Looking for appropriate software (2)
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July 6, 1997
Greetings Steve,
Looking for appropriate software
--------------------------------Greetings,
I am hoping to draw on the collective experience of list members to
point me in the direction of some appropriate software.
... stuff deleted ...
With any luck, the software should be relatively easy to use and
relatively low-end i.e. capable of being run on a 386dx system. Does
anyone know if any of th
... more stuff deleted ...
In response to your recent query regarding software for monitoring health performance and resources, I would be happy to share some of our
experiences...
During the review and reform of the Health Management Information System
in Ghana between 1990 and 1993, it was felt that self-assessment/reporting tools were necessary that would not only translate raw data into useful information, but stimulate discussion between team members at each level.
Each of these tools were developed in a simple spreadsheet format that
could be utilized at the National level for aggregating/presenting regional data or at the Regional level for aggregating/presenting
District data. Several District Health Management Teams also utilized
the same tools to aggregate, analyze and feedback health facility data.
We developed each of the tools in a spreadsheet format with some
"protected cells" that contained the headers and nationally agreed upon
denominator data (e.g. the population for a given region/district).
The reason for working in a spreadsheet format rather than a proprietary
data base software package were as you mentioned:
a) conceptual simplicity
b) minimal cost
c) easier to adopt and modify
d) DOS spreadsheets software could run on 286/386 hardware.
In Ghana, four PHC coverage and continuity aggregation tools were
developed and used for self-assessment, providing feedback to lower
levels and reporting to higher levels:
1. Primary Health Care Service Coverage Assessment
The Primary Health Care Coverage Assessment tool was developed
to be analyzed monthly at the health facility level, quarterly at the
district level (as an aggregate of health facilities), half yearly at
the regional level (as an aggregate of all districts in the region), and
annually at Headquarters. Within this tool, each technical component of
the health service has one or more indicator which could be calculated
for each district/region and the nation as a whole. There were 19
indicators which are monitored at all levels.
2. PHC Continuity/Quality of Care Assessment
Sixteen continuity of care indicators (sometimes used as a proxy
for quality of care) were to be monitored on a half yearly basis.
Although a half-yearly self-assessment tool was developed, many issues
arose during and after training which prohibited this tool from being
fully utilized.
3. OPD Disease surveillance
When aggregated, the number of cases seen for each specific
disease provide a national, regional or district total as well as
monthly trends which could then be divided by the total number of cases
to identify the leading causes of morbidity seen at the out-patient
department of health facilities and hospitals.
4. Cause of Admission, Death, and Case Fatality Ratios
The fourth self-assessment tool which was developed, focused on
monitoring of in-patient hospital services and the identification of
leading causes of admission and death as well as Case Fatality Ratios
(CFRs).
Additional Self-assessment/Reporting formats
These above-mentioned four tools were complemented by a series of
self-assessment and reporting tools which were utilized as a basis for
analyzing the overall health system performance as well as drafting the
1991 and 1992 Ministry of Health Annual Reports:
5. Age-Specific OPD New Cases, Admissions and Deaths
6. Institutions providing Health Services
7. Manpower Position by Staff Cadre by District
8. Pre-Service Training Outputs
9. In-service Training Outputs
10.Transport Position by type, location and status of vehicle
11.Approved Recurrent Allocations and Expenditure by line item and
as a percent of allocation
12.Development Budget expenditure to-date
13.Revenues generated and source
14.Total Population, Target Population and Square Km. per district
The first four tools have been described in detail in our book "From
Data to Decision Making in Health: The Evolution of a Health Management
Information System" by Bruce Campbell, Sam Adjei, and Arthur Heywood.
The publisher will provide a free diskette copy of the four PHC coverage
and Continuity/Quality aggregation tools, to individuals who purchase
the book. For further information on ordering a copy please contact:
Max Mink/Lydia Wolters
KIT Press
P.O. Box 95001
1090 HA Amsterdam
the Netherlands
Tel +31-20-5688272
Fax +31-20-5688286
e-mail: kitpress@kit.support.nl
The remaining 11 tools were developed using a similar spreadsheet format
as the PHC self-assessment tools, with the specific indicators contained
along the left hand side (Y-axis) and the regional/districts/or health
facilities across the top (x axis) with an aggregated column on the
right hand side. Alternatively, the X axis could be used for a single
institution/district/region and each of the 12 months listed across the
top with an aggregated column on the right hand side for the year-end
total. This allowed for monitoring seasonality of any of the
indicators.
Our experience with these tools was quite positive and supports your
proposition to develop a tailored spreadsheet (rather than purchasing
data base software) to monitor performance and disbursement of health
resources.
However, a data base does have several advantages over a spreadsheet
which should also be noted:
a) ease of data entry
b) greater capacity for data manipulation during secondary analysis
c) ease of storage and retrieval of data
Ultimately, a combination of spreadsheets, a data base and
graphic/geographic software can be utilized to aggregate, analyze and
disseminate health information. However, starting simple is important.
And, beginning with a spreadsheet does not prohibit us from further
analysis in a data-base programme. In any case, the system must be
flexible enough to evolve as national capacity grows and information
requirements change.
As always, we should ensure that end-users are involved in the design,
and that a mechanism for regular review (within and between levels), of
the data generated, is institutionalized as part of the HMIS system
reform.
Good luck in your efforts!
Bruce
--
Bruce B. Campbell
Royal Tropical Institute
mailto:"Bruce B. Campbell" <campbell@mos.com.np>
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