Magister Public Health - MPH / This thesis explores the interconnected problems of ―why health information is not used in practice?‖ and ―what can be done to address this problem?‖ The primary aim of the thesis was to make an assessment of the existing Health Management Information System (HMIS) in India with respect to its ability to support the use of information for action in priority areas identified by the national and state governments. The problem of lack of effective information use in health management has been fairly well documented in the literature, but much less has been said about what can be done about it, other than the rather superficial advice of increasing the levels of training. The empirical setting for the examination of these research questions was within the public sector in India, where the research took place within an action research framework. The author was actively engaged as a participant with national and state authorities in the process of redesigning of the HMIS, building and deploying to the states various HMIS reform systems including the software, capacity building and making systems sustainable and scalable. A key focus area of the action research was aimed at enabling systems that would promote the utilization of the routine data being collected through the HMIS, and integrating the same with action areas such as related to planning, monitoring and evaluation. Data collection was carried out through various methods including interviews with key stakeholders, observations, formal and informal discussions carried out face to face and through emails or telephone communication, and the writing of various reports which were then commented on by various people including the state and national level user departments. Both quantitative and qualitative data was collected and analyzed. Quantitative data collected through the ―Readiness Matrix for Information for Action‖ across the three dimensions of human resources, technical infrastructure and institutional conditions helped to see how states performed individually and how they ranked compared to each other on information generation and use. The matrix also helped to diagnose the dimensions for strengthening in order to improve the overall readiness to use information for action in the states. This diagnosis was supplemented through qualitative analysis to further probe into ―the why‖ of the performance of the states at various rankings and what could be done to improve matters. The readiness matrix,12 arguably, could be used by researchers in other settings to help diagnose key areas that need to be strengthened in order to improve information use, and also evaluate where a state is in terms of its maturity towards the same. While progress was noted in areas of data coverage in that some sporadic examples of information use were present and enhancements in capacity and infrastructure were accumulating, challenges still remained. Key ones included poor data quality, the unfulfilled promise of integration and a continuing weak culture of information use. Some key strategies identified to address these challenges included the promotion of decentralization of information to support decentralized action, the adoption of a data warehouse approach and strengthening collaborative networks. Achieving this however, requires some structural interventions such as the broad basing of education in public health informatics, institutionalization of a cadre of public health informatics staff within the Ministry of Health, and promoting the use of software which is open source and based on open standards such that widespread local use is supported.

Magister Public Health - MPH / Ensuring that routine health information systems provide good quality information for informed decision making and planning in health systems remain a major priority in several countries and health systems. The lack of use of health information or use of poor quality data in health care and systems results in inadequate assessments and evaluation of health care and result in weak and poorly functioning health systems. The Nigerian health system like in many developing countries has challenges with the building blocks of the health system with a weak Health Information System. Although the quality of data in the Nigerian routine health information system has been deemed poor in some reports and studies, there is little research based evidence of the current state of data quality in the country as well as factors that may influence data quality in routine health information systems. This study explored the data quality of routine health information generated from health facilities in Oyo State, Nigeria, providing the state of data quality of the routine health information. This study was a cross sectional descriptive study taking a retrospective look at paper based and electronic data records in the National Health Management Information System in Nigeria. A mixed methodology approaches with quantitative to assess the quality of data within the health information system and qualitative methods to identify factors influencing the quality of health information at the health facilities in the district. Assessment of the quality of information was done using a structured evaluation tool looking at completeness, accuracy and consistency of routine health statistics generated at these health facilities. A multistage sampling method was used in the quantitative component of the research. For the qualitative component of the research, purposive sampling was done to select respondents from each health facility to describe the factors influencing data quality. The study found incomplete and inaccurate data in facility paper summaries as well as in the electronic databases storing aggregate information from the facility data.

>Magister Scientiae - MSc / The purpose of this thesis is to discuss the development of a web application from scratch. It serves to build a health management information system from basic principles and covers all the software engineering activities starting from the gathering of requirements, evaluating these and eventually implementing a health management information system by applying several iterations of the Agile-extreme-programming-software-engineering approach to develop a Health Management System for the Kabul University Poly-clinic located at Kabul University campus in order to computerize clerical activities at the hospital. Questionnaires were used to uncover the clerical problems experienced by the hospital sta . Attempts to address these problems by designing and im- plementing software and re ne the software after some iterations of feedback- redesign-and-implementation following the guidelines of Agile extreme pro- gramming. The previous Health management systems at the hospital were paper based. The new computerized system has eased the burdens of tracking the les of patients at the hospital, leading to easier and more e cient access to information by the health-care professionals at the hospital. An assessment of the impact this has had on the medical and clerical sta and the smoother administration of the hospital by repeated user acceptance testing by means of questionnaires con rms the success of the project.

