1. Health Information System “ Consumers’ perspective” Gunnar Bjune March 2013 g.a.bjune@medisin.uio.no

2. Three fundamental issues The health problem Prevalence, incidence, ”disease burden” The service delivery Facilities, strategies/programs, activities The resources Man-power, skills, supplies, support ->Outcome / impact

3. Conflict of interest? Control: Global/national/local/personal ”Bottom-up strategy” (democratic) Rights: Needs/justice/legal/private Data quality, data safety, integration Efficiency: Needs – resources Analyses and research Safety: Epidemics/hazards/life-style Surveillance

4. Example: Tuberculosis control Objectives Reduce mortality Detect and treat cases (morbidity) Cure sputum positive cases Reduce transmission DOTS : 1. political commitment 2. diagnosis through microscopy 3. drugs supply 4. observed therapy 5. recording and reporting

5. Tuberculosis control “Information culture” Central management unit (in MoH) National standard formats TBMUs -> Province -> CU -> MoH Standards used as basis for supervision Emphasis on treatment outcome Often functions in isolation from PHC

6. Tuberculosis control What kind of data? Classification New pulm. sm+ Pulm. sm – Extra pulm. Transfer in Retreatment Relapse Treatment outcome Cured Treatm. Completed Dead Transferred out Chronic (“failure”) Lost to follow-up

7. Tuberculosis control What sources of data? Laboratory book TB suspects, results of 2 smears, follow-ups Treatment card Demographic data, classification, treatment, weight, regularity, lab.res. Registration book Classification, treatment outcome, comments Supervision reports Problems, solutions, data quality

8. Tuberculosis control Flow / loss of information Symptomatics Laboratory TBM Province National International (WHO) PHC Hospital serv. ”Symptomatics” Laboratory TBMU PHC Hospitals Non-TB / TB Private / public DOTS centr.

9. Tuberculosis control What we can learn from the laboratory book External quality control Work load and in service training Suspect/positive ratio Quality of diagnostic microscopy routine Quality of follow-up Transfer to treatment cards

10. Tuberculosis control What we can learn from the treatment cards Accuracy of diagnosis/classification Weight gain/loss Address* (and social background) Treatment regularity Regimen and drug reactions Treatment outcome Transfer to registration book

11. Tuberculosis control What we can learn from the registration book Incidence* and classification / PHC unit Treatment outcome / PHC unit Childhood TB (active transmission) Mortality (HIV etc) Extra pulmonary TB (HIV, M.bovis etc) Gender balance Transfer to CU/MoH reports

12. Tuberculosis control The problem of coverage WHO target: Detect 70% of estimated new cases What is the basis for the estimate? The private sector? Double reporting? Alternatives: 1. Geographical and social accessibility (GIS/season/social strata/etc) 2. Diagnostic delay

13. Tuberculosis control Integration into PHC In principle, but often not in reality Resources (transport, pharmacy, statistician, laboratory, supervision, data management) Culture (treatment outcome, data quality, district management, health rights) Power (supplies, supervision, staffing) Satisfaction (outcome data)

14. Challenge / solution Central control Quality of data Efficiency Reporting Local problems Success ”The big picture” Peripheral analyses Used by ”producers” Training Supplies etc Documented needs Treatment outcome Local interactions