Health Information System

1. Health Information System

2. Presented by: • Ashish Bhatia (roll no.-511) • Chander Pal (513) • Chandra Prakash Yadav (514) • Deepika Chopra (515) • Dinesh Kumar (517) • Divya Gupta (518) Under the guidance ofDR.ANITA THAKUR

3. Overview • Definition • Purpose & choice of information • Types of sources • Categories of information • Reporting system • Sources of information • Conclusion

4. Definition • Mechanism for the collection, processing, analysis & transmission of information required for organizing & operating health services & also for research & training. • Combination of vital & health statistical data collected from multiple sources

5. Purpose of Information • To facilitate health planning, implementation & evaluation • Supports managerial & technical functions • Makes available information which is necessary for:- • Measurement of community health • Community diagnosis • Finding solution to health problems • Prioritization • Planning of interventions

6. Contd… 6.Directing & controlling health programmes 7. Development of procedures, definitions, classification & methods of collection, analysis, storage & retrieval of data 8. Establishing administrative standards 9. Carrying on of performance appraisal 10. Determination of met & unmet health needs 11. Monitoring & evaluation of health programmes 12. Carry out Information-Education-Communication activities for community & decision makers 13. Demand social support for health activites 14. Support health legislation

7. Choice of Information • Information must be:- • Relevant :related to the particular programme • Sensitive :should change with situation • Valid : enable the measurement to be carried out of what it purports to measure • Specific :should reflect changes only in the variable concerned • Sufficiently accurate • Capable of proper analysis & interpretation :difficulties arise in qualitative information • Timely

8. Types of sources • Systems organized on a national scale : • Population & housing census • Civil registration system • Information on certain specific notifiable diseases at different levels on a national scale • Periodic reports by Ministry of Health • Policy documents of central govt., approach papers, 5-yr development plans, political statements, health legislation, budget proposals, proceedings of review meetings, statements in parliament etc. provide essential information • Activities of Health services at local level : • Routine service records & registers routinely maintained by health personnel at different levels

9. Contd… • Periodic reports • Records of dispensaries, health centres, hospitals, maternal & child health centres, labs etc. • Findings of special epidemiological & other surveys : • Objectives- case detection for TB, leprosy, blindness & malaria • Ongoing surveillance for communicable diseases, cancer registry or registers for other specific conditions • Process of planning & implementing mass campaigns • Information from other sectors : • Information on social, demographic& economic status • Developmental activities

10. Categories of Information • Pertaining to health including nutritional status of individuals & communities • Information on infant, childhood, maternal & general mortality rates & their causes • Morbidity patterns • Incidence & prevalence of various major endemic diseases • Disease-specific morbidity & mortality rates etc. • Pertaining to determinants of health & disease including physical & social envt., demographic profile, cultural factors, economic aspects, planned development programmes, food supply position, income distribution etc.

11. Contd… 3. Pertaining to health policies, priorities, plans, programmes & strategies, health care patterns, health manpower & material resources & facilities, financial, administrative & organizational aspects

12. Reporting systems • Information at 1 level is processed, grouped, condensed, classified or partly interpreted & sent to next level • Feed back is essential • At each level, types of records & registers to be maintained should be carefully designed • 2 types : • Baseline record • basic information about population covered • Data like geographical location of villages, sex & broad age distribution etc. • Need periodic updating • Yearly survey + other action-oriented programmes give reasonably accurate information • Other records • Need continuous updating

13. Contd… • Example- information on pregnant women, ante-natal care given to them & the results of follow-up In a well managed system- the frequency of submission of reports is stipulated initially itself, the submissions being made in a prescribed format. This ensures quick initiation of feedback & corrective action

14. Management of information • Standardization of formats, frequencies & procedures helps in eliminating chaos & monitoring information • Data handling facilities like adequate physical space & equipment essential • Information which cant be traced & retrieved at the time it is needed lost information • Misplaced record lost record • Retrieval system must allow the stored information to be available quickly & with minimum effort

15. Requirements to be satisfied by Health Information Systems : WHO expert committeeidentified the following :- • Population based • Avoid unnecessary agglomeration of data • Problem-oriented • Should employ functional & operational terms (for ex- episodes of illness, lab tests etc.) • Express information briefly & imaginatively (using tables, charts etc.) • Provisions for feedback

16. Sources of Information • Population Census • Civil Registration system (CRS) • Sample Registration System (SRS) • National Sample Survey (NSS) • National Family Health Survey (NFHS) • Model Registration Scheme (MRS) • Surveys • Lay reporting • Medical certification of cause of death • Surveillance • Notification

17. Population Census • The census is a total enumeration of the population of a particular area. • Earliest reference of census in India- “Arthshastra” • The 1865 & 1872 census were non synchronous. • From 1881 onwards- uninterruptedly once every 10 year.

18. Contd… • Carried out in 1st quarter of 1st year of each decade. • Constitution of India (article 256) makes this exercise mandatory for union government. • Legal basis- Census act 1948 • Headed by Registrar General & Census Commissioner. • Deputy commissioner- dist. Level • SDMO- Sub division

20. Census Operations • Biphasic • 1st phase- house numbering & house listing (April-September 2000) • 2nd phase- Population enumeration (9th – 28th Feb 2001) • Houseless population enumerated on 28th night.

21. Contd… • Census enumerators – School teachers/ patwari. • Supervisor – Graduate/Inspector. • Includes data of 593 districts, 5564 tehsils/ talukas, 5161 towns, around 6.4 lacs villages.

