STANDARD OPERATING PROCEDURES District Health Information ... · PDF fileIdentifier: SOP-WBOT Feb 2013 Revision: 0 Effective Date: 1 April 2013 STANDARD OPERATING PROCEDURES District

Identifier:

SOP-WBOT

Feb 2013

Revision:

0

Effective Date:

1 April 2013

STANDARD OPERATING PROCEDURES

District Health Information System

(DHIS) AGGREGATED Data Management

for

NON-FACILITY HEALTH PROGRAMS

Collection, Entry Validation and Dissemination:

1. Ward Based Outreach Teams (WBOT)

2. Integrated School Health Program (ISHP)

3. Environmental Health (EH)

4. Emergency Medical Services (EMS)

Draft: 6 Feb 2013

These materials have been developed in terms of Service Level Agreement between the National Department of Health and HISP

Department of Health

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Standard Operating Procedure for District Health Information System

(DHIS) Management: Ward Based Outreach Teams (WBOT)

LIST OF ABBREVIATIONS

DG Director-General

DBE Department of Basic Education

DHIS District Health Information System

DHMIS District Health Management Information System

DoH Department of Health

DSD Department of Social Development

DQ Data Quality

EH Environmental Health

EMIS Education Management Information System

EMS Emergency Medical Services

EMS PRF EMS Patient Report Form

HIS Health Information System

ISHP Integrated School Health Program

HOD Head of Department

ICT Information and Communication Technology

IT Information Technology

M&E Monitoring and Evaluation

NDoH National Department of Health

NHISSA National Health Information Systems Committee of South Africa

NIDS National Indicator Data Set

NDSA National Service Delivery Agreement

PHC Primary Health Care

PIDS Provincial Indicator Data Set

PQRS Provincial Quarterly Reporting System

QRS Quarterly Reporting System

SOP Standard Operating Procedure

WBOT Ward Based Outreach Teams


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DEFINITIONS

TERMINOLOGY OPERATIONAL DEFINITION

Accuracy

Also known as validity. Data is measured against a referenced source and found to be correct. Accurate data minimize error (e.g. transcription error) to a point of being negligible

Completeness Data are present and usable and represent the complete list of eligible sources and not just a fraction of it

Confidentiality Assurance that data will not be disclosed inappropriately and treated with appropriate levels of security

Data Raw, unprocessed numbers

Data collation

The process where data for a data element from various service points are added together. It is very important to ensure that during this process the responsible person adds the data correctly to avoid arithmetic errors

Data input forms

This refers to the final form which will be used to enter the data into the relevant database

Data sign off

Data sign off refers to the process where the person with the required authority agree to the correctness and validity of the data and commits him or herself to submit data in accordance with data flow guidelines

Indicator A quantitative or qualitative variable that provides a simple and reliable measurement of one aspect of performance, achievement or change in a program or project

Information Processed or analysed data that adds context through relationships between data to allow for interpretation and use

Timeliness Data and information is available on time for meeting budgeting, monitoring, decision making and reporting requirements

Users of data Stakeholders who are authorised to access and use data in DHIS for monitoring, evaluation, research and reporting purposes

Quintiles 1 to 5

Classifying Schools -1 to 5.

Quintile 1 being the poorest school. The poorest schools in Quintile 1 receive a greater allocation per learner than those in Quintile 2. In 2007, the Minister identified Quintile 1 and 2 schools as no-fee schools. In order to rank schools into Quintiles, each school has to be given a school poverty score. The score should be based on the relative poverty of the community around the school, looking at (1) Income (2) dependency ratio (or unemployment rate), (3) level of education of the community (or literacy rate)

The national data source used to determine the poverty score for schools is not able to analyse spatial areas smaller than wards. As such it is not sensitive enough to recognise neighbourhoods of poverty within a larger community. Poor schools in close proximity to better off suburbs will be prejudiced by the wealth of their neighbours and may be ranked in a higher quintile than is justified by their learner demographics


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LIST OF ABBREVIATIONS ............................................................................................. 2

DEFINITIONS .................................................................................................................. 3

1. Introduction ............................................................................................................. 6

1.1 Purpose ......................................................................................................................... 6

1.2 Scope ............................................................................................................................. 6

1.3 Training .......................................................................................................................... 6

1.4 Background .................................................................................................................... 6

1.5 Principles ....................................................................................................................... 7

1.6 Data Tools for AGGREGATED monthly DHIS data management .................................. 9

1.7 Reference Documents ................................................................................................... 9

1.7.1 General documents applicable to all health programs and services ......................... 9

1.7.2 WBOT-specific documents .................................................................................... 10

1.7.3 ISHP-specific documents and software .................................................................. 10

1.7.4 EH-specific documents .......................................................................................... 10

1.7.5 EMS-specific documents ....................................................................................... 10

2. DATA/INFORMATION MANAGEMENT and FLOW ............................................. 11

2.1 DHMIS Responsibilities and Procedures ...................................................................... 12

2.1.1 Health Care Provider = Data Collector ................................................................... 12

2.1.2 Deputy Manager’s DHMIS Responsibilities and Procedures .................................. 13

2.1.3 Facility / Program Manager’s DHMIS Responsibilities and Procedures .................. 14

2.1.4 Data Capturer’s Responsibilities and Procedures .................................................. 16

3. Entering monthly aggregated data for NON-FACILITY health programs .............. 18

3.1 Data Entry and Entry Validation ................................................................................... 18

3.2 Post Entry Data Validation (Data Quality Checks) ........................................................ 21

3.3 Export of data ............................................................................................................... 24

3.3.1 Export to next level ................................................................................................ 24

3.3.2 Export to Data Mart ................................................................................................ 25

3.4 Generating Reports ...................................................................................................... 26

3.5 Pivot Tables ................................................................................................................. 28

4. NON-FACILITY Health Program- Specific Annexures .......................................... 29

4.1 WBOT .......................................................................................................................... 29

4.1.1 WBOT Data Elements (extracted from DHIS Jan 2013) ......................................... 29

4.1.2 WBOT Indicators (extracted from DHIS Jan 2013)................................................. 31

4.1.3 WBOT Validation Rules (extracted from DHIS Jan 2013) ...................................... 33


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4.1.4 WBOT Tools for routine aggregated monthly DHIS data management .................. 34

4.1.5 PHC WBOT Monthly DHIS Data Input Form (DHIS auto-generated) ..................... 37

4.2 Integrated School Health Program (ISHP) .................................................................... 38

4.2.1 ISHP Data Elements (extracted from DHIS Jan 2012) ........................................... 38

4.2.2 ISHP NIDS Indicators (extracted from DHIS Jan 2012).......................................... 42

4.2.3 ISHP Data Tools .................................................................................................... 44

4.3 Environmental Health Program (EH) ............................................................................ 48

4.3.1 EH Data Elements (extracted from DHIS Jan 2012) .............................................. 48

4.3.2 EH Indicators ......................................................................................................... 50

4.3.3 EH Validation Rules (extracted from DHIS Jan 2012) ............................................ 52

4.3.4 EH Data Tools (examples) ..................................................................................... 53

4.4 Emergency Medical Services Program (EMS) .............................................................. 59

4.4.1 EMS Data Elements (extracted from DHIS Jan 2012) ............................................ 59

4.4.2 EMS Indicators (extracted from DHIS Jan 2012) ................................................... 61

4.4.3 EMS Data Tools .................................................................................................... 62

4.5 Maintain the Organisational Hierarchy of NON-FACILITY DHIS data files .................... 65

4.5.1 Organisational Hierarchy Integrated School Health Program (ISHP) data file ........ 65

4.5.2 Organisational Hierarchy Environmental Health (EH) data file ............................... 65

4.5.3 Organisational Hierarchy Emergency Medical Services (EMS) data file/set ........... 65

4.5.4 Organisational Hierarchy – Ward Based Outreach Team (WBOT) data file ........... 65

4.5.5 The PHC WBOT Household Profile Data File ........................................................ 68

4.5.6 Adding Local Data Elements and Indicators .......................................................... 69


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1. Introduction

1.1 Purpose

This document provides Standard Operating Procedures (SOPs) to ensure appropriate, standardised and effective data and information management for monthly aggregated NON-FACILITY Health Programs. It also provides guidelines for:

Standard DHIS data capturing, validation and data flow procedures

Maintaining and expanding the Organisational Hierarchy in the DHIS Data File in a standardised

manner

NON-FACILITY Health Programs include the following:

1) PHC Ward Based Outreach Teams (WBOT)

2) Integrated School Health Programs (ISHP) services

3) Environmental Health (EH)

4) Emergency Medical Services (EMS)

These SOPS focus on general principles applicable to management of all the NON-FACILITY Health Programs and specifics in terms of each program will be indicated throughout the manual.

1.2 Scope

These National Department of Health (NDoH) SOPS are mandatory and shall be implemented by all employees and contractors when engaging in health information related activities in the Department of Health (DoH) facilities. The SOPs must be used in conjunction with the following:

DHMIS Policy 2011

National Indicator Dataset (NIDS)

Reference Documents listed in Section 3

Please note that these SOPs do not cover pilot projects

1.3 Training

The Health Program Managers and Facility Managers must ensure that where relevant team members who follow these procedures understand these SOPS understand the objectives and other inter-related activities.

Each team member involved in data collection, validation capturing, dissemination and use must sign that (s)he has studied and understand these SOPs.

1.4 Background

In terms of the National Health Act (Act 61 of 2003) the National Department of Health (NDoH) is required to facilitate and coordinate the establishment, implementation and maintenance of health information systems at all levels. The District Health Management Information System (DHMIS) Policy 2011 defines the requirements and expectations to provide comprehensive, timely, reliable and good quality routine evidence for tracking and improving health service delivery. The strategic objectives of the policy are to strengthen monitoring and evaluation (M&E) through standardization of data management activities and to clarify the main roles and responsibilities at each level for each category of staff to optimize completeness, quality, use, ownership, security and integrity of data.


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PHC Ward Based Outreach Team services - Central to the PHC Re-engineering Strategy is a

cadre of Community Health Workers (CHW) organised into approximately 5,500 WBOTs. Each of

these teams, consisting of 6 community health workers (CHWs), provides outreach services to

around 1500 households with a ratio of 250 households per CHW and each team is linked to one

PHC facility, called the team’s parent facility.

Integrated School Health Program (ISHP) – As reflected in the National Service Delivery

Agreement (NSDA) strengthening of ISHP services a national Primary Health Care (PHC) Re-

engineering priority. It is also an important component of the Department of Basic Education

(DBE) Care and Support for Teaching and Learning framework.

Environmental Health Services – EH services include water quality monitoring, health

surveillance of premises, port health, and control of hazardous substances, waste management

and chemical safety.

Emergency Medical Services - EMS is recognised as a key component within the health care

delivery system. They are often an entry point into health system services when people are under

life-threatening circumstances. EMS comprises of various elements such as Emergency Care

practitioners, Emergency Physicians, specialised vehicles and equipment, computerised call

centres with computerised communication centres and training.

In 2000 the District Health Information System (DHIS) was adopted as the official South African routine health information system for managing aggregated routine health service based information. Modules NON-FACILITY Health Programs were implemented in some provinces but a standardised National Database will be implemented for each in April 2013.

The national aim is to have computers and competent data capturers at each facility in an incremental manner but, until all facilities are computerised, well managed and monitored paper-based data collection, collation and dissemination systems must be maintained in the most effective and efficient way.

