1 interpretation and use. 2 the walls inside are plastered with laboriously made graphs…
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Interpretation and use
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Appropriate interpretations
facilitate knowledge sharing & feedback are context sensitive (population, health, service status) identify plausible linkages (logical, sensible) depend on quality data should be base on clear data definitions result in action!
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Preparing for interpretation
Accuracy checks – 3 C’s and 1 T, includes:
Routine validation and trends checked over time
Data checked per month, per facility, per district
Local / contextual knowledge on:
Population data: ethnicity, lifestyle, occupation
Health data: common diseases
Service data: types of facilities, proficiency of staff
Avoid gathering large number of data elements
• Avoid data elements without contexts and without denominators– eg. 4,32,345 children given Vitamin A.– 34567 women had institutional delivery.– No idea whether this is 5% achievement or 105% achievement.
Avoid data elements that cannot be used for indicators
Avoid indicators for which there are no data elements
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Practical questions in interpretation
1. Why have you produced this indicator? 2. What does the indicator measure?3. Has the indicator been accurately measured?4. What is the target value OR action trigger value?
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Practical questions in interpretation
6. What is the normal range?In your country:
- urban- rural
In the world:- best in the world- worst in the world
7. How does it fit in with other information?8. What is the local context?9. What should you do about the situation?10. How could you implement that?
Temporal & Spatial comparisons
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The manager of a clinic in a peri-urban area was surprised by the very low numbers of male patients attending the OPD with urethral discharge. She was sure that the facility reporting system worked well. What could be the cause?
An Exercise
Low PHU Deliveries
TBAs holding on clients
Low community sensitization
High fees for deliveries
Staff attitude
Can’t afford fees
Men not involved
No proper orientation
Low educational
level
Staff shortage
Staff not motivated
Cultural beliefs
Family trust in the
TBAsCommunity
norms
Laws not instituted
Patients refusal to go to PHU
Long distance
Irregular supervision
Difficult terrain
Root Cause Analysis
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TB Exercise
You are presented with a graph for a district in Uganda showing 3 indicators on the Overall TB Cure Rate, Overall TB Success Rate and DOTS (Directly Observed Treatment Shortcourse) for each quarter of 2003.
How would you interpret the information contained in the graph?
TB INDICATORS FOR AN UGANDAN DISTRICT, 2003
4540
70
40
53
6571
6163
50
80 80
0
10
20
30
40
50
60
70
80
90
100
Q1 Q2 Q3 Q4
%
Overall TB Cure Rate Overall TB Success Rate % Patients on DOTS
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To interpret this information you may need to ask the following questions
What are the definitions of the indicators that are used?
What does the graph show?
What else do you need to know?
Is it enough to make a decision?
Is this the best way to present this information?
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USE -> Assessing coverage and quality of health services
WHO GETS SICK ?
WHAT HEALTH SERVICES EXIST ?
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Assessment of coveragewho gets sick?
Description of people who attend health services:
• age and gender breakdown
• community distribution
Use of individual patient data to construct aggregated routine data
Definition of population• catchment• target for specific services• at risk
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Assessment of qualitywhat services exist ?
For whom? Accessibility
– Catchment population– Target population– Utilization
What? Appropriateness
– Type and range– Continuity
Why? Political vs functional
When? Acceptability
– Convenience to clients and staffWhere? Distribution IntegrationHow ? Affordability Resources
– Staff– Materials– Money
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From Data to HealthInput ….Raw Data
quantity and quality of data elements (Essential Data Sets!)
data collection tools (tally sheets, registers, client cards)
Process …Analysis
turning raw data into useful information
planning tools (targets, indicators)
Output …Information
used for effective decision-making
assessment tools (aggregation, graphs, reports)
Outcome …Coverage and quality of health services + efficiency
management
planning (strategic & operational)
monitoring & evaluation Impact: Health status
Challenges to Information UseHMIS often used:
– for reporting NOT analysis
– as a form of control and reprimand
NOT used for– planning and local action
– cross checking data with other sources
– strengthening supervision processes
– improving quality of care
Multiple Perspectives on HMISOrganization Management
HMISPublic Health Service
Delivery
Technological determinism
Discussion of different interpretations and exploration of different views --> improved and mutual understanding