Health Information System “Consumers’ perspective” Gunnar Bjune March 2014 g. a. bjune@medisin. uio. no
Three fundamental issues n The health problem n n The service delivery n n Prevalence, incidence, ”disease burden” Facilities, strategies/programs, activities The resources n Man-power, skills, supplies, support n ->Outcome / impact
Conflict of interest? n Control: Global/national/local/personal n n Rights: Needs/justice/legal/privacy n n Coverage, data safety, integration Efficiency: Needs – resources, change n n ”Bottom-up strategy” (democratic) Data quality, analyses and research Safety: Epidemics/hazards/life-style n Surveillance, access to own data
Tuberculosis control Objectives Example: n n 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” n n n Central management unit (CU in Mo. H) National standard formats (basis SCM) TBMUs -> Province -> CU -> Mo. H Standards used as basis for supervision Emphasis on treatment outcome Often functions in isolation from PHC
Tuberculosis control What kind of data? Classification n New pulm. sm+ n New pulm. sm – n Extra pulm. n Transfer in n Retreatment n Relapse Treatment outcome n Cured n Treatm. completed n Dead (all causes) n Transferred out n Chronic (“failure”) n Lost to follow-up
Tuberculosis control What sources of data? n n Laboratory book TB suspects, results of 2 smears, follow-ups Treatment card Demographic data, lab. res. , classification, treatment, weight, treatment regularity Registration book Classification, treatment outcome, comments Supervision reports Problems, solutions, data quality
Data quality Lab book Id Addr. 2 s. s. Init. 1 s. s. 2 ms 5 ms end No. Suspects Treat- Id ment Addr. card 1 s. s. Treat- Classi ment fic. Reg. book 1 s. s. Id Addr. regul. 1 s. s. Classif Treat ic. ment Res. Super vision rep. + ++ + No.
Tuberculosis control Flow / loss of information «TB suspects» 1. «Point of care» Symptomatics PHC DOTS centr. Laboratory TBMU Laboratory TBM Non-TB / TB Hospital serv. Hospitals Provincial National Private / public International (WHO)
Tuberculosis control What we can learn from the laboratory book n n n 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 control What we can learn from the treatment cards n n n Accuracy of diagnosis/classification Weight gain/loss Address* (and social background) Treatment regularity Regimen and drug reactions Transfer to registration book
Tuberculosis control What we can learn from the registration book n n n n 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/Mo. H reports
Tuberculosis control The problem of coverage n n n WHO target: Detect 70% of estimated new cases What is the basis for the estimate (CDR)? The private sector? Double reporting? Alternatives: n n 1. Geographical and social accessibility (GIS/season/social strata/etc) 2. Diagnostic delay
Tuberculosis control Integration into PHC n n n Under-utilized benefits! 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 n n n Central control Quality of data Efficiency Reporting Local problems Success ”The big picture” n n n n Peripheral analyses Used by ”producers” Training Supplies etc Documented needs Treatment outcome Local interactions
Topics for discussion n n Cross-border patients Transfers in/out Private sector Step-wise integration MDR and sustainability
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