1. Uses of data in planning process at LGAs: Stories from Council Health Management Team (CHMTs). Dr. Mackfallen Anasel, Dr. Idda Lyatonga, Dr. Orest Masue
Mzumbe University

2. Outline Introduction Research Question Methodology Results Conclusion
2/24/2019
Mzumbe University

3. Introduction
According to the Tanzania National Health Policy (2007) LGAs have the task of providing health services at primary level.
They are responsible for managing District Hospitals, Health Centres and Dispensaries.
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Mzumbe University

4. Introduction cont..
The LGA formulate action plan for implementing health services at LGA.
It is the duty of health department, headed by the DMO, to prepare the Comprehensive Council Health Plan (CCHP) that includes all level of services provision.
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Mzumbe University

5. Introduction cont..
The planning processes needs data which is the basis for planning.
Good planning and management of health services depend on the availability of reliable, accurate and timely reported data.
You cannot Plan unless you know the demand, the level of implementation and the recent trends
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Mzumbe University

6. Introduction cont…
The data in health sector are collected through MTUHA and other sources and imported in DHIS2.
The DHIS2 is a web-based application and powerful software for analyzing, reporting and disseminating data for health programmes.
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Mzumbe University

7. Introduction cont…
DHIS2 store national data from many national data sets in one place and make them available in some internet browser such as IE and Chrome
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Mzumbe University

8. Introduction cont…
When data in DHIS2 are used properly it provides feedback on performance of facility to the lower and higher levels.
It provides baseline data for district planning, the level of implementation, monitoring of major indicators of disease patterns and preventive services
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Mzumbe University

9. Introduction cont…
Despite the improvement of health data in Tanzania in the last 15 years
The introduction of DHIS2,
The data quality audits and check
Still the quality of data in health sector is questionable (The National Guidelines for Health Data Quality Assessment (2016)
The data quality audits conducted by a variety of programmes and funders
The quality of routine and periodic data in health sector as a whole is questionable…
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Mzumbe University

10. Introduction cont…
Therefore, this paper goes beyond and examined the uses of data by the CHMTs in the planning process.
The aim is to get the general perspective of the actual practice of planning process and the uses of data in the same.
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Mzumbe University

11. Research Questions The study will answer two main questions:
How do the CHMTs members prepare the LGA’s Health plans?
What are the sources of data used by CHMTs in planning process?
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Mzumbe University

12. Methodology
A purely qualitative study was used to know how the planning process and the uses of data proceeds in LGAs
The source of the information was from CHMT members enumerating their general perspectives and experiences in planning processes and data uses.
To know how the planning process and the uses of data proceeds in LGAs,
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Mzumbe University

13. Sampling
Purposeful sampling technique was used to select the CHMT members from two Master’s classes
MSc-Health Monitoring and Evaluation (MSc.HME); and Master of Health Systems Management (MHSM).
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Mzumbe University

14. Sampling….
The participants represent the seven (7) Zones in Tanzania as categorized by Tanzania Demographic Health Survey
That is, the participants of the FGDs are the representatives of the seven (7) Zones in Tanzania
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Mzumbe University

15. THE PARTICIPANTS AND THE REGIONS WHERE THEY COME FROM
Sampling….
THE PARTICIPANTS AND THE REGIONS WHERE THEY COME FROM
Zones
Region
Participants
Percent
Western
Tabora 2
13.3
Central
Dodoma
Singida 1
6.7
Lake
Mwanza
Mara
Eastern
Coast Region
Morogoro
Southern
Ruvuma
Lindi
Southern Highlands
Songwe
Northern
Tanga
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Mzumbe University

16. Sampling…. To avoid biasness;
The students were informed about the study and assured that the FGDs had nothing to do with their studies as well as their job.
The FGD participants were selected from both graduates (those waiting for graduation) and continuing students
Two FGD were selected from the graduates that is the Msc.HME and MHSM students who had already completed their studies but waiting for graduation. There were no any noted difference in participation in the FGDs between the graduates and those who are proceeding with their studies
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Mzumbe University

17. Data collection method…
Three FGDs were conducted.
FGD was selected because it is commonly used method when carrying out studies to get communal perspectives on certain phenomena.
3+ 6+6= 15
The first FGD involved three (3) participants, the second FGD had six (6) participants; and the third FGD involved six (6) participants; making a total of 15 participants
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Mzumbe University

18. Data collection method…
The FGDs were done by two researchers at MU premises where one office was selected and arranged in half cycle shape
Moderator - asks questions, probes and moderate
Recorder - record all behaviours in a notebook, audio recording and draw the discussion flow (cobweb)
The thrust of FGDs was on the planning process, sources of data used in planning and quality of the data used.
FGD guide was developed and translated into Swahili language to guide the researchers.
The first researcher played the role of moderation and the second researcher was the recorder of all behaviours shown The moderator used different probes to make sure that the FGD participants provided relevant information to address the research objectives. More probing were done when there were emerging issues/concept(s) that emanated from a question that was not predetermined in the FGD guide.
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Mzumbe University

19. Data collection method…(cobweb)
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Mzumbe University

20. Data collection method…(cobweb)
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Mzumbe University

21. Data Analysis
The audio-recorded were transcribed within 24 hrs after the FGD and imported into the Atlas.ti programme for analysis
The coding was done inductively revolving issues of planning processes and the uses of data.
Inductive coding by reading the text several times and coding the data
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Mzumbe University

