
instruments, soft ware have been developed and some are being updated.




Setting and operationalizing district health data offices. This includes the deployment
of appropriate manpower, provision o
f relevant equipment, development of standard
operating procedures and training.


The different components of the HMIS like
I
FMIS,
I
HRIS etc. are at different stages of
development. As they develop, collaboration has been established to ensure future
compa
tibility and avoid duplication. Progressive integration of the components will be
conducted as the subsystems take shape. Traditionally the health data subsystem has been
around for longer than the other subsystems and already integrated disease surveillan
ce is
operational. Strengthening integration of the subsystems especially at district level will be the
second most urgent priority of the Ministry of Health and Social Services.


To some extent the HIV and AIDS Directorate, TB and EPI still maintains a
parallel
information system for some components. As capacity of the district data offices is improved,
these programmes will be urged to join the district data warehouse.


The third and crucial intervention is development of skills and enhancement of appro
priated
technology in data processing. A strategic plan for development of a critical mass of
necessary skills and equipment has been drafted. Provision for introduction of ICT training in
health institutions is made to prepare the future introduction of e
lectronic medical recording
and capacity for application of GIS in health is on development.



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1.
4

The
I
nformation
C
ycle

The principles of data management help you to understand procedures for collection,
storage, processing, analyzing, distribution and us
e of data. An illustrative tool that is used
to define data management is the
‘Information Cycle’.
The information cycle

is a data
management tool and a diagrammatic way of looking at and unpacking information. It
enables you to

see the links between the different phases of collecting data, processing data
by checking quality, analyzing data to obtain information in the form of indicators
, presenting
information in a user friendly way and using the information f
or evidence based decision
making
at local, district

and national levels.


The information cycle
1

presents the key steps in the data handling process which is
applicable to both the users and collectors of health information.


The Information Cycle:















Each stage i
s briefly described below.


Data collection

The data that is collected at facility level is used to calculate the indicators that need to be
regularly monitored and evaluated. Data is collected using tools which consist of registers,
tally sheets and forms. Facility level staff collecting data need to understand the data



1

Source:
Heywood A, Rohde J.
Using
information for action. A manual for health workers at facility level.

Arcadia, Pretoria: The Equity Project, 2001.


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elements that are collected so that this allows for accurate collection and reporting of data on
a monthly basis. The data collection tools must be located at a place
most appropriate in
terms of ease of access and recording of data. The correct use of data collection tools is a
crucial step in obtaining good quality data.


Data Processing

The processing of data involves the summaries and collation of data usually at t
he end of the
month from various registers and reporting forms. The nurse in
-
charge at the clinic is
responsible for ensuring that the monthly data that is submitted to the next level i.e. district
level is of good quality. The Nurse In
-
charge must verify
that that the data is collected from
all service points in the facility for every day of the month from all the staff members in the
facility. The data clerk is responsible for the collation of monthly data which needs to be
signed

off by the nurse in
-
cha
rge before it is submitted to the next level.


Data analysis

Analysis of data involves converting raw data (i.e. numbers) into measurable indicators.
Whilst it is practise for the analysis of data to only be done at district and central levels,
analysis o
f data must also take place at facility level where the data is generated. It is critical
for facility
-
based staff to understand what the analysed data means in terms of the services
that are rendered to communities served and their health status.


Data p
resentation and interpretation

Presentation involves compiling information into a format that is simply and easily
understood and interpreted. Health information can be presented as reports in the form of
raw data tables, indicator tables, graphs or maps.
PHC supervisors need to encourage the
display of information in the form of graphs. One or two key indicators should be compiled
and displayed at the facility on a monthly basis. During supervision visits, data could be
compared to previous month‟s data an
d this data could be used to test the knowledge of
facility staff by asking them about the trends and comparisons in the data and what
implications this has for the catchment population served by the clinic. The presentation of
data in the form of graphs a
nd tables can also be used as a tool to educate community
health workers.


Data use

People generating data are most often in the best position to explain the trends and unusual
fluctuations in data. Data use involves two key elements i.e. decision
-
making

and action. At
facility level staff should be able to use and discuss data amongst themselves and

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community health workers. Based on knowledge and understanding of data and indicators
action can be taken to improve a situation.

The PHC supervisor should
check evidence of information use with every visit and use it for
problem solving. It is important that the supervisor ensures that the monthly data submitted
to the district information office is correct and the decisions taken are based on evidence of
go
od quality data. Support from programme managers should be called in if necessary.


