District Health Information Systems

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District Health Information Systems
Topic 5
Data analysisturning data into information
João Carlos de Timóteo Mavimbe Humberto
Muquingue

• Oslo, April 2007

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Presenting Interpreting
Indicators
ANALYSIS Processing
USE
Collection
Input Raw data
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LEARNING OUTCOMES

• By the end of this session, you should be able
  to
• Explain how data is converted into information
• Explain basic epidemiological terms and
  concepts
• Explain concepts of numerator and denominator
• Explain the meaning and use of terms count,
  rate, ratio and proportion
• Make simple calculations

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Data analysisturning data into information
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Data analysiswhat, why and how?

• WHAT ? (meaning)
• turns raw data into useful information
• is the process of producing indicators
  most important step in data analysis
• uses quality data with the 3 Cs

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Data analysiswhat, why and how?

• WHY ? (purpose)
• the aim of a DHIS - the improvement of coverage
  and quality of local health services - is
  facilitated by only collecting data that can
  be analyzed and used at the local level
• allows comparisons facilities / teams
• favors self assessment (have I reached my
  target ?)
• supports decision-making

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Data analysiswhat, why and how?

• HOW ? (use)
• calculates indicators
• uses basic epidemiological concepts

Can you provide examples?
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Indicators - many definitions
Occrams rule

• variables that help to measure changes,
  directly or indirectly (WHO, 1981)
• indirect measures of an event or condition
  (Wilson and Sapanuchart, 1993)
• variables that indicate or show a given
  situation and thus can be used to measure
  change (Green, 1992)

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Indicators

• measures of COVERAGE and QUALITY
• variables used to measure CHANGE
• monitor progress towards defined targets
• describe situations
• measure trends over time
• provide a yardstick whereby facilities / teams
  can compare themselves to others

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Indicators there are many calculation types
1. Count no denominator numerator - number of
events, observations, individuals (frequency) 2.
Proportion numerator is part of
denominator expressed as per 100 (), 1000, 10
000, 100 000 3. Ratio numerator is not part
of denominator comparing 2 different
numerators 4. Rate a detailed
proportion number of events during a specific
period
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5. Aggregated, composite or indexed indicators

• - DALY (disability-adjusted life years)
• HALE (health-adjusted life expectancy)
• QALE (quality-adjusted life years)

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• There are about 1,500 indicators in the health
  sector
• (World Bank inventory)!

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An ideal indicator RAVES !!!
?
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An ideal indicator RAVES

• RELIABLE it gives the same result if
  used by
  different people
• APPROPRIATE it is the best way of measuring
  what we want
  to know
• VALID it measures what you
  want to measure
• EASY it is feasible to
  collect the data
  to produce this indicator (KISS)
• SENSITIVE, SPECIFIC it reflects changes in
  events
  being measured

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Atop the line numerators(activities /
interventions / events / observations / people)

• a count of the event being measured
• How many occurrences are there
• morbidity (health problem, disease)
• mortality (death)
• resources (humanpower, money, materials)
• Generally raw data (numbers)

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Under the line - denominators(population at risk)

• size of target population at risk of the event
• What group do they belong to
• general population (total, catchment, target)
• gender population (male / female)
• age group population (lt1, gt18, 15-44)
• cases / events per (live births, TB case)
  

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I. Systems classification

• INPUT
• monitors affordability of resources
• measures availability / quality of resources
• PROCESS
• monitors activities that are carried out
• measures accessibility of services coverage
  and quality
• OUTPUT
• monitors results of activities
• measures acceptability - use, change,
  performance, coverage and quality
• OUTCOME
• monitors changes in health status of populations
  ? IMPACT
• measures appropriateness - effectiveness,
  efficiency, equity, sustainability

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II. Functional classification

• Indicators can be grouped according to their
  function in plannning and monitoring
• Health status
• Activities
• Quality
• Resources
• Output / Efficiency
• Efficacy
• Impact / Outcome

