IMPROVING PUBLIC HEALTH SYSTEMS IN RURAL KARNATAKA FROM INFORMATION SYSTEM PERSPECTIVES

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IMPROVING PUBLIC HEALTH SYSTEMS IN RURAL
KARNATAKA FROM INFORMATION SYSTEM PERSPECTIVES
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• National health policy Guidelines
• Increased access to the decentralized
• public health system by establishing new
• infrastructure in deficient areas, and by
• upgrading the infrastructure in the existing
• institutions
• More equitable access to health services
• across the social and geographical expanse of
• the country.
• Increasing the aggregate public health
• investment through a substantiallyincreased
• contribution by the Central Government

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• National health policy Guidelines - contd
• Enhancing contribution of the private sector
• in providing health services
• Primacy to preventive and first-line curative
• initiatives at the primary health level
• through increased sectoral share of
• allocation
• Emphasis on rational use of drugs within
• the allopathic system
• Increased access to tried and tested
• systems of traditional medicine

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• Key areas for discussion related to information
  system
• What information is needed for the key
• themes identified in the policy
• documents?
• Do current routine health data satisfy
• these policy requirements?
• Are the periodically organized surveys
• effective, meaningful and do they
• provide information that can inform over
• the longer term?
• How can one improve information and
• data gathering for better policy making?

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• National health policy document says
• The absence of a systematic and
• scientific health statistics data-base is a
• major deficiency in the current scenario
• The health statistics collected are not the
• product of a rigorous methodology
• Statistics available from different parts of
• the country, in respect of major diseases,
• are often not obtained in a manner which
• make aggregation possible or meaningful.

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• Indicators needed
• Information on accessibility and availability
• of services especially to underserved
• groups such as women, adolescents,
• disadvantaged groups such as weaker
• sections of the society and those living in
• remote areas
• Prevalence and incidence rates of
• morbidities especially Malaria,
• Tuberculosis, HIV/AIDS at decentralized
• levels
• Mortality indicators especially IMR and
• MMR at decentralized levels

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• Indicators needed - contd
• Information on availability of service
• personnel
• Information on service environment
• Information on availability of equipment
• and essential drugs
• Information on professional standards and
• technical competence especially training of
• personnel in specialties

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• Indicators needed contd
• Information on extent of provision of
• services in an integrated manner
• especially with environmental
• programmes
• Information on NGOs participation in
• delivery of health programmes

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PRESENT SCENARIO ON INFORMATION GENERATION
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• NATIONAL LEVEL
• Central Bureau of Health Intelligence (CBHI)
  Health intelligence wing of the Directorate
  General of Health Services
• Collect,compile and disseminate information
• on health status, health resources,utilization
• of health facilities etc. through routine
• sources
• Provide estimates of birth rate, death rate
• and other fertility and mortality indicators
  at
• the national and sub-national levels

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• Statistics Division in the Department of Health
  and Family welfare
• Collect and periodically publish monthly
• bulletin on family welfare statistics, year
  book
• on family welfare programmme - mostly at
• National and State level
• Sample Registration System (SRS)
• Large scale demographic survey
• Provides reliable annual estimates of birth
• rate, death rate and other fertility and
  mortality
• indicators at the national and sub-national
• levels

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• STATE LEVEL
• Directorates for primary health, secondary health
  and medical education.
• Compile and transmit information on National
• level and publish statistics
• Vital statistics collected mostly through
• civil registration system

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DISTRICT LEVEL District medical and health
officer or Chief medical officer compiles
information on different programmes and transmits
to higher levels BLOCK LEVEL Medical Officers of
Health centers compile information through the
staff of different programmes and submit to
district level
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ISSUES OF CONCERN IN THE EXISTING HEALTH
INFORMATION SYSTEM
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• Structural issues
• Excessive concentration on administration
• at the state and central levels and less
• importance to information system
• Multiplicity of institutions/departments,
• which work in their own hierarchies posing
• series problems for integration and co-
• ordination resulting in fragmented data

