Analytical summary - Health system outcomes
Information is the pillar of any system, to enable it to operate efficiently and effectively. Availability and accessibility of health information is crucial for generating a knowledgeable and healthy community. However, for information to be valuable it should be reliable, complete, timely and accurate. In the United Republic of Tanzania, health information and evidence is generated through two major channels.
One channel involves data at population level, which includes:
- population-based surveys such as the Demographic and Health Survey and HIV/AIDS and Malaria Indicator Survey;
- the Population and Housing Census;
- the Demographic Surveillance System, which monitors vital statistics at sentinel sites located at various regions in country;
- sample vital registration with verbal autopsy, which operates under the sentinel panel of districts;
- national vital registration systems and other specific health and health-related research works.
The second channel operates routinely and is mainly coordinated by the Ministry of Health and Social Welfare. It generates information on the health service provision by maintaining two major systems that collect and analyse information on diseases:
- the health management information system, also known by its Kiswahili acronym MTUHA (Mfumo wa Takwimu wa Uendeshaji wa Huduma za Afya);
- the Integrated Disease Surveillance and Response.
In addition to the two systems, there are disease-specific programme systems (tuberculosis and leprosy, immunization, HIV/sexually transmitted infections). The type of data generated through these systems include morbidity; mortality; types of services delivered; drugs and commodities provided; availability and quality of services; financial sources and expenditures; and all management and supervision aspects. The root of this information is the health facility.
A number of health research institutions and universities generate survey health information. The Institute for Medical Research is mandated to coordinate the generation of research information.
Data collected from these sources are used to make a comprehensive health information database to develop health indicators used to assess overall performance of the health sector. The Government of the United Republic of Tanzania considers the health Information system to be the cornerstone of an efficient health system. Thus, giving support to sector performance monitoring systems has been identified as a priority for health development.
Access to health information for all levels, from the general community up to decision-makers, and the utilization of the generated health information, have been inadequate and this is a major challenge to the health system. There are no standardized methodologies in place to ensure appropriate information is channelled to the right person at the right time and for the right purpose. Thus, there has been poor utilization of the available information for knowledge strengthening and supportive evidence for decision-making.
Advances in information and communications technology (ICT) since the end of the 20th century have led to multiple convergences in computing, telecommunications and broadcasting. Employment of ICT in the health sector, more specifically in the health information system, will results in a significant change in how data are collected, processed and utilized. It is foreseen that ICT will improve the quality of data, which has been compromised by the existing information system.
The health sector is in a phase of transition from manual to electronic data management. Development and implementation of ICT strategies in the health system has resulted in the introduction of new tools to manage administration and technical information such as PlanRep, AfyaPro and District Health Information Software (DHIS 2). The change poses many challenges, including the high financial demand for system developments, skilled human resources, capacity-building requirements, the high cost of infrastructure at various levels, and management issues. Guidelines, regulation, policies and strategies have been developed to support the performance of the health information systems. There has also been expansion in public–private partnership to support the information systems and various technical working groups have also been introduced to facilitate their performance.
There are still several challenges in the health sector that need to be addressed to strengthen utilization of information for evidence and provision of knowledge to the relevant audience including:
- improving timely compilation of data from the routine health management information system and programmes;
- capacity-building in data analysis and use at various levels;
- conducting critical review and monitoring of set targets to evaluate the current situation;
- strengthening council understanding of linkages between problems, objectives, targets, interventions and activities;
- improving the inadequate computer skills among council health management teams and regional health management teams;
- training health personnel at all levels on the interpretation of information in the comprehensive council health planning guidelines and efficient allocation of resources;
- improving problems in reporting health information, such as inconsistency, and incomplete and incorrect data presentation in comprehensive council health plans;
- reducing the knowledge gap due to lack of English literacy.
Most of these challenges may be averted when all the components of the health information system, including the financial and human resource components, are functioning well using ICT.
In addition to the aforementioned challenges, the Tanzanian health sector has not completely utilized the availability of a national language that is widely understood and has not ensured that most of its information products are translated. Most research is published externally, and researchers have not managed to communicate their research output in a format that is easily accessible to the general public.