1 Women’ and Children’s Health Information Communication & … · Global Strategy for Women’...
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Global Strategy for
Women’ and
Children’s Health
Information
Communication &
Technology
CAMBODIA
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Accountability Workshop 2012, Manila, Philippines 19-21 March 2012
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The country Team: 1. Dr. Lo Veasnakiry, Department of Planning & Health Information, MoH 2. Mr.Hor Darith, National Institute of Statistics, MoP 3. Dr. Lam Phyrun, National Maternal & Child Health Center, MoH 4. Mr. Ros Chhun Eang, Health Economics & Financing, DPHI, MoH 5. Dr. Howard Sobel, WHO Advisor, Country office
These represent the views of individuals participating in the workshop and they do not represent the official decisions or outcomes of a country or government. Very limited or no editing has been done yet to retain the original inputs of participants.
Global Strategy for
Women’ and
Children’s Health
Areas for Action at Country level:
Cambodia up-to-date
• Country Accountability
Framework
(Commission recommendations 1-
6)
• Better Monitoring
(Commission recommendations 1-
6)
• Review and Action
(Commission recommendations 5-
7)
Global Action: Recommendation 8, 9
& 10.
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Global Strategy for Women’ and
Children’s Health
Better information for better results: Recommendation
1-3
Recommendation 1-Vital events and HIS by 2015
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Key Milestones Current Status Gaps
Conducted General
population census
Every 5 year: 2003, 2008 with
Inter-population census
Conducted Maternal &
Child Health Survey
Related survey conducted,
namely CDHC 2000, 2005,
2010
Conducted National Health
Accounts
No, but CSES, produced
Health Account(NIS)
NHA not yet established
Annual Health Statistics
Report with district online
Produced on annual basis
since 1995, but stating online
in 2011.
Use for annual performance
review
• Capacity to analyze , and
use for planning at
operational level
Coverage of birth
registration (>80%)
Current coverage 92% of the
total population. 62.1% of <5
(CDHS2010)
Annually,100,000-200,000
births registered within 30
days as mandated by sub-
degree, and up to 300,000 if
included over-30 day
registration.
• ITC: Heavily paper work at
sub-national level and
overloaded data entry at
Vital Statistics Department ,
MoI . Database is not
available at sub-national
level , esp. communes where
decentralized births /death
registration is done.
• No causes of death
specified Coverage of death
registration (>50%)
Annually estimated 50% [?}
deaths registered
Global Strategy for Women’ and
Children’s Health
Recommendation 2:11 Indicators of maternal, newborn
and child health by 2012
Key milestones Current Status
One set of 3 selected indicators to monitor women’ s
and children’s health:
2000 2005 2010 CMDDs 2015
• MMR per 100,000 live births 437 472 206 250 CDH
S
• U5 Child [Infant ] Mortality per 1,000 live births 124 [95] 83[66] 54[45] 50[60] CDH
S
• Stunting [wasting] (among children <5) 49.8
[16.8]
42.7
[8.4]
39.9
[10.9]
CDH
S
A tracer of 8 coverage indicators: 2007 2008 2009 2010 2011
• Contraceptive Prevalence Rate (modern method) 24 26 28 30 29.0
7
HIS
• % of pregnant women received ANC 2 68 85 83 72 86.2
4
HIS
• % of pregnant women with HIV+ received ARV (for
PMTCT)
n.a. 27 32.2 57.3 60.6 HIS
• % of birth delivery assisted by trained health
personnel
46 58 63 69.2 71.6
6
HIS
• % of mothers received postnatal care 38 41 47 58 60.5 HIS
• % infant aged 0-5 months exclusively breastfed 11.4 60 73.5 CDH
S
• DPT-Heb3 92 95 92 94 HIS
• % of children aged 0-59 months with suspected
pneumonia receiving Antibiotics
others CDH
S
Gaps from epidemiological view point; significant progress, but high MMR and Child mortality if compared to average MMR
and U5 mortality in Western Pacific Region. High level of under-nutrition. Indicators are disaggregated for genders, socio -
economic characteristics, including geographical .
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Global Strategy for Women’ and
Children’s Health
Recommendation 3: Integrated the use of info. and ICT in national HIS
and health infrastructure by 2015
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Key Milestones Current Status Gaps
Launched web-HIS in 2011 • Nation-wide coverage www.hiscambodia.org.gov
• Functional integrated system: Public health facilities
(monthly aggregated data, Private and NGO health
facilities , Maternal Death Surveillance Record,
PMTCT/LR and HIV/AIDS program and others
Denominator
tracking and
consistency
Launched maternal death
surveillance database in
2010
• Functioning and integrated with web-based HIS in 2011
• Reported in JAPR report of 2010, 2011
• Maternal Death Audit: MDA Committee at national,
provincial, district level
• Planned for Maternal death notification campaign
through toll free, airing, TV
Missing maternal
deaths occurred in
community , not
maternal death
cause identified in
death registration
yet
Other existing
• Training database
• Health personnel
database
• Drug management
database
• Disease-specific
database
• NGOs-database
Moved to web-based in 2011
Functioning
Nation-wide functioning
National programs
Medicam (NGOs)
On-going initiatives
web-based Health
Coverage Plan database
linked to GIS (health facility
location, catchment area/
population , staffing,
availability of services,.
