Enhancing Tuberculosis Control Through Health Information Systems

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 controlObjectives • 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. 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 Tuberculosis controlWhat kind of data?

7. Tuberculosis controlWhat 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

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

10. Tuberculosis controlWhat 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 controlWhat 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 controlWhat 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 controlThe 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 controlIntegration 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