1.5 Principles

The following principles should be kept in mind when these SOPS are implemented:

1. These SOPS are meant for managing routine aggregated DHIS data and NOT for individual

records for which SOPS will be published at a later stage

2. The DHIS contains population-based data (for example population estimates from Statistics

South Africa) and school data (for example schools and number of learners imported from the

Education Management Information System (EMIS) of the DBE) which serves as denominators

for some of the NIDS indicators

3. Data and information must be used at all levels for planning and monitoring against data quality

and health program targets

4. Data collection: Routine aggregated NON-FACILITY Health Program data to be captured into

the DHIS are collected by means of Standardised Tick Registers. The cover page of each Tick

Register should have space for the following:

Team / practitioner name and where applicable parent health facility name (as in DHIS), year

and register number (Tick Register number starts on 1 April and ends on 31 March of the

following year )

Start date of register

End date of register

Register pages must be numbered


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5. Data tools and processes for NON-FACILITY services must be managed in the same manner

as those for fixed facilities.

6. Data capturing, -validation and -feedback: NON-FACILITY data will be captured by the same

designated data capturer capturing aggregated health facility data at:

Facility level where resources are available

Sub-district level where facility level capturing is not available

7. Information Management in terms of data flow, monitoring, mentoring, training and DQ feedback

is the responsibility of Information Officers/Managers at sub-district, district, provincial and

national levels. The following are crucial for monitoring and optimising data quality:

Standardised management of Organisational Unit levels, types and ‘owners’

Standardised activation of relevant data elements at capturing level

Standardised use of 0 (zero) reporting at data collection and capturing levels

Audit readiness similar to health facilities

8. All records, data collection and collation tools must be stored in a secure facility on a daily basis

9. Non-health information staff responsibilities for each NON-FACILITY Health program and the

OrgUnit level for which the program’s data is captured are tabled below

10. Materials, equipment and staff – Facility and District Managers are responsible to ensure that

sufficient stationary, equipment and staff are available to meet responsibilities at each level.

Table 1: Responsibilities – aggregated data management

NON-FACILITY Health Program

Health service

providers = data

collectors

Collection level

validation & summary

Pre-capturing validation

Monthly feedback on data quality

and program progress

OrgUnit Level for Data Entry

WBOT CHWs CHWs &

WBOT Team Leader

Parent Facility Manager

WBOT Program Manager

(all levels)

OrgUnit 7

ISHP School Health Professional

Nurses

School Health Nurses


ISHP Program Manager

(all levels)

OrgUnit 5

EH Environmental

Health Practitioners

EH Practitioners

EH Program Manager

EH Program Manager

(all levels

OrgUnit 5

EMS

EMS Practitioners

Control Centres

Shift Manager EMS Program

Manager

EMS Program Manager

(all Levels)

OrgUnit 5


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1.6 Data Tools for AGGREGATED monthly DHIS data management

As stated before, individual patient / client records are excluded from these SOPS

Table 2: Tools – aggregated data management

Program Data collection Collation: Sub-totals

Collation: Monthly DHIS Data Input forms

(DHIS auto-generated)

PHC WBOT

CHW Household visit Tick Sheet

CHW Household Visit Monthly Summary form (CHW)

Outreach Team Monthly Summary form (Team Leader)

PHC WBOT Monthly DHIS Data Input Form

(Per WBOT)

ISHP ISHP Tick Sheet (all phases)

ISHP Summary Report Form ISHP Monthly DHIS Data Input Form

(Per School)

EH Daily Register MUNICIPAL EHO

Daily Register PROVINCIAL EHO

Daily Register PORT HEALTH EHO

No sub-total forms are used

1.Monthly Data Input form Municipal Health

2.Quarterly Data Input form Municipal Health

3.Monthly Data Input form Provincial Health

4.Quarterly Data Input form Provincial Health

5.Monthly Data Input form Port Health

6.Quarterly Data Input form Port Health

EMS Call Centre No sub-total forms are used EMS Monthly DHIS Data Input Form

(Per EMS station)

1.7 Reference Documents

Individuals using these procedures should become familiar with the following general and health program specific documents:

1.7.1 General documents applicable to all health programs and services

1) DHMIS Policy, National Department of Health, 2011.

2) National Health Act (Act 61 of 2003): Commencement Section 53 of the National Health Act, 2003.

3) PHC Supervisory Manual, National Department of Health, October 2009

4) Promotion of Access to Information Act (Act 2 of 2000): GN 585, Government Gazette 26332, 14 May 2004.

5) Public Audit Act of 2004 (Act 25 of 2004): Government Gazette Vol 474, Cape Town, 20 December 2004 No. 27121.

6) Public Finance Management Act (Act 1 of 1999): Public Finance Management Amendment Act (Act No. 29 of 1999).

7) Statistics Act (Act 6 of 1999): Government Gazette Vol. 406, Cape Town 21 April 1999. No. 19957.

8) Treasury Regulations: Government Gazette, Vol. 500, Pretoria, 20 February 2008, No 29644.

9) Health National Service Delivery Agreement (NSDA) 2011


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1.7.2 WBOT-specific documents

1) Provincial Guidelines Implementation PHC 3 Streams Overview

2) PHC Re-engineering Narrative

3) Community Health Worker Training Implementation Plan

1.7.3 ISHP-specific documents and software

1) Education Management Information System (EMIS)

2) Integrated School Health Policy

3) ISHP Monitoring and Evaluation

1.7.4 EH-specific documents

1) International Health Regulations

2) (Updated) SUPPLEMENTARY REGULATIONS MADE UNDER THE

INTERNATIONAL HEALTH REGULATIONS ACT, 1974 (ACT NO. 28 OF 1974)

1.7.5 EMS-specific documents


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2. DATA/INFORMATION MANAGEMENT and FLOW

This data flow diagram provides the timelines to ensure that the 45 day deadlines for routine data submission (for all health programs) to NDoH is met.

NATIONAL LEVEL

MONTHLY 50 days after reporting period

National import, validation & saving on server completed

Feedback 60 days after reporting period to provinces

PROVINCIAL LEVEL

MONTHLY 45 days after reporting period

Provincial import, validation & export completed

Feedback in 5 days to district level

DISTRICT LEVEL

MONTHLY 30th : District level import, validation & export completed

Feedback in 5 days down to sub-district level

SUB-DISTRICT LEVEL

MONTHLY 20th : Sub-district level capturing, import, validation & export completed

Feedback in 5 days down to facility level

FACILITY LEVEL DAILY

1. Collect data during service provision (Tick Sheets / Registers)

2. Validate data

3. Calculate sub-totals

4. Capture data (selected facilities)

WEEKLY

• Interim aggregation & validation

MONTHLY (data from 1st to last day of reporting month)

•1st Validated data collection level (sub-total) summaries complete

•2nd Validated Monthly Input Summary to manager

•5th :Validated Monthly Input Summary data capturer

•10th Facility level capturing , validation and export to sub-district level completed

•Feedback in 5 days to data collectors = health care providers


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2.1 DHMIS Responsibilities and Procedures

2.1.1 Health Care Provider = Data Collector

Health care providers (nurses, doctors, EMS and EH practitioners) are responsible and accountable for ensuring high quality data in household and individual patient records and on their own routine data collection and collation tools.

Step Action

1 RECORDING OF DATA ON DATA COLLECTION TOOLS:

On a daily basis the health service provider is responsible and accountable for the following:

1.1 Record data in individual patient/client records (for local use and therefore not included in these routine health information management SOPS). See table 2 for list of individual records used for each NON-FACILITY program

1.2 Record required data in line with the national definitions in the standardised Tick Sheets / Registers during or directly after each visit / service provided. See table 1 and 2 for list of data collectors and tools for each NON-FACILITY program (Annexure 4)

1.3 Indicate the file number / patient number (where relevant) clearly on the standardised Tick Sheets / Registers for follow-up and auditing purposes

1.4 Double check that all the correct data elements in the correct columns were ticked for each visit / service provided

1.5 Maintain confidentiality of all data / information

1.6 File and store individual client records, Tick Sheets / Registers and Summary forms in the dedicated locked facility

2 COLLATION OF DATA ON TICK SHEET / REGISTER

On a weekly and/or monthly basis the health service provider is responsible and accountable for the following:

2.3

Complete and sign Interim (weekly, monthly, ‘when page is full’, for each school) summary forms and submit to the delegated manager on the 1st day of each month. See table 2 for list of individual Sub-total summary tools used for each NON-FACILITY program (Annexure 4)

It is essential that all people write clearly and legibly on all data collection tools


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Step Action

NO BLANKS should be left on the monthly summary form

2.1.2 Deputy Manager’s DHMIS Responsibilities and Procedures

Some programs have Deputy Managers called Team Leaders (WBOT), Shift Supervisors (EMS) and various other terms.

‘Deputy Managers’ are responsible for managing respective teams and to collaborate with the linked parent health care Facility Manager and/or Health Program Manager to ensure effective NON-FACILITY services and good quality data in the DHIS.

Step Action

3 COLLATION OF DATA ON THE MONTHLY DHIS (auto-generated) INPUT FORMS

3.1 Capture the total for each health care provider / team member a Sub-total Monthly Summary Form (Table 1 and Annexure 4)

3.2 Count the number of referrals and other management related data (which doesn’t appear on Tick Sheets/Registers) and capture total on the Sub-total Monthly Summary Form

3.3 Calculate and sign clearly

3.4 Validate and transcribe the monthly totals for each team onto the Monthly DHIS Data Input Form (one auto-generated form per team) and sign (Table 1 and Annexure 4)

3.5 Submit the Monthly DHIS Data Input Form to the parent facility (or other dedicated) manager for verification and signature on 2nd of each month and file a copy in the Monthly DHIS Data Input Form file

3.6 Ensure training of team members on data elements, data quality assessment and data use

Ensure that all new team members are orientated on the health information management system

3.7 Oversee, lead and support effective and efficient data collection, management and use on:

Visits and care / health services provided

Work days and supervision visits

Stock and equipment

3.7 Provide monthly feedback to team members with regard to:

Data quality – timeliness, completeness and accuracy of data

Program-related indicators highlighting good performance and service delivery

shortcomings


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3.8 Analyse, interpret and use information for remedial interventions to optimise patient care and health care system performance

Develop action plans in collaboration with team members for indicators that reflect poor performance

2.1.3 Facility / Program Manager’s DHMIS Responsibilities and Procedures

If data submitted for capturing into the DHIS is of poor quality, evidence-based management decisions are compromised at all levels.

Where NON-FACILITY health care services are provided as outreach services, the Facility

Manager is responsible and accountable for the quality of the outreach service data (for example

WBOT and ISHP)

Where NON-FACILITY health care services are provided by teams not directly linked to health

facilities, the lowest level Program Manager/Coordinator is responsible and accountable for the

quality of health program data (for example EH and EMS)

These responsibilities focus on the management of high quality information that must be used to:

optimise patient care and/or community services

optimise public health and the health status of the population

optimise performance of health programs and the healthcare system

improve data quality

monitor, evaluate and report on performance against all legislated plans in the health sector

The health information management responsibilities of Facility Managers / Program Managers/Coordinators are similar for all health programs.

