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LSHTM Research Online
Avan, BI; Schellenberg, JA; Bhattacharya, S; Wickremasinghe, D; Srivastava, A; Gautham, M; (2014)A content analysis of district level health data in Uttar Pradesh, India. A content analysis of districtlevel health data in Uttar Pradesh, India. https://researchonline.lshtm.ac.uk/id/eprint/1917772
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A content analysis of district level health data in Uttar Pradesh, India
RESEARCH BRIEFJANUARY 2014
Key findings
• Thepublichealthsystemcollectsalargevolumeofhealthdata:
Total forms: 197(includingDepartmentofWomenandChildDevelopment)Total data elements: 15,983
• DataexistforallofWHO’shealthsystembuildingblocks,butitisunevenlydistributed.Therearefewerdataoncontextualinformation,e.g.villageinfrastructureanddemographicprofile,comparedtoservicedelivery.
• Thereislittleformalorinstitutionalroutinedatasharingbetweenthepublicandprivatehealthsectors,andbetweenthehealthdepartmentandotherrelateddepartmentssuchasWomenandChildDevelopment.
Aim:ToconductacontentanalysisofthedifferenttypesofpublichealthdatamaintainedbytheHealthDepartment,theDepartmentofWomenandChildDevelopment,andtheprivateforprofitandnotforprofithealthsectorsandthelinksthatexistbetweenthemintermsofdatasharing.
Method:Intwodistricts,SitapurandUnnao,anIDEAS/PHFIstudyteamvisiteddistrict,sub-districtandvillagelevelhealthfacilities(publicandprivate)aswellasNRHMprogrammemanagementunits,andWomenandChildDevelopmentoffices.Theteam
collectedallavailableformsandinterviewedfacilitystaffandprogrammemanagerstounderstandthetypesofdatacollected,theirflowanddatasharing.Casestudiesofthreenot-for-profitnon-governmentalorganisationsweredevelopedtounderstandhowtheymaintainandsharedatawiththepublichealthsystem.
Severalissuesrelatedtodataqualityanduseemergefromthiscontentanalysis.Theseneedtobebetterunderstoodandaddressedinthefuture.
Issue 1. Data gaps and inadequacies: Gapsindatasuchasmissingorinadequatedataelementsneedtobeidentified.Issue 2. Data duplication: Redundantandnon-criticalformsanddataelementsneedtobedifferentiatedfromthecriticalones,andprioritized.Issue 3. Data flow blockages: Blocksintheflowofdataneedtobeidentifiedtoensurethatimportantinformationcollectedatlowerlevelsispassedupwardsandusedinplanninganddecisionmaking.Issue 4. Data sharing: Amechanismneedstobedevelopedforroutinesharingofessentialdatabytheprivatehealthsectorandbyothernon-healthgovernmentdepartmentsatthedistrictlevel.
Emerging issues
About this study
Photo right: Auxiliary Nurse Midwife filling out her register, Uttar Pradesh, India. © Dr Meenakshi Gautham
CONTENT ANALYSIS OF DISTRICT LEVEL HEALTH DATA
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Figure 1 – Number of forms used for data collection at community, village, block and district levels
Figure 2 – How the 16,000 data elements balance by health system building blocks
Keydistrictlevelfindings
A. Data generation Department of Health• Totaldataforms:178• Totaldataelements:15,180.• Anonlineandpaperbaseddata
collectionsystemisinoperation.• Focusisonservicedeliverywith
littleoncontextualinformation,e.g.informationaboutfacility,villageandhouseholdinfrastructureanddemography.
Department of Women & Child Development• Totalrelevantdataforms:19• Totaldataelements:60
Private sector (for-profit and not-for-profit)• Totalrelevantdataforms:13• Totaldataelements:745
B. Data sharing• Datanotadequatelyshared
amongpublicsectorhealthdepartmentsandtheprivatehealthsector.
• Informalsharinghappens.ApotentialavenueforsharinginformationbetweenthepublicandprivatesectoristheDistrictHealthSocietymeeting,chairedbyDistrictMagistrate
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Contextual Information
Finance Governance Medical Supplies
Workforce data
Service Delivery
%In total, 15,983 data elements are collected on 210 separate forms
The Public Health System collects a large volume of data
Atthedistrictlevelthepublichealthsystemmaintainsatotalof197formsfromthevillageleveluptothelevelofprimaryandsecondaryhealthfacilitiesanddistrictheadquarters.Outofthese197forms,29arepartoftheonlineFinancialManagementReport,oneispartoftheonlineMotherandChildTrackingsystem(whichiscompiledatthedistrict/blocklevel)andthreearepartoftheonlinereportingwhichcapturesNRHMactivitiesatdifferentlevelsofthehealthsystem.Theremainingformsbelongtoanolder
paper-basedarchitecturethatstillcontinuesinthesystem.These197formsincludemorethan
15,000dataelements(Figures1and2).Thismultitudeofformsanddata
elementsincreasethelikelihoodofdataduplicationandlimitdatause.Forinstance,tetanusimmunizationandIronFolicAcidtabletdistributioniscapturedin2formsbycommunityhealthworkers(ASHAs),4formsbytheANMsand4formsatthePHCandCHClevel.Similarly,immunisationiscapturedin2formsbyASHAs,5formsbyANMsand6formsat
thePHC/CHClevel.Almostidenticaldata(e.g.numberofchildrenimmunised,totalpopulationofthevillage)iscollectedbytwocommunitylevelworkers(ASHAsinthehealthsystemandAWWsintheIntegratedChildDevelopmentServicesScheme).