Feedback

While data flows from the point of collection, feedback is a two
-
way process. Feedback plays
a vital role in promoting improved data quality and understanding the

role of information in
health service management. The most basic feedback is simply comments and views on
data that is submitted to district level and more advanced feedback relates to interpretations
and decisions / actions taken at higher levels in the
health system. Feedback on data
submitted should be provided to facility staff and this information must be discussed at
meetings held at the facility. Decisions based on the information should be recorded in the
minutes of meetings for follow
-
up and actio
n.


1.
5

The
Pl
anning cycle

Planning and implementing involves the ability to use information about the past and the
present to make decisions that will lead to actions to improve the future. The outcomes of
planning decisions are “plans” which are statemen
ts of intent concerning how resources will
be used to achieve the goals and objectives stated in the plan. Decisions about the future
require a sequence of steps which are depicted in a continuous cycle called the planning
cycle.


The planning cycle can b
e defined as a recurring process of measurement, analysis and
action designed to improve management. It is also sometimes called the “triple
-
A” cycle:
A
ssessment,
A
nalysis and
A
ction. In this planning cycle, information is at the centre of the
process a
nd analysis of information provides answers to the four fundamental planning
questions:







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Where are we now?


Situation Analysis


Assess the present situation. What information do
we need about health status
, resources and priority
needs in the service area? A complete situation
analysis will use data from a variety of sources.

Where do we want to go?


Planning Tools

What are the goals we wish to accomplish? What
indicators

will we use to measure our progress
tow
ards these goals? What objectives

will we set
ourselves for the next period of time, as we strive to
reach the ultimate goals?

How will we get there?


Action Plans

What is our strategy for action? Who will do what
activities, over what

time period and with what
resources, in order to achieve the targets

we set?

How do we know when we
arrive?

Monitoring

&
Evaluation

What data needs to be gathered to monitor
progress and to evaluate our activities desig
ned to
reach the targets
?


When we have an understanding of the situation; this is often referred to as a situational
analysis. To conduct a situational analysis, the following steps are suggested:

1.

Present the information in a logical

way, maybe in a framework, answering who, has
the problem, what is the problem, why they occur and when and how to overcome
them.

2.

Identify what information is available and the potential sources. There are two
different types of information namely quantit
ative and qualitative

information.
Quantitative

information is based on numbers. Qualitative information is based on
the opinions, perceptions and experiences of people. This information should be
seen as compleme
nting quantitative data.

3.

Identify what information is still required; this may need special surveys to collect the
required data.

4.

Collect the required information within the required timeframe.

5.

Compile and write a report

6.

Distribute the report

Use appropri
ate maps of the area, tables and supporting graphs where necessary.

After understanding the problem, the next step involves using this information to make
decisions regarding change or improvement in the future. Planning requires a clear

Page |
20



understanding of
what it is you are trying to accomplish and then determining at each level,
how you will accomplish that.

Hierarchy of questions to assess progress (Heywood & Rohde: 17)


What questions?







How questions?





I

VISION___________N___________
____MISION




D


Milestones


I

GOALS___________C____________STRATEGY





A



T

OBJECTIVES ______O____________ACTIVITIES



R


S Targets

OUTPUTS_____________________________TASKS



A
vision

is an aspired state of well being and is broad.



The HMIS vision of the Lesoth
o MOHSW is a Health Management Information
System with capacity to maintain continuous support for sector planning and
performance measurement at all levels for knowledge, accountability and judgement
about the efficiency and effectiveness, as well as sust
ainability, of the health and
social welfare system.



A
mission

is the reason of your existence. The mission states how you will achieve the
vision.



The HMIS mission of the Lesotho MOHSW is to provide timely, relevant, accurate
and complete informatio
n on a sustainable and integrated manner, by well trained
and highly motivated staff with necessary resources and appropriate technology.






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21



Goals

are broad and strategies are how you are going to achieve the mission.



The following four s
trategic goals are highlighted in the Lesotho MOHSW HMIS
Strategic Plan: 2008

=
O〱㈻
=
=
d潡l=ㄺ
=
qo=獴r敮gt桥n=捯潲摩湡ti潮=慮搠m慮agem敮t=of=桥慬th=informati潮=獹獴敭
=
d潡l=㈺
=
qo=im灲潶攠摡t愠q畡lityI=獹獴em=桡rm潮iz慴楯渠慮搠楮tegrati潮=慴=all=l敶els
=
d潡l=P

qo=im灲潶攠桥慬t栠摡ha=m慮agem敮t=at=摩獴ri捴=l敶敬s
=
d潡l=Q

qo=獴r敮gt桥n=摡t愠慮慬y獩猬=摩獳smi湡ti潮=慮搠畳d=慴=t桥=灯i湴=of=捯cl散瑩en
=

Objectives

are immediate results to be achieved in order to attain the goal. An objective is
action oriented. The

objective must be SMART:

S


Specific:


M


Measurable:



A


Achievable:

R


Relevant:


T


Time bound:



Access to reproductive health services increase from 20 to 70 by rural Basotho by
December 2015.