Step Action

1

Provide sufficient resources for routine health information management:

Stationery such as pens, rulers, carbon paper, calculators and staplers

Filing cabinets, files and an effective filing system

Telephones and fax machines

Up-to-date pivot tables, graphs and reports on data quality and program

performance

Definitions of data elements and indicators

Data collection tools (Tick Register, standardised registers, summary forms and

Data Input forms

Mobilise for further resources (staff, hardware and software, email and internet connections)

2 Include data management, monitoring and reporting in performance contracts and job descriptions of all managers, team leaders and health care providers

3

Ensure training on data elements, data quality assessment and data use for all staff responsible for data collection and collation and who manage service points

Ensure that all new staff are orientated on the health information management system


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Step Action

4

Oversee, lead and support effective and efficient data collection, management and use on:

Health visits and care/interventions provided

Work days and supervision visits

Stock and equipment

5

Optimise DHIS data quality and use by means of:

Weekly Spot checks on:

o Individual records by means of record reviews (10 records per month)

o Verification that data in Tick Sheets / Registers and on summary forms correlate

o Filing practices for records and data collection tools as required for data verification

and audits

Keep dated and signed records on spot checks done

Keep hard copies of data collection tools for a minimum of three (3) years

Establish an information committee/team for the facility / program to discuss data before

it is sent to the next level, assess data quality and promote an information culture in the

facility

Validate data on monthly DHIS Monthly Data Input Forms

Submit DHIS Monthly Data Input Forms for capturing on the 7th of each month

Ensure that data quality report and pivot table of raw data is received from data capturer

Follow up on feedback from the data capturer and make corrections. If changes to the

data are required it should be made on all the sheets to indicate that the totals have

changed. Draw a line through the incorrect value, write in the new value. These changes

are to be initialled and dated. No correction fluid is to be used. Ensure the entire data trail

back to the initial collection point is corrected

Ensure that the validation rules that were violated are corrected or commented on and

that feedback on violations are given to the sub-district/sub-structure/district office

Ensure that outliers are commented on

Ensure that updated data quality reports and pivot table of raw data is received from the

data capturer after corrections were made in the DHIS

Submit corrected signed-off Data Input form to the data capturer and ensure that a

duplicate is filed in the DHIS Monthly Input Form folder

7

Provide monthly feedback to Team Leaders and health care providers with regard to:

Data quality – timeliness, completeness and accuracy of data

Program-related indicators highlighting good performance and service delivery

shortcomings

8

Analyse, interpret and use information for remedial interventions to optimise patient care and facility / program performance

Develop action plans in collaboration with Team Leaders and health care providers for indicators that reflect poor performance

10 Ensure that facilities and programs are ready for an audit at all times


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2.1.4 Data Capturer’s Responsibilities and Procedures

Data capturers are responsible for capturing data and then forwarding the data to the next level. These responsibilities are similar for all health programs and all levels at which data is captured.

Data capturers must spend 100% of their work time on the data-related responsibilities stipulated below (integrated for all health programs)

Step Action

THE DATA CAPTURER IS ACCOUNTABLE FOR THE FOLLOWING IN TERMS OF AGGREGATED

MONTHLY DHIS DATA FOR ALL HEALTH PROGRAMS:

1 CAPTURING OF AGGREGATED MONTHLY DATA INTO DHIS (for all facility and NON-FACILITY) Health Programs

2.1

Obtain validated Data Input forms from the facility manager on all data sets on the 7th of each month

Conduct a rapid data quality assessment of data on DHIS Monthly Data Input forms –

must be 100% complete and should contain no gaps or outliers without comments

Capture monthly data into the DHIS

Indicate date of capturing on each monthly data input form and sign

Run Min/Max range violations, Absolute validation and Statistical Validation reports on

data

Run Standard Reports on data for outstanding input forms, routine raw data reports and

ad hoc reports

Follow up any discrepancies found in data with facility manager and keep record of

A facility is ready for an audit when:

All internal policies and procedure documents are available and are implemented

Each patient has only one patient folder/clinical record and file is available in the facility at all times (proper filing system)

Information recorded on data collection tool (Tick Register, standard register or patient based software application) are consistent with patient folder and supporting documentation

Where applicable all patient records are captured on electronic databases, e.g.ETR.net, TIER.net,

Information recorded in DHIS is consistent with data input forms

All data input forms applicable to the facility have data collected for and are captured in the DHIS

All data collection tools used for collection of data by institution have been reviewed for quality and have been signed off by the health care provider who collected the data

All registers are reviewed for quality and have been signed off by the facility manager

All validation errors are corrected or explained

All outliers are explained

Processing of data updates is done correctly

All sign off forms are properly completed and signed off by the facility manager


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Step Action

follow up date and person

Verify that facility manager made the appropriate corrections on the data input form. A

line should be drawn through the incorrect value and the new value should be written.

Changes are to be initialled and dated. No correction fluid is to be used. The entire data

trail back to the initial service point must be corrected

On receiving feedback from the facility manager, correct the values in DHIS and send

updated reports and pivot tables to the facility manager to sign off the data

Export data to Data Mart and refresh pivot tables – compare data in pivot tables with that

on summary forms. The following is crucial in this process:

o Save existing standard pivot tables with a different name (for example add date)

before exporting to Data Mart

o Empty the Data Mart, do a full export to Data Mart and then refresh the standard

pivot tables

Obtain sign-off from the Facility Manager of the data

Attach following DHIS reports to sign-off form as proof of data quality:

o Data entry validation report

o Min/Max violations

o Outstanding input forms

o Pivot table of raw data

Export data on all NIDS data elements and send export file to sub-district or district level

(as relevant) before the 10th of each month

Ensure that back-ups are made every time data is changed

File records needed to meet monitoring and audit requirements and store safely in a

locked facility


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3. Entering monthly aggregated data for NON-FACILITY health programs

Data capturers must provide comprehensive and integrated data capturing services and are expected to capture data for all health programs. NON-FACILITY Health Program data is captured by the same data capturers entering health facility data. This data can be captured into the DHIS at facility, at sub-district or district level, depending on resources and processes in place for capturing (ALL) health program data.

The process for capturing monthly aggregated DHIS data is the same for all NON-FACILITY health programs in their respective data files displayed below.

Health Program

WBOT ISHP EH EMS

DHIS Data Base /

Data File

DHIS_#ZA_NDOH_WBOT.MDB

DHIS_#ZA_NDOH_ISHP.MDB

DHIS_#ZA_NDOH_EHP.MDB

Provincial data file e.g.

DHIS_#ZA_ECAPE

The WBOT data file will be used to illustrate the data capturing process and program-specific aspects will be specified where relevant.

.

3.1 Data Entry and Entry Validation

Desktop – Use DHIS14 Start Up icon to open the DHIS database

Control Centre – Click on Switch data file

Data cannot be entered or edited unless logged in with a user name


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For entering PHC Ward Based Outreach Team data, select

DHIS_#ZA_NDOH_WBOT and click OK

For capturing School Health data, select

DHIS_#ZA_NDOH_ISHP and click OK

For capturing Environmental Health data select

DHIS_ZA_NDOH_EHS and click OK

For entering EMS data select your provincial data file and click OK.

Control Centre – Click on Data – Entry/Edit

Select the Data Set you want to enter data for – we will use PHC WBOT Data (PHC Ward

(1) Select the Data set for which you want to capture data

(2) Select period /month for which you want to enter data for example Nov-12

(3) Select the OrgUnit for which you want to enter data for example:

Province = nw North West Province

District = nw Dr Ruth Segomotsi Mompati

Sub-district = nw Naledi LM

Ward = nw Naledi Ward 4

Facility = nw Huhudi CHC

Team = Huhudi CHC Outreach Team 1 – W004

If the WBOT for which you want to enter

data does not display in the OrgUnit

Hierarchy, ask your information officer to

assist. See annexure 1 for explanation.

To show or hide OrgUnits, click the ‘+’ and ‘–‘.


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The following Data Entry screen will appear

Enter the data from the Monthly Input form into the Entry box for each of the elements. The sequence of the data elements on the Monthly Input form and those on the computer screen are the same, but it is good data capturing practice to make sure that each Entry is for the correct data element

Validation of data during the data capturing process

The DHIS software has several functions to assist data capturers to optimise data quality:

1. Min/max values / entry out of range – the

Min and Max values displaying the values for

each element (values with which the

database was developed), will be auto-

calculated after 3 months of data entry using

the values captured for each individual

facility

2. It is good practice to reset Min/max values

for each WBOT team with the Team Leader

when entering data for the first time


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When a value outside the min/max range is

captured a graph indicating the trend lines

appears to flag a potential data quality

problem.

After verifying the data by means of checking the value on the Input form or phoning the Parent Facility Manager, select the most suitable alternative from the action list next to the graph.

3. Colour coding of entry cells – when a

potentially incorrect value is captured, the

cell colour indicates that the data in that

Entry cell may be incorrect and should be

verified

See colour code explanation in the lower left corner of the Data Entry screens.

4. Click in the Check box if you want to

check or investigate a value at a later

stage. This will indicate that the value may

not be correct

5. A comment should be added to indicate

that a value might not be correct. You can

choose a Comment from the drop-down list

or type a comment free text.

Comments are useful as they can inform

the next person that needs to interpret the

data long after the data has been entered.

3.2 Post Entry Data Validation (Data Quality Checks)

Data validation while in the data entry screen (after completing data entry)

After data entry has been completed, the system prompts the user to run validation rules. Good data management dictates that these should be run routinely after the data for each reporting unit has been entered. Any violations found must be addressed immediately.


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After entering and saving the data in the data entry screen you need to press the Validate button at the top of the screen

The programme runs a quick validation check of the data entered and produces a report that describes any errors in the data.

Close, follow up and correct input errors for which corrections can be obtained immediately.

If you need to share these results you can copy the report to clipboard and save.

When finished click on Control Centre button in right top corner of screen

Data Validation from Control Centre

Further validation of the data is found in the Control Centre – clicking on Data Quality .

1. Routine ‘Check it’ data allows you to view all the

data entries that have been marked for follow up

Select OrgUnit

Select Data Set

Select Data Element Group

Entries for which check boxes were clicked displays – follow up and verify


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2. Data Validation:

National absolute and/or statistical validation rules have been designed in order to identify data errors for correction

Run Absolute Validation – select OrgUnits,

Source Level, Data Set, Data Period and click

Run Analysis

Run Statistical Validation

Example of Absolute Validation rule violations

To view the data elements where the violations occurred, click on Show Data Record Detail button

To edit data (after verification with facility) click Open Data Entry Form button

Examples statistical validation rule violations (no statistical validation rules set up in current WBOT data file)


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Advanced Quality Checks are for advanced users to :

- Identify gaps and outlier values. You can either identify missing records or outliers.

- Run integrity checks

3.3 Export of data

3.3.1 Export to next level

After entering and validation of data, the data capturer must export the data to the next level

Export to next level

After capturing and validation of data for all the reporting units that submitted data, OR on the d-date for sending data to the next level irrespective whether all units submitted, data must be exported to the next level.

Click on Export / Import button

Select Export to XML/Text

Select the data set you want to export

Browse for OrgUnits to include in the export and select

Select the period

Select months for which records were modified after validation

Click Export Specification button


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Select data sets you want to export by moving them from the Available (right column) to left column. Use selection arrows to move items

Data element groups

Data elements

OrgUnit groups

Click on back to Export Criteria button

Click on Export button (bottom right corner)

The export file will by default be stored in the C:\DHIS 14\Transfer folder in a 7Zip format

(R) click on the file you want to export. Click on Send to and select Mail recipient and email to dedicated person at the next level

3.3.2 Export to Data Mart

After data was forwarded to next level data must be exported to the Data Mart from where pivot tables are refreshed (see section 3.5)

Export to Data Mart

After capturing and saving new data, export it to Data Mart.

