ROUND TABLE
ROUND TABLE DISCUSSION

Indicators for a health information data set in Ghana

Sam Adjei

Deputy Director-General, Ghana Health Service, Private Mail Bag, Ministries, Accra, Ghana (email: sam.adjei@hru-ghs.org)

A health information system handles the recording, storage, retrieval and processing of health data. Broadly defined, the health information system should cover such data sources as vital registration, censuses, routine service-generated statistics, population-based surveys and research information, in order to provide evidence for decision-making in the health system.

Assessments of health information systems have given rise to several misgivings. Foremost among them is the fact that multiple data sources are not linked to each other; indeed, different instruments may generate different data on the same person or event. Routine service data are collected with the needs of higher-level programme managers and donors in mind; in addition, they may be incomplete or of doubtful quality, and timeliness can be a problem. Surveys are useful, but they tend to be expensive and donor driven and are often not linked to routine service data. Research data are generally available but are rarely included as part of the health information system because research is conducted outside the scope of ministries of health. Dissemination of the information collected is usually weak and its use, particularly in policy-making, is infrequent. Several efforts undertaken to strengthen health information have not taken into account any general framework for designing the information system.

The paper by Shaw describes efforts to correct the multiplicity of data sets in South Africa, especially at the periphery, without describing an overall framework for how this is to be achieved. Even though the process reported has reduced the data set to 100–150 elements and 80–120 indicators, the numbers still appear too large to manage effectively. An overall vision of health information needs in the context of health development is important even at the district level beyond programme managers. The current wave of health sector reforms and health system strengthening will require this broader context for the development and standardization of health information.

In Ghana, a conceptual framework for health sector development (health sector reforms) helped to generate indicators for health information (see Fig. 1). This framework allows data required for policy development, priority setting and programme performance measurement, as well as monitoring and evaluation, to be determined in the sector as a whole. Sectorwide indicators that fell into three main categories were agreed upon; 20 indicators are collected and used at all levels, which does not exclude the use of more indicators at any level.

The three categories of indicator concern: health status, including mortality and morbidity; programme output, covering programme performance in public health and clinical care interventions as well as health-related indicators such as enrolment at school; and systems development, in which a package of five cross-cutting areas of access to care, quality of care, efficiency in the use of resources, collaboration with other sectors (communities, other providers of care, other ministries and donors) and financing of care is determined. Indicators in the first two categories are easily developed but are more difficult to define in the third category, where methods of data collection are also difficult as the indicators do not lend themselves to routine service statistics and surveys may be needed.

The impact of the process adopted in the South African experience is commendable, as it appeared to influence other districts, the regions and national levels. Its impact at the global level is not indicated but, given that global initiatives and donors have major information requirements, a process that links with global development is important.

With this in view, the Health Metric Network initiative is timely. Particularly welcome is the development of a simple framework to define the scope of the health information system. The framework should serve as a diagnostic tool for evaluating the state of a country's health information system, a road map for developing plans for improvement, and a process for monitoring and evaluating progress. Its application at the country level should build on experiences such as that described in South Africa.

Competing interests: None declared.