Tuesday, November 29, 2005

HEALTH MANAGEMENT INFORMATION SYSTEM IN BAMENDA HEALTH DISTRICT

HEALTH MANAGEMENT INFORMATION SYSTEM IN BAMENDA HEALTH DISTRICT, CAMEROON, 2003-2004

INTRODUCTION
The onward transmission of the National Health Information System (NHMIS) Data Collection form from the first level health facilities through the District Service of Public Health to the Provincial Delegation of Public Health for synthesis without compiling and analysing the data at the District Service defeats the raison d’ĂȘtre of the Health Management information system.

HMIS can be defined simply as the use of information derived from the analysis of health data recorded at health facilities or from the community for decision making; planning and budgeting; mobilisation of resources; implementation of the plan of action; monitoring, supervision, and evaluation of set objectives and impact of health programmes on the health status of the community, at all levels of the health system.

In June 1999 the District Health Team elaborated the “Introduction of the Epidemiological Approach to Health Care Delivery in Bamenda Health District”

The epidemiological approach (recording, compiling and analysing health data to obtain information) is the only means of making objective decisions and appreciating the health needs, achievements, and staff performance. It lays emphasis on the utilisation of the health status indicators of the population/community as the starting point of all discussions and interventions at all levels in the Health District.

The author produced an excel programme of the National Health Management Information System (NHMIS) Monthly Data Collection form for the First level (1m) for the compilation and analysis of the data received at the Health District Service. Thus the booklet on ‘Health statistics in Bamenda Health District from January 1998 – December 2002’ was produced in November 2003.

Only the leading health facilities of health areas were concerned and since the HMIS data collection forms were transmitted to the Provincial Delegation of Public Health without synthesis, there were no health statistics at the Health District Service.

There is always need for District Health Statistics for local and external applications, it is for this reason that the author is documented the health management information system in Bamenda Health District 2003-2004. It is worth noting that many portions of the report had been applied during supervision, presentations, and as feedback.

The Bamenda Health District in 2003 and 2004 consisted of 17 health areas with 17 leading health centres

The HMIS cycle and the Health System levels for the application of the HMIS are shown in the diagrammes below.

The first step of the health management cycle that consists of recording all clients who come for services in registers is carried out by all health facilities. The extraction, compilation and forwarding to hierarchy are done by some health facilities; analysis of data is done by a few of them.

HEALTH MANAGEMENT INFORMATION SYSTEM CYCLE

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HEALTH SYSTEM LEVELS
HEALTH MANAGEMENT INFORMATION SYSTEM CYCLE,
REPORTING AND FEEDBACK


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OBJECTIVES

1) Compile annual synthesis of health data for 2003 and 2004
2) Use some indicators to assess the performance of health facilities concerned and the health status of the population
3) Discuss the strength and weaknesses of NHMIS data collection tool for the first level (1m)

METHOD

The health data from the monthly NHMIS data collection form (1m) forwarded by the leading health facilities of health areas to the District Health Service in 2003 and 2004 were compiled and analysed using the excel computer programme.
A well qualified computer secretaries helped feed the data into the computer programme.
Some indicators were used to appreciate the health status of the population and performance of health facilities.
The vaccination data were obtained from the EPI returns; it will also be done with malaria, leprosy and National Immunisation Days.

RESULTS
The global Health District results will be stated in the table below and the specific health area results in graphs in the report. The results for vaccination activities are presented separately because the age groups in 1m are not conventional

District Synthesis

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Measures to control malaria in 2003 & 2004

The prevention of malaria is done by:
- The distribution of insecticide treated mosquito nets (ITN) to pregnant women during ANC
- Pregnant women take Sulfadoxine Pyrimethamine (Fansidar) intermittent for the presumptive treatment of malaria.

ITN distributed

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Leprosy/tuberculosis

Clients Discharged from treatment

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Clients suspected for or diagnosed with Tuberculosis are referred to the Provincial Hospital for treatment, the only treatment Centre in Bamenda Health District.


POLIO NATIONAL IMMUNIZATION DAYS (NIDs) 2003 & 2004
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VITAMIN A ADMINISTERED DURING NATIONAL IMMUNIZATION DAYS (NIDs)

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DISCUSSIONS

The synthesis and analysis of health data facilitated the appreciation of the performance of health facilities considered, and the health status of Health Areas and the District.

The various activities should be used as need be for decision making, for it would be too elaborate to carry out discussion on all the items in the 1m.

Nkwen Baptist, Presbyterian Health Centres Mankon-Ntamulung and St Mary Soled Health Centre –Alakuma have the highest utilisation rates by new consultants. The possible contributing factors might be: - good reception; specialised services offered (eye unit, dental unit); good quality service; good record keeping and reporting.

Some health centres do not have maternities and thus do not conduct deliveries - Azire, Nkwen Baptist, Presbyterian Health Centre Ntamulung, Atuakom, Mulang, Ntambag, Women’s Centre and Social Insurance.

Very few pregnant women attend Antenatal Clinic in the first trimester, 10.9% in 2004. It should be noted that some health providers sometimes get mixed up and put the same figures for the cells of the first trimester and new cases.

In this synthesis the section on drug management was left out because most health facilities did not fill them; the drug system in the North West has a more concise supervision tool, however the sale of drugs was considered.

In financial management it was impossible to calculate the revenue recovery rates for consultations, deliveries, ANC, laboratory, etc, because in 1m these headings are not specified. Only State health facilities declare monthly revenue, however some private and mission health facilities state their financial activities in their annual report. It is hoped that in future monthly revenue will be declared by all health facilities that will be used only for health analysis.

The total number of beds of per health facility is not real because only beds from maternity are requested in 1m.

The volume of 1m prohibits the multiplication of the form by the District Service or the Health Facilities; the quantity of the forms supplied had never been sufficient for the health facilities in the Health District thus only the leading health facilities were declaring.

It is impossible to state the first ten causes of morbidity and mortality in Bamenda Health District for the period considered because the 1m does not have a table of morbidity and mortality.

CONCLUSION

No data collection tool is completely bad and useless; the data in it can always be used in the Health Management Information System (HMIS).

Health providers should have a very high spirit of motivation, commitment and acquire the competence for the HMIS.

A simple excel programme will permit health personnel at all levels of the health system to apply the HMIS easily.

The author has proposed a simple A3 sheet HMIS data collection form that can be used at all levels of the health system.

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1 comment:

Edwin Steve said...

Nice post.

Medstat.