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Synthesis of Plenary and Group Presentations. Purpose of Unique Identifiers. Unique identification of clients accessing multiple health facilities Link data across facilities Longitudinal record to facilitate chronic care M&E for improvement of services – effectiveness, efficiency, equity,.
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Purpose of Unique Identifiers • Unique identification of clients accessing multiple health facilities • Link data across facilities • Longitudinal record to facilitate chronic care • M&E for improvement of services – effectiveness, efficiency, equity,
Local Experiences • 5 institutions implementing Unique ID system: • Serialized number: • National ID by NRB – also linked to finger prints • AAR Member No. – preceded by country codes • Block number: PIN and driving licence by KRA • Quasi-unique: IPRS number
Assignment of Unique ID • Centralized ID Production Centre • Vetting Committees for verification • Linked to national ID • Networking for access from multiple sites
Challenges • Duplicate IDs to same individual • Retrieval of records if missing patient card • Quasi-unique: Some IDs assigned to multiple individuals • Not linked to family tree • Resistance to biometric information • Restricted to nationality and > 18 years of age • Fraud
Recommendations • Assign IPRS at birth • Eliminates need for national ID • Linked to family tree • Tighten controls to minimize duplication • All EMRs to adopt the Unique ID • Online enrolment • Inter-linkages to existing databases
Four options • National ID 1. National ID assigned to all adults e.g. NRB • National ID assigned at birth to all e.g. IPRS • Health ID • ID for health and social services by central body e.g. NHIF
Option 1: National ID for Adults Background: derived from colonial history; for > 18 years Pros: majority of adults; finger print; good infrastructure; minimal duplication Cons: used in-country only; excludes < 18 years; delayed acquisition; stigma Modification: legislation; institutional; infrastructure; Conclusion: Not viable
Option 2: National ID Issued at Birth - IPRS • Purpose: link patient records, ease of reporting, longitudinal tracking, minimize duplication • Pros: Government-led, captures all Kenyans, kids, aliens; multichannel access, mechanisms for update • Cons: ready Jun 2010, photo 3 yearly • Modifications: WAN, infrastructure, hardware, legislative, technical support, financial support (WB currently) • Conclusion: Workable but will take time • Issues: Changing district codes; DOB unknown, universal coverage, uptake and use; who has access to data; regulation of data;
Option 3: National Health Identifier by Centralised Body • Pros: functioning system, upgraded; primarily for formal sector & dependants, no duplicates, • Cons: Pre-register prior to health seeking, limited coverage; potential loss of med history • Modifications: policy, legislation, infrastructure, human resources, collaboration, financial • Conclusion: Workable with major modifications • Issues: Age limits for national ID
Option 4: Health ID Issued by Health Facility: Block ID using MFL • Pros – simple, immediate, all-inclusive, acceptability by patient/provider • Cons – duplication by different sites, not compliant to international standards • Modifications: governance, set standards; health systems strengthening, security/back up • Requirements: legislative, infrastructure, HR, • Timeline: 6-12 months • Conclusion: Workable with modifications • Issues: clients accessing multiple sites;
Desired Features • Easy and quick acquisition • Universal coverage • Multichannel access • Wide acceptability • Multiple usage • Confidentiality
Consensus • Ned a lifetime multi-purpose national unique ID: for health, social services, banks, etc. • Purpose: quality of care, planning and management • Standards based • Best option: Majority IPRS: 14-digit • Century, DOB, District, Birth ID, Check digit
Issues not Addressed • Design • Managing authority • Confidentiality and security • Allocation: central or decentralised