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A. Health status indicators

• They inform about the causes of disease and death
  in a given population.
• Examples
• Morbility rates of measles
• Death rates of TB
• Incidence rates of diarrhea
• Low birth weight rates

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B. Activity indicators

• They inform about of volumes of work.
• Examples
• Coverage rates of a programme
• Achievement indexes
• Use of services (OPD utilisation rates)
• Admission rates per inhabitant

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C. Quality indicators

• They inform about the excellence of activities
  carried out.
• Examples
• Antenatal attendance rates
• Direct obstetric death rates in the facility
• Vaccine dropout rates

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D. Resource indicators

• They inform about the availability / quality of
  consummables, equipments, staff, health
  facilities and money.
• Examples
• Cost of drugs prescribed per consultation
• Number of inhabitants per clinical officer
• Percentage of health facilities with vehicle for
  programme activities
• Availability of vital drugs

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E. Efficiency indicators

• They refer to the volume of activities performed
  using a given resource. They inform whether the
  resources were well used, underused or overused?
  the ratio of inputs needed per unit of output
  produced
• Examples
• Deliveries per nurse
• Bed occupancy rates
• Average length of stay

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F. Output or efficacy indicators

• They show to what extent the expected result was
  attained with the available resources ? the
  degree to which outputs affect outcomes and
  impacts
• Examples
• Reported new cases of acute flaccid paralysis
• Incidence rates of EPI-targeted diseases
• Percentage of fully immunised children

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G. Impact or outcome indicators

• The impact of a programme is the effect that
  programme induced on the overall health status
  and socio-economic conditions of the target
  population
• Examples
• Nutritional status of children
• Percentage of new family planning acceptors
• Incidence and mortality rates due to HIV
• Infant mortality rates

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III. Classification according to indicator level

• Local indicators
• Indicators from censuses and surveys

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1. Local indicators

• Compiled from routine HMIS data
• Should follow principles of minimum data set
  and information filter

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Minimum or Essential Dataset
? the minimum amount of data that needs to be
collected ? for the effective management of
services which allows them to make the
greatest impact on the health needs of the
community which they serve (thus improving
coverage and quality) ? uses minimum number of
data collection tools
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The Information filter
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2. Indicators from censuses and surveys

• Infant mortality rate
• Crude death rates
• Crude birth rate
• Death rates of children aged 0-4 years
• Maternal mortality rates
• Seroprevalence of HIV or BHep

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Epidemiological questions
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(No Transcript)
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Epidemiology who, where, when ?
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Epidemiologywhat, why and how?
WHAT ? (meaning) study of the distribution,
frequency and determinants of health problems and
disease in human populations WHY ?
(purpose) obtain, interpret and use health
information to promote health and reduce
disease HOW ? (outcome) uses indicators to
answer basic epidemiological questions
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• Information cycle meets
• Planning cycle

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Information Cycle
Stages Tools Outputs
Decision-making for effective management
What do we collect?
data sources tools
Good quality data
What do we do with it?
How do we use it?
Quality at every stage EDS
Interpretation of information
analysis
Data converted to information
feedback
How do we present it?
Reports and graphs
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Planning Cycle
Stages Tools Outputs
Where are we now? Situation analysis
Review of plans
Priority problems
Where are we going? Goals, Targets, Indicators
How will we know when we arrive? Monitoring and
Evaluation
Quality information at every stage EDS
Key interventions
Key strategies
How will we get there? Action Plans
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GOALS

• broad policies and long term objectives
• broad aims stated in general terms
• represent future direction
• Set at national level by political and health
  decision makers
• general objectives (aims, long term
  objectives)
• correlated with local context
• set at provincial and district levels by health
  managers

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TARGETS

• they are a subset of objectives
• state exactly what has to be achieved, by
  whom and by when
• a realistic point at which to aim to reach a
  goal
• turning the goal into number terms

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TARGETS

• should be
  SMART
• Specific measurable based on changes in
  situation concerned
• Measurable able to be easily quantified
• Appropriate fit in to local needs, capacities and
  culture
• Realistic can be reached with available
  resources
• Time bound to be achieved by a certain time