In the Control Menu choose Export To Data Mart. Then click on Export Data to Data Mart button again and choose Full if it’s the 1st time and Partial export thereafter and set the dates for ideally the


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previous month in case there were adjustments made.

3.4 Generating Reports

Short reports on the data can be generated by clicking on the Control Centre.

The two common reports we will examine will be the

1. Routine Raw Data Report and the

2. Ad Hoc Raw Data Report.

The Routine Raw Data Report:

a) choose the Data Set (eg CHW Outreach Teams) b) Select the Org Unit - district, sub-district or facility you

wish to create a report for (nw Naledi Local Municipality)

If you tick Use Default OrgUnit from Data Entry Form - your drop-down options for select Org Unit described above will have the same OrgUnit tree as in your Data Entry screens

c) The Source level is the reporting Unit d) Set the data period e) You can filter the Org unit group to show just the

reporting Unit.


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Select if you want to Include the Min/Max Values or if you want to Include Totals in the report.

Under Outputs you have a variety of choices for the format you want the report in:

MS Word Report

If you select this MS Word Setup screen will open

You can edit the title, margins and layout of the report in Word on this screen.

Click OK

Your Word report will look similar to this.

The Ad-Hoc Raw Data report allows you to extract any raw data and display it in a pivot table. The report is useful if you only want data for a selected few data elements.

Similar steps are followed as above but the ‘Root’ Org Unit is usually at District or Province so that you can pivot at different levels in the data.

Select the data elements you want in your report by highlighting the elements in the Available List and clicking on the Right arrow.

An example of the resulting report.


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3.5 Pivot Tables

Pivot tables are generated when data is exported to the Data Mart. The pivot tables are located in the DHIS root folder or you can access them from the DHIS Control Centre. The following looks very briefly at accessing the PHC Outreach Pivot table.

Pivot tables are saved in Excel files with naming DHIS_$ followed by the province.

Another way of opening the Pivot Table is to click this shortcut on the Control Centre in the DHIS.

A table appears for you to select what Pivots are available.

Click on the table name and the excel pivot table opens.

At the bottom of the screen there are different tabs for different sheets.

The Overview explains the Org unit setup. So you can see all the Outreach teams per clinic

Routine data allows you to examine the data elements and the Indicator Sheet allows you to examine the indicators.

The ‘DE Des’ and ‘Ind Des’ is where you will find the definitions of either Data Elements or Indicators in this Outreach Data File.

4. NON-FACILITY Health Program- Specific Annexures

4.1 WBOT

4.1.1 WBOT Data Elements (extracted from DHIS Jan 2013)

Number Data Element

Name Definition Use and context

IndGroup

Frequency

Collected By

Collection Points

Tools

1 OHH Households in population

Total number of households in the population that should be visited and registered by Ward Based Outreach Teams

Monitors implementation of PHC re-engineering in terms of Ward Based Outreach Teams. Will be auto-calculated when stats SA releases break-downs of 2011 Census data (the Small Area Layer)

PHC WBOT

Yearly StatsSA N/A N/A

2 OHH CHW supervised by team leader

The number of CHWs who are supervised by the Ward Based Outreach Team leader

Team leader should enter this monthly PHC WBOT

Monthly Manager WBOT N/A

3 OHH allocated to team

Number of households allocated to Ward Based Outreach Teams

Each Ward Based Outreach Team is allocated a specific number of households to support

PHC WBOT

Monthly WBOT Household Tick Register WBOT

4 OHH registration visit

Number of initial visits to households by Ward Based Outreach Teams that included completing a household registration form

Each household allocated to Ward Based Outreach Team must be registered during the first household visit by a team member, using the standardised Household Registration form

PHC WBOT


5 OHH follow-up visit

Number of households visited by a Ward Based Outreach Team to provide follow-up health care support

Members of the Ward Based Outreach Teams are expected to visit each household for follow-up support each month. At risk households might need to be visited more frequently

PHC WBOT


6 OHH visits total Total number of households visited by Ward Based Outreach Teams

This is the sum of registration visits and follow-up visits PHC WBOT

Monthly N/A N/A DHIS calculate

7 OHH supervised visit

Number of Ward Based Outreach Team visits accompanied by a supervisor

Monitors supervision of Ward Based Outreach Team member (Community Health Workers - CHW)

PHC WBOT


8 OHH with pregnancy care

PHC outreach household (OHH) visit where care was provided to pregnant women

Do not count individual pregnant women PHC WBOT


9 OHH with postnatal care

PHC outreach household (OHH) visit where care was provided to woman and/or newborn baby within 6 days after delivery

Do not count individual postnatal woman PHC WBOT


10 OHH with child under 5 years care

Outreach household (OHH) visit where care was provided to child(ren) under 5 years of age

Do not count individual children PHC WBOT



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Number Data Element

Name Definition Use and context

IndGroup

Frequency

Collected By

Collection Points

Tools

11 OHH with adherence support

Outreach household (OHH) visit where adherence support was provided

Do not count individual clients PHC WBOT


12 OHH with home based care

Outreach household (OHH) visit where home based care was provided

Do not count individual clients PHC WBOT


13 OHH client refer to facility

Number of clients of all ages referred to health facilities by Ward Based Outreach Teams

Include referrals to all health facilities, including referrals for care provided by special teams like Oral Health or Mental Health

PHC WBOT


14 OHH client refer to social services

A client who was referred to social services by a Ward Based Outreach Team (CHW) during a household visit

Monitors referral to social services. Count individual clients

PHC WBOT


15 OHH client refer to home based care

A client who was referred to home based care by a Ward Based Outreach Team (CHW) during a household visit

Monitors referral to home based care. Count individual clients

PHC WBOT


16 OHH headcount under 5 years

Number of children under 5 years to whom care was provided by Ward Based Outreach Teams

The community health worker (CHW) must enter the total number of children under 5 years of age to whom support was provided in each household visited, on the CHW Household visit form

PHC WBOT


17 OHH headcount 5 years and older

Number of clients 5 years and older to whom care was provided by Ward Based Outreach Teams

The community health worker (CHW) must enter the total number of clients 5 years and older to whom support was provided in each household visited, on the CHW Household visit form

PHC WBOT


18 OHH headcount total

Total number of outreach clients care for (sum of outreach headcount under 5 years and outreach headcount 5 years and older)

Add the total of the outreach headcount under 5 years and the total of the outreach headcount 5 years and older

PHC WBOT


19 OHH support group

The number of community support groups facilitated by Ward Based Outreach Teams

Count the number of support group meetings facilitated

PHC WBOT


20 OHH campaign The number of community campaigns supported by Ward Based Outreach Teams

Count each campaign once irrespective of number of team members involved

PHC WBOT


21 OHH back-referral form

Outreach household (OHH) client with health facility back referral form

Count individual forms PHC WBOT



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4.1.2 WBOT Indicators (extracted from DHIS Jan 2013)

Nr Indicator Name Type Annualised

Numerator Denominator Definition Use and context IndGroup Freq Level Key

reports

1 OHH registration visit coverage (annualised)

% 1 OHH registration visit

OHH in population

Proportion of households in the target wards covered by Ward Based Outreach Teams

Monitors implementation of the PHC re-engineering strategy

PHC WBOT

Monthly Output

2 OHH follow-up visit rate

% 0 OHH follow-up visit

OHH visits total

Outreach household follow-up visits as proportion of all households visits by Ward Based Outreach Teams

Monitors follow-up visits to registered households. Community health workers are expected to visit each household for follow up support monthly. At risk households need to be visited more frequently

PHC WBOT

Monthly Process/Activity

3 OHH supervised visit rate

% 0 OHH supervised visit

OHH visits total

Outreach household (OHH) visits accompanied by a supervisor as proportion of all household visits by Ward Based Outreach Teams

Monitors supervision of ward based community Health workers

PHC WBOT


4 OHH with pregnancy care rate

% 0 OHH with pregnancy care

OHH visits total

Outreach households (OHH) visits during which antenatal care was provided to pregnant women as proportion of households visited by the Ward Based Outreach Team

Monitors households where care was provided to pregnant women, irrespective of the number of pregnant women cared for

PHC WBOT

Monthly Output

5 OHH with postnatal care rate

% 0 OHH with postnatal care

OHH visits total

Outreach households (OHH) with postnatal care provided to a mother and/or neonate within 6 days after delivery as proportion of households visited by the Ward Based Outreach Team

Monitors households where care was provided to postnatal women, irrespective of the number of postnatal women cared for

PHC WBOT

Monthly Output

6 OHH with child under 5 years care rate

% 0 OHH with child under 5 care

OHH visits total

Outreach households (OHH) with basic health care provided to children under 5 years as proportion of households visited by the Ward Based Outreach Team

Monitors households where care was provided to children under 5, irrespective of the number of children under 5 cared for

PHC WBOT

Monthly Output

7 OHH with adherence support rate

% 0 OHH with adherence support

OHH visits total

Outreach households (OHH) with adherence support provided as proportion of households visited by the Ward Based Outreach Team

Monitors households where adherance support was provided, irrespective of the number of clients who received support

PHC WBOT

Monthly Output

8 OHH with home based care rate

% 0 OHH with home based care

OHH visits total

Outreach households (OHH) with home based support provided as proportion of households visited by the Ward Based Outreach Team

Monitors households where homebased care was provided, irrespective of the number of clients who received homebased care

PHC WBOT

Monthly Output


Page 32 of 69




Numerator Denominator Definition Use and context IndGroup Freq Level Key

reports

9 OHH back-referral forms rate

% 0 OHH client with back-referral form

OHH client referred to facility

Outreach households (OHH) back referral forms received from PHC facilities as proportion of all households with referrals to PHC facility done by the Ward Based Outreach Team

Monitors back-referrals fron PHC facilities. Each back-referral form is counted

PHC WBOT


10 OHH client referred to facility rate

% 0 OHH client refer facility

OHH headcount total

Proportion of outreach household clients referred to health facilities

Monitors referral by Community Health Workers (CHW) to health facilities. Individual clients referred are counted

PHC WBOT


NSDA; NSP; WHO

11 OHH client referred to social services rate

% 0 OHH client referred to social services

OHH headcount total

Outreach households (OHH) clients referred to social services as proportion of the total number of clients supported (total headcount) during outreach team visits

Monitors referral by Community Health Workers (CHW) to social services. Individual clients referred are counted

PHC WBOT


NSDA; NSP; WHO

12 OHH client referred to home based care rate

% 0 OHH client referred to home based care

OHH headcount total

Outreach households (OHH) clients referred to home based care as proportion of the total number of clients supported (total headcount) during outreach team visits

Monitors referral by Community Health Workers (CHW) to home nased care. Individual clients referred are counted

PHC WBOT


NSDA; NSP; WHO

13 OHH registration visit rate

% 0 OHH registration visit

OHH allocated to team

Outreach household (OHH) registration visits as proportion households allocated to Ward Based Outreach Teams

Monitors household registration. Each household allocated to a community health worker must be registered during the first outreach household visit, using the standardised Household Registration form

PHC WBOT

Monthly Output

14

OHH headcount under 5 years coverage (annualised)

% 1 OHH headcount under 5 years

Population under 5 years

Proportion of children under 5 years in population who received care during Ward Based Outreach Team visits

Monitors proportion of population under 5 years attended to during household visits

