Table of Contents
Chapters
- Understanding the Concept
- Evidence-Based Practices
- Adaptability
- Links with Other Services
- Minimizing Paperwork
- Physical Factors
- Service Hours and Scheduling
- Client Flow
- Division of Labor and Job Design
- Social Factors
- Implementing the Concept
- Bibliography
This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.
Published by the INFO Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.
Volume XXXII, Number 1,
Winter 2004
Series Q, Number 2
Maximizing Access to Quality
| Health System | |
4 |
Minimizing Paper-work, Maximizing Information Use |
At every level of a health program, collecting up-to-date, reliable, and relevant information is crucial to analyzing operations, solving problems, identifying trends, setting goals, and using resources wisely. Managers can encourage their staff to collect and use only essential data. Collecting too much data can waste time, produce unnecessary paperwork, and obscure rather than illuminate decision-making.
Principles of Information Management
Collect what is needed, but no more. The information that managers and providers collect should relate directly to the decisions that they must make. For instance, supply managers need only data from their own organization—such as amounts currently in stock, rates of consumption, order dates and receipts, and amounts ordered—to know when to order more supplies (36, 115).
District or provincial program managers need more than just local data. For example, having both national and local data on the number of postpartum women receiving family planning services can help managers compare their program’s output with that of other programs and possibly identify where improvements can be made (99).
Collecting only essential data reduces paperwork. Managers and providers can decide what data to collect by looking at organizational objectives and selecting indicators that measure achievement of them (73). For instance, before 1997 in the Eastern Cape district in South Africa, health facilities collected and sent vast amounts of data up the information pipeline. Much of the information collected was unnecessary, and the few useful data were lost in the mass of numbers. The clinic and hospital managers determined which information was essential for their facilities to function effectively and selected appropriate measurable indicators. The value of the data to the facilities increased, while the volume of data reported up the information pipeline decreased (33).
Principles in Action India: Using Data EffectivelyIn India health workers at a rural hospital in Bhorugram, Rajasthan, used data on immunization dropout rates to improve childhood immunization coverage dramatically. In the early 1990s the hospital installed a computerized system to collect and manage client data. With access to the new system, service providers discovered that fewer than half of children in the area received full immunization coverage against the six major childhood diseases. The 1990 World Summit for Children had set a goal of immunizing 90% of children under one year of age by 2000 (117). Alerted to the wide gap between actual and recommended immunization rates, the dispensary staff began an outreach campaign. The hospital’s community health workers and auxiliary nurse-midwives visited the 40 surrounding villages and urged parents to have their children immunized. The number of child immunizations increased dramatically. In 1996, for example, 82% of children in the community were fully immunized, compared with just 45% in 1992, before the campaign began. Encouraged by this success, clinic administrators are using the outreach workers to promote other primary health care services, such as antenatal care and family planning (105). |
Make good use of what you collect. Managers should be able both to analyze the data that they collect and to act on it. Once collected, the data should be tabulated and summarized in reports that facilitate access and analysis. To be useful, data must be converted into information that can be easily understood and delivered to the program staff who are able to apply it in decision-making (see box right). Too often, however, managers simply aggregate the data and report them to higher levels.
Developing a plan for sharing information is important to get the right data to the right people in a useful form. As a first step, creating an information flow table that summarizes how information moves internally can help managers discover which staff need what information, how they will use it, and how detailed the information needs to be. This flow table will help staff compare current with desirable practice and close the gaps (123).
Empower staff to both collect and use data. The more relevant that data are to program staff members’ jobs, the more that staff are likely to collect data accurately and on time (66). When they understand how program data can be used to identify problems or improve services, staff are more likely to make use of data (15). Charts and diagrams can help. For example, in maternal and child health and family planning centers in Istanbul, Turkey, the staff recognized that recording on a central wall chart the number of family planning clients as well as stock levels of IUDs, pills, and condoms improved their ability to monitor supplies and avoid shortfalls (32).
Provide feedback on data collected. Managers can show providers the importance of data by providing feedback on the data collected and used. Feedback also displays appreciation for staff effort and motivates staff to maintain the information system regularly. To provide constructive feedback, managers should determine whether data are being provided on all key indicators, all gaps in data collection have been identified, information is accurate and reliable, and decisions or actions are based on the data (123). If staff members are making many mistakes in collecting, tabulating, or analyzing data, managers may need to redesign or simplify clinic forms or to train staff to reduce errors (115).
