Communitybased information systems for integrated monitoring and evaluation

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Community-based information systemsfor
integrated monitoring and evaluation
Charles Teller and Theo Lippeveld
Mini-University presentation Washington, DC, May
10, 2004
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Community-based information systems
Concepts(section by Theo Lippeveld, JSI)
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Why community-based health (information) systems

• Epidemiology Health care is not the only health
  determinant
• Effectiviness better responding to individual
  and population health needs (health reform)
• Efficiency costs (of data collection) vs
  benefits (better coverage)
• Equity better serving marginal population and
  risk groups (census-based monitoring)
• Empowerment of communities information is power

D. Marsh (2000)
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Impact of Main Health Determinants
Potential contribution of interventions towards
reducing mortality in the United States (in )
Adapted from Devers G.E.A. An Epidemiological
Model for Health Policy Analysis Soc.Ind. Res.,
1976 Vol.2 P 465
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Complementarity individual and community health
interventions

• Individual health interventions mainly
  restorative (focused on health care)
• Community (and public health) health
  interventions mainly preventive with a focus on
  lifestyle and environment

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Fragmentation of the health system

• individual health ? public health
• curative ? preventive
• generalist ? specialist
• public ? private
• provider ? user
• economic ? social

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How to better integrate individual and community
health interventions?

• Focus on a reference population and a defined
  geographical area in the context of a
  decentralized health services system
• Organizational models for supporting coordination
  and integration processes
• Use of a comprehensive health information system

Towards Unity for Health, Phuket, 1999
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Defined geographical area the Health District
District Population
HEALTH CARE LEVEL
CATCHMENT AREA POPULATION
Patient/Client contact
First level care unit
PRIMARY
DISTRICT LEVEL
Referred patients
District Hospital
SECONDARY
Regional Health Management Team
NON-ROUTINE DATA COLLECTION METHODS
Referred patients
REGIONAL LEVEL
Regional Hospital
TERTIARY
Ministry of Health Universities Other Health
Institutions
National Hospital University Hospital
NATIONAL LEVEL
Referred patients
INDIVIDUAL CARE MANANAGEMENT
OTHER SECTORS -Environment -Civil
Administration -Transport -Education
HEALTH UNIT MANAGEMEET
SYSTEM MANAGEMENT
Routine Health Information System
HEALTH CARE SERVICES
HEALTH SERVICES SYSTEM
HEALTH SYSTEM
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Organizational models in support of integration

• Vertical integration
• between health systems levels use of essential
  data sets
• Horizontal integration
• between health programs HIV/AIDS and family
  planning
• between sectors health and education

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Community-based Information System

• Adding another layer to the routine
  facility-based information system
• Definitional issue community-focused versus
  community-based
• Community involvement in defining indicators, in
  collecting data, and in use of information
• Ideal level for horizontal integration
• Mostly in research settings (Narangwal, Matlab,
  Kasongo) or NGO driven (AKHS in N.Pakistan,
  Schweitzer Hospital in Haiti)
• Few large scale applications Iran, Philippines,
  Thailand

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Community-based, Integrated ME Strategies,
Methods and Tools(section by Charles Teller,
USAID/GH)
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Horizontal Integration Strategies

• Multi-level (within the broader community)
• Multi-sectoral (health edu. AIDS RD)
• Bridging Relief and Development
• Balancing Risk and Resilience
• External and internal ME
• Combining quantitative and qualitative data
• Home-based records IMCI

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Sources of Community Information

• Facility-Based vital registration (births,
  deaths), programs reports, record books,
  observations, etc.
• Population-based Maps ( GIS), census, rosters,
  health cards, PRA/RRA, surveys, etc.

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Population-based Methods

• Census
• Sample vital registration (SAVVY)
• DHS/RHS (surveys)
• KPC/KAP (surveys)
• LQAS
• Household mapping
• Registers and enumerations

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Information Tools for ME at Community Level
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Case Study Horizontal Integration of C-B
Information for Famine Mitigation

• Goal Reducing excess mortality and malnutrition
  in periods of food shortage in Ethiopia
• Strategic objective (for HPN and Ed.)
  strengthen social resilience at community level

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Proposed Indicators of COMMUNITY CAPACITY AND
SOCIAL RESILIENCE Ethiopia

• Positive, early coping strategies
• Forced out-migration of whole families reduced
• Traditional social groups supportive of high risk
  
• Community-based, timely, self-targeted food aid
• High coverage of measles vaccination
• Low school dropout from primary school
• Local Famine Early Warning system functional

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Community-Focused Baseline Methods and Tools
Ethiopia

• Quantitative
• School records
• Health cards
• Agri. Extension data
• Early warning system relief/EGS rolls
• HH livelihoods LQAS sample survey
• Anthropometry

• Qualitative
• Focus groups
• Key informants
• Mapping/transect
• Observation
• Community council discussion

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Research Questions

• Are large-scale community health information
  systems (CHIS) feasible in developing countries
  (culturally, politically)
• How to develop such large-scale systems?
• What are the trade-offs between scientific rigor
  and flexible, capacity-building participatory
  methods?
• How horizontally integrated can a CHIS be without
  losing efficiency, focus and data reliability?
• How to sustain CHIS (mostly externally managed)?