HEA'LTH DATA ISSUES FOR PRIMARY HEALTH CARE DELIVERY SYSTEMS IN DEVELOPING COUNTRIES

INTRODUCTION

This paper is intended to describe some of the basic concepts of data collection and information systems development that should be an inherent consideration for primary health care programs in developing countries. Various types of data are described which comprise a minimum basic data set for the management and operation of primary care programs. Sources of data axc presented and uses and applications are outlined. A brief discussion of the introduction of data collection and information management systems in Sierra Leone is given for a particular primary health care center.

BACKGROUND

I A major component of primary health care delivery systems is the identification, collection, analysis, interpretation, and dissemination of data. Data are necessary to effectively carry out the planning, management, direction, and evaluation of health care programs. All too often, however, this component receives a low level of attention due to the demands required for providing adequate health care services in a particular area. The focus of primary health care is to have available those resources – medical and support staff, supplies and equipment, pharmaceuticals, transportation – needed to address the health needs of the population. With these items representing major operational needs of the system and often requiring constant attention in order to carry out programs of the health care delivery system, the role of a health database or information system is often not adequately emphasized or fully integrated into the health care system. The collection of data and the use of that data are, however, essential elements of a health care delivery system. Health needs of the population must be defined for data collection to take place and, once obtained, the data must be used in order to realize the benefits within the program. Otherwise efforts to provide health care may result in a significant waste of staff time, resources and funds. Where data are not collected, or collected and not used in an operational health care program, it may be that the value of the data are not recognized or that resources such as technical staff and equipment are not available to analyze or interpret the data. The latter reason is quite often the case as observed in primary health care projects in many developing countries.

This points up a signifkant gap in these programs i.e., the failure to recognize data as an integral component of the system in providing health care. It is clear that the decision-making functions of an organization, and the allocation and distribution of resources to conduct an adequate program of primary health care delivery require a great deal of health information and analysis. Information must be derived from statistically sound, complete and reliable data reporting activities; by the judicious use of administrative and other information systems which may not be directly managed by the primary health care facility; and through survey sampling methods. Data reporting activities must necessarily be defined as a function of the goals of the delivery system in place.

Forms design, instructions on completing forms content, distribution, and training all must be addressed for successful reporting. The &sign of report forms must be developed so that they are useable in a variety of environments. For example, the use of pictorial representations of health events can produce results where questionnaires could not be read or understood. The content of the form should be simple and straightforward, and limited to very specific health outcomes. Generalizations are not well received in this type of environment, and should be left to the analytical staff at the health care center following data collection activities. Pre-existing administrative record systems can also serve as a valuable data resource to the system. Historical records relating to prior censuses can provide basic demographics of the population; inventories of drugs and other medical supplies can reflect in part the health conditions and problems of an area; documentation required to obtain employment and school records can provide data on family structure and households; and, other required reporting or registration that may exist for a variety of reasons can represent valuable input to the knowledge base for the health care system. Sample surveys, whether to determine population characteristics or health status, are an essential component of the data collection plan. Though this activity requires field work, a properly designed sample and a plan for the logistics in conducting the survey can be cost effective and produce relevant and timely data.

Sampling plans may be narrowly focused or broad-based in terms of content, geographic coverage, or population; may serve to develop baseline data, provide ongoing input to the health care system, or provide an evaluation process for programs of the system; and, may be ‘used to maintain a continuous health surveillance or monitoring system in support of the health care delivery programs. The variety of data and information represented in these areas, if recognized, integrated and analyzed can significantly impact the organization, administration and direction of many primary health care activities in developing countries. In doing so, benefits are realized not only in the operation of the program itself, but by the recipients of the services provided and from the support of national and international affiliates concerned with quantitative assessments and health outcomes of the program. Requests for financial support, supplies and related health items which are justified on the basis of hard data and information from the health care program itself have a greater degree of success.