SAMPLE PROJECT PROPOSAL FOR HEALTH STATISTICS

SAMPLE PROJECT PROPOSAL

TITLE:

BAMENDA HEALTH DISTRICT 2004 ANNUAL HEALTH STATISTICS, NORTH WEST PROVINCE, CAMEROON
PRINCIPAL INVESTIGATOR

MAIN COLLABORATOR

PLACE OF STUDY

Bamenda

AREA OF STUDY

Bamenda Health District (present Bamenda and Tubah Health Districts)

OBJECTIVE OF THE STUDY

Produce the Bamenda Health District 2004 annual health statistics, obtained from the annual synthesis of the conceived health management information system (HMIS) data collection form, as a contribution to the development NHMIS in the North West Province and Cameroon

PERIOD OF STUDY

Duration of 85 days
It is based on working days Monday to Friday of the week
- Preparatory phase: Computer programming, acquiring inputs: 20 days
- Implementation phase: 45 days
- Report phase: 10 days
- Dissemination phase: 10 days


INTRODUCTION

The onward transmission of the National Health Information System (NHMIS) Data Collection form from the 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’être of the Health Management information system.

A system is a group of elements that interact and function together as a whole for a common purpose, goal, or objective.

Information is obtained from the organisation and analysis of facts and data; it allows decisions to be made and knowledge to be gained for a specific purpose.

Management is the planning and accomplishing of specific organisational objectives with the use and control of resources (human, financial, material, logistics, time, etc). Management involves proactive and reactive decisions that plan for new actions and evaluate past actions.

Health can be defined within this context as the physical, socio-economic, and mental well being of the individual, the population, and the community.

A Health Management Information System (HMIS) is an integrated set of interrelated elements of data and facts organised and analysed to obtain information that facilitates:
* Decision-making,
* Planning and implementation of health programmes and activities using available resources,
* Supervision,
* Monitoring, and
* Evaluation of actions directed towards ensuring the physical, socio-economic and mental well being of the individual, the population and community.

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:
Ø Determining priority needs and problems
Ø Decision making and setting of goals and objectives
Ø Planning and budgeting;
Ø Mobilisation of resources;
Ø Implementation of the plan of action;
Ø Monitoring,
Ø Supervision, and
Ø Evaluation of set objectives and impact of health programmes on the health status of the community, at all levels of the health system.

Managers rely on both informal and formal ways of obtaining the information they need to make decisions. Informal information includes rumours and unofficial discussions with colleagues. Personal experience, education, common sense, intuition, and knowledge of the political and socio-economic environment are also part of the informal means of gathering information.

Routine statistical and management reports comprise the more formal methods of presenting and moving information within organisations. These reports, which are generally standardised in format and produced on regular basis, constitute the most visible, relevant, and reliable part of the health management information system (HMIS).

The HMIS, based on the routine statistical and management reports, is continuous and cyclic, thus the health management information system cycle.

The HMIS cycle comprises the following steps:
- Register-Record data
- Collect/Extract data from registers
- Compile data, and fill synthesis forms and forward to hierarchy
- Process/Analyse data
- Obtain and interpret information
- Identify achievements
- Identify needs and problems
- Determine contributing factors; propose solutions
- Determine priority needs and problems; make decisions
- Make decisions – Select priority needs/problems
- Set objectives
- Define strategies
- Elaborate a plan of action/work plan/budget
- Mobilise resources
- Review/adjust plan of action/ work plan according to resources available
- Implement/execute the plan of action/work plan
- Supervise and monitor
- Evaluate

The HMIS cycle consists of three main components:
i. The Health Information component or situational analysis, which includes recording of clients and compiling returns at health facilities, data processing and analysis, to determining priority health needs and problems.
ii.The health management component, that includes decision making in selecting priority needs, setting objectives, planning, mobilisation of resources, implementation to evaluation
iii. Dissemination of information and reports of activities to hierarchy, other institutions, community, and feedback to collaborators.

The HMIS should be used at all levels of the health system and within health facilities and programmes by all staff and community members.



HEALTH MANAGEMENT INFORMATION SYSTEM CYCLE

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

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SITUATIONAL ANALYSIS
Each step of the HMIS cycle has its tools; for example registers are used for recording of clients at health facilities, monthly synthesis forms for the collection/extraction and compilation of data and forwarding of returns to hierarchy.

