Each country will have its own system of collecting routine health information and reporting it from the periphery to the centre. District health workers need to be familiar with this system and to appreciate what is required to make it work efficiently. An outline of such a system is shown in Figure 5.1.
Information is collected when people visit the health facilities and the data are written down or recorded in various ways. The collected data are then analysed and included in reports, which may be communicated by the DHMT to health workers and to other district organizations. The national ministry of health is responsible for collating the information for the whole country.
Unfortunately the health information systems in many countries are frequently characterized by elaborate forms filled in by clerical workers in outpatient clinics and hospitals and sent for analysis at central headquarters. This analysis is often carried out many months or even years later, with no feedback to those collecting the original data. The result is data that are of limited value to the DHMT.
For the most part, district staff may have little say in the number or format of the forms to be used, but they can influence how well they are used. It is important to keep in mind that information is needed by virtually everyone involved in health and that the efficient and timely communication of that information is essential. Properly designed forms are necessary to accomplish this.
Figure 5.1. Routine district health information or surveillance system
For the primary health care level, emphasis should be on collecting the minimum amount of necessary data in the simplest possible way. An important principle is that any data recorded by health workers should be useful to the workers themselves and to their supervisors in their duties. The major purpose of collecting such information should be to support the management and evaluation of the health activities being carried out at the worker's level. The DHMT is in a good position to make the best use of this health information system and to keep these principles in mind.
Controlling the quality of the collected data is of vital importance and checks will have to be made to ensure compliance with the methods laid down. One way to do this is to make certain that the forms are directly useful to the health workers and supervisors in planning and evaluating their own district health services and programmes.
Districts may participate in and use national reporting and surveillance systems, but they may also need to set up their own local system. It is important to realize that for a system to be useful it does not have to detect all cases. Good estimates of incidence can be invaluable for planning and evaluating health programmes and, provided the proportion of cases detected remains reasonably constant, trends over time can be forecast. Incomplete data are certainly much better than none, provided that the problems and defects in the data are understood. This is well illustrated by the number of poliomyelitis cases detected in Brazil before and after the onset of a polio immunization campaign (see Figure 5.2). Even though all cases were not detected the trend suggests very strongly that the incidence of poliomyelitis has been markedly reduced since the start of the campaigns.
Figure 5.2. Decline in the incidence of paralytic poliomyelitis in Brazil following mass immunization campaigns