This article seeks to identify the role of databases in health policy. Access to information and communication technologies has changed traditional relationships between the state and professionals, creating new systems of surveillance and control. As a result,databases may have a profound effect on controlling clinical practice. The results demonstrate that policy makers hardly used the databases, neither for cost control nor for quality assurance. Further analysis revealed that these databases facilitated self-regulation and quality assurance by (national) bodies of professionals, resulting in restrictive prescription behavior amongst physicians.
Monitoring equity and research policy
Databases as policy instruments: About extending networks as evidence-based policy
de Bont A, Stoevelaar H and Bal R: BMC Health Services Research 7:200, 7 December 2007
Geographical information system and access to HIV testing, treatment and prevention of mother-to-child transmission in conflict affected Northern Uganda
Chamla DD, Olu O, Wanyana J, Natseri N, Mukooyo E, Okware S, Alisalad A and George M: Conflict and Health 1:12, 3 December 2007
Researchers used Geographical Information System (GIS) as a tool to determine access to and gaps in providing HIV counselling and testing (VCT), treatment (ART) and mother-to-child transmission (PMTCT) services in conflict affected northern Uganda. Access to VCT, PMTCT and ART services was geographically limited due to inadequacy and heterogeneous dispersion of these services among districts and camps. GIS mapping can be effective in identifying service delivery gaps and presenting complex data into simplistic results hence can be recommended in need assessments in conflict settings.
Information for decision making from imperfect national data: tracking major changes in health care use in Kenya using geostatistics
Gething PW, Noor AM, Goodman CA, Gikandi PW, Hay SI, Sharif SK, Atkinson PM and Snow RW: BMC Medicine 5:37, 11 December 2007
Most Ministries of Health across Africa invest substantial resources in some form of health management information system (HMIS) to coordinate the routine acquisition and compilation of monthly treatment and attendance records from health facilities nationwide. Despite the expense of these systems, poor data coverage means they are rarely, if ever, used to generate reliable evidence for decision makers. One critical weakness across Africa is the current lack of capacity to monitor effectively patterns of service use through time so that the impacts of changes in policy or service delivery can be evaluated. Here we present a new approach that, for the first time, allows national changes in health service use during a time of major health policy change to be tracked reliably using imperfect data from a national HMIS. The methodological approach presented can compensate for missing records in health information systems to provide robust estimates of national patterns of outpatient service use. This represents the first such use of HMIS data and contributes to the resurrection of these hugely expensive but underused systems as national monitoring tools. Applying this approach to Kenya has yielded output with immediate potential to enhance the capacity of decision makers in monitoring nationwide patterns of service use and assessing the impact of changes in health policy and service delivery.
Using hospital discharge data for determining neonatal morbidity and mortality: a validation study
Ford JB, Roberts CL, Algert CS, Bowen JR, Bajuk B and Henderson-Smart DJ: BMC Health Services Research 7(188), 20 November 2007
Despite widespread use of neonatal hospital discharge data, there are few published reports on the accuracy of population health data with neonatal diagnostic or procedure codes. The aim of this study was to assess the accuracy of using routinely collected hospital discharge data in identifying neonatal morbidity during the birth admission compared with data from a statewide audit of selected neonatal intensive care (NICU) admissions. Although under-ascertained, routinely collected hospital discharge data had high PPVs for most validated items and would be suitable for risk factor analyses of neonatal morbidity. Procedures tended to be more accurately recorded than diagnoses.
Interim measures for meeting needs for health sector data: births, deaths, and causes of death
Hill K, Lopez AD, Shibuya K, Prabhat P: The Lancet Volume 370(9600): 1726-1735, November 2007
Most developing countries do not have fully effective civil registration systems to provide necessary information about population health. Interim approaches—both innovative strategies for collection of data, and methods of assessment or estimation of these data—to fill the resulting information gaps have been developed and refined over the past four decades. To respond to the needs for data for births, deaths, and causes of death, data collection systems such as population censuses, sample vital registration systems, demographic surveillance sites, and internationally-coordinated sample survey programmes in combination with enhanced methods of assessment and analysis have been successfully implemented to complement civil registration systems. Methods of assessment and analysis of incomplete information or indirect indicators have also been improved, as have approaches to ascertainment of cause of death by verbal autopsy, disease modelling, and other strategies. Our knowledge of demography and descriptive epidemiology of populations in developing countries has been greatly increased by the widespread use of these interim approaches; although gaps remain, particularly for adult mortality.
