A review of health care indicators in the South African district health information system used for planning, monitoring and evaluation.
Bhana, Rakshika Vanmali.
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Introduction A plethora of health indicators have been added into the District Health Information System (DHIS) since its adoption and implementation as the routine health information for South Africa in 1999. The growing demand for the production and dissemination of routine health information has not been equally matched by improvements in the quality of data. In the health sector the value of monitoring and evaluation is not simply the product of conducting monitoring and evaluation but, rather from discussing and using performance indicators to improve health service delivery. Aim The aim of this study was to classify health care indicators in the national health data sets used for planning, monitoring and evaluation and to review the data management practices of personnel at provincial and district level. Methods An observational, cross sectional study with a descriptive component was conducted, in 2009, using a finite sample population from district and provincial level across eight provinces. The study participants completed a self-administered questionnaire which was e-mailed to them. Results A total of 32 (52%) participants responded to the questionnaire and of this total 21 (65.5%) responses were from district level and 11 (34.4%) from provincial level. The National Indicator Data Set, the key source for primary health care and hospital data, was implemented in 1999 with approximately 60 indicators. In less than 10 years it has grown in size and presently contains 219 performance indicators that are used for monitoring and evaluating service delivery in the public health sector. Whilst both district and provincial level personnel have a high awareness (83%) of the DHIS data sets there is variability in the implementation of these data sets across provinces. The number of indicators collected in the DHIS data sets for management decisions are “enough”, however a need was expressed for the collection of community health services data and district level mortality data. Similarities were noted with other studies that were conducted nationally with respect to data sharing, utilisation and feedback practices. Data utilisation for decision making was perceived by district level personnel to be adequate, whereas provincial level personnel indicated there is inadequate use of data for decision making. Whilst 87.1% of personnel indicated that they produce data analysis reports, 71.9% indicated that they never get feedback on the reports submitted. The top 4 data management constraints include: lack of human resources, lack of trained and competent staff, lack of understanding of data and information collected and the lack of financial and material resources. There was agreement by district and provincial level personnel for the need for additional capacity for data collection at health facility level. Discussion The increasing need for accurate, reliable and relevant health information for planning, monitoring and evaluation has highlighted critical areas where systems need to be developed in order to meet the information and reporting requirements of stakeholders at all levels in the health system Recommendations An overarching national policy for routine health information systems management needs to be developed which considers the following: emerging national and international reporting requirements, human resources requirements for health information and integration of systems for data collection. In the short-term a review of the National Indicator Data Set needs to be conducted.