1. Health Information System “ Consumers’ perspective” Gunnar Bjune March 2014 g.a.bjune@medisin.uio.no

2. Three fundamental issues The health problem Prevalence, incidence, ”disease burden” The service delivery Facilities, strategies/programs, activities The resources Man-power, skills, supplies, support ->Outcome / impact

3. Conflict of interest? Control: Global/national/local/personal ”Bottom-up strategy” (democratic) Rights: Needs/justice/legal/privacy Coverage, data safety, integration Efficiency: Needs – resources, change Data quality, analyses and research Safety: Epidemics/hazards/life-style Surveillance, access to own data

4. Example: Tuberculosis control Objectives Reduce mortality Detect and treat cases (morbidity) Cure sputum positive cases Reduce transmission DOTS : 1. political commitment 2. diagnosis through microscopy 3. drugs supply 4. observed therapy 5. recording and reporting

5. Tuberculosis control “Information culture” Central management unit (CU in MoH) National standard formats (basis SCM) TBMUs -> Province -> CU -> MoH Standards used as basis for supervision Emphasis on treatment outcome Often functions in isolation from PHC

6. Tuberculosis control What kind of data? Classification New pulm. sm+ New pulm. sm – Extra pulm. Transfer in Retreatment Relapse Treatment outcome Cured Treatm. completed Dead (all causes) Transferred out Chronic (“failure”) Lost to follow-up

7. Tuberculosis control What sources of data? Laboratory book TB suspects, results of 2 smears, follow-ups Treatment card Demographic data, lab.res., classification, treatment, weight, treatment regularity Registration book Classification, treatment outcome, comments Supervision reports Problems, solutions, data quality

8. Data quality Lab book Id Addr. 2 s.s. Init. 1s.s. 2 ms 1s.s. 5 ms 1s.s. end No. Sus- pects Treat- ment card Id Addr. 1 s.s. Treat- ment regul. Classi fic. Reg. book Id Addr. 1 s.s. Classi fic. Treat ment Res. Super vision rep. + ++ + No.

9. Tuberculosis control Flow / loss of information Symptomatics Laboratory TBM Provincial National International (WHO) PHC Hospital serv. «TB suspects» 1. «Point of care» Laboratory TBMU PHC Hospitals Non-TB / TB Private / public DOTS centr.

10. Tuberculosis control What we can learn from the laboratory book External quality control Work load and in service training Suspect/positive ratio Quality of diagnostic microscopy routine Quality of follow-up Transfer to treatment cards

11. Tuberculosis control What we can learn from the treatment cards Accuracy of diagnosis/classification Weight gain/loss Address* (and social background) Treatment regularity Regimen and drug reactions Transfer to registration book

12. Tuberculosis control What we can learn from the registration book Incidence* and classification / PHC unit Treatment outcome / PHC unit Childhood TB (active transmission) Mortality (HIV etc) Extra pulmonary TB (HIV, M.bovis etc) Gender balance Transfer to CU/MoH reports

13. Tuberculosis control The problem of coverage WHO target: Detect 70% of estimated new cases What is the basis for the estimate (CDR)? The private sector? Double reporting? Alternatives: 1. Geographical and social accessibility (GIS/season/social strata/etc) 2. Diagnostic delay

14. Tuberculosis control Integration into PHC Under-utilized benefits! Resources (transport, pharmacy, statistician, laboratory, supervision, data management) Culture (treatment outcome, data quality, district management, health rights) Power (supplies, supervision, staffing) Satisfaction (outcome data)

15. Challenge / solution Central control Quality of data Efficiency Reporting Local problems Success ”The big picture” Peripheral analyses Used by ”producers” Training Supplies etc Documented needs Treatment outcome Local interactions

16. Topics for discussion Cross-border patients Transfers in/out Private sector Step-wise integration MDR and sustainability