Magister Public Health - MPH / Aim: This study aimed to evaluate the effectiveness of the Mobile HIV/AIDS Treatment Teams in initiating and treating patients with HAART at fixed primary health care clinics Amajuba District.

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The prevention of mother-to-child transmission (PMTCT) of HIV is a key maternal and child health intervention in the context of the HIV/AIDS pandemic in South Africa. Accordingly, the PMTCT programme has been incorporated in the District Health Management Information System (DHMIS) that collects monthly facility-based data to support the management of public health services. To date, there has not been a comprehensive evaluation of the PMTCT information system. By comparing the experiences in two health districts, using the Performance of Routine Information System Management (PRISM) framework and tools, this study seeks to evaluate the availability, quality and use of process and output indicators for monitoring PMTCT interventions. A comparative analytical and observational study was undertaken using a multi-method approach which included: a self-administered survey of health information personnel to assess confidence and competence levels for routine health information system (RHIS) tasks, an assessment of the routine PMTCT data for quality, completeness, accuracy, and data use; and a facility survey of RHIS processes and resources. In addition, in-depth interviews with 22 key informants and observations in health facilities were conducted. Data were collected from 57 health facilities in a convenience sample of two health districts, and also from 182 health information personnel in the 57 health facilities, three sub-districts, and two district offices. Descriptive statistics, χ2-test, correlation and multiple regression analyses were conducted using STATA® Version 13. A general inductive approach was also used to analyse the qualitative data, which was used for triangulation. The study revealed considerable data quality concerns for the PMTCT information with an average accuracy between the register and routine monthly report of 51% and between the routine monthly reports and DHMIS database of 84% suggesting that the primary point of departure for accurate transfer of data is during the collation process. The importance of human factors was emphasised by the observation that the average confidence level for performing RHIS-related tasks (69%) was not commensurate with the average competence levels (30%). Education was found to be associated with competence, implying that levels of education may be associated with the level at which RHIS competencies are acquired; and that three years or more of post-matriculation education is necessary. Motivation, on the other hand was not associated Stellenbosch University https://scholar.sun.ac.za iv with competence. The study observed the absence of processes such as data-quality checks and data-analysis in place in facilities. There was a general absence of a culture of information use, as a result of lack of trust in the data, and the inability of programme and facility managers to analyse, interpret and use information. We observed differences in the data accuracy by organisational authority, and multivariate analysis and qualitative information suggested that feedback may be an essential process to ensure quality. Although the PRISM framework has been developed from a multi-disciplinary evidence base, this study has been able to validate some of the internal assumptions but has also found some aspects that were not supported such as motivation and data display. Data collected from a larger number of facilities will be required to investigate this further. Institutional capacity to improve RHIS processes, ensure core competencies for RHIS-related tasks are needed, and in the longer term, measures to tackle problems associated with low pass rates in numeracy subjects among high school learners are needed. Further exploration of the possible factors that may influence data accuracy, such as supervision, training and leadership are needed as well as investigating the relationships between human and institutional agency-related aspects, in particular, how individual actions can bring about changes in institutional routines. Further study is needed to determine how decision for planning and evaluating key programmes