22. Data Analysis cont…
The grouping was done for the similar themes to form families.
Then after memoing was done to add the researchers’ views on the coded concepts and families.
The grouping was done for the similar themes to form families which are Planning process and data uses in planning.
After coding and creation of code family the memoing was done to add the researchers’ views on the coded concepts.
Memoing is the act of recording reflective notes about what the researcher (fieldworker, data coder, and/or analyst) is learning from the data. Memos accumulate as written ideas or records about concepts and their relationships.
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Mzumbe University

23. Data Analysis cont…
This was included in the descriptive report produced by the Atlas.ti and the final report was written based on the downloaded output from the software
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Mzumbe University

24. Results. Planning Process
Planning process in LGAs is done into two stages, namely, pre-planning and the real planning.
Pre-planning is mainly done at least one or two months before the real planning
The members are CHMT team, Council Planning Officer, representatives from the dispensary and other stakeholders or working with the LGAs
It involves inviting all individuals and organisations that support, cooperate or work with the respective LGA in the area of health.
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Mzumbe University

25. Results cont…
The purpose of pre-planning is to familiarise the members on the real planning and to get their views and priorities.
The pre-planning meeting is a forum to provide and get preliminary inputs which are combined into a zero draft for the planning meeting.
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Mzumbe University

26. Results cont…
The Dispensaries prepare their plans and forward to the council where they are discussed in pre-planning meeting
The Dispensaries prepare their plans and forward to the council where they are discussed in pre-planning meeting and combined in the zero draft document which will be discussed in the actual planning
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Mzumbe University

27. Results cont…
The engagement of the health governing committees and health boards in planning process seems to be an important element in the planning process
However the majority of CHMT question their capacity and experience
They were reported to lack basic and relevant skills and knowledge which limit their participation
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Mzumbe University

28. Results cont… Challenges experienced in planning process includes:
Deciding the priorities of the dispensaries
High demand and limited budget
Aligning the budget with guidelines
Formula, criteria and the basis for fund distribution to dispensaries not clear.
Personal preferences and politics may affect the decision of the issues to be included in the plans
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Mzumbe University

29. Results cont… Uses of data
Data used in the planning are provided by MTUHA focal person and the coordinators.
‘’It is the task of the MTUHA focal person, coordinators and health secretaries to prepare data before the meeting’’
It was clarified that before the meeting all members such as MTUHA focal person and coordinators must have the relevant data that they will use in the planning activities.
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Mzumbe University

30. Results cont…
It was clarified that sometime the data were in the notebooks and hard copies from the dispensaries
‘there was a time when the health secretary was not present, the whole activity of planning became very difficult since we could not trace the data which were in their notebooks and some data was not clear’
Some data in the documents from the dispensaries not clear….
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Mzumbe University

31. Results cont…
The use ‘cooked data’ to meet the required standards of preparing the health plans.
This is when the available data are not realistic while the system needs a certain percent or amount to be filled for the plans to be accepted.
To fulfil the requirement of filling the information in the system, the CHMT shared their experience that they sometime manuver the data to reflect the reality. The basis for manuvering is the trend that is looking for the previous data and add or reduce….
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Mzumbe University

32. Results cont…
Example: The system of preparing plans is sensitive that it needs the expenditure to reflect the plans in the system.
This has been a problem in the councils because what is implemented is not what is on the actual plan.
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Mzumbe University

33. Results cont…
The data in the hospitals are worse compared with the data in the dispensaries.
They are not filed well and sometime not filed at all.
For instance the data in OPD data do not match with the laboratory data.
Busiest schedule in the hospital eg a dr who has a long waiting quer to attend is supposed to fill the detailed data of each and every patient, sometime they treat and espect to fill the books later which in most cases is not done.
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Mzumbe University

34. Results cont…
The ‘good data’ (data that tells what the higher authority and donors want to hear) are reported, but in most cases they do not reflect the reality in the health facilities.
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Mzumbe University

35. Results cont…
Eg. Data related to abortion, maternal mortality and deaths caused by cholera are likely to differ from the original and may sometimes not be documented.
This reflect data quality in DHIS2 and was mentioned as the reasons for not using DHIS2 data in planning
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Mzumbe University

36. Results cont…
The data entered into the database do not actually reflect what is happening in the facility, and they sometimes differ significantly with the data available in health facilities in MTUHA monthly summary form.
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Mzumbe University

37. Results cont…
All CHMTs participated in FGD have the access to DHIS2 database, but they never accessed the system neither cross checking the quality of data nor downloading the data for use
Despite the fact that all CHMTs participated in FGD have the access to DHIS2 database, all of them declared that they never accessed the DHIS2 data for neither cross checking the quality of data entered into database nor downloading the data for use in planning activities and preparation of various reports
‘It is the duty of MTUHA focal person to make sure that the data that are entered into database are correct’
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Mzumbe University

38. Results cont…
The culture of data use in planning and reporting in health is still low among CHMTs.
They have a mentality that the data collected are for ‘them’ (higher authorities and donors) and not for their personal use
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Mzumbe University

39. Conclusion
The CMHTs follow the required guidelines in preparation of Health plans
The question remains on the uses of quality data in planning process.
This might be attributed by the culture of not using the data and perhaps low analytical skills
2/24/2019
Mzumbe University

40. Conclusion cont..
The CHMT members should undergo intensive training on conducting simple analysis of DHIS2 data.
To increase data analysis skills
Develop a culture of using data in planning
Improve the quality of plans to reflect the real problem.
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Mzumbe University

41. Conclusion cont… Training lower level staff on simple analysis
To ensure quality of data collected
Increase capacity to make a sense of data from the collection stage
Lower level staff, who are the data collectors….
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Mzumbe University

42. THANK FOR LISTENING
THANK FOR LISTENING
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Mzumbe University