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• Procedural issues
• Exhaustive and many times not warranted
• information collected and hardly used
• resulting in inaccuracies
• Data collection becomes a preoccupation
• to a level of distraction, so much so that the
  
• purpose of information is ignored
• For each vertical health program there is a
• separate target population register, different
• activity registers and a separate register for
• each inventory item

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• General information is collected routinely
• every time and reported afresh
• Not only the number of reports is large
• but also the reports are not in an easily
• collatable form from the existing registers
• No feedback to the PHC, hospital, district
• and state by the higher processing
• systems

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• At every level Administrators are not
• trained to view the information in terms
• of Indicators and the tendency is to look
• at them in absolute numbers
• Even in meetings the targets are
• discussed in absolute numbers and are
• never discussed as indicators

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• Content related issues
• Only Information summaries reach the
• higher levels
• Details miss the attention of the policy
• makers and managers due to lack of
• databases
• At present health information system
• generates socio-demographic data mostly
• at the state level

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• There are no useful data on the incidence of
• many diseases and disabilities
• Most of the health and other indicators
• available are of state level
• Planning fails to take into account the
• district wise and block wise developmental
• differentials and health seeking behavior

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• Information is more focused on target
• achievement in numbers and financial
• aspects and less on the socio-cultural data
• needed for developing and adjusting health
• services and disease control programme to
• local health related perceptions, values and
• resources

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• Human resources related issues
• Absence of training and motivation on
• the use of information at higher levels
• At lower levels staff involved in the
• HMIS process have serious inadequacies
• in training on information system

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• Technological issues
• Manual paper based systems no data
• bases are maintained at any level
• Although Computers have been supplied
• at almost all the districts and block level
• they are hardly used
• Used minimally to summarize and collate
• the data and they are used for word
• processing and other printing works

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Role of Surveys for information
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• National Family Health Survey (NFHS) - Third
  round carried out in 2005-2006
• Provides
• Essential data on health and family welfare
• needed by the Ministry of Health and Family
• Welfare and other agencies for policy and
• programme purposes
• Information on important emerging health
• and family welfare issues

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• BUT
• Information is available only up to State
• level Sample size does not allow district
• or Block level estimates
• Concentrated more on MCH and FP
• information
• Report preparation takes a long time
• Detailed information not provided to
• State level for programme
• implementation

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• Household survey for RCH program By GOI
• Only State level information
• Sample size does not allow district or
• Block level estimates
• Usually the data is not available to the
• State governments in database formats
• Reports are supplied after a long time
• and there is hardly any follow-up.

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Facilities survey For RCH program By GOI
Usually the data is not available to the state
governments in database formats Reports are
supplied after a long time and there is hardly
any follow-up Immunisation coverage surveys in
each state Routine affair and not used much for
programme implementation
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• External donor agencies like World bank, DFID and
  others usually conduct elaborate studies before
  launching a program
• Information collected through consultants
• relevant to a particular programme funded
• by them
• Not much supervision on quality of data as
• different external agencies collect
• information

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• Many times different aspects of information
• is collected by different agencies in a
• fragmented manner and available only at
• the State level and no particular officer or
• individual would know where and with
• whom the data lies

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WHAT REQUIRES TO BE DONE
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• HMIS has to develop extensively as
• Database Technology on various aspects
• Use of information system at the primary
• health care level should be strengthened
• as a managerial tool
• Managers should be trained to formulate
• questions to be addressed by the health
• information system, should grasp the
• information presented to them and should
• use it to plan, evaluate and control the
• health services

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• Block level indicators, if not village level
• are to be developed for focused attention
• and efficient targeting of the needy
• populations
• There has to be a separate effort in culling
• out the information from the registers to
• prepare reports

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• The reporting formats are to be developed in
• such a way that they are oriented to reduce
• the effort in writing and encourage use of
• computers
• Conduct periodical surveys to obtain
• information on those information which are
• not available by routine information system
• especially on demography, sociology and
• economic aspects of the population