Abstract
In 1997 the Ministry of Health instituted the national HMIS in response to global and national call for greater accountability and results-based management. The goal being to provide timely reliable health information that would inform decision making in the sector to aid provision of better health care services to the people of Uganda. However, there are already concerns about the functionality of the system characterized by late and inadequate reporting. The purpose of this paper was to make a critical analysis of the contextual challenges to HMIS and propose a framework that would improve the collection of timely reliable data at all levels in the system. After critical analysis of the existing literature, reports and presentation at various MOH workshops and review meeting, and interactive informal talks with some personnel at the Ministry, this paper asserts that failure to use HMIS data, poor culture of accountability, lack of incentives for performance, strategic planning and vertical programs-HIV/AIDS are the strategic contextual challenges to this menace. Data utilization at all levels in the system will be the linchpin in realization of timely collection and reporting of data and to this end, a user-friendly system is at the core of any successful public health system when it will; Assist hospital managers to align health system resources with the needs of service users Link performance measurements to accountability Monitor health-related activities to help assess what works and what doesn’t Contribute to organizational development This paper proposes a framework that will see data utilization as the foundation for timely collection and reporting at all levels in the system. There will be organizational learning with the associated organizational development breeding ownership and sustained demand for data collection and reporting. Key in the implementation will be; leadership, change management, organizational embedding and capacity development.
Highlights
Over the last three decades there has been increased global and national demand for greater accountability and results-based management [1,2,3]. This demand has necessitated the need for designing of useful and useable monitoring and evaluation systems (M&E) that support programming and design of evidence based policies and work plans [4,5,6]
The study shows that Completeness of district reporting is poor in 9% of districts and completeness of health facility reporting is problematic for one-third of the districts
In the MOH technical review meeting held in July, 2011, lack of reliable data due to failure by some health facilities and districts to report was highlighted as a major challenge of the M&E unit of the AIDS control Program (ACP)
Summary
Over the last three decades there has been increased global and national demand for greater accountability and results-based management [1,2,3]. In the MOH technical review meeting held in July, 2011, lack of reliable data due to failure by some health facilities and districts to report was highlighted as a major challenge of the M&E unit of the AIDS control Program (ACP). For example data from the national HIV counseling and testing ( HCT) unit indicated that 49%, 33% and 53% of the districts in the country registered 100% reporting in 2008, 2009 and 2010 respectively This observation cuts across all the programmatic areas of the ACP unit according to the M&E program officer. The Minister of state for primary health at the HIV/AIDS coordination meeting held 30th June-1st July, 2011 said despite achievements made in sector over time, the public perception of the sector is negative He attributed this largely on the use of old un-updated data and lack of dissemination mechanisms. The goal of this paper was to attempt to make a critical analysis of the contextual challenges to HMIS to decipher the true face of this problem and thereafter propose a framework that would improve the collection of timely reliable data/information at all levels of the health care system
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