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EVALUATING THE DISTRICT HEALTH INFORMATION SYSTEM (DHIS) IN THE NORTH WEST PROVINCE Prof M Lubbe and Dr Petra Bester Faculty of Health Sciences Provincial Research Conference 2 October 2014, Big 5 Boardroom, New Office Park, Mahikeng
DISCUSSION POINTS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Background to project initiative General aim and focus Specific research objectives / Phases of the study Study sites Study population Data collection instruments Ethical consideration Risk analysis Operational plan Research team
Background to project initiative In terms of Section 74(1) the National Health Act (Act 61 of 2003) the National Department of Health (NDo. H) of South Africa is required to facilitate and coordinate the establishment, implementation and maintenance of routine health information systems at all levels: “facilitate and coordinate the establishment, implementation and maintenance of the information systems by provincial department, district health councils, municipalities and the private health sector at national, provincial and local levels, in order to create a comprehensive national health information system”. In South Africa, routine health information are collected routinely for the District Health Information System (DHIS) - crucial for informed health service planning, monitoring and reporting.
Background to project initiative • The District Health Management Information System (DHMIS) Policy 2011 defines the requirements and expectations to provide – – comprehensive; timely; Reliable; and good quality routine evidence for improving health service delivery. • Strategic objectives of the policy – to strengthen monitoring and evaluation through standardisation of data management activities; – to clarify the main roles and responsibilities at each level for each category of staff to optimize completeness, quality, use, ownership, security and integrity of data.
Status of DHIS in the North West Province 1. 2. • Significant investment of time/money into data collection, capturing, collation yet lacking quality control; insufficient analysis/interpretation, limited use for decision-making, absent reciprocal feedback-loop. • Fragmentation, separate information systems, resulting in conflicting official information. 3. • Although vast amounts of information were generated on different health systems levels, the data aren’t used optimally, especially for managerial purposes. 4. • Different methods of data collection (manual-, paper-based tools [registers and tick sheets]) captured into an electronic database and exported to different health system levels. 5. • Concerns regarding data quality in un-standardized data collection processes, due to insufficient norms/ standards/guidelines on data collection tools; 6. 7. • Poorly defined/un-standardized indicators; indicators changed without notification. • Shortage data capturers/info clerks - data capturing conducted by staff members not designated to drive DHIS.
General aim and focus • to evaluate the DHIS in the Dr. Kenneth Kaunda and Bojanala Platinum Districts in the North West province. General aim • be on quality, affordability, accessibility and sustainability of processes and systems. Focus
Specific research objectives and phases of the study PHASE 1 PHASE 2 PHASE 3 PHASE 4 • To assess the input factors (technical, organisational and behavioural factors) that may influence the DHIS. • To assess processes factors ( including the collection, transmission, processing, analysis, display, quality checking of data and feedback) in the current DHIS. • To measure DHIS performance needs by evaluating data completeness, quality and comprehensiveness of the indicator data sets utilised in the DHIS. • To determine current, regular uses of DHIS information by all stakeholders for managerial/patient care decisions, aimed at improving performance of entire system on provincial level.
Municipalities in two districts Municipality within Bojanala Platinum District Municipality within Dr Kenneth Kaunda District (with major towns/cities) Ventersdorp Kgetleng River Tshing, Ventersdorp Borolelo, Derby, Koster, Nooitgedacht, Reagile, Swartruggens Maquassi Hills Madibeng Wolmaranstad, Makwassie, Leeudoringstad Brits, Ga-Rankuwa, Hartebeespoort, Mooinooi, Pelindaba, Sonop Matlosana Moretele Buffelsfontein, Dominionville, Hartbeesfontein, Makapanstad Jouberton, Kanana, Khayalihle, Khuma, Klerksdorp, Orkney, Stilfontein, Tigane, Vaal Reefs Tlokwe Moses Kotane Ikageng, Mohadin, Potchefstroom, Promosa Bafokeng, Dinokaneng, Mogwase, Sun City, Zwartklip Rustenburg, Rooikoppies, Kroondal, Bafokeng
Detail study sites Hospital level Provincial level District office (2) Sub-district offices (9) • Regional(2) • District(8) • Specialised hospitals(2) PHC facilities • CHC / CDC (39) • Clinics (116) • Mobile (19) • Satellite (6) Non-facility health programmes • EMC • EH • Integrated school health • Ward based outreach
Study population LEVEL OR INSTITUTION PROPOSED STUDY POPULATIONS Provincial level Provincial health information officer District office CEO, District health information officer, Data capturers (Data. C) Administrative officer, IT head / officer Sub-district office CEO, Sub-district health information officer Data. C, Administrative officer, IT head / officer. Hospital level CEO- Hospital, Clinical Head – hospital. (Regional, district, specialised) Hospital health information officer, Data. C, Administrative officer in information office, Administrative Officers (clerks) / Data. C in Wards/ Units, Unit heads / Operational manager of units and wards (HCP) IT head / officer. PHC facilities Operational manager (HCP) (CDC, CHC, clinics, mobile clinics, satellite Administrative Officer (clerks) (if available) clinics) Data. C (if available) Non-facility programmes Emergency Medical Services (EMS) Director, Station officers, Shift head, Administrative officers, Provincial health information officer Environmental Health (HE) Unit head (HCP), Administrative officers Integrated School Health programme Unit head (HCP), Administrative officers Ward Based outreach programme Unit head (HCP), Administrative officers