Activities

are planned tasks to accomplish objec
tives
,



Facilitate training of 20 health information officers in Data Management



The tasks achieve the
outputs
.



20 health information officers trained in Data Management




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22



Indicators

are markers that show the progress or lack of
it. Effective programme
implementation relies on monitoring and evaluation. This depends on tracking relevant
indicators. You could only monitor progress




Infant Mortality Rate (IMR) is defined as the number of infant deaths in a year per
1,000 live bir
ths during the year. A live birth is defined as a fetus or product of
conception that on expulsion or extraction shows signs of life, e, breathing, beating of
the heart, umbilical pulsation etc.





Total # of babies who die before first birth day i
n a year

IMR =


______________________________________ x 1000



Total number of live births

for the same period



Targets

are milestones that show when you have arrived.



The following five strategic targets are highlighted in

the Lesotho MOHSW HMIS
Strategic Plan: 2008

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O〱㈻
=
=
q慲来t=ㄺ
=
A=䙵湣ti潮慬=ai獴ri捴=e敡lth=j慮慧敭敮t=fnformati潮=py獴敭=批=㈰ㄲ=i渠慬l=
㄰=摩獴ricts
=
=
q慲来t=㈺
=
fntegrat敤=慮d=桡rm潮iz敤=摡ta=捯cl散瑩e測nm慮ag敭敮tI=慮慬y獩猬=獨sri湧=
慮搠畳攠at=慬l=l敶敬s
=
批=㈰ㄲ
=
=
q慲来t=㌺
=
sit慬=oegi獴rati潮=捯c敲慧e=of=㠰┠慮d=慢潶攠批=㈰ㄲ
=
=
q慲来t=㐺
=
e敡lt栠摡t愠qu慬ity=t桡t=m敥ts=t桥=ejkLtel
O
=
d潬搠却慮摡r摳=by=㈰ㄲ
=
=
q慲来t=㔺
=
bvi摥湣n
-
扡獥s=inf潲m慴楯n=i猠畳u搠to=慣ai敶攠摥獩r敤=r敳elts=慴a慬l=l敶敬s=
批=㈰ㄲ
=
=


I
f you

have a system in place;

Health Management Information System comes into play.




2

HMN/WHO


Health Metrics Network/World Health Organisation


Page |
23




1.5

Group exercise


Divide participants into small groups of
5
-
10

participants per group. Explain the
exercise and tell groups to each appoint a presenter who will give feedba
ck in
plenary. Provide groups with flipchart paper and pens.


Exercise:


1.

The MOHSW M&E Head is coming to the health centre/district and you and your
team have been asked to prepare a poster on
HMIS
. Draw up a poster illustrating
the different stages in th
e information cycle
and planning cycle
and
use this to
explain
how well
HMIS

is functioning

in your facility/district
.


2.

Draw up a poster using the
information and operational plan template below
.



SEXUAL AND REPRODUCTIVE HEALTH
(Safe motherhood)

Indi
cator


Performance

Proportion of pregnant women provided with ANC by
health professional



Use the information provided above to complete the Lesotho district operational
plan template below.






Page |
24



Module 2: Managing HMIS in Lesotho

AIM OF THE
MODULE
:

Module

2

aims to familiarise the participants with the management of information at
facility, district and central levels



LEARNING OUTCOME:

By the end of this module participants should be a
ble to understand
management of HMIS at
the different levels in the Lesotho MOHSW and the various role players in the information
system


LEARNING CONTENTS:



National Health Management Information System



Management of HMIS at Central level



Management of HMI
S at District level



Management of HMIS at Facility level


LEARNING ACTIVITY:



Facilitator presentation



Group exercise



Feedback in plenary



Group discussion



2.1

National Health Management Information System

As you have read previously, A Health Management
Information System (HMIS) can be
defined as “a system that integrates data collection, processing, reporting and use of the
information necessary for improving health service effectiveness and efficiency through
better management at all levels of health se
rvices.”


If we add the word „national‟ to this, we are therefore saying that a National Health
Management Information System does all of the above on a national level for the whole of
Lesotho.