PHC WBOT

Monthly Output

15

OHH headcount 5 years and older coverage (annualised)

% 1 OHH headcount 5 years and older

Population 5 years and older

Proportion of people 5 years and older in the population who received care during Ward Based Outreach Team visits

Monitors proportion of population 5 years and older attended to during household visits

PHC WBOT

Monthly Output


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4.1.3 WBOT Validation Rules (extracted from DHIS Jan 2013)

1 OHH registration visit must be less than or equal to OHH total visits

2 OHH supervised visit must be less than or equal to OHH total visits

3 OHH with pregnant care must be less than or equal to OHH total visits

4 OHH with postnatal care must be less than or equal to OHH total visits

5 OHH with child under 5 years care must be less than or equal to OHH total visits

6 OHH with adherence support must be less than or equal to OHH total visits

7 OHH with home based care must be less than or equal to OHH total visits

8 OHH client refer to clinic must be less than or equal to OHH headcount total

9 OHH client refer to social services must be less than or equal to OHH headcount total

10 OHH client refer to home based care must be less than or equal to OHH headcount total

4.1.4 WBOT Tools for routine aggregated monthly DHIS data management

4.1.4.1 WBOT Tick Register / Sheet


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4.1.4.2 WBOT sub-total Summary Form


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4.1.4.3 WBOT Monthly Summary Form (Team Leader)

4.1.5 PHC WBOT Monthly DHIS Data Input Form (DHIS auto-generated)

District: ______________________________ Sub-district: ________________________

Health Facility: __________________________ Ward: _______________________________

WBOT Team: ______________________________ Reporting Month: _____________________

SortOrder

DataElement Value Comment

1 OHH follow-up visit

2 OHH supervised visit

3 OHH with pregnancy care

4 OHH with child under 5 years care

5 OHH with adherence support

6 OHH with home based care

7 OHH headcount under 5 years

8 OHH headcount 5 years and older

9 OHH support group

10 OHH campaign

11 OHH back-referral form

12 OHH registration visit

13 OHH visits total

14 OHH allocated to team

15 OHH CHW supervised by team leader

16 OHH with postnatal care

17 OHH headcount total

18 OHH client refer facility

19 OHH client refer social services

20 OHH client refer home based care

Designation Name & Surname (Print clearly) Data Verification

Signature Date

PHC WBOT Team Leader


Data Capturer (after entry)

4.2 Integrated School Health Program (ISHP)

4.2.1 ISHP Data Elements (extracted from DHIS Jan 2012)

Nr Data Element

Name Type Definition Use and context IndGroup Frequency

Collected By

Collection Points

Tools

1 School Quintile classification

Number

All schools are classified into quintiles by the DBE, with for instance Q1 and Q2 schools being the poorest/no fee schools

Planning and monitoring. Schools including their quintile classification are imported from the Department of Basic Education (DBE) database into the DHIS, or if not available from the provincial/local DBE

School Health

OnChange DoE EMIS N/A

2 School Grade All - learners total

Number The total number of learners in the school


School Health


3 School Grade 1 - learners total

Number Total number of Grade 1 learners in the school


School Health



Number The total number of Grade 4 learners in the school


School Health





School Health





School Health


7 School learners screened - total

Number

The total number of all grade learners in the school screened by a nurse in line with the ISHP service package

This data element is also used to calculate indicators for proportion of schools covered by the School Health Teams

School Health


8 School Grade 1 - learners screened

Number

Number of Grade 1 learners in the school screened by a nurse in line with the ISHP service package

Health Screening include oral health, vision, hearing, speech, height and weight, physical assessment, mental health, tuberculosis, chronic illnesses, psychosocial support. On-site services include deworming, immunization, oral health, minor ailments. Health education include hand washing, personal and environmental hygiene, nutrition, tuberculosis, road safety, poisoning, know your body, abuse (sexual, physical, emotional). Quintile 1 (Q1) and Quintile 2 (Q2) schools are the poorest / no fees schools. Integrated School Health Package (ISHP) includes health screening, on site services, health education)

School Health

Monthly School Health

School

Tick Register School Health


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(DHIS) Management: Facility level

Nr Data Element


Collected By

Collection Points

Tools


Number


Health Screening include oral health, vision, hearing, speech, height and weight, physical assessment, mental health, tuberculosis, chronic illnesses, psychosocial support. On-site services include deworming, immunization, oral health, minor ailments. Health education include hand washing, personal and environmental hygiene, nutrition, tuberculosis, road safety, poisoning, know your body, abuse (sexual, physical, emotional). Integrated School Health Package (ISHP) includes health screening, on site services, health education)

School Health


School



Number


Health Screening include oral health, vision, hearing, speech, height and weight, physical assessment, mental health, tuberculosis, chronic illnesses, psychosocial support. On-site services include deworming, immunization, oral health, minor ailments. Health education include hand washing, personal and environmental hygiene, nutrition, tuberculosis, road safety, poisoning, know your body, abuse (sexual, physical, emotional). Quintile 1 (Q1) and Quintile 2 (Q2) schools are the poorest / no fees schools. Integrated School Health Package (ISHP) includes health screening, on site services, health education)

School Health


School



Number



School Health


School


12 School Grade Other - learners screened

Number

Number of Other Grade learners in the school screened by a nurse in line with the ISHP service package (not in grade 1/4/8/10)


School Health


School



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Nr Data Element


Collected By

Collection Points

Tools

13 School learner underweight

Number

A learner with weight diagnosed below the -2 SD line but above the -3 SD line for the first time


School Health


School


14 School learner overweight

Number

A learner with weight diagnosed above the -2 SD line for the first time


School Health


School


15 School learner referred for Oral Health

Number A learner referred for Oral Health issues


School Health


School


16 School learner referred for Eye Care

Number A learner referred for Eye Care


School Health


School



Page 41 of 69



Nr Data Element


Collected By

Collection Points

Tools

17

School learner referred for Hearing problems

Number A learner referred for Hearing problems

Health Screening includes oral health, vision, hearing, speech, height and weight, physical assessment, mental health, tuberculosis, chronic illnesses, psychosocial support. On-site services include deworming, immunization, oral health, minor ailments. Health education includes hand washing, personal and environmental hygiene, nutrition, tuberculosis, road safety, poisoning, know your body, abuse (sexual, physical, emotional). Integrated School Health Package (ISHP) includes health screening, on site services, health education)

School Health


School


18

School learner referred for Speech problems

Number A learner referred for Speech problems

Health Screening includes oral health, vision, hearing, speech, height and weight, physical assessment, mental health, tuberculosis, chronic illnesses, psychosocial support. On-site services include deworming, immunization, oral health, minor ailments. Health education includes hand washing, personal and environmental hygiene, nutrition, tuberculosis, road safety, poisoning, know your body, abuse (sexual, physical, emotional). Integrated School Health Package (ISHP) includes health screening, on site services, health education)

School Health


School


19 School learner referred for Suspected TB

Number A learner referred for Suspected TB

Health Screening includes oral health, vision, hearing, speech, height and weight, physical assessment, mental health, tuberculosis, chronic illnesses, psychosocial support. On-site services include deworming, immunisation, oral health, minor ailments. Health education includes hand washing, personal and environmental hygiene, nutrition, tuberculosis, road safety, poisoning, know your body, abuse (sexual, physical, emotional). Integrated School Health Package (ISHP) includes health screening, on site services, health education)

School Health


School


20 School learner immunised

Number A learner given immunisation


School Health


School



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Nr Data Element


Collected By

Collection Points

Tools

21 School learner dewormed

Number A learner given deworming tablets


School Health


School


4.2.2 ISHP NIDS Indicators (extracted from DHIS Jan 2012)


Numerator Denominator Definition Use and context IndGroup

Freq Level Key

reports

1 School ISHP coverage (annualised)

% 1 Schools with any learner screened

Schools - total Proportion of schools in which the ISHP service package was provided

Monitors implementation of the Integrated School Health Program (ISHP)

School Health

Monthly

Process/Activity

APP; NSDA

2 School learner screening coverage (annualised)

% 1 School learners screened

School learners - total

Proportion of all learners screened by a nurse in line with the ISHP service package


School Health

Monthly

Process/Activity

APP

3 School Grade 1 screening coverage (annualised)

% 1 School Grade 1 learners screened

School Grade 1 learners - total

Proportion of Grade 1 learners screened by a nurse in line with the ISHP service package


School Health

Monthly

Process/Activity

APP






School Health

Monthly

Process/Activity






School Health

Monthly

Process/Activity

APP






School Health

Monthly

Process/Activity

7 School learner underweight rate

% 1 School learners underweight

School learners screened - total

Proportion of learners screened by a nurse in line with the ISHP service package diagnosed as underweight (below -2SD but above -3SD)


School Health

Monthly

Process/Activity


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8 School learner overweight rate

% 1 School learners overweight


Proportion of learners screened by a nurse in line with the ISHP service package diagnosed as overweight (above +2SD)


School Health

Monthly

Process/Activity

9 School learner referred for Oral Health rate

% 1 School learner referred for Oral Health


Proportion of learners screened by a nurse in line with the ISHP service package and referred for Oral Health


School Health

Monthly

Process/Activity

10 School learner referred for Eye Care rate

% 1 School learner referred for Eye Care


Proportion of learners screened by a nurse in line with the ISHP service package and referred for Eye Care


School Health

Monthly

Process/Activity

11 School learner referred for Hearing problems rate

% 1 School learner referred for Hearing problems


Proportion of learners screened by a nurse in line with the ISHP service package and referred for Hearing problems


School Health

Monthly

Process/Activity

12 School learner referred for Speech problems rate

% 1 School learner referred for Speech problems


Proportion of learners screened by a nurse in line with the ISHP service package and referred for Speech problems


School Health

Monthly

Process/Activity

13 School learner referred for Suspected TB rate

% 1 School learner referred for Suspected TB


Proportion of learners screened by a nurse in line with the ISHP service package and referred for Suspected TB


School Health

Monthly

Process/Activity

14 School learner immunised rate

% 1 School learner immunised


Proportion of learners screened by a nurse in line with the ISHP service package and given immunisation


School Health

Monthly

Process/Activity

15 School learner deworming rate

% 1 School learner dewormed


Proportion of learners screened by a nurse in line with the ISHP service package and given deworming tablets


School Health

Monthly

Process/Activity

4.2.3 ISHP Data Tools


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4.2.3.1 ISHP Tick Sheet / Register (all phases) Each new school visited should be captured on a new page School: EMIS number: Quintile: Sub-district: Date:

Serial nu

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er

Learner’s Name and Surname

Gen

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r: M

or

F

Gra

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1

Gra

de 4

Gra

de 8

Gra

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Gra

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Unde

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Over

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Referred

Imm

uniz

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6 y

r T

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12 yr

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ive

n

Min

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nm

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Psycho

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l

Dew

orm

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Follo

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Comment and/or Treatment given

Ora

l H

ealth

Vis

ion o

r E

ye

Heari

ng

Speech

Suspe

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B

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refe

rrals

SHS 7

4.2.3.2 ISHP Sub-total Summary form

ISHP SUMMARY REPORT FORM: DATA ITEMS Unit: Period:

TO

TA

L

1. Number of Q1 and Q2 schools in which the ISHP service package was provided.

2. Number of Grade 1 learners in Q1 and Q2 schools screened by a nurse in line with the ISHP service package




6. Number of Grade 1 learners screened by a nurse in line with the ISHP service package




10. Number of learners screened by a nurse in line with the ISHP service package

11. Grades 1 learners referred for visual problems after screening.

12. Grade 1 learners referred for hearing problems after screening.

13. Learners given 6 year Td immunisation on site

14. Learners given 12 year Td immunisation on site

Completed by: Name: Signature: Date:

