BY
Akumengwa Neba N(HS12 A001)
Department of Public Health and Hygiene
MPH 698
Supervisors: Dr. Nde Fon Peter.
Co-supervisor: Dr. Atashili Julius.
MPH Thesis Proposal: Assessment of
the Health Information System in the
Buea Health District
Academic Year 2013/2014
University of Buea, Cameroon1
Outline
Academic Year 2013/2014 University of Buea,
Cameroon2
Chapter I: Introduction
Background
Problem statement
Justification
Research Goal
General objective
Specific Objectives
Research questions
Research scope
Definition of terms and concepts
Chapter II: Literature Review
Chapter III: Methodology
Study design
Study area and settings
Study population and sampling
Sample Size
Inclusion criteria
Exclusion criteria
Study procedure
Data management and Data analysis
Ethical considerations
Study limitation
Timeline
Budget
Chapter I: Introduction
Academic Year 2013/2014 University of Buea,
Cameroon3
Background
Information is defined as a specific determinants
about entities such as facts, events, things,
persons, processes, ideas, or concepts1 and is
needed by people and patients, communities,
service providers, programme managers, policy-
makers, providers of funds, global agencies and
organizations.
Health information system according to
Lippeveld, et al (2000)2,11, is “a set of
components and procedures organized with the
objective of generating information which will
improve health care management decisions at all
levels of the health system”
Chapter I: Introduction
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Cameroon4
A WHO report (2012) 12, on the HIS assessment
of 61 countries scored Cameroons’ HIS at 45%
(present but not adequate) and recommended
more effort to be put in place towards
strengthening it.
Chapter I: Introduction
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Cameroon5
Problem statement
An observation made of data reported on
vaccination that was above the quantity of
supplied vaccine doses.
In addition, data about Cameroon on some
health indicators on the WHO database is often
missing.
There is also disaggregation of data
characterised by separate data collection and
reporting by parallel running programs
Assignment as a staff of health information
system is often considered a disciplinary by the
staff in Cameroon 8
Chapter I: Introduction
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Cameroon6
Justification
For better decision making and improved health
service delivery, there is the need for reliable,
complete, timely, accurate, adequate
information.(strong HIS)
Cameroon falls amongst the United Nations
Commission on Information and
Accountability(COIA) priority Countries that
needs focused support to improve its HIS and
its reporting on the MDGs
This study seeks to assess the adequacy in order
to improvement the HIS of Buea Health Districts.
Chapter I: Introduction
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Cameroon7
Research Goal
The goal of this study is to improve the health
information system in Buea Health District.
General objective
To establish the level of adequacy of the Health
Information System (HIS) in the Buea Health
District
Chapter I: Introduction
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Cameroon8
Specific Objectives
To determine the adequacy of components of the HIS
in Buea Health District.
To provide an overall state of adequacy of the entire
HIS
To identify the weaknesses that exist in the HIS of the
Buea Health District.
To outline priority areas for improvement of the HIS in
the Buea Health District.
Chapter I: Introduction
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Cameroon9
Research questions
How adequate are the various HIS components in the
Buea Health District?
What is the overall state of adequacy of the HIS in the
Buea Health District?
What are strengths and weaknesses of the HIS in
Buea Health District?
What are the priority areas for improvement on the
HIS of the Buea Health District?
Chapter I: Introduction
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Cameroon10
Research scope
We will focus on assessing components of health
information system (resources, indicators, data
sources, data management, information products,
dissemination and use) in the Buea Health District.
We will assess HIS components at the Regional,
Districts and health facilities and health related
organisations in the Buea District.
Chapter I: Introduction
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Cameroon11
Definition of terms and concepts
Information is defined as specific determination about
entities such as facts, events, things, persons, processes,
ideas, or concepts5
Information system is part of an institution that processes
and stores data, information, and knowledge.
It is defined as that socio-technical subsystem of an
institution, which comprises all information processing as
well as the associated human or technical actors in their
respective information processing roles 5.
According to Winter A, et al (2011)8, a health information
system (HIS) is an information processing and storing
subsystem of a health care organization, which may be a
single institution, for example, a hospital, or a group of
health care institutions like a health care network.
Chapter II: Literature Review
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Cameroon12
Importance of a Health Information System.
Components of a Health Information System.
Assessment of the Components of the Health
information System.
Chapter III: Methodology
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Cameroon13
Study design
A descriptive survey involving groups and key
informants directly involved with the HIS activities
health Organisations and NGOs.
Study area and settings
Buea Health District in the South West Region of
Cameroon.
Settings include: Regional Delegation of Public Health,
District Health Service , Public and Private Health facilities
(14 public and 10 private), NGOs.
Chapter III: Methodology
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Study population and sampling
Organisations/health facilities involve with HIS
activities in the Buea Health District
Purposive sampling (non-probabilistic sampling)
of Organisations involved with health information
systems activities in Buea.
A convenience sampling of Buea Health District
followed by the selection of all health facilities in
the district.
Chapter III: Methodology
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Cameroon15
Inclusion criteria
Organisations involved with HIS activities in the Buea
Health District.
Acceptance to participate in in-depth interview or
group interview by staff of the various
organizations/facilities selected.
Exclusion criteria
Organisations select with a non-functioning HIS unit.
Chapter III: Methodology
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Sample Size Calculation
Our sample, made up of all 0rganisations (Regional,
District and health facilities levels) in Buea Health
District.