22. Census in Himachal • The scanning of data is now done in Chandigarh. • Earlier the scanning was done in Shimla manually.

23. Findings of Census 2001 • India is the 2nd largest populated country. • 16.87% of worlds population. • Growth rate (1.9%) much higher than China(1%)

24. Information provided & uses • Data for calculation of many rates used as demographic and socio-economic indicators • Size, age & sex structure of population • Distribution & density of population • Religion, educational level for male & female population

25. Civil Registration System (CRS) • Concerned with vital statistical data • Mode of information collection- functionary entrusted • For collection, registration, transmission, analysis and publication of information, more than 1 department are involved.

26. Registration of Birth & Death • Under birth and death act 1969 • Aim is to collect and compile vital statistics. • Chief registrar- Director of health services. • Registrar – rural area drawn from panchayat, police, health department. • Urban area – health officers or municipalities.

27. Contd… • Every registrar has to register births and death occurring within his/her administrative area. • Both events to be registered within 21 days. • In case of delay upto 30 days fine is charged. • If delay is more than 30 days but within a year an affidavit from a notary public or an officer is required for registration besides late fees. • For delay beyond 1 year, an order from class 1 officer/ magistrate is neccesary.

28. Limitations of CRS • Unsatisfactory • Incomplete coverage • Mistakes of omission as well as commission • Variable degree of under-registration • Time lag between collection & compilation of data

29. Sample Registration System (SRS) • Biggest sample survey system run on a continuing basis in the field of demography • Collection of data- from randomly selected urban blocks and villages • Local volunteer- Enumerator maintains the list …..list is periodically updated……

30. Contd… • Every six months- SUPERVISOR visits • Checks population, vital events & sends a report • These reports are collected at district centers & data is compiled

31. Advantages of SRS • Better coverage, content & timeliness • Urgent necessity of having reliable estimates achieved • Data collected is separate for rural & urban areas

32. National Sample Survey (NSS) • Agency engaged in collection of factual information regarding :- • Social • Economic • Demographic • Industrial • Agricultural conditions through sample surveys on the countrywide basis is the National Sample Survey Organisation

33. Contd… • Permanent survey organization • Undertakes research for improving quality of survey data • Surveys conducted are integrated surveys, each covering several topics with emphasis on 1 or 2 • Each 1 is taken up in the form of “Rounds” stretched over a specific period • Information is collected on health topics. For ex- fertility, morbidity, maternity & child care etc.

34. National Family Health Survey (NFHS) • Household survey • NFHS-1(1992-93),NFHS-2(1998-99),NFHS-3(2005-06) • Ministry of health & family welfare

35. Contd… • Nodal agency-international institute for population sciences, Mumbai • Interviews with more than 2,30,000 women(15-49) & men(15-54) • Tested –women & men for HIV &adults & young children for anemia

36. Survey Process • Designing the sample, questionnaire (household,woman’s &man’s), survey procedures • Selecting & training survey organizations • Translating data into electronic data file • Preparation of reports

37. Objective • Provide state & national estimates of fertility • Practice of family planning • Infant& child mortality • Maternal and child health • Utilization of health services provided to mothers & children

38. Information on - • Quality of health & family welfare services • Indicators of the status of women • Women’s reproductive health • Domestic violence

39. In Addition - • Height & Weight measurements • Blood test • Testing cooking salt • Blood for HIV testing

40. NFHS-3 also provides information on- • Perinatal mortality,male involvement in family welfare,adolescent reproductive health,high risk sexual behavior,family life education,safe injection,TB & malaria • Family welfare & health conditions among slum & non slum dwellers.

41. Model Registration Scheme (MRS)(Survey of causes of death) Questionnaire + postmortem study Causes of death (major causes and subcauses) Trained paramedical staff PHCs

42. Major Causes • Accidents & injuries • Childbirth & pregnancy complications • Fever • Cough • Digestive disorders • Disorders of CNS • Disorders of circulatory system • Causes peculiar to infancy • Senility

43. Recording of data by Health Guide • Record births & deaths • Birth weights

44. Lay Reporting of cause of death Collection of information, its use & Transmission to other levels of Health system by non-professional Health workers (probable cause of death by broad categories)

45. Medical Certification of cause of death • Legal Record • Geographical Distribution • Vulnerability of different age & sex groups

46. Cause of death does not mean themode of dying e.g. HFIt means the disease,injury or complications which caused death RESPONSIBILITY OF CERTIFYING MP Antecedent conditions Direct cause

47. Surveillance • Epidemiological tool for study of disease as a dynamic process involving the ecology, the organisms, the host, reservoir, vector & environment, as well as the complex mechanism concerned with the spread of infection & the extent to which spread occurs.

48. Functions of Surveillance • Helps to assess the incidence & prevalence of diseases • Helps to establish priorities & plan preventive programmes • Essential for identifying high risk groups • Helps in understanding of local epidemiological trends & patterns • Useful in monitoring & impact evaluation of control programmes against specific diseases

49. Surveillance activities may include collection of data by active surveillance, passive surveillance, routine service activities, establishment of sentinel surveillance centres, special epidemiological investigations & undertaking sample surveys.

50. Routine Service Statistics • Routine reporting of cases of selected communicable diseases can be done by all Medical institutions, treatment centres etc. • A list of some 20 diseases for submission of monthly reports has been laid down by National Institute of Communicable Diseases, Delhi (N.I.C.D.) under the Integrated Disease Surveillance Project (I.D.S.P)