AFRO-NETS> Health Cards (40)

[We got some complaints about rather lengthy contributions to this
conference and that people can't cope with the number of messages any more.
- What is the opinion of subscribers? D.N. Mod.]

Health Cards (40)
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Arie Verburgh wrote:

I would like to comment (from a South African viewpoint) on a few of the
points made by Bill in Health Cards (36). [...]

Arie,

I'm glad to see that we are continuing this discussion in the broader
context of health information systems(HIS). My response to the issues you
raised in Health Cards (39) may be rather limited due to the lack of an
adequate understanding of your current health care system methodologies and
policies at various levels. For example, regarding district priorities, I
have no idea as to what may conflict with these priorities because I don't
know what the priorities are. Hopefully, even without an adequate context,
we can attempt to address the issue of equity as it relates to HIS in
general.

The registration (census) challenges you mentioned are not unique to South
Africa. The original development site for IMPACT met with some of the same
issues. Incompetent and corrupt enumerators, lack of supplies, electrical
shortages, an international embargo, strikes, and the like were our
constant companions. These uncertainties are inevitable in the developing
world, and can be extremely discouraging.

When we first started the registration process on a population of 220,000
in the district, all we had to begin with was a couple of donated IBM XT
computers and a VISION. In spite of seemingly insurmountable odds, scant
resources, and an international embargo, the HIS team took the district's
information system from a 1956 manual system to 1996 automated system,
which included networking 20 computers in three different buildings, within
two years. There is a proverb that says, "little by little the bird builds
its nest". That is how we approached the development of the HIS, which has
now become IMPACT. We began with the vision to link community-based data
with facility-based data and began putting the "little pieces" of the
foundation into place long before we saw any evidence of our "vision"
becoming a reality. I would imagine that this principle would work in South
Africa as well.

The idea is to begin to put in place an "information infrastructure" upon
which to build your health care delivery system. This foundation is made
up of many building blocks that will support the health care system
structure. These building blocks include things such as the assigning of
unique health identification numbers (HIN) to every individual and
identifying every community with a code, much like the U.S. Postal Zip
Code. These are just a couple of samples. The building of the foundation
also includes how service providers document and report services performed.
You don't have to put this entire foundation in at once. You can do it a
little at a time within the scope of a long range goal. You can begin with
a small facility catchment area and expand as resources permit.

Now, concerning the issue of registering your families. It really does come
done to resources. Whether human or other, we are mostly talking about
financial resources. If you have adequate funding you can accomplish your
goals. My first question would be can you possibly secure funding for a
project that would include the registration of all your families within
your district (I am assuming this is at the district level)? I think that
in order to secure such funding you would have to provide adequate
justification. I think that the implementation of a system such as IMPACT
might provide a good basis for the justification. (I know, there is some
bias there, but what else is out there?)

If you can't possibly commit to the registration then the alternative is to
somehow identify individuals residing in a defined catchment area or
district. This includes the identification of immigrations, births, and
deaths. The implementation of a Health Passport or some type of health card
that uniquely identifies individuals with an HIN. This data would be kept
in a central database where all subsequent services are identified and
linked using the HIN. The system could then generate reports showing which
HINs have no activity. For example, a child is born, and a TBA gives the
mother a health card for the child. The TBA submits her report to the
central site showing that a new number has been assigned to this new baby.
The birth mother's information is also collected and submitted in the
report. If after a specified period of time there is no activity on this
new baby's HIN in the way of immunizations, or other care, the central
site's monthly report would include this child. This child is now an
active "target" for follow-up.

Why is there no activity associated with this HIN. Did the child out-
migrate? Die? Does the mother realize her child needs to be immunized? This
would also serve as a quality assurance function for health worker
evaluations, providing a means for registering births, and provide other
significant data currently not available.

Until the health care sector comes to the point that it is willing to
assign HINs to its populace, and document services using the HIN, the goal
of providing "real time" rates and indicators will never be achieved. The
health care sector will also forfeit the opportunity to link community-
based preventive/promotive data with facility-based curative data, and thus
exponentially increase the value of its data. "The whole is greater than
the sum of its parts" is especially true within the context of integrating
demographic and health facility-based data.

Arie, I wish I could be of more assistance to you, but I am afraid I just
don't have enough information regarding your policies and activities to
present a more objective appraisal. It is also difficult when brevity is
required for such a complex issue such as HIS. Perhaps if you could provide
some specifics regarding the health care sector in South Africa I could be
of more assistance. Is there anything on the WWW that may be useful?

Regards,

Bill

--
William Billingsley
mailto:wbillingsley@aztechcon.com

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