1 Women’ and Children’s Health Information Communication & … · Global Strategy for Women’ and Children’s Health Information Communication & Technology CAMBODIA 1 Accountability

Global Strategy for

Women’ and

Children’s Health

Information

Communication &

Technology

CAMBODIA

1

Accountability Workshop 2012, Manila, Philippines 19-21 March 2012

2

The country Team: 1. Dr. Lo Veasnakiry, Department of Planning & Health Information, MoH 2. Mr.Hor Darith, National Institute of Statistics, MoP 3. Dr. Lam Phyrun, National Maternal & Child Health Center, MoH 4. Mr. Ros Chhun Eang, Health Economics & Financing, DPHI, MoH 5. Dr. Howard Sobel, WHO Advisor, Country office

These represent the views of individuals participating in the workshop and they do not represent the official decisions or outcomes of a country or government. Very limited or no editing has been done yet to retain the original inputs of participants.

Global Strategy for

Women’ and

Children’s Health

Areas for Action at Country level:

Cambodia up-to-date

• Country Accountability

Framework

(Commission recommendations 1-

6)

• Better Monitoring


6)

• Review and Action


7)

Global Action: Recommendation 8, 9

& 10.

1

Global Strategy for Women’ and

Children’s Health

Better information for better results: Recommendation

1-3

Recommendation 1-Vital events and HIS by 2015

1

Key Milestones Current Status Gaps

Conducted General

population census

Every 5 year: 2003, 2008 with

Inter-population census

Conducted Maternal &

Child Health Survey

Related survey conducted,

namely CDHC 2000, 2005,

2010

Conducted National Health

Accounts

No, but CSES, produced

Health Account(NIS)

NHA not yet established

Annual Health Statistics

Report with district online

Produced on annual basis

since 1995, but stating online

in 2011.

Use for annual performance

review

• Capacity to analyze , and

use for planning at

operational level

Coverage of birth

registration (>80%)

Current coverage 92% of the

total population. 62.1% of <5

(CDHS2010)

Annually,100,000-200,000

births registered within 30

days as mandated by sub-

degree, and up to 300,000 if

included over-30 day

registration.

• ITC: Heavily paper work at

sub-national level and

overloaded data entry at

Vital Statistics Department ,

MoI . Database is not

available at sub-national

level , esp. communes where

decentralized births /death

registration is done.

• No causes of death

specified Coverage of death

registration (>50%)

Annually estimated 50% [?}

deaths registered


Children’s Health

Recommendation 2:11 Indicators of maternal, newborn

and child health by 2012

Key milestones Current Status

One set of 3 selected indicators to monitor women’ s

and children’s health:

2000 2005 2010 CMDDs 2015

• MMR per 100,000 live births 437 472 206 250 CDH

S

• U5 Child [Infant ] Mortality per 1,000 live births 124 [95] 83[66] 54[45] 50[60] CDH

S

• Stunting [wasting] (among children <5) 49.8

[16.8]

42.7

[8.4]

39.9

[10.9]

CDH

S

A tracer of 8 coverage indicators: 2007 2008 2009 2010 2011

• Contraceptive Prevalence Rate (modern method) 24 26 28 30 29.0

7

HIS

• % of pregnant women received ANC 2 68 85 83 72 86.2

4

HIS

• % of pregnant women with HIV+ received ARV (for

PMTCT)

n.a. 27 32.2 57.3 60.6 HIS

• % of birth delivery assisted by trained health

personnel

46 58 63 69.2 71.6

6

HIS

• % of mothers received postnatal care 38 41 47 58 60.5 HIS

• % infant aged 0-5 months exclusively breastfed 11.4 60 73.5 CDH

S

• DPT-Heb3 92 95 92 94 HIS

• % of children aged 0-59 months with suspected

pneumonia receiving Antibiotics

others CDH

S

Gaps from epidemiological view point; significant progress, but high MMR and Child mortality if compared to average MMR

and U5 mortality in Western Pacific Region. High level of under-nutrition. Indicators are disaggregated for genders, socio -

economic characteristics, including geographical .

1


Children’s Health

Recommendation 3: Integrated the use of info. and ICT in national HIS

and health infrastructure by 2015

1


Launched web-HIS in 2011 • Nation-wide coverage www.hiscambodia.org.gov

• Functional integrated system: Public health facilities

(monthly aggregated data, Private and NGO health

facilities , Maternal Death Surveillance Record,

PMTCT/LR and HIV/AIDS program and others

Denominator

tracking and

consistency

Launched maternal death

surveillance database in

2010

• Functioning and integrated with web-based HIS in 2011

• Reported in JAPR report of 2010, 2011

• Maternal Death Audit: MDA Committee at national,

provincial, district level

• Planned for Maternal death notification campaign

through toll free, airing, TV

Missing maternal

deaths occurred in

community , not

maternal death

cause identified in

death registration

yet

Other existing

• Training database

• Health personnel

database

• Drug management

database

• Disease-specific

database

• NGOs-database

Moved to web-based in 2011

Functioning

Nation-wide functioning

National programs

Medicam (NGOs)

On-going initiatives

web-based Health

Coverage Plan database

linked to GIS (health facility

location, catchment area/

population , staffing,

availability of services,.

