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Explore the implementation of a computer database at the district level to improve health data analysis in Tanzania. This study focuses on solving existing problems of the health information systems to better serve patients and inform health planners. Research methods include qualitative approaches like case study research, ethnography, and grounded theory. By balancing action and research, this project aims to bring positive change to the healthcare system.
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Action Research Juma Lungo PhD Candidate University of Oslo 15th September 2005 1
Qualitative Research Methods • Case Study Research • Ethnography • Grounded Theory • Interpretive Research • Action Research 2
Action Research • Action research has been typified as a way to build • theory, • knowledge, and • practical action • by engagement with the world in the context of practice itself 3
Action Research • Is a research approach, which has the dual aims of action and research • action to bring about change in some community or organisation or program; • research to increase understanding on the part of the researcher or the client, or both 4
Action Research • Action research aims to contribute both to the practical concerns of people in an immediate problematic situation and to the goals of social science by joint collaboration within a mutually acceptable ethical framework 5
Phases of Action Research • The most prevalent description of action research details a five phase, cyclical process which can be described as an ‘ideal’ exemplar of the original formulation of action research 6
Phases of Action Research • This ideal approach first requires the establishment of a ‘client-system infrastructure’ or research environment • Then, five identifiable phases are iterative: • (1) diagnosis, • (2) action planning, • (3) action taking, • (4) evaluating, and • (5) specifying learning 7
Phases of Action Research DIAGNOSING Identifying or Defining a Problem ACTION PLANNING Considering alternative courses of action CLIENT SYSTEM INFRASTRUCTURE Specification and agreement that constitutes the research environment SPECIFYING LEARNING Identifying general findings EVALUATING Studying the outcomes of an action ACTION TAKING Implementing a course of action
Ministry of Health Province District Health posts, dispensaries, health centres,and Hospitals CBD, TBA, VHW RESEARCH PROBLEM AREA • Routine health delivery services • Basic health services at community level, health posts, dispensaries, health centres, and hospitals • Decision-making and health planning take place at the top (Ministry, and provincial levels) 9
Why HIS? • Patients/clients at a remote • health facility. • How does health planners at the Ministry of Health plan for these health facility clients • Health planner at the Ministry • of Health, • “ah! the number of clients has increased this year. The health facility needs one more Nurse”
RESEARCH QUESTIONS • What are the existing problems of the health information systems in Tanzania? • How can a computer database be implemented at the district level in order to serve as a Health Data Analysis tool? 11
RESEARCH OBJECTIVES • To assess problems of the district health information system • To design, develop and implement a prototype, DHIS, at the district level • To identify how learning gathered in HISP network can be useful in Tanzania 12
RESEARCH SETTINGS • Five districts in Tanzania Mainland • Bagamoyo, Kibaha, Temeke, Ilala, and Kinondoni • Four districts in Zanzibar • Micheweni, Chakechake, North A, and North B • Two Hospital • Mnazi Mmoja and Chakachake 13
ACTION RESEARCH CYCLE • Establishment of a ‘client-system infrastructure’ or research environment HISP memorandum signed between University and Ministry of Health (identifications of HISP pilot sites) 14
Balancing Action and Research • Organize the actions into small units which can be completed in short time • Take field notes on every action • Actions includes: fieldwork entrance letters, fixing computers items, meetings and workshops • Anything that consumes our time in the field is part of the action • Use some known data analysis techniques • Align our field notes empirical material in those techniques • Think and make sense of the actions and results • Sometime is required to be away from the field 18
Field notes • Field notes should be written as soon as possible after leaving the field site, immediately if possible • Plan to leave a block of time for writing just after leaving the research context 19
METHODOLOGY • Data Collection Methods • Semi-structured interviews • Participant observations • Analysis of documents • Use of checklists: data registers, analysis tools, and health workers • Software prototyping process • Group discussions and Training workshops • Video/still pictures • Analysis of press media reports 20
Data Analysis and Presentation • Empirical materials are presented in • Descriptive statistics (quantitative data) • Excerpts of encoded user reactions • Screen shots of programs • Field documents • Photos 21
Data Analysis and Presentation • Example: qualitative excerpts of encoded user reactions “No EPI data set, no HIV data, it is missing a lot of information” (DHIS User, Bagamoyo district, February 17, 2005) 22
Data Analysis and Presentation • A model and measurement instrument for the formation of Information Systems satisfaction (7-point semantic differential) 23
Data Analysis and Presentation • Example: Software evaluation 24
Data Analysis and Presentation • Example: Software evaluation 25
Data Analysis and Presentation • Screen shots 26
Concluding Remarks • Knowledge created in action research is not sometime utilized immediately • Does not bring up radical changes • Interviews, Observations, Questionnaires, and site documents work together to support the research claims. 27
Concluding Remarks • Secondary Sources of Data • Documents from the fields • Photos and video taking • Excerpt from interviewee • Depict originality of the research • Acknowledgement • Try to write somebody’s name correctly 28
Thanks The End 29