HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) “A mechanism for the collection, processing, analysis and transmission of information required for organizing and operating health services, and also for research and training”.

THE OBJECTIVES OF HMIS To provide reliable information To provide reliable information Relevant & up-to-date information Relevant & up-to-date information Adequate & timely information Adequate & timely information Complete information for health managers at all levels. Complete information for health managers at all levels. Sharing of technical and scientific information Sharing of technical and scientific information FOR FOR Planning purposes Planning purposes Evaluate H services & programmes Evaluate H services & programmes Trends in demands and work load. Trends in demands and work load.

REQUIREMENTS OF HEALTH INFROMATION SYSTEMS: The system should be population based The system should avoid the unnecessary agglomeration of data The system should be problem-oriented The system should employ functional and operational terms The system should express information briefly and imaginatively (e.g., tables, charts, percentages) The system should make provision for the feed-back of data.

USES OF HMIS To measure the health status of the people and to quantify their health problems and medical and health care needs. To measure the health status of the people and to quantify their health problems and medical and health care needs. For local, national and international comparisons of health status. For local, national and international comparisons of health status. Data need to be standardized Data need to be standardized Quality control. Quality control. For planning, administration and effective management of health services and programmes For planning, administration and effective management of health services and programmes For assessing whether health services are accomplishing their objectives in terms of their effectiveness and efficiency For assessing whether health services are accomplishing their objectives in terms of their effectiveness and efficiency For assessing the attitudes and degree of satisfaction of the beneficiaries with the health system, and For assessing the attitudes and degree of satisfaction of the beneficiaries with the health system, and For research into particular problems of health and disease. For research into particular problems of health and disease.

COMPONENTS OF HMIS Demography and vital events Demography and vital events Environmental health statistics Environmental health statistics Health status Health status Health resources, facilities, manpower Health resources, facilities, manpower Utilization of health services Utilization of health services Financial statistics Financial statistics Outcome of medical care Outcome of medical care

SOURCES OF HEALHT INFORMATION Census Census Registration of vital events Registration of vital events Sample Registration System (SRS) Sample Registration System (SRS) Notification of Diseases Notification of Diseases Hospital records Hospital records Disease Registers Disease Registers Record Linkage Record Linkage Epidemiological surveillance Epidemiological surveillance Health service records Health service records Environmental health data Environmental health data Health manpower Health manpower Population surveys Population surveys Other routine statistics related to health Other routine statistics related to health

1.CENSUS The total process of collecting, compiling and publishing demographic, economic and social data pertaining at a specified time to all persons in a country. The total process of collecting, compiling and publishing demographic, economic and social data pertaining at a specified time to all persons in a country. Contact every member of population in a given time Contact every member of population in a given time Variety of information is collected Variety of information is collected Needs Needs An big organization An big organization Considerable time for full results Considerable time for full results

CENSUS FIRST CENSUS IN THE WORLD-1749 FIRST CENSUS IN THE WORLD-1749 FIRST CENSUS IN INDO-PAKISTAN FIRST CENSUS IN INDO-PAKISTAN REPEATED IN-1881 REPEATED IN-1881 FIRST CENSUS IN PAKISTAN-1951 FIRST CENSUS IN PAKISTAN-1951 CARRIED OUT EVERY 10 YEARS, 1961, CARRIED OUT EVERY 10 YEARS, 1961, 1972, 1981, , 1981, 1998.

census Enumeration Enumeration Questionnaire method Questionnaire method Both combined Both combined Enumeration Enumeration Visit of every home Visit of every home Collection of desired information like age, sex, marital status, caste, educational characteristics, monthly income, occupation, rural and urban, condition of living etc Collection of desired information like age, sex, marital status, caste, educational characteristics, monthly income, occupation, rural and urban, condition of living etc Base line information for medicine, ecology, social sciences & entire govt. system. Base line information for medicine, ecology, social sciences & entire govt. system.

Types of census De facto: De facto: A person is counted where he or she is found at the time of counting A person is counted where he or she is found at the time of counting Dejure: Dejure: A person is counted at the place of his or her usual or normal residence A person is counted at the place of his or her usual or normal residence

ESTIMATION OF POPULATION Natural increase method Natural increase method Arithmetic progression method (APM) Arithmetic progression method (APM) Geometric progression method Geometric progression method

APM Estimate mid year population for 1990? Estimate mid year population for 1990? First of April 1971 = 500,000 First of April 1971 = 500,000 First of April 1981 = 700,000 First of April 1981 = 700,000 increase in 10 years=700, ,000 increase in 10 years=700, ,000 =200,000 =200,000 Increase in 1 year=200,000/10=20,000 Increase in 1 year=200,000/10=20,000 increase in 9 years & 3 months=20000×28/3 increase in 9 years & 3 months=20000×28/3 186, ,667 Population in Mid year 1990=700, ,667 Population in Mid year 1990=700, ,667 =886,667. =886,667.

