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In my view the performance of an indicator is closely linked to the type of the skill available to manage a specific program area. For example you need a qualified or skilled personnel to perform the required service e.g in maternal health ” delivery by skilled health worker”. If this indicator has to improve, you need a qualified or skilled personnel such as midwife, Doctor, etc. hence the need to link statistics to the service area.
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There are two types of ways we can link service statistics.
One is to look at public health indicators/aggregate service delivery indicators reported at the facility level. We would then cross-reference (via the facility) against an HRH indicator, such as the # of HWs by cadre (for that facility).
The second main way is to look at clinical information systems such as a facility based Electronic Medical Record system, or a longitudinal/shared health record (such as in the OpenHIE architecture). Typically here, the health practitioner that performed the service is recorded in the clinical transaction.
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Dear RHINOs
I am curious to hear from participants from various countries if they have an “interoperability” mechanism in place to link service statistics to human resource databases (if they exist), so that for example one could calculate the “workload” of care providers in a given facility to provide a particular services, such as prenatal care. -
To add to Theo’s question, I am curious how comfortable stakeholders are with understanding interoperability. Is how interoperability works clear or do we need to do more to share both basic and complex details about interoperability for health information systems? Are the benefits clear to everyone?
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Interoperability for linking service statistics and HR databases, or any database, for that matter, has to start with a SHARED Master Facility List (MFL). So often systems are created, where they create a new unique identifier, or even don’t use a Unique ID number, but just have the facility name and what District it is in to go on. Trying to match facility records between databases is without a SHARED Unique Identifier is often very problematic.
For instance, in Nigeria, MEASURE Evaluation conducted a data collection survey in 2014 that collected facility name, State, LGA (District), type and ownership information for over 34,000 public and private health facilities. From another source, geo-coordinates (latitude/longitude) for over 24,000 health facilities had been collected, but there was no common identifier that could be used to easily link these 2 sources of data. Even the LGA names were problematic to match with over 60 LGA where the spelling of the name was different between the 2 data-sets. After resolving the LGA names, an attempt to match facilities between the 2 lists based on the name was attempted, but only about 1700 facilities had matching names. So now the task of individual matching of the rest of the sites is obviously a tedious and very time-consuming activity.
The moral of this story – establish a Unique Identifier for health Facilities that is SHARED among all stake-holders, and put a plan in place to manage the update of the Master Facility List.MikeE
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Back to Amanda’s question on Interoperability. I don’t think the concept is very clear to everyone, especially at policy and health system management levels. On one hand policy makers and health system managers often think or are made to think that the solution to their wide range of parallel electronic systems is to through establishing interoperability. This might be true, but lot has to go into it before the systems become interoperable. So, I think it would be good to have some discussion on the basics of how interoperability works and the minimum pre-requisites of interoperability; for example, if we are talking about linking HR data and service statistics (i.e. HMIS), what are the basic requirements to make these two datasets interoperable? A quick reply could be that you create unique IDs for health staff and unique IDs for health facilities and then use those to link the data. But, to add to the complexity of this matter, CHWs mostly don’t work from a fixed facility, and the service statistics generated by them is most often lost in the aggregate data reported from the health facility. In such cases, how can you link the service statistics with the CHW data?
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I fully agree with Michael Edwards that first we need a Master Facility List (MFL) in country with HF Unique Identifier .
In Mozambique we don’t have a MFL but we are working with all simple HF List and our systems are not connected. So what we are using Business Intelligence tools and collect service and production information for other sources like HIV or MNH and to load it to a HRH datawarehouse. After that we cross analyse HRH info with other HF information.
We had some good results, like:
– which HF have HIV service but don’t have Trained HRH in TARV
– a relation of HIV population with HIV Trainned HRH
– which HF don’t have a minimum team
– Which HF with laboratory don’t have laboratory technicianThe HRH information is automatized and monthly updated but service or production information is not regularly updated and it takes efforts in linking information till HF level because it have different identifier.
I have a question: Is there any examples in success implementation of a MFL?
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This editor seems to have not captured the links, so I will just copy them as text:
Kenya:
http://kmhfl.health.go.ke/#/homeTanzania:
http://hfrportal.ehealth.go.tz/Haiti Journal article:
http://www.ghspjournal.org/content/2/3/357.full -
For my point of view, the interoperability problem start by the lack of eHealth Strategy in a lot of Country. Because this document constitutes a guideline to build a framework for the Health Information System as component of the Health System. Many stakeholder start thinking of Interoperability after the implementation of some eHealth applications at the national level. Some countries don’t have even eHealth Strategies or Roadmap document that express their need in term of eHealth tools implementation. Interoperability is not a common concept in the vocabulary of stakeholder unless the need of sharing data is raised on the ground and at that time most country realize that some eHealth tools may share data and some not. But in my point of view, the starting point is to have a Master Facility List, an Interlinked Health Worker Registry and to provide a unique identifier to the population that will allow to build a longitudinal Electronic Health Record System to track patient across the country.
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