Key objectives of a National HMIS



Strengthen the use of info
rmation for management and planning

purposes


Page |
25





Improve access to updated health information to relevant stakeholders



Assist in improving the quality of data



Strengthening of monitoring and evaluation

at all levels of th
e health system



Contribute to health and management information and related policies.



Develop and distribute relevant health information materials



Share information and lessons learnt in health information in the country


Essential data sets

Collecting
data costs money in terms of the staff that have to be paid, as well as the time
and effort it takes to collect and validate the data. If too much information is collected, you
may end up with poor quality data which is a waste of resources.

One principle

to be followed is that
ONLY
essential data
; i.e. the information that you really
need to know in order to manage the health system efficiently and make key decisions
should be collected.

The National Indicator Data Set

This is a set

of indicators

that are collected at every health facility in the country and sent to
the MOHSW for use in making decisions. It is seen as the
minimum

number of indicators

needed for the country.


It is important to unde
rstand the roles and responsibilities of the key players involved with
data management at the various levels in the health system. Health information personnel at
each of these levels have a critical role to play in ensuring that data gets captured and
sub
mitted to the next level until it reaches the national level.


2
.
2

Management of HMIS at Central level

The National Health
Management Information System

Unit plays a critical role in setting up
standardised Information Systems for collecting health informa
tion from the various levels.
Support to the districts in establishing and maintaining of the Health Information System
remains one of the main tasks of the Information Unit. The key roles and responsibilities of
the Unit are:


1. Policy development and i
mplementation



Implementation of national HIS policies and directives.


Page |
26





Development of national policy

for health information in consultation with the relevant
role players.



Communication of national policies and/or directives to the health
area management
structures and districts to ensure uniform implementation.



Monitoring

and evaluation

of policies and and/or directives to assess applicability and
success of implementation.


2. Planning



Development of
a business plan for the implementation of health information
systems. The plan should address amongst others, national objectives

and priorities,
training and skills development, IT requirements, procurement
, support
, timeframes,
roles and responsibilities and monitoring and evaluation

strategies.



National budget

preparation and support to the districts on HIS budget
.



Establishment of a National Health Information Commi
ttee (NHIC) in accordance with
legal imperatives.


3. Training and development



Development of a core team at national level to provide needs
-
based HIS training to
district and national level staff.



Development of monitoring mechanisms to assess the succe
ss and outcomes of
training on the implementation of HIS i.e. measuring the impact of training on the
quality of data, time
ly
submission of data and quarterly reports produced by districts.



Development of a training programme/plan based on an assessment of

HIS training
needs at facility, district and national level.


4. Coordination of all Health Information



Co
-
ordinate and maintain a central data repository of information.



Integrate, where appropriate, vertical data collection systems into the current rout
ine
data

collection system.



Ensure that all ad
-
hoc information needs, surveys and additional information required
from facilities are channelled through the Information Unit.


5. Support to health management areas and/or districts



Prov
ision of support to districts with regards to IT requirements, procurement

and
maintenance, including e
-
mail, intra
-
and internet.


Page |
27





Act in an advisory capacity to district management structures with regards to
planning

an
d provisioning of HIS human resources to ensure the successful
implementation of HIS as an integrated health system activity.



Establish a monthly forum for DIOs.



Provide technical guidance to DIOs in conducting an annual information audit.


6. Data timelin
ess and quality



Ensure submission of monthly data according to the data flow policy
.



Implement sustained strategies for monitoring data quality.


7. Feedback



Monthly feedback to districts on data quality, timeliness and submission rates.



Ge
neration of quarterly standardised programme reports.



Monitoring

and evaluation

of the use of information to build capacity in the analysis
and interpretation of information.


The above
-
mentioned roles and responsibili
ties of the National Health Information Unit
should not be seen as a complete list. It is imperative for the information unit to maintain
communication with all directorates within the MOHSW and districts to ensure
standardisation, optimal use of availabl
e resources and information to overcome duplication
and fragmentation of health information.


2
.
3

Management of HMIS at District level

Accurate and complete data collection is the foundation of a good district data management
plan
3
.


Data Quality Assuranc
e

All district health data offices will ensure that their data meet standards of reliability,
transparency and completeness in line with the recommended Data Quality Assessment
Framework. Five dimensions are considered in this framework;



Maintaining data
integrity



Use of methodological sound procedures



Ensuring of data accuracy and reliability




3

Framework and Standards for Development of Country HMIS
-

WHO and HMN


Page |
28





Ensuring data serviceability



Maintaining data accessibility


Procedures for Maintaining Data Integrity at the District Level



Professionalism and professional compete
ncy should be exercised by the office
bearers. The DHIO will attempt to build well trained health personnel, motivated to
use data for decision making.



