Human factors affecting the quality of routinely collected data in South Africa

1. Human factors affecting the quality of routinely collected data in South Africa MRC Burden of Disease Research Unit Division of Community Health, Stellenbosch University E. Nicol1,2, D. Bradshaw1, T. Phillips1, L. Dudley2 Medinfo 2013 20-23 Aug, Copenhagen, Denmark

2. Background • Maternal and child health interventions are important programmes to meet MDGs 4, 5, and 6 • Tracking coverage of these interventions is challenging due to lack of accurate and reliable statistics • NDoH has developed a district health information system (DHIS) to collect monthly facility based data • Audits of the human resources and equipment to drive the DHIS have been undertaken but there has not been a comprehensive evaluation • Studies on Routine Health Information System (RHIS) • focus on availability of human resources • not on competence and motivation • nor use of data for decision making and improving services.

3. Problem statement • RHIS rationale • Data quality not accurate& reliable for monitoring • Data not used by programme managers • Nurses are tasked with multiple responsibilities • HI personnel not sufficiently trained in RHIS tasks.

4. Data collection Primary data collection Clinic Records Da • Daily tick registers • Tally sheets • Programme registers • Midnight Census • Patient folders • Attendance registers • OTEs • Facility monthly summary Patient Record Patient record, tick registers or tally sheets & patient folders updated simultaneously • Verify accuracy and completeness. • Monthly Data Input Form • OTEs Tick registers Daily, weekly & monthly • Collation of aggregated data • Facility manager and • Supervisor sign data off • Tally sheets Monthly • OTEs • OTEs Midnight census • Daily and monthly Submit for capturing • OTEs Attendance registers Daily, weekly & monthly Sub-district/District • Ensure accurate collation and completeness (data from all health workers & work stations) • OTEs: Opportunities for transcribing errors

5. Reality • “I don’t think nurses tick every patient that comes in for care, sometimes they will just dish out the tablets for those who come for their doses and then maybe after four or five patients, they will remember to tick and suddenly they just tick twice. • So sometimes they may tick less or tick more, so it’s difficult to keep accurate statistics, because the same person who is taking the stats is the same person who has to give the tablets, it’s the same person who has to find the patient folder, the same person who must listen to the entering patient, you see. So I don’t think it gives the true reflection.” – AO

6. Reality Current paper based RHIS Not very well organized

7. Objective • The purpose of this study is to assess the Humanfactors affecting the routine health information systems’ (RHIS) performance

8. PRISM Framework

9. Methods Human factors • Knowledge of RHIS rationale • Data quality checking skills • Problem-solving skills • Competence • Confidence • Motivation Source: Adapted from Aqil et al (2010) INPUTS The PRISM framework

10. Methods Source: Adapted from Aqil et al (2010)

11. Methods C2b. Explain the findings of the bar chart C2c. Did you find a trend in the data? Explain your answer C2d. Provide at least one use of the above chart finding at: • UD1. Facility level • UD2. District level • UD3. Policy level • UD4. Community level Source: Adapted from Aqil et al (2010)

12. Results

13. Results: Human factors

14. Results: Skills

15. Conclusion • Personnel appear to be reasonably motivated and confident about RHIS tasks but there is a skills and knowledge gap about RHIS and data use and interpretation. • Institutional capacity to train personnel on data collection processes and data quality checking skills should be encouraged • Basic numeracy skills should be a mandatory requirement when recruiting information personnel as well as clinical, health facility and programme managers

16. Acknowledgment SURMEPI Stellenbosch University Rural Medical Education Partnership Initiative

17. THANK YOU Burden of Disease Research Unit Tel: +27 21 9380899 Fax: +27 21 9380310 Edward.Nicol@mrc.ac.za Health Systems & Services Research Faculty of Medicine & Health Sciences, Stellenbosch University, South Africa