ROUND TABLE
ROUND TABLE DISCUSSION

The data set must focus on service quality

Jens Byskov^I,1; Oystein Evjen Olsen^II

^IDBL-Institute for Health Research and Development, Jaegersborg Allé 1D, Charlottenlund, DK-2920 Denmark (email: jbyskov@dblnet.dk)
^IIDBL-Institute for Health Research and Development, Primary Health Care Institute, Iringa, PO Box 105297, Dar es Salaam, United Republic of Tanzania (email@dblnet.dk)

The paper by Vincent Shaw highlights some of the long awaited practical approaches to ensure relevance and use of health information systems in developing countries. The South African experience he recounts is very relevant as current "best practice". It is a very important step forward in the simplification and integration of programme areas and routine services into a shared essential set of routine data. The cohesion of health services and the whole system will be much strengthened by such a shared data reference and information base.

The essential data are still to be selected by programme managers, however, even though the definition of the data set emanated from the district level. It is not shown how the data will be turned into useful information that will assist in planning and monitoring at all levels of the health system. The examples taken from the nutrition programme and the Expanded Programme on Immunization only exemplify health status (outcome) and service provision (output) data.

In the section on specific programme surveys, resource and staff availability are mentioned as well as service quality. It is worrying that these are not shown to be included in an essential routine data set, as it is extremely important that an essential data set allows production and sharing of information on health management. It is also not shown whether quality of care will be viewed from both provider and user perspectives and whether user views on service priorities and other qualitative data are included.

In Shaw's figure, the column of information used by the national level on a routine basis within the triangle of information should be seen as the core data on facility performance that must be shared in an accessible database for the whole health service and other parts of the health system, and be available for sharing with users and the public.

The information needs triangle could also be depicted as service quality at the bottom, supervision and coordination needs at the intermediate level, and policy needs at the top. The main focus of the data set must be on service quality, with less emphasis on supervision and coordination and even less on policy. Service quality must relate to health management, service output and outcomes as viewed from both the provider and the user sides.

The number of data elements and indicators still seems to be high in relation to similar elements in the core part of the health information system in other African countries and may indicate a still limited degree of compromise and shared focus between the levels and programmes. A stronger emphasis is needed on the iterative nature of the health information system, and not so much on annual or quarterly "reporting". We need to move away from a culture of reporting to a culture of using the data for ourselves — facilities or districts first — on a continuous basis. Benchmarking and quality assurance processes exemplify some useful frameworks for continuous use of data.

Competing interests: none declared.

1 Correspondence should be sent to this author.