SHS 9


Page 48 of 69



4.3 Environmental Health Program (EH)

4.3.1 EH Data Elements (extracted from DHIS Jan 2012)

Nr Data Element Name Definition Use and context IndGroup Frequency Collected By

Collection Points

Tools

1 EH Domestic water samples collected

Total number of domestic drinking water samples collected and analysed from a Water Services Authority and Non Water Services Authority (Vessels, Aircrafts, etc) in terms of the standards set out in SANS 241

This should exclude samples collected in outbreaks and for other specific purposes

Environmental Health

Monthly EHP EH sites Tick Register EH

2 EH Domestic water samples compliant

Number of domestic drinking water samples collected and analysed from a Water Services Authority and Non Water Services Authority (Vessels, Aircrafts, etc) in terms of the standards set out in SANS 241

This should exclude samples collected in outbreaks and for other specific purposes



3 EH Food poisoning reported new

Number of new food poisoning cases reported to EHP officers

Monitors food safety Environmental Health


4 EH Food sample bacteriological analysis

Total number of food samples taken for bacteriological analysis according to regulations promulgated in terms of the Foodstuffs, Cosmetics and Disinfectants Act, Act 54 0f 1972

This includes milk samples taken for bacteriological analysis



5 EH Food sample bacteriologically compliant

Number of food samples bacteriologically analysed that complied to the Foodstuffs, Cosmetics and Disinfectants Act, Act 54 0f 1972

This includes milk samples taken for bacteriological analysis



6 EH Food samples chemical analysis

Total number of food samples taken for chemical analysis according to the regulations promulgated in terms of the Foodstuffs, Cosmetics and Disinfectants Act, Act 54 0f 1972

This includes imported food stuffs



7 EH Food samples chemically compliant

Number of food samples chemically tested that complied to the Foodstuffs, Cosmetics and Disinfectants Act, Act 54 0f 1972

This includes imported food stuffs



8 EH Hazardous substance dealer compliant

Number of the Hazardous Substances dealers inspected that comply with the regulations for hazardous substances

All hazardous substances dealers must be inspected and compliant with Hazardous Substances Act and Regulations



9 EH Hazardous substance dealer inspected

The total number of Hazardous Substance dealers inspected

All hazardous substances dealers must be inspected and compliant with Hazardous Substances Act and Regulations




Page 49 of 69




Collection Points

Tools

10 EH Health care waste generator compliant

Number of registered health care waste generators inspected that complied with minimum standards according to SANS 10248

All waste generators should be inspected at least once a year. Inspection should be done according to SANS 10248 and any other applicable legislation



11 EH Health care waste generator inspected

Total number of registered health care waste generators inspected according to SANS 10248

All waste generators should be inspected at least once a year. Inspection should be done according to SANS 10248 and any other applicable legislation



12 EH International conveyance arrival at first point of entry

Total number of international conveyances arrivals at each international point of entry



13 EH International conveyance inspected at first point of entry

Number of international conveyances arrivals at each international point of entry inspected in terms of the National Port Health Standard Operating Procedures (revised SOPs)



14 EH International imported consignment arrival at point of entry

Total number of international imported consignments arrivals at each international point of entry



15 EH International imported consignment inspected

Total number of international imported consignments inspected at each international point of entry in terms of the National Port Health Standard Operating Procedures (revised SOPs) and International Health Regulations (IHR, 2005)



16 EH Lead poisoning reported new

Number of new cases of lead poisoning reported to EHP officers

Registered under Act 36 of 1947 Environmental Health


17 EH Mercury poisoning reported new

Number of new cases of mercury poisoning reported to EHP officers



18 EH Milling establishment compliant

Number of maize meal/bread flour mill establishments that were inspected and found to comply with the fortification regulation

Regulation promulgated in terms of the Foodstuffs, Cosmetics and Disinfections Act (Act 54 of 1972) and regulations promulgated in terms of the Act




Page 50 of 69




Collection Points

Tools

19 EH Milling establishment inspected

Total number of maize meal / bread flour mill establishment that were inspected

Inspected according to regulation promulgated in terms of the Foodstuffs, Cosmetics and Disinfections Act (Act 54 of 1972) and regulations promulgated in terms of the Act



20 EH Notifiable medical conditions investigated new

Number of Notifiable medical conditions reported to the District Health Office that were investigated by EHP officers

Only count the first inspection during the financial year. Don't include follow-up inspections



21 EH Notifiable medical conditions reported to District Health Office

Total number of Notifiable medical conditions reported to the District Health Office

Only count the first inspection during the financial year. Don't include follow-up inspections



22 EH Pesticide poisoning reported new

Number of new cases of pesticide poisoning reported to EHP officers



23 EH Premises tobacco legislation compliant

Number of premises (as defined in the National Health Act) inspected that comply with Tobacco legislation

Standards set out in the Tobacco Products Control Act, Act 83 of 1993



24 EH Premises tobacco legislation inspected

Total number of premises (as defined in the National Health Act) inspected for Tobacco Legislation

Standards set out in the Tobacco Products Control Act, Act 83 of 1993



4.3.2 EH Indicators

Nr Indicator Name Typ

e

Annualised

Numerator Denominator Definition Use and context

IndGroup Freq Level Key

reports

1 EH Domestic water sample compliance rate

% 0 EH Domestic water samples compliant

EH Domestic water samples collected

Proportion of routine domestic water samples taken for a Water Services Authority and Non Water Services Authority that conforms to the standards set out in SANS 241

Monitors domestic water safety



2 EH Flour mills compliance rate

% 0 EH Milling establishment compliant

EH Milling establishments inspected

Proportion of operational flour milling establishments that were compliant with regulations

Monitors flour milling establishment compliance



3 EH Food sample bacteriological compliance rate

% 0 EH Food sample bacteriologically compliant

EH Food sample bacteriological analysis

Proportion food samples bacteriologically tested that complied to the Foodstuffs, Cosmetics and Disinfectants Act, Act 54 0f 1972

Monitors food safety. Includes imported food stuffs




Page 51 of 69




e

Annualised



reports

4 EH Food sample chemical compliance rate

% 0 EH Food samples chemically compliant

EH Food samples chemical analysis

Proportion food samples chemically tested that complied to the Foodstuffs, Cosmetics and Disinfectants Act, Act 54 0f 1972

Monitors food safety. Includes imported food stuffs



5

EH Hazardous substance dealers compliance rate

% 0 EH Hazardous substance dealer compliant

EH Hazardous substance dealer inspected

Proportion Hazardous Substances dealers that complied with the regulations for hazardous substances

Monitors hazardous substance dealer compliance



6 EH Health care waste generator compliance rate

% 0 EH Health care waste generator compliant

EH Health care waste generators inspected

Proportion inspected health care waste generators that complied with minimum standards according to SANS 10248

Monitors health care waste generator compliance



7 EH International conveyance inspection rate

% 0

EH International conveyance inspected at first point of entry

EH International conveyance arrivals at first point of entry

Proportion international conveyance at arrival inspected for compliance to International Health standards

Monitors international conveyance inspection



8

EH International imported consignment compliance rate

% 0

EH International imported consignment inspected

EH International imported consignment arrivals at first point of entry

Proportion international imported consignments that complied to International Health standards, compliant in terms of the National Port Health Standard Operating Procedures (revised SOPs) and International Health Regulations (IHR, 2005)

Monitors international imported consignment inspection



9

EH Notifiable disease investigation rate

% 0 EH Notifiable medical conditions investigated new

EH Notifiable medical conditions reported to District Health Office

Proportion Notifiable medical conditions reported to the District Health Office that were investigated by EHP officers

Monitors Notifiable medical condition inspections by EHP officers



10 EH Premises tobacco compliance rate

% 0 EH Premises tobacco legislation compliant

EH Premises tobacco legislation inspected

Proportion inspected premises that were compliant with Tobacco Act

Monitors premises compliant with Tobacco Act



11

EH Reported Food poisoning incidence (annualised)

per100K


Population total New cases of food poisoning reported to EHS per 100 000 population

Monitors food poisoning trends


Monthly Outcome

12

EH Reported lead poisoning incidence (annualised)

per100K


Population total New cases of lead poisoning reported per 100 000 population

Monitors chemical poisoning trends


Monthly Outcome


Page 52 of 69




e

Annualised



reports

13

EH Reported mercury poisoning incidence (annualised)

per100K


Population total New cases of mercury poisoning reported per 100 000 population



Monthly Outcome

14

EH Reported pesticide poisoning incidence (annualised)

per100K


Population total New cases of pesticide poisoning reported per 100 000 population



Monthly Outcome

4.3.3 EH Validation Rules (extracted from DHIS Jan 2012)

No ValidationRule RoutineDataValidationRuleDescription

1 Domestic water samples collected VS Domestic water samples compliant Domestic water samples collected MUST be greater than or equal to Domestic water samples compliant

2Food samples bacteriological analysis VS Food sample bacteriologically

compliant

Food samples bacteriologically analysed MUST be greater than or equal to Food sample bacteriologically

compliant

3 Food samples chemical analysis VS Food sample chemical compliant Food samples chemically analysed MUST be greater than or equal to Food sample chemically compliant

4Hazardous substance dealer inspected VS Hazardous substance dealer

compliant

Hazardous substance dealer inspected MUST be greater than or equal to Hazardous substance dealer

compliant

5 Health care waste generator inspected VS Health care waste generator compliantHealth care waste generator inspected MUST be greater than or equal to Health care waste generator

compliant

6 International conveyance arrival VS International conveyance inspectedInternational conveyance arrival at first point of entry MUST be greater than or equal to International

conveyance inspected

7International imported consignment arrival VS International imported consignment

inspected

International imported consignment arrival at point of entry MUST be greater than or equal to

International imported consignment inspected at point of entry

8 Milling establishment inspected VS Milling establishment compliant Milling establishment inspected MUST be greater than or equal to Milling establishment compliant