In Bamenda Health District the monthly synthesis for some programmes and activities are effective because of the availability of concise and simple data collection forms; this is true for EPI, Leprosy, tuberculosis, Family Planning, STI, HIV/AIDS, etc. Some units of health facilities, such as the laboratory do not produce monthly data on their activities.

Most health facilities do not produce monthly data synthesis report except for leading health centres of health areas. A comprehensive data on morbidity and mortality cannot be obtained from the present data collection forms.

In June 1999 the District Chief of Service of Public Health, the Principal Investigator, 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 and community as the starting point of all discussions and interventions at all levels in the Health District.

The first level health centres use National Health Management Information System (NHMIS) data collection form (1m) for reporting to the hierarchy; the Provincial and District Hospitals, and Sub Divisional Medical Centres use the NHMIS data collection form for the second level (2m).

The NHMIS data collection forms were transmitted to the Provincial Delegation of Public Health through the District Health Service without synthesis; consequently there were no health statistics at the District Health Service. There is always need for District Health Statistics for local and external applications.

The author therefore produced an excel programme for 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, and the Bamenda Health District health statistics for 2003-2004, in September 2005.

PROBLEM
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 exceptionally done by a few of them, including the District Health Services.

Most health facilities do not regularly produce monthly data synthesis report except for leading health facilities of health areas.

Some contributing factors are:

- The suppression of the Public Health activities form and the table of morbidity and mortality.
- The introduction of the National Health Management Information System data collection form for the first level health facilities – 1m
- The introduction of the National Health Management Information System data collection form for the second level health facilities – 2m, after some years
- The National Health Management Information System (NHMIS) data collection forms for the two levels do not contain an elaborate table of morbidity and mortality.
- The quantity of theses forms has never been sufficient for all health facilities.
- The volume of theses forms prohibits their local production at the District and health facility levels
- Most health personnel do not know the importance of data collection
- Most health personnel do not understand the National Health Management Information System and it’s application to their daily health activities.
- Health statistics in most health facilities are reserved for recalcitrant and low qualified staff.
- Most health personnel do not attach any importance to the correlation between their output and its corresponding revenue in their health facilities.
- Most private health facilities do not produce monthly health data on their activities
- The policy foresaw for the computer programmes for the synthesis of 1m and 2m to be installed only at the Provincial level; these programmes had never been effective.

Consequently the availability of trustworthy statistical information at the District Health Service was not possible. Thus, the Principal investigator, the then Bamenda District Chief of Service for Public Health elaborated a concise data collection form that was distributed to be used by all health facilities at all the health levels in 2004. Integrated training courses for chiefs of health centres and representatives of private clinics and public hospitals were held in December 2003 and on 17 February 2004 before the application of the new data collection form in 2004.


ELABORATION AND DESCRIPTION OF THE NEW CONCISE DATA COLLECTION FORM

The data collection forms being used in the Health District were studied. These included amongst others
- The Public Health activities form and the table of morbidity and mortality
- The National Health Management Information System data collection form for the first level health facilities – 1m
- The National Health Management Information System data collection form for the second level health facilities – 2m.
- The data collection form for collecting data on STI/HIV/AIDS
- The data collection form for collecting data on family planning activities.

The pertinent and relevant elements were studied and selected to elaborate the new concise data collection form “HEALTH MANAGEMENT INFORMATION SYSTEM DATA COLLECTION FORM” consisting of four pages:

Page 1 comprises:
- The period (year, month, date)
- The identity of the health facility
- Name and signature of the responsible official of the health facility
- The number of beds
- Consultations
- Family planning
- Maternal health
- Child care
- Vaccination of children 0 – 11 months and pregnant women
- Hospitalisation
- Activities of the Maternity
- Activities in the surgical theatre
- Community commitment
- Supervision by members of District Health Team

Pages 2 and 3 include
- List of diseases with number of cases and deaths by age and sex
Some nomenclatures of diseases have been modified taking into account the names used presently by various programmes and recommended by the World Health Organisation (WHO) for example in the syndromic management of sexually transmitted infections (STI)

Page 4 states
- Laboratory activities
- The pharmacy
- Finances of the health facility
- Personnel

