Health Information and Decision Making at the Community Level: Building and Using Simple Systems

Karima Saleh

A community-based Primary health care system in urban slums of Karachi, Pakistan involved a simple health management of information system (HMIS). Data was collected by community health workers for an efficient management of their service delivery area. Supervisors monitored the workers more effectively due to timely and action oriented data available at hand, and therefore prompt feedback and support was provided to community workers. Program managers and policy makers monitored the coverage of the program, and evaluated the targets achieved, and provided quick program support and budgetary response.

Some of the successes of the HMIS was attributed to the following: the primary reason for routine data collection was for " program use", and not for recording or to meet someone else's data needs. The collector of routine data was trained in the purpose of the data being collected, and therefore was able to use the data in the job. "Minimal" data was collected, and therefore the HMIS avoided overwhelming the workers with data, and relieved the workers from spending too much time on data recording. Data played the role of support for the work to be delivered, as data not only flowed from bottom-to-top, but the HMIS was developed to provide feedback from top-to-bottom. The key message was that routine data was to be collected for "decision making" and for "decision support".

Some of the shortfalls of the program highlighted the importance of workers' training, workers' motivation, and supervisory support. A cost-effectiveness analysis awaited the evaluation of the program.