Data products should be appropriately managed and shared in a transparent
manner. Rules of engagement w
ith relevant stakeholders are spelled in the HMIS
policy.



Ethical standards as described in the National HMIS policy are adhered to.


In pursuance of the above the key person on HMIS at district level will be a trained
statistician with the under mentioned

duties.


Job Description for
-

District Health Information Officers


Job Purpose:

To support the District Health Management Teams (DHMT) through

provision of relevant, timely, accurate and useful data for service
management accountability and learning.


Ministry
:


MOHSW (initially and latter to Local Authorities)


Division
:


District Health Teams


Directly Responsible to:

District Director of Health and Social Services



Responsible for
:


Medical Record /Data Clerks



Requirement
s:

Degree in Statistics or

Demography



Main Duties:


1.

To co
-
ordinate and supervise the total collection of quality health data as well as the
updating and maintenance of the District Health Management Information System
databases.


Page |
29



2.

Responsible for coordination of collection, compi
lation, analyzing, and interpretation
of health data and promote use for the improvement of health service delivery at
district level.

3.

Provide support and capacity building to medical record clerks and individuals in the
management of health data and infor
mation

4.

Work with PHN to compile both summary and comprehensive health data and
information reports on the status of health and health delivery service in the district of
assignment.

5.

Contribute constructively and critically to appropriate policy developmen
t and
implementation in the district, based on sound and verified data and information
resource.

6.

Member of the District M&E committee.

7.

O
ther
duties as

service might demand.


To
fulfil

the above duties, the officers will maintain;



a list of all health facil
ities in their district of jurisdiction (GOL and Private) and update
it on annual basis.



an annual checklist of expected reports in and out of the district for all the facilities
including DHMT showing dates when the reports were received or dispatched.



a system of follow
-
up of none reporting stations, a system of support and training of
district health personnel on data management and use.



a sufficient stock including buffer stock for all data collection and processing tools for
all programmes.



district
capacity to enter , clean verify and validate all health data in the district of
jurisdiction.



a system of data compilation, analysis, publication as well as dissemination


Data Entry Procedures at District Health Office


Data Recording at District Leve
ls



In line with HMIS policy, recording of health data will be undertaken daily while
reporting will be done weekly, monthly or quarterly depending on the requirements of
the programmes concerned. Prescribed formats for recording and reporting should
be us
ed and DHIOs should supervise and support both processes.



Page |
30





DHIO will organize regular update training for recording and transcribing clerks to
improve quality of reports.




The DHIO will on quarterly basis match a sample of data reports from randomly
selec
ted facilities to their corresponding registers to ascertain consistence and
concordance in transcription.




DHIOs will establish a system of following transcription errors to the source and
ensure correction.


Data Keying at District Level

Each DHMT will

maintain one or two data clerks to key the health data in formats and
software‟s prescribed by the relevant authorities. These officers will work under the direction
of the DHIO. The Statistics Unit at the MOHSW in consultation with the ICT Unit will
pres
cribe standard soft ware and format to be used by all districts for data capture so that
data can be easily merged. To ensure quality keying, most of the soft ware in use has been
configured to allow only valid data in most fields whenever possible.


Data
Flow at the DHMT




Job Description of District Data Clerks


Register
and Tick
Register
and Tick
Check Error,
Track Errors,
Check
completeness
Check Error,
Track Errors,
Check
completeness
Cleaning,
verification
validation and
aggregation
Cleaning,
verification
validation and
aggregation
Data
Keying
Data
Keying
Reports from
Facilities (By 15
th
of
following month)
To DHIO
To District Data Clerk
Data report to
MOHSW
Analysis report
to DHMT
Data report to
MOHSW
Analysis report
to DHMT
To DHIO
By the30
th
of following
month


Page |
31



Job Purpose:

Facilitate capture and compilation of the health and social welfare
activity data at district levels.


Job Title
:


District Health Data Capture Operator


Responsible to
:

District Health Information Officer (DHIO)


Department
:


Primary Health Care


Programme
:


District


Ministry
:


Health & Social Welfare


Objectives of the post

1.

To capture health data in line with prescribed formats and soft ware.

2.

To supervis
e collection of health data from all district facilities

3.

To maintain an inventory of reporting institutions and expected reports.

4.

Order and distribute HMIS stationery


Key Performance Outputs



District electronic database for health activities



Adequate HMIS

stationery



90
-
100% reporting completeness


Receivers/Clients



District Health Information Officer



Data clerks in all district health facilities



Community



NGOs


Range/Context Variable

1. Work normal working hours.

2. Extensive interaction with data clerks
at hospital and staff at H/C





Page |
32



Sub
-
outputs


D

W

M

Q

HY

Y

1.