Modalities for filling the Health Management Information Monthly Data Collection Form

i. All staff, and all units of the health facility must be involved in extracting/collecting of data from the registers; compiling and filling the HMIS data collection form at the end of every month.
ii. The health facility will produce copies of the form for the units whenever the initial stock is exhausted; all the team members of respective units will fill the form, including the consulting doctors and nurses. A copy of the form will be used as a tally sheet.
iii. If the result is null or if the activity is not practised in the health facility, fill in “0” (zero).
iv. The heads of the units will meet to make the synthesis and fill the data collection form for the health facility, and make some analysis to ameliorate the service.
v. The head of the health facility will analyse and make decisions for service improvement, and then forward a copy the form to the District Chief of Service latest the 05 of the following month.
vi. The standard list of the average costs for acts performed in the health facility will be attached to the HMIS data collection form in order to enhance the calculation of revenue recovery rates for the interest of the institution.
vii. Some definitions: -
1) Consultation – New Case: Any initial or first visit for a given disease episode.
2) Consultation – Old Case: Any subsequent visit during the same disease episode.
3) Hospitalisation days for the month are obtained by adding the number of patients in the ward each morning of the day as recorded in the ward register by the night shift staff. Adding those of all the wards constitutes the total hospitalisation days in the health facility for the month.

Some advantages of the form are:
1) It is printed on one A3 sheet paper of four pages
2) Its content is made of extracts from most currently used data collection forms
3) It contains an elaborate morbidity and mortality table
4) It will be cheap to produce, and reproduce by photocopy by health facilities in the Health District
5) It will be used by all health facilities, each health facility filling its corresponding sections
6) It will enhance the compilation of list of common causes of morbidity and mortality.
7) It will facilitate the application of operational health indicators
8) It is bilingual

RAISON D’ÊTRE FOR RESEARCH

The personnel at service delivery point are the foundation and pillars of the HMIS; they register clients at health facilities, compile health data, fill the monthly synthesis forms, and forward them to the District Health Service/Provincial Delegation of Public Health/Ministry of Public Health.

Most programmes and projects have their various tools for data collection at health facilities; these numerous forms are filled by the same staff and forwarded to them without the data being centralised at the District Service of Public Health

The author proposed this “HEALTH MANAGEMENT INFORMATION SYSTEM DATA COLLECTION FORM” for extracting, compiling and reporting of health statistics.

The introduction of this data collection form will not exclude the monthly return forms for specific programmes and the national data collection forms currently being used, but it would permit the District Service to obtain a summary of reliable data on most health activities in the Health District.

Health staff at service delivery point more often falsely assumes that their role in the HMIS is relegated to collecting and transmitting data, including even the District Health Services

In this era of information technology objective health and administrative decisions cannot be made without objective information from data collected routinely by health personnel.

At the District Health Service the District Health Team should process data from routine returns using simple excel programmes and apply the information thus obtained to improve the quality of service and the health status of the population through appropriate strategies.

Although routine data collection is not exhaustive it permits the appreciation of the trends of diseases and the impact of control programs, and the elaboration of research hypothesis

The HMIS is not a computer system; but the computer is an inevitable and important tool to facilitate the processing and storage of data and facts. However, all stored documents must be printed and made into books to serve as reference.

Data and facts have to be fed into the computer manually, thus data and facts collected manually have to be correct and precise otherwise information will be erroneous; training is a important prerequisite.

The health facility staff should deliver integrated, continuous care and holistic (global) care to clients, looking beyond the patient at the health facility to the community from where they come. Using the health problems identified at the health facility the staff should elaborate and carry out activities in the community, in partnership with the community, in order to reduce and prevent health problems thus identified.

The health facility is the mirror of the health status of the community that can be appreciated only through data collected by the health facility using an appropriate tool. It is for this reason that the author has produced this

“HEALTH MANAGEMENT INFORMATION SYSTEM DATA COLLECTION FORM”

The most important prerequisite for the success in the use of this data collection form and the application of the HMIS cycle is the commitment of health staff.

Planning cannot be done without situational analysis that is based on the processing data and analysis of information from routine declarations from health facilities and results of research.


