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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

614

6 95

60

0

10

20

30

40

50

60

70

80

90

100

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.

8

1915

71

26

58

13

0

10

20

30

40

50

60

70

80

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