To capture health data in line with prescribed
formats and soft ware









Routine data from monthly returns is captured

x








Data verification is implemented


x







Database is certified a
nd transferred to DHIO
every second Friday of the month.



x




2
.
To supervise collection of health data from all
district facilities









An inventory of all GOL, CHAL and private health
institutions in the districts






x



List of facilities that re
ported against expected
reports every month



x






District supervision on health data recording




x





Reports from non reporting facilities




x



3. Order and distribute HMIS stationery









District budget for HMIS stationery






x



Adequate s
tock of HMIS stationery at district
level



x






Adequate stock of HMIS stationery at all facilities.


x







Performance Indicators



Number of due statistical reports timely received



Percentage of the monthly returns not capture electronically by the en
d the month



Completeness of reports



Number of facilities visited



No of planned supervision visits accomplished


Competencies:


Knowledge



COSC with at least pass in Mathematics and English



Computer literacy will be an added advantage.



Page |
33



Skills



Working know
ledge in MS Windows is an advantage



Arithmetic skills



Data processing skills


Attributes



Pay attention to details



Self motivated.



Honest.


Data Cleaning Procedures at District Health Offices

Data cleaning in
the Lesotho

context refers to the process of
detecting

and
removing

errors
and inconsistencies from a data set in order to improve the quality. The DHIO is responsible
for establishment and overseeing the existence of functional and systematic data cleaning in
the DHMT.


Methods for data cleaning

The priori assumption for each DHIO is that the dataset contains some errors until proved
otherwise. If the errors are not corrected they might lead to drawing wrong conclusions.

The
starting point for data cleaning is,



honesty and disciplined systematic a
pproached to the task.



the next step is to anticipate common sources of error and check for their integrity.



Common sources of error



missing data coded code as „999‟
=


not applicable left as blank or „0‟
=


ty灩湧 敲r潲, 捯ci湧 敲r潲, 獰slli湧 敲r潲 整e.




t愠f潲 潮攠捯eum渠敮ter i渠t桥 慤j慣ant 捯cum渠



„made up data‟

=
摩獨sn敳琠k敹i湧I=i湥ligi扬攠eriti湧=潲=摩慧湯獩s
=


m敡獵牥m敮t error猠or i湴敲vi敷 敲e潲猠摵ri湧 捯ll散瑩e渠nf r慷 摡ta



tr慮獣ri灴楯渠nrror猬 mi獳灥lli湧, mi獤s慧湯獩s



r敤畮摡湴 or v慬略 摵灬
i捡瑩cn



捯ctr慤ict潲o v慬略s



湡mi湧 潲 str畣t畲慬 捯cfli捴s


Page |
34





inconsistence in aggregating



inconsistence in timing etc.



Detection and Correction of Errors

Two main methods of error detection are proposed for all DHIOs,



manual inspection of the data and v
alidation



rapid inspection of descriptive outputs of the data


e.g. frequencies or scatter plots.
In a frequency print
-
out, look for common causes of data errors and if the responses,
summaries, conclusion etc. are logical e.g.


look for things like occ
urrence of an
abortion in one year old.


Data verification and validation

Data verification is a systematic process for evaluating performance and compliance of a set
of data when compared to a set of standards to ascertain its completeness, correctness,

and
consistency.
On the other hand,

data
validation

is the process of ensuring that a programme
operates on clean, correct and useful data. It
involves checking

that the data are valid and
sensible/reasonable before they are processed. In pursuance of the

above tasks, it is
proposed that
DHIO systematically

look thorough the data as follows;



Checks and confirmation that the data is in a specified format



Checks and confirmation that the data lie within a specified range of values, e.g.,
age = adult or a
ge = 0 don‟t make sense.



Checks and confirmation that important data are actually present and have not been
missed out, e.g., name of the facility from where the data came from etc.



Checks and
confirmation

of the use of prescribed codes e.g
.

ICD 1
0



Checks and confirmation
correction

of missing records.


Once errors are detected, the DHIO is expected to;



deal with the immediate error causes like spelling, etc. or



review the raw data sheet and arrange for re
-
entry



Phone or visit the respective

facilities for clarification



if the error variables are minimal the field can be treated as if it carries missing data.


Use of methodological sound procedures

Currently the IP data is coded using the WHO recommended format
-

ICD10. In future efforts
wil
l be exerted to format the OPD data in the same manner.