GENERAL OBJECTIVE OF THE RESEARCH PROPOSAL:
Produce the Bamenda health district 2004 annual health statistics, obtained from the annual synthesis of the conceived health management information system (HMIS) data collection form, as a contribution to the development NHMIS in the North West Province & Cameroon

SPECIFIC OBJECTIVES OF THE RESEARCH PROPOSAL:
- Assemble the monthly data forms already received from health facilities in for 2004
- Search, collect and complete as much as possible the remaining data form from health facilities
- Develop a computer excel programme for compiling and analysis of the data the data
- Identify the health indicators to be used
- Programme the indicators thus identified
- Input data in to the computer
- Analyse results
- Write up the result document, stating the strengths, weaknesses, opportunities and threats of the form and propose solutions
- Disseminate the results of the research.


METHODOLOGY

This project will be carried out within 85 days. It is based on working days Monday to Friday of the week. The execution of the project will be in three phases:
- Preparatory phase: Computer programming, acquiring inputs: 20 days
- Implementation phase: 45 days
- Report phase: 10 days
- Dissemination phase: 10 days

Activities will be carried out according to the work plan presented below.




WORK PLAN AND CHRONOGRAM
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THE OUTPUT OF THE PROJECT
- The excel computer programme for the synthesis of the data collection form at the District Health Services is elaborated
- The Data Collection form is ameliorate and will continue to be used both locally and perhaps nation wide.
- Dissemination of the excel programme for data processing and analysis is done


OUTCOME OF PROJECT

I. The 2004 annual health statistics for Bamenda Health District will be produced
II. The health status of the community will be known
III. The morbidity and mortality will be established
IV. The revenue of health facilities will be stated
V. The results of all other established indicators will be obtained
VI. The excel programme for data processing of routine collected data on health activities will be obtained and used by other health services, projects and programmes because it is easy to use, even by secretaries.
VII. The team could be called up to elaborate simple excel programmes for other routine data collection tools.


PROJECT MONITORING AND VERIFICATION

The Sponsors through reports of activities forwarded by the Principal investigator will do the monitoring and verification according to the stated objectives and time frame in the work plan.

The finances will be handled and disbursed by a financial secretary according to the approval of the principal investigator and main collaborator.


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REFERENCES:
- Ministry of Public Health: National Health Management Information System Data Collection form for the first level – 1m.
- Ministry of Public Health: National Health Management Information System Data Collection form for the second level – 2m.
- Ministry of Public Health: Fiche d’activités de santé publique et tableau de morbidité-mortalité.
- Ministry of Public Health: Form for weekly notification of diseases with epidemic potential.
- Ministry of Public Health: Form for the monthly report of activities and surveillance of target diseases of EPI.
- Dr MFONFU Daniel, Sept 1995, Development of Kumba Health District January-August 1995
- Ministry of Public Health: EPI, Form for weekly notification of diseases with epidemic potential.
- Prof. Mbede Joseph, Dr Owona Essomba René, Dr Mfonfu Daniel, Mme Agbor Tabi, Dr Julia Walsh, Octobre 1989, Rapport du séminaire pour la création du conseil national d’épidémiologie (Epidemiology board) au Cameroun. Ministère de la Santé Publique.
- Direction des Etudes, de la Planification et des Statistiques, Ministère de la Santé Publique: Rapports statistiques d’activités des Services de Santé Publique, Années 1977, 1978, 1979.
- Urbain Olanguena Awona, Renforcement de la surveillance du Syndrome Respiratoire Aigu Sévère (SRAS), D26-34/LC/MSP/DLCM de24 Juil 2003, Ministère de la Santé Publique
- Dr Mfonfu Daniel, Nkuo Rebecca, Waye Henry, Introduction of Epidemiological Approach to Health Care Delivery in Bamenda Health District. June 1999
- Dr Ghogomu, Dr Mfonfu et al, Guide for dialogue Structures, June 2000 , Provincial Delegation of Public Health North West Province.
- Freund, Paul J, and Katele Kalumba. Information for Health Development. World Health Forum, Volume 7, 1-6, 1986


ANNEXESElectronic copies of computer excel programmes of:
- 1m 2004
- EPI returns 2005
- SNID Polio May 2004

Developed by the project team



HEALTH FACILITIES IN BAMENDA HEALTH DISTRICT

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