• Completed database development and still data entry, plan for pre-test

soon

• To train Operational Districts’ and Provincial Health field test Departments’

HIS staff

• To be launched in mid-2012

Social health protection

database

• Database developed : final review , Plan for pre-test and

train, use

Patients medical records

(electronic)

• Tested in one provincial hospital (by INGO/URC)


Children’s Health

1


THE by financing sources, per

capita

US$48 (Gov’t 24%, DP 17%, OOP 59%)

Total RMNCH by financing

sources, per capita

Available in term of planned expenditure

captured in Health Sector AOP 2011:

G0v’t 35%, DPs 18%

Better tracking resources for women’s and children health’s :

Recommendation 4-6

Recommendation 4- tracking and reporting 2 aggregated resource indicators

by 2015

Recommendation 6- Country capacity to regular review health spending incl.

RMNCH by 2015

Key Milestones Current

Status

Gaps

Annual review on health spending (1) against priorities

budgeted -analysis THE, distribution across priority),

(2) equitable distribution and spending for

women/children health- disaggregated indicators,

financial burden and services utilization, (3) comparing

overall public health spending vs. results, prioritization

(effectiveness & efficiency).

n.a.

Recommendation 5- “Country Compact” in place for reporting on externally funded

expenditures and predictable commitments by 2015


Joint Declaration ….. Signed by RGC and major DPs

• Structures and process established

• Tools

CDCF, TWGs (TWHG)

Online-Database, guidelines etc.

ITC tracking development

assistance?


Children’s Health

1

Key Milestones Current Status

Health sector review process 33th NHC and 10th JAPR- 4 Program reviewed

Enhance capacity of financial

decision making

Budget negotiation with MoEF on annual basis

Meeting with NA Commission VIII including

Commission for Finance, at least 2 times/year.

High Political event focusing on

women’s and children’ health

National Midwifery Day

Better oversight of results and resources nationally &

globally:

Recommendation 7- National oversight– Established national

accountability mechanisms in all countries by 2012

Global Action:

Recommendation 8- transparency– publicly sharing information

on commitments, resources provided and results achieved

annually, at both national and int’l level by 2012 (Health outcomes

and resources spent on health available on public domain web site. )

Recommendation 9 (Independent Review ) and 10 (Global

Oversight)

Information Communication

& Technology

2

Health Management Information System: Cambodia

up-to-date

Web-based Database HIMS

• Web based database is an interoperability and multiple

data sources

• An integrated system of relevant and functional information

on a routine basis; ensuring the quality of health data,

Strengthening the ability to analyze and use data and

informing decision-making.

• The system allows for collecting , collating , processing,

reporting, analyzing disseminating and using for

programming, planning monitoring and decision-making.

• ICT to improve data quality and timely reporting and

improved use of ICT for management of HIS: Health

Informatics (Public, Private and NGO, Electronic Health

Records, Interoperability, Access to Information- ICT as a

tool for the dissemination of information

Interoperability and multiple sources of data

HMIS Interoperability

MOH-HIS MCH-

HIS

MDSR

TB-HIS Others: QAO, HFAT, SOA

HIV/AIDS

SHP

MIS

Reporting

• Morbidity and mortality statistics

(OPD and IPD) in public, private

and NGO supported health

facilities (monthly aggregated data)

• Maternal Death Surveillance data

• PMTCT/LR and HIV/AIDS

program)

• Social Health Protection

• Population data including ID poor

• Others: health facility assessment

results

Register

s

Monthly Form

OPD

IPD

Maternity

Delivery

ANC

PNC

HIV/AIDs

TB

Village Data

HC1

HO2

OD

PHD

DPHI

PH

Partners

N.P

RH

HC HC HC

NGO

Pri.