POPULATION OF PAKISTAN

2.Registration of vital events Registration, statistical recording and reporting of occurrence of, and the collection, compilation, presentation, analysis and distribution of statistics pertaining to vital events, i.e., live births, deaths, foetal deaths, marriages, divorces, adoptions & legal separations. Registration, statistical recording and reporting of occurrence of, and the collection, compilation, presentation, analysis and distribution of statistics pertaining to vital events, i.e., live births, deaths, foetal deaths, marriages, divorces, adoptions & legal separations. Census is an intermittent of population, Census is an intermittent of population, Registration of vital events keeps a continuous check on demographic changes. Registration of vital events keeps a continuous check on demographic changes. It can serve as a reliable source of health information. It can serve as a reliable source of health information. Rural areas Rural areas Urban areas Urban areas

3.Notification of Diseases The primary purpose of notification is to effect prevention and/or control of the disease. The primary purpose of notification is to effect prevention and/or control of the disease. Notification is also a valuable source of morbidity data i.e., serious menaces to public health. Notification is also a valuable source of morbidity data i.e., serious menaces to public health. Incidence of diseases in a community/ country. Incidence of diseases in a community/ country. Fluctuations among dis. Frequency/communities Fluctuations among dis. Frequency/communities International –cholera, plague, yellow fever International –cholera, plague, yellow fever It covers small part of sickness in the community It covers small part of sickness in the community System suffers under reporting System suffers under reporting Escape of clinical / sub clinical cases Escape of clinical / sub clinical cases

4.Hospital records Basic and primary source of information about diseases prevalent in the community. Basic and primary source of information about diseases prevalent in the community. No definite population served by a hospital No definite population served by a hospital Health care activities and utilization can be derived from hospital records. Health care activities and utilization can be derived from hospital records.

Hospital records A study of hospital data provides information A study of hospital data provides information geographic sources of patients geographic sources of patients age and sex distribution of diff. diseases age and sex distribution of diff. diseases distribution of health problems & their magnitude distribution of health problems & their magnitude association between different diseases association between different diseases the period between disease and hospital admission the period between disease and hospital admission the distribution of patients a/c areas, social &culture the distribution of patients a/c areas, social &culture Period between disease & hospital admission Period between disease & hospital admission the cost of hospital care. the cost of hospital care. Bed occupancy rates Bed occupancy rates Duration of stay in the hospital Duration of stay in the hospital For planning & monitoring of H. services For planning & monitoring of H. services

5.Disease registers Valuable source of information about morbidity, stay in hospital, Valuable source of information about morbidity, stay in hospital, Permanent record be established Permanent record be established Cases can be followed up Cases can be followed up Morbidity registers exist only for certain diseases, acute & chronic like myocardial infarction, cancer, case fatality and survival Morbidity registers exist only for certain diseases, acute & chronic like myocardial infarction, cancer, case fatality and survival Mortality data, causes of deaths Mortality data, causes of deaths

HEALTH SYSTEM REPORTING instruments for collection of data from FLCF instruments for collection of data from FLCF Population data collection Population data collection Patient / client record Patient / client record Facility record keeping Facility record keeping Facility reports Facility reports Immediate report for epidemic diseases Immediate report for epidemic diseases Monthly reports Monthly reports Annual reports Annual reports

PRIORITY HEALTH PROBLEMS HMIS CODE HEALTH PROBLEM 101 Diarrhoea < 5 years Without dehydration With some dehydration With severe dehydration Dehydration status not specified 102Dysentery 103 Acute respi infection 104 Fever ( clinical malaria) 105 Cough > 2 weeks

106 SUSPECTED Cholera 107 SUSPECTED meningococcal Meningitis 108 PROBABLE poliomyelitis 109 Probable Measles 110 Probable/Confirmed Neonatal Tetanus 111 Probable Diphtheria 112 Probable Whooping Cough 113Goiter 114 Suspected Viral Hepatitis 115 Suspected AIDS 116 Snake bite (s/s) of poisoning 117 Dog bite 118Scabies

6.Record Linkage The process of bringing together records relating to one individual originating in different times or places The process of bringing together records relating to one individual originating in different times or places Medical record linkage: the assembly and maintenance of a file for each individual in a population, Medical record linkage: the assembly and maintenance of a file for each individual in a population, records relating to his healthi.e. Birth, marriage,, hospital admission and discharge & death, Sickness absence from work, prophylactic procedures, records relating to his healthi.e. Birth, marriage,, hospital admission and discharge & death, Sickness absence from work, prophylactic procedures, A method for studying associations between diseases; A method for studying associations between diseases;

7.Epidemiological surveillance

8.Health service records From hospital OPD From hospital OPD PHCs & BHUs PHCs & BHUs Polyclinics Polyclinics Private hospitals Private hospitals MCH centers MCH centers Specialized hospitals Specialized hospitals

9.ENVIRONMENTAL HEALTH DATA AIR QUALTY & POLLUTION AIR QUALTY & POLLUTION WATER QUALITY & POLLUTION WATER QUALITY & POLLUTION HARMFUL FOOD ADDITIVES HARMFUL FOOD ADDITIVES INDUSTRIAL TOXICANTS INDUSTRIAL TOXICANTS INADEQUATE WASTE INADEQUATE WASTE DISPOSALPOPULATION EXPLOSION DISPOSALPOPULATION EXPLOSION IDENTIFICATION OF CAUSES OF SISEASES IDENTIFICATION OF CAUSES OF SISEASES

10. HEALTH MANPOWER STATISTICS No. of physicians / dentists No. of physicians / dentists Age, sex Age, sex Specialty Specialty Place of work Place of work Hospital nurses, pharmacists Hospital nurses, pharmacists Health technicians Health technicians PMDC PMDC No. admitted / year No. admitted / year No. qualified / year No. qualified / year No. of specialists etc No. of specialists etc