Gathering health information seems simple to those who live in a world with computers, networks, reliable electricity and well trained doctors: You go into your clinic; the medical secretary puts down some personal information to register you; you wait for the doctor; the doctor sees you and jots some notes into a file or in a computer. Behind the scenes your health information (and everyone else’s) travels through corridors of electrical wiring to complex databases where public health epidemiologists review the data and carefully make decisions that can change clinical management or public health policy.
In a low resource setting like South Sudan, things are completely different. There are no computers or shared database systems. There isn’t even electricity or cellular networks at most clinics. There are no doctors as clinics are generally run by community health workers who get only about three to six months training before running an entire health facility. The roads to get to some of these clinics are generally impassable during the rainy season.
Every person’s clinic visit gets entered as a single line in what is called a register book. This single line contains the patient’s name, age, sex, symptoms, and diagnosis and treatment outcomes.
To get population level data each month, one person from each clinic sits with a register book (be it outpatient department, antenatal care, HIV department) and tally’s one by one each of the indicators needed in the monthly report. The indicators can include the number of malaria cases or number of diarrhea cases for children under five in that month. This entire process is called the Health Management Information System (HMIS).
As simple as this sounds, this method to collect health information is arduous and labour intensive. Tallying can take hours each month to complete and often the accuracy of tallying is faulty. Not every facility can deliver the monthly reports on time as the distances are far and the facility is responsible for funding the delivery of the monthly report to the County Health Department. Most facilities do not have the personal funds to make these deliveries. Some can’t even reach the County Health Department as the roads are washed out in the rainy season.
The County Health Department is still learning how to establish a strong Health Management Information System. Like the newly formed country, the technology and system required to gather this information has just been introduced to them. The Dutch Consortium for Rehabilitation (DCR), under the MFS-II grant, has provided funding to improve the capacity of the Country Health Department so that they can collect and process the monthly reports better.
Through the work of a.o. HealthNet TPO, the County Health Department and health facilities have been assessed to determine greatest needs to improve the quality of data. HealthNet TPO has determined that training of the County Health Department is needed in terms of computer literacy in order to use the main piece of software needed to aggregate the data (District Health Information Software – DHIS). Also a refresher training to the health facility workers to improve their understanding of the definitions of the indicators was recommended, as well as translated versions of the register books and monthly reports for those that only speak Arabic and other minor details which all make small improvements to the system and those who use it.
HealthNet TPO has made some important contributions to the HMIS in South Sudan since starting the efforts at the Ministry of Health at the beginning of 2012. Trainings have occurred to improve the level of computer literacy of the County Health Department. Individual, one-on-one counseling has been provided to the County Health Department to review data quality and determine how they make changes to the way data is tallied at the facilities. A feedback system has been introduced and will soon be implemented. An HMIS refresher training course is planned for July where all health facility staff will come to Wau, South Sudan to relearn what the Ministry of Health expects from them in terms of good quality data.
By the end of the year, the State Ministry of Health, the County Health Department, and the health facility staff will be given the tools needed to produce high quality health data. The next step is using that data to make good public health decisions which will ultimately save lives and improve the health of the people that use the health facilities daily.
To be continued…!
Oren Jalon – Health Management Information Systems (HMIS) Advisor
Background: Oren has a B.Sc. in Biochemistry (University of Ottawa, Canada) and a M.Sc. Epidemiology (University of London School of Hygiene and Tropical Medicine). Oren has worked across several health sectors including HIV, cancer, and diabetes. Before working at HealthNet TPO, he was establishing surveillance systems to monitor malaria in Liberia. Currently Oren is working in Wau, South Sudan to improve the HMIS of the Ministry of Health for the State of Western Bhar el Ghazal.