Department of Informatics University of Oslo, Norway Prof. Jens Kaasbøll Prof. Jørn Braa School of Public Health University of Western Cape South Africa Prof. David Sanders Dr. Gavin Reagon

Health Information Systems in South Africa THEN NOW and the FUTURE

The HIS Situation 6 Years ago Vast Amount of Data collected Raw Data only Invalid Indicators –Malnutrition (invalid Denominator) –Hypertension (invalid Numerator) Inability to construct Indicators –Minimal Denominator Data collected No Sharing of Data/Information Lots of Duplication (Vertical Programmes)

The HIS Situation 6 Years ago Accuracy Appalling (e.g in a District) –MMR 6800 per –IMR 2 per 1000 –Admission Rate 640 per 1000 Multiplicity of incompatible Tools used –Ranged from Paper to DOS to Mega-Systems No/Minimal Use of Information No Information Officers –District Level –Hospital Level

The HIS Vision Minimum Dataset Integrated Dataset Standardised Definitions –Data –Indicators Accuracy Checks at all Levels Trained Information Officers Health Information timeously available Routine Discussion and Use of Information Surveys routinely done by health workers themselves

The Process Followed Start in a few Districts Bottom-up Approach Later Bottom-up meets Top-down First Develop Minimum Dataset Brainwashing on Accuracy Develop Appropriate Tools –Paper systems –Customised Flexible Database Software (open source) Action Research to develop sustainable systems Train, Train, Train and More Training

What was Achieved (NORAD supported) Trained Information Officers Minimum Dataset –Standardised but Flexible –Data Dictionary Routinised Accuracy Checks Analysed Information

What was Achieved (NUFU and USAID Supported) Routine Analysis, Interpretation and Sharing of Data and Information Standardised but Flexible Database Developed and Used throughout South Africa and in some areas within other countries: Malawi, Mozambique, India, Tanzania, Ethiopia, Mongolia, Cuba, Botswana Minimum Set of Indicators (MindSet) that RAVE (Reliable, Accurate, Valid, Easy to produce)

What was Achieved (NRF and RCN Supported) Equity Assessment accomplished using routine information Routine Surveys being done by health workers themselves Community based Information system developed Hospital information systems refined and extended to wards in hospitals

NeedResources Need Resources Need Resources

% Informal Dwelling

HIV prevalence 2000 (estimates)

What is Still Required (Suggestions to NRF and RCN) Greater Use of available information Further development of Open Source Software appropriate for developing countries Support for Widespread implementation of Routine Surveys Strengthening of Health Information Units within the Health Department

Research programme suggestion for development Capacity building in developing countries –South-Africa – Norway collaboration for developing research capacity in other Sub-Saharan countries –10 years period Funding needed –Travel, equipment and running cost –TIME: Research staff –TIME: Scholarships for students from South- Africa, Norway and other partners EU, NUFU and NFR-NRF provide mostly networking funding

Norwegian Research Council vs Norwegian Research Council