Are we in the right path ?

1. Are we in the right path ? • the data have been collected… • collated… • validated… • analyzed… • presented… • the indicators have been calculated… • NOW…….  What is the meaning of the “stuff” we have?

2. Interpretation - making sense of information MED-INF 5200 TOPIC 6 Humberto Muquingue April 16, 2007

3. Learning outcomes At the end of this topic, you should be able to: • Define what is interpretation of information • Describe the requirements for interpretation • Understand the practical issues involved in interpretation • List some problems related to interpretation

4. The walls inside are plastered with laboriously made graphs…

5. Outside, people have been queuing for hours…

6. Interpretation(making sense of information) • Is about UNDERTANDING … constructing meaning with: • Old information – to find known patterns • New information – to place a new look at known patterns • Rational and logical approaches: • Mix new information with old • Put new information into the context • Link up different pieces of new information • Link up different pieces of new and old information

7. How is Information Interpreted ? Understanding implies: • Appropriate interpretations • make many linkages possible (correct, logical, sensible) • may answer important questions • may result in action • Possible interpretations • are context dependent (population, health, service status) • depend on data quality • rely on data definitions Therefore: discuss, explore and consult •   discuss different interpretations and explore different views • this allows improved understanding

8. Preparing for interpretation- The essential ingredients • Accuracy checks – 3 C’s and 1 T, includes: • Routine validation and trends checked over time • Data checked per month, per facility, per district • Local / contextual knowledge on: • Population data: ethnicity, lifestyle, occupation • Health data: common diseases • Service data: types of facilities, proficiency of staff  Effective interpretation needs a minimum of 6 months worth of data

9. Garbage in ?  Garbage out !!!! • one cannot effectively analyse data that is of poor quality, • one cannot interpret information that is of poor and suspect quality… • …with any hope of relevance, appropriateness and usefulness !!! ASK: Is this data measuring what it is required to measure?

10. Practical questions in interpretation 1. Why have you produced this information/ indicator? 2. What does the indicator measure?3. What is the actual measurement unit?4. Has the indicator been accurately measured?5. What is the target value OR action trigger value?

11. Practical questions in interpretation 6. What is the normal range? In your country: - urban - rural In the world: - best in the world - worst in the world7. How does it fit in with other information?8. What is the local context?9. What should you do about the situation?10. How could you implement that?

12. DIFFERENT INFORMATION REQUIRE DIFFERENT INTERPRETATION

13. NO TRESPASSING TRESPASSERS WILL BE SHOT ! SURVIVORS WILL BE SHOT AGAIN !!

14. EXERCISE • The manager of a clinic in a peri-urban area was surprised by the very low numbers of male patients attending the OPD with urethral discharge. She was sure that the facility reporting system worked well. What could be the cause?

15. Example of reasoning on info • Use of MUDs1 as data element for prevalence of STI… • Is problematic because it only relates to males • of whom few go to health facilities… • due to the dominance of women and children in PHC facilities and a perceived lack of privacy? • STIs not very stigmatizing in a male-dominated environment… • …but embarrassing vis-à-vis female neighbors! •  many males prefer to go to a private GP! 1MUD = male urethral discharge

16. EXERCISE • You are presented with a graph for a district in Uganda showing 3 indicators on the Overall TB Cure Rate, Overall TB Success Rate and DOTS (Directly Observed Treatment Shortcourse) for each quarter of 2006. • How would YOU interpret the information contained in the graph?

18. To interpret this information YOU would ask the following questions. • What are the definitions of the indicators that are used? • What does the graph show? • What else do you need to know? • Is it enough to make a decision? • Is this the best way to present this information?

19. Matching information to reality

20. USE = Assessing coverage and quality of health services WHO GETS SICK ? WHAT HEALTH SERVICES EXIST ?

21. Assessment of coveragewho gets sick? • Description of people who attend health services: • age and gender breakdown • community distribution • Use of individual patient data to construct aggregated routine data • Definition of population • catchment • target for specific services • at risk

22. For whom? Accessibility Catchment population Target population Utilization What? Appropriateness Type and range Continuity Why? Political vs functional When? Acceptability Convenience to clients and staff Where? Distribution Integration How ? Affordability Resources Staff Materials Money Assessment of qualitywhat services exist ?

23. Applying the “systems model” to data and indicators • Inputs…. resources • Processes …. activities • Outputs …. results • Outcomes … impacts

24. The path from Data to Information • Input ….Raw Data • quantity and quality of data elements (MDS !) • data collection tools (tally sheets, registers, client cards) • Process …Analysis • turning raw data into useful information • planning tools (targets, indicators) • Output …Information • used for effective decision-making • assessment tools (aggregation, graphs, reports) • Outcome …Coverage and quality of health services • management • planning (strategic & operational) • monitoring & evaluation Impact: Health status