STRATEGIES FOR PERMANENT ACCESS TO SCIENTIFIC INFORMATION IN SOUTHERN

AFRICA: FOCUS ON HEALTH AND ENVIRONMENTAL INFORMATION FOR

SUSTAINABLE DEVELOPMENT

AN INTERNATIONAL WORKSHOP

5-7 SEPTEMBER 2005

CSIR CONVENTIONCENTRE, PRETORIA, SOUTH AFRICA

UTILIZATION OF HEALTH INFORMATION IN NAMIBIA

FOCUS ON CHALLENGES AND OPPORTUNITIES FACED BY

HEALTH CARE DELIVERY SYSTEM

DR. L. HAOSES-GORASESPhD, M Cur, Hon Cur, BA Cur, Adv.

Univ. Dipl. in CHN & Education

INTRODUCTION• 2001 Population Census – 1.830,330• Population 1.830,330-2001 Housing Census• Annual growth rate 2.6%• Surface area 824,116 km2

• Average 2 persons per km2

• People spread unevenly across the country• Urban 33%• Rural 67% (SSS 2004)

NAMIBIA BY REGION

BACKGROUND HIS under Epidemiology Division Collect routine data – all health facilities

(clinics, health centres & hospitals)Aim: Analyze Documentation Disseminate – planning Direct changes in policies Improve monitoring performance Identify support needs

KEY PLAYERS MoHSS & Central Bureau of Statistics

(CBS) Major surveys & census Data duplications occurring With new developments new programmes

on board Prevention of Mother to Child

Transmission (PMTCT) Anti Retroviral Treatment (ART) Voluntary Counseling & Testing (VCT)

CONTINUE Health Information System

developed in 1990 after independence

Many challenges –improvement in the past years

In 2004 and 2005 situation analysis and comprehensive assessment of the system

OBJECTIVES To improve individual and institutional

performance To measure quality and efficiency of the strategies

in place To compare performance over time in relation to

national targets To provide support to regions, districts & health

facilitiesTo monitor trends in: Coverage Quality Effectiveness of the services Guide policy-makers for resource allocation

RECORDING PROCEDURES Tally sheets Daily ward census Monthly summary forms E-mail Floppy diskettes from regional to

national level

CONTINUE Information covers indicators on: Human resources Population Health facilities Financing Directive in terms of MDG’s Information only from: Public and mission health facilities

QUALITY OF THE DATA Training of staff Computerized system E-mail functioning (80%) Floppy diskettes also introduced

SOURCES OF DATA Located in different directorates Directorate Planning & Human Resources

(MIS) Central Bureau of statistics in National

Planning Commission (Census, vital events)

Ministry of Home Affairs (registration birth, deaths, immigrants etc.)

Discussions for 3rd national statistic plan

STRENTHENING OF HIS Revision in 1994 New forms introduced in 1995 Revised again after five years International standards ICD-10 included

DECENTRALIZATION/COMPUTERIZATION

All 13 regions 33 districts (computerized) To improve channels of processing

of the data: Health facilities to district, regional

and national level Telephoning instant training ICD-10 for coding purposes (IP)

INTRODUCTION OF STANDARD REGISTERS

Outpatient Department (OPD) Inpatient Department (IPD) Antenatal Care (ANC) Expanded Programme on

Immunization (EPI) Legal records Reference manuals are available

INTERNATIONAL PARTNERS ROLE

Investing in specific programmes GF, USAID, FHI, CDC, PEPFAR UN

AGENCIES (Malaria, TB, HIV/AIDS) Reporting circles UN agencies support the health

service e.g. Country Response Information System (CRIS)

REGULARLY & LEGAL FRAME WORK

Facility Act – draft Health Act –draft Consolidate information from

private health facilities & other stakeholders

STRATEGIES CBS conducts surveys & household census Ministry of Home Affairs generates info on

births, death and immigration Integrated disease surveillance system

collects info on notifiable diseases such as: Measles Neonatal Tetanus Polio (AFP) etc NDHS scheduled for 2006 (every five

years)

INFORMATION MANAGEMENT

Several sets: Health indicators used for:PlanningResources allocationMonitoring & evaluation Compiled at district to regional and national Data cleaned at all levels & actions taken Several data bases coming up Development partners choice MOHSS is constantly updating it’s website – new

version to be release this year SPSS, EPI-INFO & Microsoft Access in used

AVAILABILITY OF SOUND HEALTH STATISTICS

Strength (quality) of the data assessed Statistical techniques examinedMajor elements (domains) Health profile of the population Risk factors Service coverageFactors influencing data Timeliness Representativeness Periocity Consistency 65% info readily available

2004 SENTINEL SURVEY

UTILIZATION Vital vehicle – M & E Reprogramming Planning Development of policies/guidelines Setting of priorities

NATIONAL HEALTH STATISTICS, 2005

Domain Indicator Score (%)

Health status Overall score (mean)

Child mortalityMaternal mortalityAdult mortalityCauses of death in childrenHIV prevalenceTB incidenceUnderweight in childrenObesity in adults

65

73555041

7578870

CONTINUE NATIONAL HEALTH STATISTICS, 2005

Domain Indicator Score (%)

Health service coverage

Measles coverageSkilled birth attendantTB treatment DOTProportion of children sleeping under bed nets

837083

50

CONTINUE NATIONAL HEALTH STATISTICS, 2005

Domain Indicator Score (%)

Risk factor Smoking prevalenceCondom use at higher risk sexImproved water supply

7868

87

System Total health expenditure (per cap)Health worker density

63

76

CHALLENGES Turn-over of staff/training Timeliness – info – national level No designated staff at district level Computer – literacy lacking Info – private sector not available Development partners agenda Coordination of the systems Involvement of top level management

OPPORTUNITIES Strengthening/coordination of system Capacity development Completion of facility & facility & Health Act Capitalize on development partners’

support to strengthen lower levels Regional collaboration/expertise (SADC,

WHO etc). Development of critical mass in the region

e.g. WHO, SADC etc. Availability of expertise in the SADC region

CONCLUSION

Key constituencies to form coordinating mechanism

Designated staff at district level Mobilization of resources by all

stakeholders Involve policy-makers (vital tool) Country needs driven system Indicators to match with National

Development Plan

CONTINUE Train staff on computer literacy on HIS Involvement of policy makers and

stakeholders for better understanding & support

Computer back-up system at regional level

Facility and Health Acts be finalized and implemented

Sustainability of HIS address Horizontal learning (regional expertise)

NB! HIS is serving as a vital instrument in

our health service delivering system It is directing the MoHSS in

identification of shortcomings (revision of the system, adjusting of the indicators, software etc.

Strengthening at all levels Make information available in a user-

friendly manner Proper utilization of the system

CONTINUE HIS is reporting on diseases

targeted for eradication and elimination (e.g. Polio (80% WHO) Measles and Neonatal Tetanus

HIS is in high demand by sectors – positive move

Thank you!!!