Health Cards (56)
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July 8, 1997
Greetings John,
Health Cards (55)
-----------------By the way it's you and the Royal Tropical Institute staff (who
documented that rich MIS experience in a magnificent booklet) whoOne question to you from the discussion.
1. Is the MIS approach now in use all over Ghana?
2. Do you think that in the new system, the "INSTITUTIONS" WILL CARE
FOR PATIENT RECORDS BETTER THAN THE PATIENTS THEMSELVES?
Thank you for the complement on our documentation of experience in
Ghana. In this regard, there remains a paucity of documentation in the
literature related to efforts at HMIS reform. Would you give any
thought to a step-by-step review and documentation of the process in
which you are involved in Tanzania? Such an effort may require a
significant amount of time, but I am sure there are a number of valuable
lessons from which we could all benefit.
Regarding your questions, let me share a few thoughts:
1. Is the MIS approach now in use all over Ghana?
At the end of our input between 1991 and 1993, the integrated HMIS had
been institutionalized in 3 of 10 regions including training of all
health workers in those regions. The same reporting formats were being
utilized in the remaining 7 regions, although staff had not received
training. I have not been back to Ghana for over a year so am not
certain of the current status, although I have heard of reports from
non-project regions which utilize a similar system of data aggregation
and analysis.
2. Do you think that in the new system, the "INSTITUTIONS" WILL CARE FOR
PATIENT RECORDS BETTER THAN THE PATIENTS THEMSELVES?
This might be a good issue to tackle through a simple one-year
prospective appraisal, contrasting experience with home-based vs.
institution-based client cards in a small sample of districts. In any
case, it is in the client�s best interest to have the latest information
on hand for a follow-up visit to the same facility (which may argue in
favor of institution-based) or if the client is not satisfied with a
facility (or particular service provider), to have the latest
information available during a second consultation at another facility
or private practitioner (which may argue in favor of home-based).
There are many advantages and disadvantages of each (reviewing the
AFRO-NETS discussion on health cards, of which yours is number 55!), and
certainly no universally correct approach. Furthermore, the two
approaches (home-based or institution-based) do not have to be mutually
exclusive.
For example, a carefully designed register can provide you with the most
important information that the institution requires (in case a card is
lost, for reporting, or for rapid record review research), while the
client card stays with the client and (in principle) moves with that
client to different service delivery sites to minimize double reporting
of new clients/cases and more importantly ensures continuity of
services. There should be no reason why a client should be told to pay
for new diagnostic services, if recent results are available on a well
designed client card which she has with her at the time of a second
consultation at a different health facility.
If such an analysis is designed to include advocates of both approaches
in the study team, the ensuing discussion during study design,
implementation and dissemination will help to build consensus on
whichever approach is ultimately utilized.
As you know from your recent debate in Tanzania, this spirit of
participation and consensus building may well be more critical to the
success of your initiative than whatever technical advantages of
home-based vs. institution based are identified during your study.
I�d be curious to hear how you choose to proceed...
best wishes!
Bruce
--
Bruce B. Campbell
Royal Tropical Institute
mailto:campbell@mos.com.np
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