9Notifiable medical conditions reported VS Notifiable medical conditions

investigated

Notifiable medical conditions reported MUST be greater than or equal to Notifiable medical conditions

investigated

10Premises tobacco legislation inspected VS Premises tobacco legislation

compliant

Premises tobacco legislation inspected MUST be greater than or equal to Premises tobacco legislation

compliant

4.3.4 EH Data Tools (examples)

1) DAILY REGISTER: MUNICIPAL ENVIRONMENTAL HEALTH PRACTITIONER

EHP Name: ______________________________________ Month: __________________

DAILY REGISTER: MUNICIPAL ENVIRONMENTAL HEALTH PRACTITIONER

EHP Name: ______________________________________________

EH

Do

me

stic w

ate

r sa

mp

les c

olle

cte

d

EH

Do

me

stic w

ate

r sa

mp

les c

om

plia

nt

EH

He

alth

ca

re w

aste

ge

ne

rato

rs in

sp

ecte

d

EH

He

alth

ca

re w

aste

ge

ne

rato

r co

mp

lia

nt

EH

Le

ad

po

iso

nin

g r

ep

ort

ed

ne

w

EH

Me

rcu

ry p

ois

on

ing

re

po

rte

d n

ew

EH

Pe

sticid

e p

ois

on

ing

re

po

rte

d n

ew

EH

Fo

od

po

iso

nin

g r

ep

ort

ed

ne

w

EH

Fo

od

sa

mp

le b

acte

rio

log

ica

l a

na

lysis

EH

Fo

od

sa

mp

le b

acte

rio

log

ica

lly c

om

plia

nt

EH

Fo

od

sa

mp

les c

he

mic

al a

na

lysis

EH

Fo

od

sa

mp

les c

he

mic

ally c

om

plia

nt

EH

Millin

g e

sta

blish

me

nts

in

sp

ecte

d

EH

Millin

g e

sta

blish

me

nt co

mp

lia

nt

EH

Pre

mis

es to

ba

cco

le

gis

latio

n in

sp

ecte

d

EH

Pre

mis

es to

ba

cco

le

gis

latio

n c

om

plia

nt

EH

No

tifia

ble

me

dic

al co

nd

itio

ns r

ep

ort

ed

to

Dis

tric

t H

ea

lth

Offic

e

EH

No

tifia

ble

me

dic

al co

nd

itio

ns in

ve

stig

ate

d n

ew

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Surveillance

of Premises

Communicable

Diseases

Comment

TOTAL

Food Control

Date __________________________________________________

Reference

Water

Quality

Waste

ManagementChemical Safety


Page 54 of 69



2) DAILY REGISTER: PROVINCIAL ENVIRONMENTAL HEALTH PRACTITIONER

EHP Name: ___________________________________ Date: _____________________________

DAILY REGISTER: PROVINCIAL ENVIRONMENTAL HEALTH PRACTITIONER

EHP Name: ______________________________________ Date:________________________

EH

Ha

za

rdo

us s

ub

sta

nce

de

ale

r in

sp

ecte

d

EH

Ha

za

rdo

us s

ub

sta

nce

de

ale

r co

mp

lia

nt

EH

He

alth

ca

re w

aste

ge

ne

rato

rs in

sp

ecte

d

EH

He

alth

ca

re w

aste

ge

ne

rato

rs in

sp

ecte

d

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Comment

TOTAL

Waste

Management

Reference

Hazardous

Substances


Page 55 of 69



3) DAILY REGISTER PORT HEALTH ENVIRONMENTAL HEALTH PRACTITIONER

EHP Name ______________________________________ Date: ___________________

DAILY REGISTER: PORT HEALTH ENVIRONMENTAL HEALTH PRACTITIONER

EHP Name: ______________________________________________Date __________________________________________________E

H D

om

estic w

ate

r sa

mp

les c

olle

cte

d

EH

Do

me

stic w

ate

r sa

mp

les c

om

plia

nt

EH

He

alth

ca

re w

aste

ge

ne

rato

rs in

sp

ecte

d

EH

He

alth

ca

re w

aste

ge

ne

rato

r co

mp

lia

nt

EH

Fo

od

sa

mp

le b

acte

rio

log

ica

l a

na

lysis

EH

Fo

od

sa

mp

le b

acte

rio

log

ica

lly c

om

plia

nt

EH

Fo

od

sa

mp

les c

he

mic

al a

na

lysis

EH

Fo

od

sa

mp

les c

he

mic

ally c

om

plia

nt

EH

Fo

od

po

iso

nin

g r

ep

ort

ed

ne

w

EH

In

tern

atio

na

l co

nve

ya

nce

arr

iva

ls a

t firs

t p

oin

t o

f e

ntr

y

EH

In

tern

atio

na

l co

nve

ya

nce

in

sp

ecte

d a

t firs

t p

oin

t o

f e

ntr

y

EH

In

tern

atio

na

l im

po

rte

d c

on

sig

nm

en

t a

rriv

als

at p

oin

t o

f e

ntr

y

EH

In

tern

atio

na

l im

po

rte

d c

on

sig

nm

en

t in

sp

ecte

d

EH

Pre

mis

es to

ba

cco

le

gis

latio

n in

sp

ecte

d

EH

Pre

mis

es to

ba

cco

le

gis

latio

n c

om

plia

nt

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Comment

TOTAL

Conveyance Control

Reference

Water QualityWaste

ManagementFood Control

Surveillance of

Premises


Page 56 of 69



4.3.4.1 EH DHIS Monthly Data Input form

1) Monthly Data Input Form Municipal Health Services

Municipal EHS Area : ____________________________________

Month: _______________________________________________

Completed by:_____________________________ Verified by: ______________________________

No Data Element Value Comment

Water Quality Monitoring



Chemical Safety




Food Control






11 EH Milling establishments inspected

12 EH Milling establishment compliant

Surveillance of Premises



Communicable Diseases

15 EH Notifiable medical conditions reported to District Health Office

16 EH Notifiable medical conditions investigated new

Waste Management

17 EH Health care waste generators inspected

18 EH Health care waste generator compliant


Page 57 of 69



2) Monthly Data Input Form Provincial Environmental Health Services

Provincial EHS Area___________________________________________

Month:________________________________________________

Completed by:_________________________________ Verified by: __________________________


Control of Hazardous Substances

1 EH Hazardous substance dealer inspected

2 EH Hazardous substance dealer compliant

Waste Management


4 EH Health care waster generator complaint


Page 58 of 69



1) Monthly Data Input Form Port Health Services

Port Name____________________________________ Month: ___________________________

Completed by:_________________________________ Verified by: _________________________


Water Quality Monitoring



Food Control






Port Health

8 EH International conveyance arrivals at first point of entry

9 EH International conveyance inspected at first point of entry

10 EH International imported consignment arrivals at point of entry

11 EH International imported consignment inspected

Surveillance of Premises



Waste Management


4 EH Health care waster generator complaint

4.4 Emergency Medical Services Program (EMS)

4.4.1 EMS Data Elements (extracted from DHIS Jan 2012)

Nr Data Element Name Definition Use and context IndGroup Frequency Collected

By Collection

Points Tools

1 EMS call client transported

Number of calls which resulted in any number of clients being transported

Monitors calls which resulted in clients being transported in relation to total calls for which ambulances were dispatched

EMS Monthly EMS Call Centre

EMS Call Centre

Tick Register EMS

2 EMS calls total Number of calls received by the communications centre

Only count calls for which an ambulance was requested


EMS Call Centre

Tick Register EMS

3 EMS inter-facility transfer

Number of clients transferred between health facilities by an ambulance (from one inpatient facility to another inpatient facility)

Monitors use of ambulances for inter-facility transfers


EMS Call Centre

Tick Register EMS

4 EMS obstetric client Number of maternity/obstetric clients transported to a health facility

Monitors use of ambulances for transporting maternity/obstetric clients. Include clients transported in Obstetric Emergency Units and those transported in other operational ambulances


EMS Call Centre

Tick Register EMS

5 EMS operational ambulances

Actual number of operational ambulances at an ambulance station during the shift

Monitors compliance with norm for operational ambulances. Exclude Obstetric Emergency Units


EMS Call Centre

Tick Register EMS

6 EMS operational Obstetric Emergency Units

Number of operational Obstetric Emergency Units at an ambulance station

Monitors compliance with norm for Obstetric Emergency Units


EMS Call Centre

Tick Register EMS

7 EMS P1 calls total Total number of P1 calls received by the communication centre

Sum of EMS P1 urban calls and EMS P1 rural calls

EMS Monthly N/A N/A DHIS calculate

8 EMS P1 response under 60 minutes total

Number of P1 calls where the response time was within 60 minutes in both urban and rural areas

Monitors effectiveness of EMS services. Response time is the time it takes an ambulance to reach an emergency medical scene, calculated from the time of the first call to the control room up to the time of arrival on the scene


EMS Call Centre

Tick Register EMS

9 EMS P1 rural calls Total number of P1 calls received from rural areas by the communication centre

Monitors P1 EMS needs in rural areas EMS Monthly EMS Call Centre

EMS Call Centre

Tick Register EMS

10 EMS P1 rural response under 40 minutes

The number of P1 calls in a rural area where the response time was under 40 minutes

Monitors effectiveness of EMS services in rural areas. Response time is the time it takes an ambulance to reach an emergency medical scene, calculated from the time of the first call to the control room up to the time of arrival on the scene


EMS Call Centre

Tick Register EMS


Page 60 of 69



Nr Data Element Name Definition Use and context IndGroup Frequency Collected

By Collection

Points Tools

11 EMS P1 urban calls Total number of P1 calls received from urban areas by the communication centre

Monitors P1 EMS needs in urban areas EMS Monthly EMS Call Centre

EMS Call Centre

Tick Register EMS

12 EMS P1 urban response under 15 minutes

The number of P1 calls in an urban area where the response time was under 15 minutes

Monitors effectiveness of EMS services in urban areas. Response time is the time it takes an ambulance to reach an emergency medical scene, calculated from the time of the first call to the control room up to the time of arrival on the scene


EMS Call Centre

Tick Register EMS

13 EMS clients total Total number of clients transported by an ambulance during reporting period

Total number of emergency clients (all priorities) transported by ambulance, irrespective of the number of calls or trips


EMS Call Centre

Tick Register EMS


Page 61 of 69



4.4.2 EMS Indicators (extracted from DHIS Jan 2012)

Nr Indicator

Name Type

Annualised

Numerator Denominator Definition Use and context IndGroup

Freq Level Key

reports

1 EMS call transport rate

% 0 EMS call client transported

EMS calls total Proportion EMS calls which resulted in clients being transported

Monitors the proportion of calls which resulted in clients actually being transported to health facilities in relation to the total number of calls dispatched by the Communications Centre

EMS Monthly Output

2 EMS inter-facility transfer rate

% 0 EMS inter-facility transfer

EMS clients total

Inter-facility (from one inpatient facility to another inpatient facility) transfers as proportion of total EMS clients transported

Monitors use of ambulances for inter-facility transfers as opposed to emergency responses

EMS Monthly Output

3 EMS obstetric client transport rate

% 0 EMS obstetric client

EMS clients total Obstetric clients as proportion of total EMS clients transported

Monitors need for and use of ambulances for obstetric clients. Includes obstetric clients transported in obstetric and other operational ambulances

EMS Monthly Output

4

EMS operational ambulance coverage (annualised)

per10K


Population total Number of operational ambulances per 10 000 population

Monitors compliance with the norm for operational ambulances to meet population needs. This includes obstetric ambulances

EMS Monthly Input

5

EMS operational Obstetric Emergency Unit coverage

% 0

EMS operational Obstetric Emergency Units

Population total

The number of operational obstetric units available for transporting obstetric cases per 10,000 population

Count only operational obstetric units. Exclude normal operational ambulances

EMS Monthly Input

6 EMS P1 call response under 60 minutes rate

% 0 EMS P1 response under 60 minutes

EMS P1 calls total

Proportion of all P1 calls with response times under 60 minutes

Monitors compliance with the norm for all critically ill or injured clients to receive EMS within 60 minutes. This includes P1 urban responses under 15 minutes and P1 rural calls under 40 minutes. Low rates indicate inadequate resources

EMS Monthly Output

7 EMS P1 rural response under 40 minutes rate

% 0 EMS P1 rural response under 40 minutes

EMS P1 rural calls

Proportion P1 calls in rural locations with response times under 40 minutes

Monitors compliance with the norm for critically ill or injured clients to receive EMS within 40 minutes in rural areas

EMS Monthly Output

8 EMS P1 urban response under 15 minutes rate

% 0 EMS P1 urban response under 15 minutes

EMS P1 urban calls

Proportion P1 calls in urban locations with response times under 15 minutes

Monitors compliance with the norm for critically ill or injured clients to receive EMS within 15 minutes in urban areas

