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Analytical summary - Health information, research, evidence and knowledge

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To support the implementation of the new health policy based on the primary health care (PHC) approach, the Ministry of Health and Child Welfare (MOHCW) designed and piloted a National Health Information and Surveillance (NHIS) system in 1985.

Since the nationwide rollout of the system in 1988, its further strengthening continued as envisaged in “Zimbabwe Health for All Action Plan”. In 1999, the MOHCW and the World Health Organisation (WHO) carried out a joint evaluation of the system, which identified several issues and recommended necessary remedial measures[1].

In 2005, the MoHCW in collaboration with the United Nations Children’s Fund (UNICEF) carried out another assessment after noting that the information for some indicators did not match at facility, district, provincial and national levels.

The overall assessment revealed that the structures required for proper functioning of the national health information and surveillance system were in place. Generally, the information at the points of collection - in all types and levels of health facilities – was found to be complete but less so at higher levels. It was noted that districts tended to put effort to meet deadlines with the result that transmitted data was incomplete.

The districts were incorporating late returns from clinics into their databases and not updating the Provincial Medical Director (PMD) and headquarters (HQ) levels. Thus, data at the National Health Information Unit (NHIU) was found to be less complete than that at PMD, which was also less complete than that at the districts.

The variations in reporting coverage also made it difficult for the Ministry to monitor disease trends, health status or service utilization at district, provincial or national levels. These challenges were partly resolved by providing transport to District Health Information Officers (DHIOs) to visit health facilities and collect missing returns; providing email and reasonable telephone access to HIOs at all levels, to enable them to communicate, and holding PMDs and District Medical Officers (DMOs) accountable for obtaining information from lower levels and its timely submission to the higher level etc.

NHIS Information Flow

The system was also reconfigured so that every time a district /province submits its monthly or quarterly report to PMD /head office, it simultaneously submits reports of the past six months so that the district, PMD and the Ministry headquarters have the same up to date data at all times. Upward and downward reporting was similarly reconfigured to follow the channel described in the diagram shown here.

References

  1. NHIS: An Assessment & Recommendations report, 2005