Face-to-face interviews with a structured questionnaire Structured questionnaires Le vel of car e/f aci lity typ e Data collection instruments Surveys form (Diagnostic instruments) completed during faceto-face interviews and observations Combination of national and international validated data collection instruments
Data collection instruments according the different Phases Phase 1 Assessment of the input factors that may influence the DHIS. Structured questionnaires for Face -to-face interviews (7 individual questionnaires) Structured questionnaires (6 individual questionnaires) Phase 2 Evaluation of different processes, including the collection, transmission, processing, analysis, display, quality checking of data and feedback, in the current DHIS. Survey forms (Diagnostic instruments) will be completed during face to face interviews and observations of existing routing health information (documented during the past two year period. ) (> 6 different survey forms)
Data collection tools according the Phase 3: Measurement of DHIS performance needs by evaluating data completeness, quality and comprehensiveness of the indicator data sets utilised in the DHIS Survey forms (Diagnostic instruments) will be completed during face to face interviews and observations of existing routing health information (documented during the past two year period. ) (> 6 different survey forms) Phase 4: Identification of current regular utilization of routine health information by all stakeholders for managerial and patient care decisions, aimed at improving the performance of the entire system on provincial level. Structured questionnaires for Face -to-face interviews (7 individual questionnaires) Structured questionnaires (6 individual questionnaires)
Ethical consideration • Confidentiality agreement - all researchers involved in the study protocol. • Consent to access facilities for data collection. • Informed consent will be obtained from all participants at all levels. • Ethics clearance from – Health Research Ethics Committee (Human) of the Faculty of Health Sciences, North-West University – North West Department of Health.
Operational Plan Development of operation plan / MOU / budget planning July-August 2014 Development of research protocol, data collection instruments and ethics application (22 Oct) August – November 2014 Training of fieldworkers / co-researchers January 2015 Fieldwork in DKKD January – February 2015 Fieldwork in Bojanala Platinum District February – March 2015 Fieldwork in Non-facility programmes and Provincial level February – March 2015 Data capturing and validation of data February – April 2015 Statistical analysis March – April 2015 Collaborative report writing 1 May – 30 June 2015 Dissemination of results 1 July – 31 July 2015
Research Team RESPONSIBILITY INDIVIDUAL Implementing Entity. Head of Department (HOD), Mr. Andrew. Kyereh Manager Of Project NW Provincial Do. H Dr Andrew Robinson (Provincial Clinical Head, Do. H NW Province) Research Consultant (NWU DHIS Project team) MUSA: Medicine Usage in South Africa INSINQ – Quality in Nursing and Midwifery
NWU DHIS Project team RESPONSIBILITY INDIVIDUAL Project Manager (PM) Prof MS Lubbe Operational Manager (OM) Dr P Bester (INSINQ) Principle investigators from INSINQ and MUSA Mrs J Clase (INSINQ) and second PI to be confirmed. / School of Pharmacy Liaison officers Mrs D Griessel, Mrs W du Plessis Data analysis coordinator Dr J Burger Research assistants (Fieldwork / Data capturing) Post-graduate students of MUSA Statistical support Mrs M Cockeran, Mr A Bekker Ethical support Mrs I Kotzé, Mrs M Cockeran, Prof M Greeff (ad hoc) Administrative support Mrs E Oosthuizen (MUSA), Ms A Bekker
DHIS Project team RESPONSIBILITY INDIVIDUAL Co-investigators from the NWU • Personnel of Pharmacy Practice • Personnel of Clinical Pharmacy • Personnel of MUSA Internal consultants Prof M Viljoen (Acting Director: School of Nursing Science) Dr K Minnie (Director: INSINQ) Prof S van Dyk (Director: School of Pharmacy) Co-investigators from DKKD and Bojanala Platinum District Do. H All Hospital Information Officers. District Health Information Officers. Sub-district Health Information Officers. IT Head of hospitals and District Offices. A sample of Operational managers of PHC facilities in each district. District Pharmacists in Dr Kenneth Kaunda and Bojanala Platinum districts.
Operational Plan Development of operation plan / MOU / budget planning Development of research protocol, data collection instruments and ethics application Training of fieldworkers / co-researchers Principle investigator? Ethics and statistical support Co-investigators - to help develop data collection instruments Fieldwork in DKKD Fieldwork in Bojanala Platinum Districts Co-investigators and research assistants Fieldwork in Non-facility programmes and Provincial level Data capturing and validation of data Statistical analysis Research assistants Collaborative report writing Co-investigators Dissemination of results