EMS Monthly Output

4.4.3 EMS Data Tools

4.4.3.1 EMS Individual patient record / data collection tool


Page 63 of 69



4.4.3.2 EMS Tick Sheet / Register

Date Name / number Sex Age

EM

S c

all

clie

nt tr

ansport

ed

EM

S c

alls

tota

l

EM

S in

ter-

facility

tra

nsfe

r

EM

S o

bste

tric

clie

nt

EM

S o

pera

tional a

mbula

nces

EM

S o

pera

tional O

bste

tric

Em

erg

ency U

nits

EM

S P

1 c

alls

tota

l

EM

S P

1 r

esponse u

nder

60 m

inute

s tota

l

EM

S P

1 r

ura

l calls

EM

S P

1 r

ura

l response u

nder

40 m

inute

s

EM

S P

1 u

rban c

alls

EM

S P

1 u

rban r

esponse u

nder

15 m

inute

s

EM

S c

lients

tota

l

RUNNING TOTAL

TOTAL

MonthStation Name


Page 64 of 69



4.4.3.3 EMS DHIS Monthly Data Input form (DHIS auto-generated)

EMS Station Month

Completer by Date

Verified by Date

Checked by (Station Manager) Date

Captured by Date

SortOrder DataElement Value Comment

1 EMS call client transported

2 EMS calls total

3 EMS inter-facility transfer

4 EMS obstetric client


6 EMS operational Obstetric Emergency Units

7 EMS P1 calls total

8 EMS P1 response under 60 minutes total

9 EMS P1 rural calls

10 EMS P1 rural response under 40 minutes

11 EMS P1 urban calls

12 EMS P1 urban response under 15 minutes

13 EMS clients total


Page 65 of 69



4.5 Maintain the Organisational Hierarchy of NON-FACILITY DHIS data files

The provincial and district Information officers are responsible for managing the Organisational Hierarchy in the DHIS data files.

4.5.1 Organisational Hierarchy Integrated School Health Program (ISHP) data file

ISHP data is captured by School at OrgUnit 5 level

If a School is captured where the name is not on the DHIS list, the Information Officer must contact the Department of Education.

4.5.2 Organisational Hierarchy Environmental Health (EH) data file

EH data is captured at OrgUnit 5 level.

4.5.3 Organisational Hierarchy Emergency Medical Services (EMS) data file/set

EMS data is captured at OrgUnit 5 level

4.5.4 Organisational Hierarchy – Ward Based Outreach Team (WBOT) data file

PHC Outreach Teams have to use a more complex Organisational Hierarchy for reporting than normal health facilities for at least two reasons:

1. The routinely collected data must relate to the community, which in this case means each of the

current political wards in the country.

2. The same data and the teams must also relate to the “parent facility” of each team, both because

the outreach teams are managed via these facilities and because the households and individuals

covered receive health services from these facilities.


Page 66 of 69



OrgUnit Level

Description

OrgUnit

1-5

These Organisational Unit levels are the standard ones used for normal monthly and quarterly reporting from health facilities: National (OU 1), Province (OU 2), Health District (OU 3), Health Sub-district (OU 4), and Health Facility (OU 5). The naming convention for these OU1-OU5 OrgUnits is the same as for all other DHIS data files containing facility data.

OrgUnit 6

The currently (2012) 4,277 political wards in the country form the Organisational Units at level 6. Each ward must be linked to a “parent” PHC health facility within the same health sub-district, preferablye the health facility that provide the bulk of health services to the population in the ward. The closest or largest fixed PHC health facility in the within or in the vicinity of each ward has initially been allocated as the parent facility for each ward in the DHIS. Local managers must review this initial allocation and move the ward to a more suitable “parent” PHC facility where required.

The naming convention for political wards follows the format

<Prov Prefix> <Health sub-District Name> <Ward><Ward Number “0xx”>

Examples: Ward 7 in the City of Johannesburg is “gp City of Johannesburg Ward 007” and ward 112 is “gp City of Johannesburg Ward 112” (always use 3 characters for the ward number).

OrgUnit

7

The activities of each outreach team active in a ward forms the reporting unit at level 7. Note that one reporting unit is only directly equivalent to one outreach team if that outreach team work only in one ward. It is important to understand that

There might be several outreach teams working in the larger wards (i.e. several reporting

units)

One outreach team might work in several (usually smaller) wards (i.e. several reporting units)

While not recommended, there might be cases where an Outreach Team linked to a health

facility in health sub-district A assist with the work in a ward in the neighbouring sub-district B.

Such reporting units must reside under that ward in sub-district B. In the highly unlikely event

that one team is operating in two wards from different sub-districts with the same ward

number, then name those reporting units by adding an “a” or “b” at the end of the name.

The primary analysis of Ward Based Outreach Team activities and health data will be per ward and then geographically aggregated to sub-district, district, province, and national. The DHIS has nevertheless also been configured to enable aggregation of data via the “parent” facility of each outreach team, since that often will be relevant for monitoring the Ward Based Outreach Team roll-out across the country.

The naming convention for Ward Based Outreach Team reporting units follows the format

<Prov Prefix> <Parent Health Facility> <- W><Ward Number “0xx”>

Example: The first Outreach Team at the Stanza Bopape II Clinic in the City of Tshwane are working in Ward 20, 27, and 97, whereas the second team is working in Ward 98. Four reporting units are created:

gp Stanza Bopape II Clinic Outreach Team 1 - W020, child OU under Tshwane Ward 020




It is important that all reporting units under a specific facility have identical names except for the team and ward numbers, since that part of the name will be used to group reporting units in accordance with the PHC facility that the teams are operating from.


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4.5.4.1 Managing and Expanding the WBOT Organisational Hierarchy

When establishing Ward Based Outreach Teams, district and sub-district management teams should consider several aspects that will make long term data management easier:

Each ward should have as many Outreach Teams as required by the current number of

households, and preferably not more – avoid dividing up a ward among many teams if possible,

and even if such fragmentation might have a few logistical/transport benefits.

Avoid cross-sub-district-border Outreach Teams if possible.

Temporary allocations of Outreach Teams to wards might be particularly tempting during the

initial build-up of the Ward Based Outreach Team structure, but should be avoided if possible.

Significant shifts over time in which teams work where, will either result in a significant number of

closed reporting units with data for only a few months or years, or calls for moving data between

teams (mergers etc).

Ensure that all new Outreach Teams being established are clearly defined in terms of (a) the ward

or wards they will work in and how many households allocated to each team; (b) the “parent” PHC

facility they are attached to; and (c) any other semi-permanent data about the team required for

processing indicators or monitoring the roll-out.

4.5.4.2 Updating the Primary Health Facility “Parent” for each Political Ward

All districts and sub-districts must as soon as possible review the preliminary allocation of political wards to their “primary PHC service provider” facility done by the National Department of Health. This preliminary allocation was based on the following (except for a few cases where Outreach Teams had been established already):

If one or more fixed PHC facilities were located within the borders of the ward, the largest such

facility was selected as the “parent” health facility for that ward.

If there were no fixed PHC facility within the ward, then select the largest and/or “dominant” fixed

PHC facility located in any of the surrounding wards.

In order to correct this child-parent relationship between the ward and its primary service provider in the DHIS, go to Maintenance and then Organisational Hierarchy. Select the relevant ward, and use the MOVE function to place it under the correct health facility within the geographically correct health sub-district.

Note again that allocating wards to health facilities in other sub-districts are prohibited. Even if one or more wards end up being serviced by Outreach Teams from neighbouring sub-districts, and even if the population in that/those wards predominantly used health facilities from neighbouring sub-districts – such wards must use a health facility located in the correct sub-district as a “parent”.

Political wards are in general demarcated by the Municipal Demarcation Board, with revisions before every local election. Modifications to the WBOT data file related to such national revisions from the Municipal Demarcation Board will be co-ordinated by the National Department of Health.

In the exceptional event that wards are created or modified in between these election cycles, the District Manager is responsible for ensuring that the WBOT reporting and the DHIS OrgHierarchy is updated accordingly and that the province and national are informed.

The primary PHC health facility “parent” for a ward might change over time, for instance due to the sub-district re-organising its services or due to a new health facility opening. If that is the case, simply MOVE the relevant ward to its new facility “parent”, and all existing data will be moved along with it.


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4.5.4.3 Adding or Modifying Ward Based Outreach Team Reporting Units

The DHIS WBOT data file will be disseminated with a few hundred Outreach Team reporting units included, and some of these might be incorrect in terms of the ward or in terms of which facility the team is related to. Verify the level 7 reporting units for your area before you start capturing data.

The number of teams is expected to expand rapidly over the next 2-3 years, with an expected total of around 6,500 teams active when the re-engineered PHC system is fully operational. This means on average around 1.5 teams for each political ward.

When a new team has been established or started in a ward, then create a new reporting unit at level 7 under that ward, naming it as described above (fixed PHC facility name + team number under that facility + ward number):

Add the new Reporting Unit to the DHIS under Maintenance -> Organisational Hierarchy, set the

correct start data (note: always use the first day of the start-up month), and tick the “Submit data”

tick-box. Follow the established naming convention also for the short version of the name. If

“standard” short names end up being over 25 characters when the “Outreach Team X” and

“W0xx” are added, then use common sense to shorten the first “facility” part of the name and

make sure all reporting units linked to that facility have short names constructed in an identical

manner.

Add the Reporting Unit’s Organisational Code if available from the district management team

Use “Ward Based Outreach Team” for OrgUnitType

Use “Province Outreach Team” or “Municipality Outreach Team” or “NGO Outreach Team” for

OrgUnitOwnerShip

Use “Rural” or “Urban” or “Peri-Urban” for OrgUnitRuralUrban

A Ward Based Outreach Team reporting unit and its data are primarily linked to the ward, so the normal response to a specific team ceasing activity in a ward would be to CLOSE that reporting unit. Remember then that the closing date should be the last day of the last reporting month, and that the “Submits data” tick-box should be un-ticked.

When a specific team changes the PHC facility it is affiliated with, but otherwise continue its activities in the same ward as before, then each of the relevant WBOT reporting units should be RENAMED so the reporting unit names reflect its affiliated PHC facility name.

4.5.5 The PHC WBOT Household Profile Data File

A separate DHIS data file has been created to capture and store the data from the Household Profile/Registration forms collected during the initial visit to each household, and possibly later updated.

As the Organisational Hierarchy is the main WBOT data file is updated and maintained as outlined above, the same changes should be done to the Household Profile data file (which runs under the DHIS Patient Module).

The PHC WBOT Household Profile Data File will be rolled out for implementation at a later stage


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4.5.6 Adding Local Data Elements and Indicators

For the large majority of Ward Based Outreach Teams that work according to the national guidelines for such teams, adding local data elements or indicators are strongly discouraged during the initial roll-out of the WBOT system.

In districts or areas that have opted for an expanded mandate that includes additional services during household visits, it might be necessary to add local data elements and indicators. This should be done as follows:

Add the additional data elements and indicators as required (see other sections of the SOP and

the DHIS user manual for how to do this)

Create a new local data set that contain all national data elements plus the local ones – do not

modify the national WBOT data set.

Clarify with the district and with the province if they want such local data elements / data

submitted. If yes, use the extended “WBOT Local” data set for export. If no, use the standard

WBOT data set for export to higher levels.

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