such as PMTCT are made, and what informs such decisions if not routine data. / AFRIKAANSE OPSOMMING: In die lig van Suid Afrika se MIV/VIGS-pandemie kan ’n ingryping op gesondheidsvlak ’n belangrike rol speel om moeder-na-kind-oordrag (beter bekend as PMTCT) van MIV te voorkom. ’n Inligtingstelsel vir distriksgesondheidsbestuur – die DHMIS – was ontwerp vir die invordering van maandelikse fasiliteitsdata, wat gebruik kan word om die bestuur van openbare gesondheidsdienste en -programme te ondersteun. Die inligtingstelsel self was nog nie omvattend evalueer nie. Hierdie studie het die ervarings van twee gesondheidsdistrikte vergelyk met behulp van die PRISM- (Performance of Routine Information System) raamwerk en -instrumente. Derhalwe het hierdie studie die beskikbaarheid, gehalte en gebruik van proses- en uitsetaanwysers probeer bepaal om die PMTCT-ingrypings te monitor. ’n Vergelykende analitiese en waarnemingstudie is onderneem met behulp van ’n veelvuldige benadering. Die verskillende metodes het ’n selfopname onder gesondheidsinligtingspersoneel ingesluit om hul selfvertroue en bevoegdheid in roetinegesondheidsinligtingstelsel (RHIS)-take te evalueer. Daar was ook ’n assessering van die PMTCT-roetinedata om datagehalte, -volledigheid, -akkuraatheid en -gebruik te beoordeel.’n Fasiliteitsopname oor RHIS-prosesse en –hulpbronne was ook gedoen. Ander navorsingsmetodes het diepte-onderhoude met 22 sleutelpersone ingesluit, sowel as waarnemings in gesondheidsfasiliteite. Data is van 182 gesondheidsinligtingpersoneel van die 57 gesondheidsfasiliteite in ’n geriefsteekproef van twee gesondheidsdistrikte ingesamel. Deskriptiewe statistiek, χ2-toetsing, korrelasie en veelvoudige regressie is met behulp van STATA® weergawe 13 ontleed. ʼn Algemene induktiewe benadering is ook gevolg om die kwalitatiewe data te ontleed. Die studie toon dat menslike faktore ’n impak op datagehalte en -inligting kan hê, met ’n gemiddelde akkuraatheidsyfer van 51% van beide die register en roetine maandelikse verslae. Die akkuraatheid van die maandelikse verslae en RHIS databasis is 84%, wat aandui dat akkuraatheid slegs toegepas word indien inligting uit die staanspoor korrek aangeteken word. Die impak van menslike hulpbronafaktore was beklemtoon toe daar bevind was dat hoewel 69% van RHIS-dataverwerkers vertroue getoon het in die gebruik van RHIS-verwante take, slegs 30% wel bevoeg was om die werk te doen. Opvoeding was grootliks geassosieer met bevoegdheid, wat moontlik voorstel dat sekere vlakke van opvoeding benodig word vir spesifieke RHIS-bevoegdhede. Minsten drie jaar tersiêre opleiding word aanbebeel. Motivering was nie met Stellenbosch University https://scholar.sun.ac.za vi bevoegdheid geklassifeer nie. Die studie het bevind dat daar te min aandag aan datagehalte en –analise gegee word in fasiliteite. Oor die algemeen was daar nie ’n ordentlike kultuur van inligtinggebruik nie, a.g.v. die feit dat daar nie vertroue in die data was nie. Terselftertyd was program- en fasiliteitbestuurders nie bevoeg om inligting te analiseer en ontleed nie. Ons het verskille in die akkuraatheid van data opgetel wat deur organisasie-hoofde gedoen was. Meervoudige analise en kwalitatiewe informasie stel voor dat terugvoering ’n belangrike deel van die proses moet wees om kwaliteit te verseker. Hoewel die PRISM-raamwerk saamgestel was uit ’n multi-dissiplinêre bewyslewering, kon hierdie studie sommige van die interne voorneme valideer, maar daar was aspekte wat nie gestaaf kon word nie. Inligting van ’n groter aantal fasiliteite sal benodig word om verder hierna ondersoek in te stel. Institusionele kapasiteit word benodig om RHIS-prosesses te verbeter en basiese vaardighede vir RHIS-verwante take te verseker. Op langtermynvlak moet daar ook gekyk word na probleme wat lei tot laë slaagsyfers in syfervaardighede in hoërskoolleerders. Verdere ondersoek moet ingestel word om vas te stel watter faktore moontlik akkurate data teweeg kan bring. Dit sluit toesig, opleiding en leierskap, asook die verhoudings tussen menslike en agentskap-verwante aspekte in. Die feit dat optrede op individuele vlak veranderings in institusionele roetines kan aanbring, moet spesifiek na gekyk word. Verdere studies kan help om vas te stel hoe besluite vir beplanning en evaluaring vir hoofprogramme soos PMTCT gemaak word – asook hoe die besluite gemaak word indien hulle nie roetine voorafgaan nie.