Technical efficiency, efficiency change, technical progress and productivity growth in the national health systems of continental African countries
Kirigia JM, Zere E, Greene AW, Emrouznejad A: East African Social Science Research Review 23 (2): 19-40, 2007
In May 2006, the Ministers of Health of all African countries, at a special session of the African Union, undertook to institutionalise efficiency monitoring within their respective national health information management systems. The specific objectives of this study were: (i) to assess the technical efficiency of National Health Systems (NHSs) of African countries for measuring male and female life expectancies, and (ii) to assess changes in health productivity over time with a view to analysing changes in efficiency and changes in technology. The analysis was based on a five-year panel data (1999-2003) from all 53 countries. Data Envelopment Analysis (DEA) − a non-parametric linear programming approach − was employed to assess the technical efficiency. Malmquist Total Factor Productivity (MTFP) was used to analyse efficiency and productivity change over time among the 53 countries' national health systems. The data consisted of two outputs (male and female life expectancies) and two inputs (per capital total health expenditure and adult literacy). All the 53 countries' national health systems registered improvements in total factor productivity, attributable mainly to technical progress. Over half of the countries' national health systems had a pure efficiency index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change.
The social determinants of health: Developing an evidence base for political action
Kelly MP, Morgan A, Bonnefoy J, Butt J, Bergman V: Measurement and Evidence Knowledge Network, WHO Commission on the Social Determinants of Health
This report begins by identifying six problems which make developing the evidence base on the social determinants of health potentially difficult. In order to overcome these difficulties a number of principles are described which help move the measurement of the social determinants forward. The report proceeds by describing in detail what the evidence based approach entails including reference to equity proofing. The implications of methodological diversity are also explored. A framework for developing, implementing, monitoring and evaluating policy is outlined. At the centre of the framework is the policy-making process which is described beginning with a consideration of the challenges of policies relating to the social determinants.
A scandal of invisibility: making everyone count by counting everyone
Setel PW, Macfarlane SB, Szreter S, Mikkelsen L, Prabhat P, Stout S, AbouZahr C: The Lancet 370(9598): 1569-1577, 29 October 2007
Most people in Africa and Asia are born and die without leaving a trace in any legal record or official statistic. Absence of reliable data for births, deaths, and causes of death are at the root of this scandal of invisibility, which renders most of the world's poor as unseen, uncountable, and hence uncounted. This situation has arisen because, in some countries, civil registration systems that log crucial statistics have stagnated over the past 30 years. Sound recording of vital statistics and cause of death data are public goods that enable progress towards Millennium Development Goals and other development objectives that need to be measured, not only modelled. Vital statistics are most effectively generated by comprehensive civil registration. Now is the time to make the long-term goal of comprehensive civil registration in developing countries the expectation rather than the exception. The international health community can assist by sharing information and methods to ensure both the quality of vital statistics and cause of death data, and the appropriate use of complementary and interim registration systems and sources of such data.
Controlling extensively drug-resistant tuberculosis
Porco TC, Getz WM: The Lancet ; 370, (9597), 1464-1465, 27 October 2007
Nosocomial transmission of XDR strains seems to have contributed to a major outbreak in HIV-positive individuals in Tugela Ferry, South Africa. To better understand how to control XDR tuberculosis, this issue of the Lancet presents a report of a new mathematical model, developed by Sanjay Basu and colleagues, of the transmission of tuberculosis in this region. Their model builds on previous tuberculosis models, and was corroborated by independently collected epidemiological data for the area. Such mathematical models of tuberculosis can be useful instruments for policymaking because they incorporate a representation of the natural history and transmission of infection and disease, and are the only way to rigorously explore the effects of policies before they are field-tested.
Measuring global health inequity
Reidpath DD and Allotey P: International Journal for Equity in Health 6(16), 30 October 2007
Notions of equity are fundamental to, and drive much of the current thinking about global health. Health inequity, however, is usually measured using health inequality as a proxy - implicitly conflating equity and equality. Unfortunately measures of global health inequality do not take account of the health inequity associated with the additional, and unfair, encumbrances that poor health status confers on economically deprived populations. Using global health data from the World Health Organization's 14 mortality sub-regions, a measure of global health inequality (based on a decomposition of the Pietra Ratio) is contrasted with a new measure of global health inequity. The inequity measure weights the inequality data by regional economic capacity (GNP per capita). The least healthy global sub-region is shown to be around four times worse off under a health inequity analysis than would be revealed under a straight health inequality analysis. In contrast the healthiest sub-region is shown to be about four times better off. The inequity of poor health experienced by poorer regions around the world is significantly worse than a simple analysis of health inequality reveals.