Page |
35




Ensuring of data accuracy and reliability

What DHIO should do to improve the quality of data;



Maintain focus on the minimum data set as advised by the MOHSW Statistics Unit



Undertake regular loca
l quality control visits to all facilities at least twice a year.



Ensure regular local data use



Maintain and use clear definition of data elements (metadata dictionary will be
developed by MOHSW Statistics Unit)



Conduct training of data provider and data

users



Maintain frequent feedback to those collecting and using


Ensuring data serviceability

Districts will collect and report only approved data. Timely processing and reporting is also
important.



Facilities will notify to DHMT weekly notifiable diseas
e every Monday morning.



Facilities will daily collect and monthly compile all health activity data for their
catchment area and report to DHMT attention DHIO by 15
th

of the following month.



The DHIO to organize the capture, cleaning and validation of all h
ealth activity data in
the district of jurisdiction and send electronic copies to MOHSW Statistics Unit by 30
th

of the following month.


Maintaining data accessibility

The DHIO will promote data use at district level through;



Production and dissemination
of Quarterly District Statistics Summaries (use format
as advised by the Central Statistics Unit)



Support DHMT in using the data to monitor their Annual Operation Plan



Establish baseline and annual update of the District Essential Indicators.



Participate
in hospital mortality review meetings, operational research undertaking
and district planning.



Orientate DHMT staff on data analysis.



Participate pre
-
service data management training for districts with training.





Page |
36



2.
4

Management of HMIS at Facility level


The data that is collected at facility level is used to calculate the indicators that need to be
regularly monitored and evaluated. Data is collected using tools which consist of registers,
tally sheets and forms. Facility level staff collecting data nee
d to understand the data
elements that are collected so that this allows for accurate collection and reporting of data on
a monthly basis. The data collection tools must be located at a place most appropriate in
terms of ease of access and recording of dat
a. The correct use of data collection tools is a
crucial step in obtaining good quality data.


The processing of data involves the summaries and collation of data usually at the end of the
month from various registers and reporting forms. The nurse in
-
cha
rge at the clinic is
responsible for ensuring that the monthly data that is submitted to the next level i.e. district
level is of good quality. The Nurse In
-
charge must verify that that the data is collected from
all service points in the facility for ever
y day of the month from all the staff members in the
facility. The data clerk is responsible for the collation of monthly data which needs to be
signed

off by the nurse in
-
charge before it is submitted to the next level.


The key roles and responsibilitie
s of the
facility data clerk

are:


Data collection



Ensure all staff has the same understanding of data element

definitions.



Collection and collation of routine monthly summary data.



Check the quality of data for completeness, consiste
ncy and correctness and make
amendments as required.



Sign off the data by the relevant manager and submit to the next level acc
ording to
data flow procedures.


Data processing and feedback



Calculate key indicators

for the month



Graph key

indicators

and ensure that these are displayed prominently on facility walls
e.g. in

the waiting areas



Discuss the quality of data with staff at the facility or ward level once a month during
a staff meeting.
Support the facility managem
ent team to compile

action plans to
improve the situation.



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37



2.5

Group exercise


Divide participants into small groups of
5
-
10

participants per group. Explain the
exercise and tell groups to each appoint a presenter who will give feedback in
plenary. Provi
de groups with flipchart paper and pens.


Exercise:

Define the role of the following MOHSW staff in terms of the use of HMIS:

1.

Data Clerk at facility level

2.

Nurse at facility level

3.

Facility manager/management

4.

Data Clerk at district level

5.

District Health Info
rmation Officer

6.

District Management Team



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38



Module
3
:
Data and
I
nformation

AIM OF THE
MODULE
:

Module

3 aims
at
familiaris
ing the participants
with the types of data
and indicators
that are available within the information system



LEARNING OUTCOME:

By the end of this module participants should be able to describe the types of data
a
nd
realise
the importance of good quality data
. P
articipants should
also
be able to describe indicators
and understand the
difference
between data and information


LEARNING CONTENTS:



Data types



Data sources



Data presentation



Data quality



What is an indicator



Levels of indicators



Calculating indicators


LEARNING ACTIVITY:



Facilitator presentation



Group exercise



Feedback in plenary



Group d
iscussion



3.1

Data types

There are two types of measurements (data).
The

measurements (data)
are broadly divided
into qualitative and quantitative. I
n health care
the data are found in

health
facility

(facility
based)
and
communities (community based).


Qualitative data

This is “soft” data. The
se

data look at quality and provide answers to reason for doing things.
The data are not measure data in terms of numbers, and this makes it difficult to quantify.
The data measure
attributes

feelings perceptions
and characteristics of an issue e.g. asking
TB patients the reasons why they default on treatment.


