1. Informacao sobre Saude MSP course March 2002

2. Information sobre Saude Information system as social system informacao – information organizational, social, political, ambiental Information as social resource use, purpose, communication, interaction Information as ‘artifact’ tools, media – meias, documents, systems

3. Informacao sobre saude Information mapping –Mapping reporting systems –Registry books, forms –Reports, documents Information flows Information audit Quality and use of data Information systems for health management

4. Field research--always Who What Where When Why How

5. Field research Who What Where When Why How Quem? Qual? Onde? A --? De --? Quando? Porque? Como?

6. TOOLS (eg, info systems, computers, Schedule+ etc) OBJECT-OUTCOME To act as a mediator between computer industry and clients SUBJECT CommArc RULES (inc. values, ethics) COMMUNITY OF PRACTICE (other CommArc staff members, suppliers, customers etc) DIVISION OF LABOUR e.g. of a “system”: Activity system – individuals & teams in social practices, tools— artifacts, purposes, community, rules, division of labor

8. A chronology of important events in the HISP case.

9. Figure 3: Hierarchy of standards where each level has freedom to define their own standards as long as they align with the standards at the level above.

10. Central level Admn health program Statistic and planing dep Provincial level statistic and planing dep. District level Other community sources HC HP D. Hospital. Standard formsBooks Health services Standard forms District information officer Feedback Reports Meetings Supervision Reports Meetings Supervision

11. District level Health services Other community sources Standard formsBooks District Hospital/HC/ Priv sector HP Nurse chiefNurse, Doc, Lab men, or farmac Basic health worker District information officer + 2 representative ( Nur or admin) Forms + Reports Reports Basic health worker Schools NGO Local Gov Unions Special intergroups

12. 01-Adilabad 02-Karimnagar 03-Warangal 04-Khammam 05-East Godavari 06-Visakhapatnam 07-Vizianagram 08-Srikakulam 09-West Godavari 10-Krishna 11-Guntur 12-Prakasam 13-Nellore 14-Chittoor 15-Cuddapah 16-Anantpur 17-Kurnool 18-Mahbubnagar 19-Nalgonda 20-Rangareddi 21-Medak 22-Nizamabad

15. Health Centre 1 labHealth Centre 2 labHealth Centre 3 lab District lab data compiled in a Rural Hospital lab Nucleus for Planning and Statistics (Aggregation of health district data) Department for Planning and Statistics Community level District level Other relevant data from the community and health facilities Provincial level Provincial lab data compiled and analysed by the lab manager National level Health Information Department National Section for clinical labs Reporting system usually delayed Feedback reports and supervision less frequent Figure 1 – The vertical top-down approach of lab information system coupled to the complex health information system in the National Health System

16. Central Government (Ministries/Departments) State Government Scientific Institutions District Administration --------------------------------------------------------------------------------- Line Departments Fund s Policy Issues Feedback Funds Prog. Priorities & Monitoring GIS S/W and data Beneficiaries, Local People, NGOs Technology Development & Related Policies Interplay of institutions

17. Figure 2: Comparison of the new tally sheet in the injection room on the left with the old reporting form on the right, reporting 66 and 59 ‘events’ respectively. Note the columns marked ‘E’, ‘C’, ‘B’ and ‘A’ in the old form, for European, Coloured, Black and Asian. These columns are not in use anymore, and the space is used for marking the categories of the events reported.