A Decentralized Information System for the Monitoring and Evaluation of Maternal and Child Health/Family Planning Program PerformanceBy M. Azelmat, M. Edwards, T. Lippeveld, M. Yassine, S. Naya and M. Archach Abstract Aware of the lack of relevant, timely, and reliable information for the planning, management and evaluation of health programs, the Morocco Ministry of Health (MOH) has since 1986, with the assistance of numerous international donors (USAID, WHO, UNFPA, UNICEF, European Union) made efforts to restructure the National Health Information System. The Ministry of Health was strongly committed to the development of a health information system which serves as a utility for decision makers at all levels of the health service system to effectively plan, manage and evaluate health programs. This effort was part of a broader health system reform effort, to decentralize health services management, after the creation in 1996 of 16 regions, as an intermediate level between national and provincial levels. Restructuring the Health Information System Three concerns of the MOH guided the restructuring of the information system: (1) promote usage of information to improve service quality; (2) integrate the data collection from the different MCH/FP programs by facilitating a holistic approach to child and reproductive health; and (3) introduce new programmatic focuses, such as the integrated management of childhood illnesses (IMCI) and the management of obstetric emergencies. Restructuring activities were implemented in three phases, which occurred mostly in parallel: (1) revision of data collection supports; (2) development of a computerized MCH/FP data entry and analysis system; and (3) training of managers at regional and provincial levels in the utilization of data for decision-making. Revision of data collection supports In 1997, several working groups were set up to adapt the data collection supports (DCS) to the needs generated by the integration of reproductive and child health programs, and by new programmatic approaches in child health and mother health: Emergency Obstetric Care (EOC), and the Integrated Management of Childhood Diseases (IMCI). These working groups were composed of key staff representing the relevant programs, SEIS and JSI resource persons. Following a series of meetings, the following decisions were taken:
Development of a computerized FP/MCH data entry and analysis system With the objectives of (1) improving the quality of MCH/FP data collected at peripheral level, (2) encouraging the use of data at regional and provincial levels and (3) reducing delays in data availability at central and regional levels, it was decided to decentralize data entry to the provincial level. A computerized entry and processing system for MCH/FP and curative data at provincial level was developed between 1998 and 2000. This application, called système SMIPF, was developed using Microsoft Access and VBA (Visual Basic for Applications), with technical assistance from John Snow Inc., in close collaboration with future users from central and peripheral levels. It permits central program managers and peripheral health services managers to monitor MCH/FP service performances on an immediate basis. Système SMIPF Application: data processing and analysis possibilities
Training in data utilization In parallel with the changes in the data collection system and the development of computerized data processing and analysis tools, a sustained effort was made by the project team to strengthen the capacity of managers at both central and peripheral level to use information for better management and delivery of MCH/FP services. Strengths and weaknesses The information system restructuring has been a beneficial but operationally complicated process The integration and simplification of several data collection instruments and monthly reports will decrease the workload of service providers and help them to use a holistic approach to case management. Information system restructuring is a rather complex endeavor, and while a consensus-building process ensures later ownership and sustainability, it makes it time-consuming, which can lead to other problems. In this case, during the long field-testing period, the SEIS received two different monthly report formats. The co-existence of these two different monthly report formats generated data entry problems with the new application, as well as disturbances to the national MCH/FP databases available to program planners and managers at national level. Another issue, that has caused major problems during the pilot phase of restructuring, was the stock-out of DCS. Creating an information culture is a long-term behavioral intervention. From the very beginning, the major objective for the health information system was to improve the use of MCH/FP data generated by the system for decision-making at all the levels. Although the health information system restructuring had transformed the system into a more relevant, reliable and rapid information production tool, it did not automatically lead to better use of information. Computerized data processing requires both capital and recurrent investments The Ministry of Health, with the assistance of donors, has made major investments in the acquisition of high-performance computer equipment and the training of managers from all levels in its use. Despite these efforts, the information tool is not yet well utilized by most MOH key staff and decision-makers, at both central and peripheral level. Recommendations and future perspectives
Many efforts are still required to assure that the MCH/FP data produced by the new information system are reliable, complete and timely, and that MCH/FP information is used for decision making at all levels.
Both MCH/FP and epidemiological data should become part of an integrated health services database at provincial and regional levels.
In order to optimize MOH and international donor investments in the computerization of health services management, sustainable mechanisms must be created to ensure the maintenance of the computer pool and to train health personnel in its use. |