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39



Qualitative data describes a phenomenon and experiences, whereas quantitative data
measures the phenomenon.


Quantitative Data

Quantitative

data
are data that measure
in terms of numbers or numerical measurements.
The measurements that could be counted for example 200 women attended antenatal clinic
in the month of November 2010.

Th
e
data
are
often collected in experiments, manipulated
an
d statistically analyzed. Quantitative data can be represented visually in graphs and
charts.

Examine the differences between qualitative

and quantitative data.

Qualitative Data

Quantitative

Data

Overview:




Deals w
ith descriptions.



Data can be observed but not
measured.



Colour, textures, smell, taste,
appearance, beauty, etc.



Qualit
ative →
Qualit
y

Overview:



Deals with numbers.



Data which can be measured.



Length, height, area, volume, weight,
speed, time, temp
erature, humidity,
sound levels, cost, members, ages,
etc.



Quantit
ative


Quantit
y



Example 1:

Oil Painting


Qualitative data
:



blue/green color, gold frame



smells old and musty



texture shows brush strokes of oil
paint



peaceful scene of the country



masterful brush strokes




Beautiful mountains in Lesotho

Example 1:

Oil Painting


Quantitative

data:



picture is 10" by 14"



with frame 14" by 18"



weighs 8.5 pounds



Surface

area of painting is 140 sq. in.



cost $300




The facility based data are data fo
und within the health facilities and the community based
data are the data set found in the communities. When planning to collect data, you need to
think of where the data is based (source
s). The data collection method is decided by the
sources of the data
. For example number of patients on first line of TB treatment could only

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40



be found in the health facilities and the level of satisfaction with health care is community
based.


You could combine qualitative and quantitative data in reports,
i.e.

in Novembe
r
2010, the outpatient utilization rate increased by 90% because the health facility provides
best services.


3.
2

Data sources

In this section, the reader is provided with an overview picture about the sources of data in
health care.


Patient Records

An

individual patient record is the portion of a client‟s health record that is made by doctors
or nurses and is a written or transcribed history of various illnesses or injuries requiring
medical care, including inoculations, allergies, treatments, prognose
s, and frequently health
information about immediate family, occupation, and military service.


It is the property of the patient although is usually kept in the health facility. It is the legal
record of all treatment administered to the patient. Patient
records will be discussed in more
detail later.


Routine data

This is the data that
are

collected every month by all health facilities. It forms the basis of
measuring all the indicators
. It measures indicators

that can
change over a relatively short
period of time. This is the information that you will be collecting and working with most of the
time.


Survey Data

Survey data
are

collected from a survey. This is where
data are
collected from a sample
group of people which

is
supposed to
be representative of the
total
population

of interest.
For example, if one was conducting a survey, one would have to make sure a broad
selection of the target group was interviewed; otherwise the results may not be reliable

and
valid
.


Cen
sus Data

In a survey you choose part of the population to represent the total population. In a census,
the data are collected from all the population of interest
.

In most cases, the census is done
every two years. It is a costly exercise. The data in cens
us relates to
population, geographic

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41



trends

and the economy. Census data are used in a multitude of ways. This data
are
used to
allocate government resources and determine where additional resources are required. It
measures a wide variety of indicators

relating to educational status, employment status,
access to water and sanitation, as well as counting the population. Th
e

data
could also be
used by
entrepreneurs
to
evaluate business opportunities, consumer preferences, and
competitive st
rategies, as well as locate the best geographic sites for new businesses.


3.
3

Data presentation

Data could be presented or organised as a group or by sub
-
groups. When the data are
presented in one form, they are called aggregated dat
a
. For example 200 pe
ople started
ART treatment
at Queen 2 hospital

in November 2010. The data does not show the number
of number of people by age and gender. It is impossible to distinguish an individual patient or
facility in aggregated data. It is difficult to make good de
cisions with aggregated data. In the
case above how could you plan for ART using the above data?


It is important to disaggregate the data. This means presenting the data in groups like age,
sex, type of health facility, area of residence and many more. W
hen the data are
disaggregated, you get a clear picture, for example number of <5 children, women, men,
women, boys and girls on ART. Please note that data could be aggregated or disaggregated
at any level based on the use of the data by the stakeholders.
It is important to have a health
management information system that could aggregate and disaggregate the data.


3.
4

Data quality

Accurate, timely and accessible health care data plays a vital role in the planning,
development and maintenance of health ca
re services. Poor data means poor decisions.


Good quality data facilitates:



Good decision making



Appropriate planning



Ongoing monitoring

and evaluation



Improved coverage