Health System Performance

UNICEF

Health System Performance is critical to measure efficiency in using scarce resources, especially in time of budget cuts. This requires a complex information strategy that is based on sound logical framework, a complex data collection system, a careful data quality check and a sophisticated analysis to correctly interpret the information that will be used to improve management. This is not an easy task, considering that most data come from routine management information systems which have data reliability problems.

I can assist in assessing health system performance. This includes the logical framework underpinning the role and functions of the health care system, the relevant indicators and the potential data sources, the method to identify and correct unreliable reporting, the interpretation of trends in efficiency indicators, the use of the information to spot management problems and the use of the results for action.

Examples include:

(a) A Primary Health Care (PHC) review in the Sidamo Region, Ethiopia according to a methodology used by WHO to monitor the progress of the PHC strategy. The method encompassed a planning phase; a field survey of a representative sample of households and services; interview of government officials at the middle and high administrative levels; analysis and synthesis of the findings and suggestion of the way forward. The household survey provided an overall picture of household characteristics, prevalence of child malnutrition and morbidity, treatment of common illnesses, immunization coverage rates, use of family planning methods, use of safe water supplies and sanitation, access to antenatal and delivery services. The survey of the health services covered the status of the infrastructure, availability of equipment and supplies, staff composition and training, provision of services (including outreach), and problems met by the staff during the daily activities. The interview of the high level officials at the regional department of health shed light on policies, administrative procedures, methods used to decide priorities and assign resources, health accounting systems, and monitoring and evaluation mechanisms. The results were part of a process to monitor the progress towards health for all by the year 2000 targets.

(b) Analysis of health system performance in KwaZulu-Natal (KZN), South Africa. I assisted the Department of Health (DOH) of KZN in devising an information strategy to produce local epidemiological estimates, assess the reliability of the information that was collected through the health management information system, interpret the trends of the indicators of health services' performance. These included the indicators of hospital efficiency (Issue 7), primary health care clinics' utilization, patients' epidemiological profiles, immunization coverage, TB
 treatment outcomes, ART coverage, costs per outpatient and per patient day equivalent. Validation of the information was conduced through chart audits.

(c) Analysis of the performance of the Ethiopian Health Sector Programme. This was based on quarterly and annual updates on the following numbers and indicators: health extension workers trained and deployed, households' latrines constructed, heath posts and health centres constructed and equipped, coverage of target children with vitamin A supplements and deworming treatment, coverage of target clients with counseling and testing for HIV, coverage of target HIV/AIDS patients with antiretrovirals, coverage of HIV+ mothers with preventive treatment to avoid mother to child transmission of HIV, coverage of target households with treated bed nets to prevent malaria transmission, TB
 detection and treatment rates, hospital utilization, antenal and delivery coverage rates, immunization rates and health expenditures by type of services.

In both KZN and Ethiopia, the data originated from a complex health management information system that was reorganized and scaled up over a period of several years. One important aspect was the critical analysis of the quarterly trends to spot reliability issues due to problems affecting the numerators and denominators of specific indicators. Data originators were contacted to discuss reliability issues so that numbers were rechecked and corrected. These indicators were used to monitor the achievements of quarterly and annual Health Sector Programme's targets and the results were discussed with stakeholders at semiannual and annual review meetings. The semiannual and annual review meetings helped to track the progress in achieving the targets, spot management problems and take decision on the changes to be made.