AFRO-NETS> HMIS reform (10)

HMIS reform (10)
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Dear friends,

Let me add a telegraphic style response to Bruce's questions of 12. July;
they distill my own frustrations of years with the topic. (I'm afraid
you'll need the original email to understand my comments)

[titled 'Health Management Information Systems (HMIS) reform', sent out
Sat, 12 Jul 1997 12:20:47 -0400. D.N. Mod.]

Q1: A decision audit should be the entry point to HMIS reform. Get all
users and see what decisions they make; then decide which indicators to
leave in. Indicator not used, strong candidate for scrapping. Thereafter,
no proof of data use in one full year, also consider scrapping in a second
cut to streamline the HMIS. I suggest a test: Take 3 districts in a
country; stop the HMIS altogether; wait 2 yrs; see how very little will
change; end of test.

Q2: So far very little, if any relationship between HMIS + HS reform.

Q3: Would think we should place little emphasis on participatory approach
in this. People in periphery have no clue how and for what the stuff of
the HMIS is used for...and they do not use it either... Rapid assessment
should be enough. I am talking of a "less comprehensive" HMIS design...
not a more comprehensive one (see below for reason).

Q4: I'd put it in the Planning Division agreeing with Richard (as with much
of the rest of his email).

Q5: YES!! keep simple. Rest of needed info collect in sentinel and
periodic surveys.

Q6: Routine data will then not be sufficient (if we reduce the HMIS). WHO
SEAsia Office has recently been here in Vietnam promoting a (structured)
simplified HMIS and our MOH is going for it. Quality of care cannot be
collected by routine system. What should be collected through HS research
will be a changing picture according to needs. Advantages/disadvantages
have to do with validity, reliability and timeliness. Financial resources
for the HMIS should be shifted drastically towards sentinel surveillance
systems.

Q7: In the new HMIS, as many as possible clinical indicators should shift
to syndromatic, away from clinical diagnoses.

Q8: Through well supervised sentinel sites only. Always assume GIGO
(garbage in...) in routine system.

Q9: For the time being, updated census estimates.

Q10: Sentinelize vertical reporting systems! And add surveys every 3-4
yrs. At present, vertical HISs are more efficient but not more
sustainable.

Q11: Absolutely no evidence to my knowledge.

Q12: Computers will reach districts whether we want them or not! BUT if the
system did not work manually, it will not work electronically either. This
is an iron law.

Q13: Neither. A new simplified HMIS is needed in most places. (Patching up
the old is..... each of you please complete the sentence).Then we need
retraining AND a viable support supervision system. Existing sentinels may
need a strengthening of management.

Q14: Quarterly for most. Rapid appraisal for what....if we do not have
rapid response capacity? Stop the neurosis.

Q15: This relationship is mandatory. Period.

Q16: This is a dream in most the countries of the third world under current
conditions. Pls. ask me the question again in 2005 .

Q17: Politics, inertia, poor decision audit we made to begin with, poor
insistent follow up of end users and decision-makers from our side (if we
even have bothered to know who they are), zero feedback we give to the
field.....add your favourites.

Q18: Ensuring sustainability is not a question of money, please! HMIS
could not be further from cost-effectiveness.

Please excuse the laconic and sarcastic style, but as most of you, I have
been there, and hitting your head against the wall too often adds up to a
concussion and gives you a dry (and bitter) mouth.

In solidarity,

Claudio Schuftan
PHCU, MOH
Hanoi
mailto:aviva@netnam.org.vn

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