Health Cards (47)
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Dear William,
Its hard to let this rampant technological optimism go by unchallenged!
The foundation of an effective and efficient health care system(HCS)is
its information system.
A healthy foundation(HIS) will not only support the HCS, but it will be
the driving force.
Put the foundation in place first, then build the HCS intervention
structure. The accuracy and usefulness of your data will forever silence
their scepticism.
If you had said that the foundation was the connection with the community,
or the quality and effectiveness of the care, I might have thought -
plausible, but I still would have asked the question: Where is your
evidence? So let me ask you: where is your evidence that HIS makes the
difference (and not the committed, excellent leadership which your team
clearly offered to the Haiti case)?
It seems to me that you are saying that high quality information is an
essential contributor to better health outcomes. Given the cost of such
information, I really think I would like to see some data to show that the
investment is worthwhile, and that it is better than any other way of
improving health care and thus health status.
Would investment in HIS result in a bigger impact on health than hiring
three extra staff members per 1000 population? Would it make more
difference than a mass immunisation programme, repeated regularly? Would it
make more difference than improving the drug delivery for STD treatment,
thereby helping to prevent HIV? HIS is a management information system,
just one step in the chain from problem to problem definition to planning
to participation to action to impact to outcome. Valid information is
seldom the sole barrier, and I am not yet convinced that its removal will
make THE difference to the health of communities.
Resources are scarce; information systems represent running costs, not one
off expenditures and may be very expensive indeed.
We are currently seeking pilot sites for the implementation of IMPACT. We
would like the system to be tested in other countries and are currently
discussing possible sites in Africa.
I think it would be a brave move if you subjected your optimism to some
form of controlled trial. Then at least we would know if you were right or
wrong! If you were right, it would give massive impetus to your idea and
the case you are arguing, if wrong it would save the world lots of money
which could be put into proven interventions.
Merrick Zwarenstein
Division Head
Health Systems Division
Centre for Epidemiological Research in Southern Africa
Medical Research Council
POSTAL ADRESS:
PO BOX 19070, Tygerberg, South Africa, 7505
STREET ADRESS:
Fransie van Zyl Drive, Parow, South Africa, 7500
Tel. +27-21-938-0247
Fax: +27-21-938-0342
mailto:mzwaren@eagle.mrc.ac.za
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