Sample size calculated using Cochran14 formula for
proportions, followed by adjustment using the finite
population correction for proportions formula.
A sample frame of 27 organizations, with an expected
0.5 variability and a 0.05 precision at 95% confidence
interval will be considered.
Chapter III: Methodology
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Sample Size Calculation
Cochran14 formula for proportions
no= Z2pq/d2
Finite population correction for a proportion
n= no/1+ (n0-1/N)
N=27 (total population size)
Z=1.96 (assume normal distribution)
P= 0.5 (expected maximum variability)
d= 0.05 (precision for a 95% confidence interval)
n= 25.28 or 26 health organizations
Chapter III: Methodology
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Study procedure
Administrative approval from: FHS, Regional
Delegation of Public Health South West.
Key informants/groups identified and
appointments set at various study settings
During appointment groups or key informants will
be briefed on components of the HIS to be
assessed.
Version 4.00 of the HMN assessment tool will be
used to collect data on their responses about the
state of the various HIS components.
Chapter III: Methodology
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Data management and Data analysis
Data collected will be entered in to HMN Excel
Assessment Tool Version 4.00 for analysis.
Analysis will be done for each component of the
HIS, followed by and overall analysis of the entire
HIS.
Chapter III: Methodology
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Ethical considerations
Administrative approval to carry out studies will
be obtained from the Faculty of Health Sciences
as well as from each organization participating in
the study.
Respondents will be briefed on the purpose of
the survey, will have the option to participate and
to provide reliable and accurate information about
the HIS or not to participate
Chapter III: Methodology
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Study limitation
Non probabilistic sampling method
Some respondents may not provide honest
assessment of the state of components
Chapter III: Methodology
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Expected Outcome
The state of adequacy of the various components
and the entire HIS are the expected outcomes.
A classification of the HIS and its components either;
Highly adequate,
Adequate,
Present but not adequate,
Not adequate is expected.
Chapter III: Methodology
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Timeline
ACTIVITY MONTH April May June July August Septembe
r
Proposal writing
Identification of study
sites and application for
administrative approval,
setting appointments with
study population.
Data collection.
Analysis and reporting of
results.
Thesis defense
Chapter III: Methodology
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BudgetCategory Cost
Human resources
The principal investigator (PI) and an assistant are needed to meet the various study
participants to collect data. The PI also will input data into the excel version of assessment
tool for analysis.
(Motivation for assistant)
40 000frs
Material resources
Pens and pencils, assessment forms according to component assessed and level of
assessment.
4000frs
HMN Assessment Tool Version 4.00 (forms and excel version). These tools will be downloaded
from the WHO website.
Other web material. (Internet access)
5000frs
Communication 5000frs
Transportation to book appointment and actual interview. 60 000frs
Snacks for participants 40 000frs
Data analysis 0frs
Write-up, printing assembling of the necessary number of copies ( protocol and theses) 30 000frs
Miscellaneous 50000frs
Data analysis Tool
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Items
Highly
adequ
ate
Adequ
ate
Prese
nt but
not
adequ
ate
Not
adequ
ate at
allRation
ale/
comm
ents
Response from interviewees
Aver
age
3 2 1 0
Na
me
1
Na
me
2
Na
me
3
Na
me
4
Na
me
5
Na
me
6
Na
me
7
Na
me
8
Na
me
9
Na
me
10
Na
me
11
Na
me
12
Na
me
13
Na
me
14
I.A.1 The country has up-
to-date legislation
providing the
framework for health
information covering
the following specific
components: vital
registration;
notifiable diseases;
private sector data
including social
insurance;
confidentiality; and
fundamental
principles of official
statistics
Legisl
ation
coveri
ng all
aspect
s
exists
and is
enforc
ed
Legisl
ation
coveri
ng
some
aspect
s
exists
and is
enforc
ed
Legisl
ation
exists
but is
not
enforc
ed
There
is no
such
legisla
tion
Refrences
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1. World Health Organisation. Components of a strong health information system. A guide to the health metrics network framework. Geneva, World Health Organization: 2008
2. Health Metric Network. HMN: Issues in Health Information System. WHO. http://www.who.int/healthmetrics/library/ (accessed 19 February 2014).
3. Winter A. Haux R. Ammenwerth E. Brigl B. Hellrung N. Jahn F. Health Information Systems- Architectures And Strategies. Health informatics, e-ISBN 978-1-84996-441-8. 2. Ed .London: Springer-Verlag London Limited:2010. http://store.freecollege.org/noleech1.php (accessed 29 Jan 2014).
4. Health Metrics Network. Version 4.00. Framework and standards for country health information systems: Assessing national HIS information dissemination and use. Geneva, World Health Organization: 2008.
5. Stansfield S, Walsh J, Prata N, Evans T. Information to Improve Decision Making for Health.1,017-1,030.New York: Oxford University Press; 2006. Available from: www.dcp2.org (accessed from 15 February 2014)
8.WHO. Health Research Methodology: A guide for training in research methods. ISBN 92 9061 157 X. 2 ed. Manila: World Health Organization: 2001
11.WHO. HMN Assessing the National Health Information System, An Assessment Tool version 4.00. 2008. Availab le from: www.healthmetricsnetwork.org. (accessed from April 3rd 2014)
12. Lippeveld, Theo, R. Sauerborn, and C. Bodart. Design and Implementation of Health Information Systems. Health Information System Module. Geneva: WHO. 2000.