A Review of Health Management Information System in Akuapim South District of Eastern Region of Ghana

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Health Managers at the district level must be provided with information that is relevant, accurate and timely to enable them make proper decision and planning for provision of an efficient and effective health care. This study was aimed at strengthening the Health Management Information System at the district in order to improve health care delivery, Health status and to a surveillance system that could identify virtually every ease rapidly to allow immediate intervention. Specific objectives of the study were: To describe existing mechanism of data collection, analysis dissemination and the type of data being collected. To describe existing planning and decision-making process for health care delivery To identify gaps in the information system. The following data collection techniques were used; Interviews health workers in decision -making process. Inspection of official documents Seven DHMT members, three SDHT members as well as four HMT members were interviewed. Storekeeper, TB co-ordinator, coders and forty TBAs were interviewed. Official documents that were reviewed include, minute’s meetings, action plans, annual report and reporting forms. The responses on the questionnaire were coded and codes entered into the record file of EPI info computer soft ware programme for analysis. The major findings were: Organisation of Information Information is used by Medical Assistants in assessing their performance and in identifying problems in the area. SDHT did use this information in drawing action plans and decision- making but depend on views of members about what is happening in area. They also depended on the views of members. MCH/FP and two sub-districts used the information in writing annual reports. Targets at the district/sub-district levels were set by incrementalism. District Health Management Team (DHMT) members used information to assess work of staff and in response to disease outbreak. Supervision Supervision of Traditional Birth Attendants (TBAs) by the MCHIFP Unit was better and encouraging and they need commendation. MCH/FP visited the TBAs on their usual outreach programmes and specifically to collect data from them. Their inadequacy here was their failure to test or explain the pictures in TBA pictorial book. However supervision of SDHT by DHMT is completely non-existent. Every sub-district responded that they had not been visited this year by the DHMT. Feedback to the sub-districts was mainly corrective and done verbally as well as congratulatory Training Most of TBAs were illiterate and their training did not enable them to fill their books. The literate ones had not received in-service training ever since they were trained. Sometimes the recorders were not available and they had to rely on others in the community. The problem worsened when the recorders kept the books. Six TBAs kept an extra book in which they recorded parents names, village of residence and date of birth. At the sub-district level, most of the workers had not received in-service training. This form of training had its own inadequacies. One MCH/FP staff complained that whenever the format of form changes, they should be given in-service training. The coders in the hospital and at Pampamso sub-district had not received any in-service training since they were employed. Analysis Health data was analysed into disease categories. All units did analyse their data before submission. The common equipment used in the analysis was a calculator of the very basic type, i.e. those that do simple operations such as addition, subtraction, multiplication and division. These simple calculators did not have enough memory and could not compute means and standard deviations. Storage Data was stored in files with reference to no order and this made retrieval very difficult. Dissemination Besides the region, the DHMT did not send information to any other place, not even the District Assembly. Three sub-districts sent their monthly returns to the region directly even though the district got its copies. This however made the whole dissemination process chaotic. The Eye Clinic at Aburi sent data directly to the national level. The DHMT did not discuss the data at meeting. Recommendations • There is the need for community surveys to complement routine data in the district. • Reporting form should be designed for stores and supplies • Data on personnel should be part of routine data collection. • Private Practitioners must be made sub-district parents so that they can participate fully in health services management of the district. • In-service training must be organised for staff on statistics. • Workshop for Ministry of Health workers must also include the staff of the private practitioners. • There is the need to teach district and sub-district Heads how to analyse data and to produce graphs and charts. • The Biostatistician in the district must be provided with a means of transport to coordinate routine data collection, submission of returns and supervision of data collection. • The DHMT must include supervision schedules in their annual plan and give copies to the SDHTs. • DHMT must be provided with scientific calculators and computers with e-mail link to the Region. • The Region/National should only accept returns that are certified by the DDHS • There should be National, Regional and District Epidemiological Bulletins, which should be printed quarterly and sent to all health institutions at all levels and also to health related institution/sectors. • DHMT must form purchasing committee to see to purchasing of items for DHMT and SDHT. During budget preparation DHMT must include the District budgeting Officer from District Assembly so that the district assembly would know when to help
A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirement for the award of Master of Science Degree in Health Services Planning and Management, 1999