Health watch framework (HWF): how effectively it is being implemented and how useful it is for monitoring and utilisation of routine health information system (HIS) data at facility, sub district and district level?
Date of Award
Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)
Community Health Sciences
Title Health Watch Framework (HWF): How effectively it is being implemented and how useful it is for monitoring and utilization of routine HIS data at facility, sub district and district level? Background Health Information Systems (HIS) are increasingly important to accurately measure and improve the quality and coverage of services for better health outcomes of the population. In Pakistan, though large amount of data are collected through facility based routine HIS i.e. first level care facility Health Management Information System (FLCF-HMIS), but poorly utilized. HWF is a process that is developed and implemented by PRIDE (Primary health acre revitalization, integration and decentralization in earth quake affected areas) project. The HWF tools are being used in peripheral health care facilities (BHUs, RHCs, Civil hospitals) in district Mansehra to improve information utilisation. All the facility data through FLCF-HMIS and MISs of vertical programs including Lady Health Workers' Program are used by HWF for evidence based decision making. The HWF requires users to display data as charts in health facilities. The aim of HWF is to monitor the progress on priority health problems and related health services at different level using existing data. Objectives 1. To determine proportion of health facilities implementing HWF effectively in district Mansehra for the second quarter (April-June) of 2009. 2. To explore perceptions of facilities staff, district health and PRIDE managers about usefulness of HWF for monitoring and improving service delivery at the facility and sub district level. 3. To find out the views of district health and PRIDE managers to effectively implement, upscale and sustain the use of HWF. Method We used mixed method, concurrent triangulation design to study HWF in tehsil Mansehra, NWFP. The data collection methods included in-depth interviews with the government staff (health facilities staff and district managers) and PRIDE managers. Moreover, observations were also made using a checklist. Ethical approval was obtained from Ethical Review Committee of the Aga Khan University (ERC-AKU). For qualitative component, we employed purposive sampling technique to recruit participants, while for quantitative component census of all facilities in tehsil Mansehra was done. The study period was July-September, 2009. Results The study revealed that HWF was available in 19 (70.4%) health facilities. None of the facilities could fulfill all criteria set for effective implementation. However, HWF was available and updated on monthly basis in seven 7(36.84%) health facilities. Three health facilities had mechanisms for monthly updating and quarterly totals. All the stakeholders interviewed considered HWF, as a very useful tool for monitoring and supervision and data utilisation. The major constraints identified in the utilisation of HWF data and it implementation were lack of resources, increased workload, decreased coordination among the staff and poor support and feedback from district managers. The PRIDE managers while pushing the HWF agenda and working hard for its success, but the buy in and involvement of district government was at a much lower level. The facility staff thought HWF as a useful tool and worked on it despite the government's lack of ownership. The district and PRIDE managers were sure of its sustainability and strongly recommended its replication. Conclusion HWF is effective tool for monitoring, supervision and data utilisation. Though, facility staff found HWF useful, measures should be taken to address the issues at facility level and to involve district health management in HWF processes to ensure its success and sustainability.
Khan, U. (2009). Health watch framework (HWF): how effectively it is being implemented and how useful it is for monitoring and utilisation of routine health information system (HIS) data at facility, sub district and district level? (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.