AFRO-NETS> Health Cards (57)

Health Cards (57)
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John & Afro-Nets Friends,

Welcome to the discussion. Thanks for responding. Hopefully I will be
able to sift through what you have recently submitted and provide some
meaningful feedback. I apologize for not responding sooner.

John wrote:

Please send me the IMPACT Methodology

We have recently set up a WWW site.
http://www.aztechcon.com/impact/impact.htm The site is not complete,
but should be by 7/14/97. We have numerous reports and other links that
we need to enter, but you should get somewhat of an idea as to what
IMPACT is all about.

"Country specific" approach and Tanzania=92s 120 tribes.

=85that is a good question. I would need to have some additional
information regarding the tribes etc. before I would even begin to
address that issue. Although I will say, that I would attempt to
accommodate each of the tribes incrementally.=20

..integrate into the formal system whereby it will have to be given=20
some legal re->enforcement=85but how???

Once again each setting would be different. In most country settings the
MOH sets the guidelines regarding required documentation. I would focus
my efforts at that level.

If it were to be introduced in This district in Tanzania...don't you=20
think that it's good to start with a proper system of identifying=20
ourselves from which ALL THE OTHER >TYPES OF IDENTIFICATION CAN BE=20
BUILT?...

Yes, that is one way of doing it. In the United States everyone has a
social security number and it is used by many different organizations
and sectors as the identifying number. However, the drawback is that
some don=92t like the "big brother" implications of this type of system.
Again, it depends on the attitude of the populace. Do they fear such as
system? Although, I will state that as much as the U.S. population
disdains this approach, it has been in place for many years and I doubt
that it will ever go away. As long as it serves a good purpose, such as
providing equitable and efficient health care, then it will most likely
be accepted. The idea of using the health care system as an impetus for
assigning a national ID may possibly pass without too much opposition.
This is especially true if the system can provide valuable health
indicators.

What if this CHC identification is based on a more universal national=20
level identification system; upon which other ID systems are=20
built?...like the CHC sub-system?

See above.

This embodies all the idea of a comprehensive family registration=20
system...henceforth a more permanent Health Identification Number...It=20
makes the whole idea more sustainable...with all the possibility of=20
"binding it to the legal system"

Yes, sustainability is more likely. Many initiatives lack a proper
foundation upon which to build its services. This foundation contributes
significantly to issues of sustainability. There is a brief paper on
"Building an Information Infrastructure" at the IMPACT web site.=20

Will available resources allow for this? or prioritisation will push=20
it aside? ..this appears in many "first impression" comments on the =20
CHC initiative.=20

It is my impression that too few resources have been committed to HIS in
general. We need to lay a solid foundation that insures resources are
committed to HIS and that HIS is a priority.

Will it not take very long and be very costly before mass computer=20
literacy is achieved at the district level?

John, we had great success at our development site when computers were
installed. Most of the data entry operators had only an 8th grade level
of education. You could not keep them away from the computers. The
IMPACT system is very intuitive, and at the district level, most of the
data would already have been entered at the service delivery level. You
also need to remember that computer operators in the developing world
are considered prestigious jobs, unlike the U.S. or Europe. It=92s not as
difficult as one would imagine. I could present you with many examples
of the benefits of automation within a Third World environment.

John, I would recommend that you read "Rapid Assessment of National
Health Information Systems(HIS) Including Epidemiological Surveillance
by Lwanga and Sapirie. A link to the site is under Links at the IMPACT
web site. This paper will provide excellent guidelines regarding the
development of a national HIS and may provide you with some much needed
direction. I am pleased to state that the IMPACT methodology
accommodates a vast majority of the assessment principles mentioned. It
deals with foundation issues that need to be addressed in the
development of a national HIS.

I have followed your most recent dialogue with Bruce Campbell regarding
the use of hand held records vs. institution-based records. I would have
to state that both are necessary because each has different and multiple
functions. Bruce has appropriately defined the functions of each and I
would agree that there are advantages and disadvantages of each, when
only one method is employed. However, if they are both utilized, and
recognized as part of the same system, their usefulness increases
substantially, as well as their value.=20

The greatest argument against this type of system is the duplicate
documentation. Many consider it redundant to document the same service
in both a CHC and a facility-based register. This is especially true
when the facility-based register is for vertical reporting. You
mentioned previously that HCWs wanted an increase in salary due to the
added work of keeping 9 separate registers. My questions would be:

1) Does the filling out of these registers have any direct impact on =20
    the HCWs responsibilities?=20

2) Does it make their job easier, or is it additional work to enter and=20
    then aggregate the data?

The issue comes down to the mechanisms employed in collecting the
facility-based data. Nine unique disease or service specific registers
does not contribute to a decrease in a HCWs workload. Again, I would
point you to the IMPACT web site for an explanation of a routine
service delivery methodology that benefits the HCW by decreasing
reporting requirements, yet still provides daily financial and inventory
reconciliation, as well as any health indicators.=20

I have just received an estimate from the printer regarding the cost of
a 48 page CHC with a laminated cover and waterproof paper. For 50
thousand copies it would be less than 58 cents per copy. I am sure that
if someone wanted 200,000 copies or more, the price would be
substantially less.

Cheers!

Bill

--
William Billingsley
Impact Demographic Health Surveillance Information Systems
Application Software Technologies, Inc.
1841 South Ridge Road
Green Bay, WI 54304 USA

+1 (800) 992-0533 : Voice
+1 (414) 499-0533 : Voice
+1 (414) 655-3962 : Cell
+1 (414) 490-3218 : Fax
+1 (715) 823-6375 : Home

mailto:wbillingsley@aztechcon.com
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