NH DPHI/MOH

Server

N.P

N.P

Caminfo

ID-Poor

Data Flow Through HIS

1084

964

31

8

0 200 400 600 800 1000 1200

Public Health Facilities

Health Facilities with PMTCT

Private sites

NGO sites

Number of public health facility who submitted monthly reports in HMIS web

database As of September 2011

Data Quality

Check

67% 67% 67%

73%

81% 86%

0%

20%

40%

60%

80%

100%

2006 2007 2008 2010 Oct-10 2011

HMIS data quality index 2006-2011

Start HMIS web based Db

Communications E-Feedback

System • Phone call tracking

• E-Feedback system

in HMIS

• Update news in

HMIS

User Rate

0

20

40

60

80

100

120

140

User Daily Frequency Jan-Feb 2012

0

1000

2000

3000

4000

5000

6000

7000

HMIS Page Visit Daily Frequency Jan-Feb 2012

Top 10

Users

(public

facilities)

Data Use and

Analysis

User Rate

48.45 53.27 47.5861.94

48.631.18

47.41 45.92 50.16

29.58 33.67

54.8241.41

57.8642.23

33.93 39.74 47.7431.22

73.48 65.42 64.21

37.4

66.37

49.3455.78

49.16

59.54

47.31

35.3

49.7 48.1351.99

41.0544.71

53.54

50.21

56.05

54.71

41.4941.2

51.22

42.4

74.47

62.72 70.28

41.71

75.5

0

20

40

60

80

100

120

140

160

Bante

ay M

eanc

hey

Batta

mba

ng

Kampo

ng C

ham

Kampo

ng C

hhnan

g

Kampo

ng S

peu

Kampo

ng T

hom

Kampo

t

Kanda

l

Koh K

ong

Kratie

Mon

dul K

iri

Phnom

Pen

h

Preah

Vihea

r

Prey

Veng

Pursa

t

Rat

anak

Kiri

Siem

reap

Sihan

oukv

ille

Stung

Tre

ng

Svay

Rieng

Takeo

Odd

ar M

eanc

hey

Kep

Pailin

2010 2011

Delivery assisted by

trained health personnel

at health facility

National:

2010: 69.92%

2011: 71.66%

Top 10 main health problems reported

86746

84465

33555

31460

20055

18776

16377

11959

11737

11268

ARIs

Delivery

Tuberculosis

Diarrhea

All road traffic accidents(affectinghead excluded)

Other Injuries(mine & traffic acc.excluded)

Typhoid fever

Gynecological Pathology

High Blood Pressure

Road traffic accidents affectinghead

12

34

56

78

91

0

IPD main health problems in 2011

6293

2611

2435

2221

1909

1807

1792

1556

1037

744

Lower ARI

Diarrhea

Upper ARI

Cough > 14 days

High Blood Pressure

Other Injuries(Mines & trafficaccidents excl)

Mental Health

All Road traffic accidents(Headinjuries excluded)

Road traffic accidents affected head

Dysentery

12

34

56

78

91

0

OPD main health problems in 2011

Open Source

• Free licensee

• Power and control system

• Escape Vendor lock in (Users can customize)

• Greater security and quality

• Continuity-Source code available

• Patient registration database: – Open Source (PHP/MySQL)

– Standard platform

– Interoperability (more data sources)

– Unique ID as national scale

– Automatically report to HMIS

– National scale up (linked between hospital to hospital)

Technology

Information

Communication &

Technology

2


up-to-date Strengths

1. Degree of compliance with regard to

the two selected key indicators of

timeliness and completeness- 100%

timely reports

2. Overall increased capacity of HIS

staff at all level and maintain the

HMIS moving towards interoperability

system (integration).

3. Increased daily access and use of

health data with improved quality.

4. Increased mobile phone and internet

coverage

5. Strong supports from health

development partners at all levels.

Gaps/Weaknesses

1. Fragmented reporting systems due to

increasingly growing demand i.e.

diseases specific programs

2. Limited utilization of data at HC level

3. Data validation process /tools need

to be strengthened

4. Limited M-health technology , new

expertise of E-health in Cambodia

and lack of ICT skills at public health

sectors.

5. Lack of appropriate IT equipment and

materials at health facilities e.g health

center leading to heavy paper work.

Information Communication

& Technology

2


up-to-date

Priority activities Status

1. Vital Registration: (1) upgrade sub-degree on Civil registration to

become a law, (2) Develop Strategic Plan for Civil registration; (3)

further develop civil registration database and decentralize the system

operational to sub-national level .

planni

ng

2. Population based data collection e.g. survey, census

3. National Health Information :

3.1 Review & revised HSP2 M&E Framework,

3.2 Develop “ protocol for HMIS” ( use of national M&E framework,

access to web-based HIS, reporting and feedback, data quality

assessment),

3.3 Develop social health protection database

3.4 Health Account according to/depending on Public Financial

Management platform 2 of MoEF

On-

going

4. Capacity building requires for priority activity #1, #2 and #3, as well.

#3:

• DPHI (manage HMIS web based database, back-up data and

storage in a server at MoH/DPHI, maintain hospital patient

registration database )

• HIS staff as operational level (operational database system;

maintain, reporting & feedback, analysis, use,…..)

Planni

ng

On-

going

5. Increase investment : equipment and appropriate ICT On-

going

Documents

1 Women’ and Children’s Health Information Communication & … · Global Strategy for Women’ and Children’s Health Information Communication & Technology CAMBODIA 1 Accountability