Further analysis is required to pick out redundancies and blocks in the data flow, and find ways to streamline the existing data overload.
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Community health worker
(ASHA)
Community health worker
(AWW)
Sub center / Additional
PHC(managed by
ANM)
PHC / CHC / BPHC
District Female Hospital
District Programme
Management Unit and Chief Medical Of�icer
Private sector (for-pro�it and not-for-pro�it)
Community Village Block District
Num
ber
Overall 210 forms are used in the public and private health sectors
CONTENT ANALYSIS OF DISTRICT LEVEL HEALTH DATA
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District level health data cover all of WHO’s 6 health system building blocks but are unevenly distributed
Figure 3 – Health service data and flow
Private system(for profit/NGO)
District Magistrate(Administrative Head of
District)
District ICDS funtionaries
District Programme Managment Department
Divisional Programme
Management Unit
State Health Directorate
State Programme Management
Unit
Block ICDS functionaries
Community level Anganwadi worker
District Hospital (female)
District Chief Medical
Officer Divisional Head
Department of Women and Child
Development
Community levelASHA/ANM
Department of Health
National Rural Health Mission
Directorate of Health Services
BlockPHC/BPHC/CHC
Informal data sharing
Formal data sharing
There is limited data sharing between the private and public health sector as well as different public sector departments
Publichealthdataaredistributedoverthe6WHOcategoriesindifferentproportions:contextualinformation(3.6%),finance(13.5%),governance(5.7%),medicalsupplies(9.3%),workforce
(4.9%),andservicedelivery(59.4%).Therationaleforthisdistributionisnotclear,butthegreatestvolumeofdataisgeneratedundertheservicedeliverycategory.
Further analysis may point out the exact nature of inadequacies in the distribution of data across the different categories and strategies for rationalising this distribution.
TheDepartmentofWomenandChildDevelopmentandtheprivatehealthsector(for-profitaswellasnot-for-profit)alsocollectpublichealthdata,butthereislimiteddatasharingwiththepublichealthsystem.
TheDepartmentofWomenandChildDevelopmentalsocollects19formsand60dataelementspertainingtopublichealth.Thenotforprofitandforprofitprivate
sectorsalsocollecttheirowndata(Box
1).TheDepartmentofWomenandChildDevelopmentdataarenotsharedthroughaformalmechanismwiththedistricthealthsystem.HoweversomeofthesedatadogototheDistrictMagistrate’soffice(Figure3).
Information from good-quality data play a major role in programme monitoring, review, planning, advocacy and policy development. Information shared across public and private health sectors can catalyse local decision-making, so that health service delivery is in line with community needs and available resources.
CONTENT ANALYSIS OF DISTRICT LEVEL HEALTH DATA
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Funding from theBill&MelindaGatesFoundationDrJoannaSchellenberg,PrincipalInvestigator,IDEASproject,LondonSchoolofHygiene&TropicalMedicine
ContributorsResearch supervised by DrBilalIqbalAvanResearch byDrSanghitaBhattacharyya,DeepthiWickremasinghe,DrAradhanaSrivastavaandDrMeenakshiGauthamCoordination of publication by AgnesBeckerCopyright LondonSchoolofHygiene&TropicalMedicine
What is needed?
Informationfromgoodqualitydataiscentraltogoodqualityprogrammemonitoring,review,planning,advocacy,andpolicydevelopment.Informationsharedacrosspublicandprivatehealthsectorscansignificantlyenhancelocaldecisionmaking,sothathealthservicedeliveryisinlinewithcommunityneedsandavailableresources.
Ourpreliminaryanalysisofpublichealthdatasuggeststhatalotmoreneedstobedone:• Furtheranalysisisneededto
understandtheduplicationofdataatdifferenthealthsystemlevels,theblocksindataflow,andtheredundancyofsomeelements.
A mechanism for regular data sharing• Timelysharingofinformation
acrossothergovernmentalandprivatesectorserviceproviderscouldfurtherreducetheduplicationofeffortandensureoptimumuseofresourcesthroughjointdecisionmakingandplanning.Thereisaneedtouseinnovativewaystoengagetheprivatesectorindatasharing.
• Thereisneedforamechanismtobringgovernmentalandnon-governmentalserviceproviderstoacommonforumonaregularbasis,tosharedatainasystematicmanner,anduseinformationasatoolinprioritysettingforplanningandresourceallocation.
IDEAS projectLondon School of Hygiene & Tropical MedicineKeppel Street, London, WC1E 7HT, UK
t +44 (0)207 927 2871/2257/2317w ideas.lshtm.ac.uk
@LSHTM_IDEAS
Photo above:Recordofwomenwhohavereceivedcashincentivesfordeliveryatahealthfacility©BilalAvan
HEALTH DATA USE AT DISTRICT LEVEL
Acronym Definition
ANM Auxiliary Nurse Midwife
ASHA Accredited Social Health Activist
AWW Anganwadi worker
BPHC Block Primary Healthcare Centre
CHC Community Health Centre
ICDS Integrated Child Development Services
NRHM National Rural Health Mission
PHC Primary Health Centre
Health System Categories Thematic Areas
Contextual Information Infrastructure of facilities, village and household infrastructure, demography
Finance Expenditure, financial incentive, insurance scheme
Governance Management (supervision), grievance redress, utilization data
Medical Supplies Resources/supplies
Workforce Human resources, training
Service Delivery Antenatal care, delivery, post-natal care, newborn care, immunisation of infants and children, childhood care, abortion, family planning, adolescent health, nutrition, water and sanitation, non-communicable disease, TB, malaria, HIV, mortality.
Table 1 – Data elements collected in a district