Strengthening HIS regarding Tobacco Use By N.Jeeanody Chief Health Statistician

1. Strengthening HIS regarding Tobacco Use By N.Jeeanody Chief Health Statistician Ministry of Health & Quality of Life njeeanody@mail.gov.mu

2. “The need for reliable and timely information on the health of the population – a critical input in the public policy process” Recognised by the World Health Organisation from its inception in 1948

3. Health Information System Integrates data collection, processing, reporting and use of information necessary for improving health service effectiveness and efficiency through better management

4. Components of Health Information System • Population and Vital Registration • Morbidity and mortality • Health service delivery data • Health Systems – personnel, infrastructure, finance • Reproductive health service data • Cancer registry • Communicable disease surveillance HIV/AIDS, malaria, tuberculosis

5. HIS in Mauritius has a long tradition of good censuses and civil registration, a core set of indicators with a solid system of high quality data collection from facility level upwards using both personnel, resource and service records.

6. Main data producers • Central Statistics Office ( vital statistics) • Ministry of Health & Quality of Life • Health Statistics Unit (Morbidity / Mortality) • Health Records Division (Service statistics) • Research / Survey

7. Raw data collected (routinely) from various health institutions (public and private) • Pre-designed forms and electronic format • Data are edited, captured, compiled, tabulated, analysed and published • Daily, Weekly, Monthly, Yearly Reports (website: http://health.gov.mu) • Non-Routine – Health Research + Surveys - Adhoc collection

8. The Health Statistics Report, which covers almost all government health services and private clinics with in-patient care, include inter-alia a whole range of information pertaining to : • Population & Vital Statistics • Health Infrastructure & Personnel • Health Service Delivery Statistics (Hospital, AHC & CHC’s, Maternal & Child Health, Vaccination, Attendances at Health service, School Health, Dental etc) • Morbidity- illness • Mortality-causes of death

9. It also contains a list of indicators including inter-alia • Crude Birth Rate • Infant Mortality Rate • Maternal Mortality Ratio • Life Expectancy • Coverage rates (vaccination) • Incidence rates of illness • Death rates due to different causes • % Low birth weight

10. Deaths due to Lung Cancer • Recent Studies ……….. • Cancer Register ………..

11. Present HIS on tobacco use data assessed • Cause of death and hospital discharged patients data without information on smoking habit • Patients with amputation – inadequate data on smoking status • Survey data : results not related to diseases

12. NCD 2004 2 highly significant OR value also indicating a potential effect of smoking on trig level

13. NCD Clinics assessed SSRN Hospital & Riv du Rempart AHC • Questions inadequate and information not systematically updated • No patient database • No analysis • Dissemination and use very low • No feedback mechanism

14. SSRN Hospital & Riv du Rempart AHC • Absence of good networking • No written health information policy to ensure compliance • Absence of data management procedures and guidelines • Limited resources • Personnel not trained

15. SSRN Hospital • NCD sheet not available in 80% case-notes • Smoking status data present in 45% records • 24% case notes contained tobacco use data on subsequent visits Riv du Rempart AHC • NCD sheet not available in 3% case-notes • Smoking status data present in 97% records • No data available on subsequent visits

16. Opportunities for strengthening • ATSA/IDRC initiative • New tobacco regulations • Collaboration • Setting up of tobacco cessation clinic • Good organisational structure in place

17. Opportunities ….(cont.) • HIS strengthening Strategic Plan • HMN • Implementation • Regional HI • E-Health Plan …

18. HIS strengthening on tobacco use data • Corrective measures proposed : • Review NCD Sheet - No of years smoked (Smoker / Ex-smoker) - Whether advised to stop? - Exposure to passive smoke (duration / Site)

19. Subsequent Assessment • Change in smoking habit The revised tools and guidelines • Purposely limited not to disturb the process • Pilot testing

20. Implementation • Training • Committed Personnel • Close supervision • Transmission of data (special form)

21. Data Processing • Tabulation • Analysis • Change in smoking habit (52%) • Passive smoking (2%) • Smoking v/s BP Level Association (Not significant – small sample)

22. The pilot exercise has highlighted • the possibility of linking tobacco use with disease • The importance of additional data to support smoking cessation programme • Few changes resulted into accurate & reliable evidence ….

23. Way Forward • To amend the NCD Sheet • Develop guidelines for data collection and use • Capacity building • Physicians • Records Staff • Nursing / HCA

24. Way Forward….. (cont.) • Networking / IT • Regional / National Reports to be produced • Further research to measure health and economic burden of tobacco use

25. Way forward ….(cont.) • From “data driven” to “action driven” HIS RBM • M&E (smoking cessation programme) • Proper reporting and feedback mechanism • Optimal use of available data: clinical and intervention monitoring…

26. “HIS strengthening is part of a broader effort to improve health systems to deliver needed interventions and track progress …..” HMN

27. Thanks a lot ! • Merci Beaucoup !