• Completed database development and still data entry, plan for pre-test
soon
• To train Operational Districts’ and Provincial Health field test Departments’
HIS staff
• To be launched in mid-2012
Social health protection
database
• Database developed : final review , Plan for pre-test and
train, use
Patients medical records
(electronic)
• Tested in one provincial hospital (by INGO/URC)
Global Strategy for Women’ and
Children’s Health
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Key Milestones Current Status Gaps
THE by financing sources, per
capita
US$48 (Gov’t 24%, DP 17%, OOP 59%)
Total RMNCH by financing
sources, per capita
Available in term of planned expenditure
captured in Health Sector AOP 2011:
G0v’t 35%, DPs 18%
Better tracking resources for women’s and children health’s :
Recommendation 4-6
Recommendation 4- tracking and reporting 2 aggregated resource indicators
by 2015
Recommendation 6- Country capacity to regular review health spending incl.
RMNCH by 2015
Key Milestones Current
Status
Gaps
Annual review on health spending (1) against priorities
budgeted -analysis THE, distribution across priority),
(2) equitable distribution and spending for
women/children health- disaggregated indicators,
financial burden and services utilization, (3) comparing
overall public health spending vs. results, prioritization
(effectiveness & efficiency).
n.a.
Recommendation 5- “Country Compact” in place for reporting on externally funded
expenditures and predictable commitments by 2015
Key Milestones Current Status Gaps
Joint Declaration ….. Signed by RGC and major DPs
• Structures and process established
• Tools
CDCF, TWGs (TWHG)
Online-Database, guidelines etc.
ITC tracking development
assistance?
Global Strategy for Women’ and
Children’s Health
1
Key Milestones Current Status
Health sector review process 33th NHC and 10th JAPR- 4 Program reviewed
Enhance capacity of financial
decision making
Budget negotiation with MoEF on annual basis
Meeting with NA Commission VIII including
Commission for Finance, at least 2 times/year.
High Political event focusing on
women’s and children’ health
National Midwifery Day
Better oversight of results and resources nationally &
globally:
Recommendation 7- National oversight– Established national
accountability mechanisms in all countries by 2012
Global Action:
Recommendation 8- transparency– publicly sharing information
on commitments, resources provided and results achieved
annually, at both national and int’l level by 2012 (Health outcomes
and resources spent on health available on public domain web site. )
Recommendation 9 (Independent Review ) and 10 (Global
Oversight)
Information Communication
& Technology
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Health Management Information System: Cambodia
up-to-date
Web-based Database HIMS
• Web based database is an interoperability and multiple
data sources
• An integrated system of relevant and functional information
on a routine basis; ensuring the quality of health data,
Strengthening the ability to analyze and use data and
informing decision-making.
• The system allows for collecting , collating , processing,
reporting, analyzing disseminating and using for
programming, planning monitoring and decision-making.
• ICT to improve data quality and timely reporting and
improved use of ICT for management of HIS: Health
Informatics (Public, Private and NGO, Electronic Health
Records, Interoperability, Access to Information- ICT as a
tool for the dissemination of information
Interoperability and multiple sources of data
HMIS Interoperability
MOH-HIS MCH-
HIS
MDSR
TB-HIS Others: QAO, HFAT, SOA
HIV/AIDS
SHP
MIS
Reporting
• Morbidity and mortality statistics
(OPD and IPD) in public, private
and NGO supported health
facilities (monthly aggregated data)
• Maternal Death Surveillance data
• PMTCT/LR and HIV/AIDS
program)
• Social Health Protection
• Population data including ID poor
• Others: health facility assessment
results
Register
s
Monthly Form
OPD
IPD
Maternity
Delivery
ANC
PNC
HIV/AIDs
TB
Village Data
HC1
HO2
OD
PHD
DPHI
PH
Partners
N.P
RH
HC HC HC
NGO
Pri.
NH DPHI/MOH
Server
N.P
N.P
Caminfo
ID-Poor
Data Flow Through HIS
1084
964
31
8
0 200 400 600 800 1000 1200
Public Health Facilities
Health Facilities with PMTCT
Private sites
NGO sites
Number of public health facility who submitted monthly reports in HMIS web
database As of September 2011
Data Quality
Check
67% 67% 67%
73%
81% 86%
0%
20%
40%
60%
80%
100%
2006 2007 2008 2010 Oct-10 2011
HMIS data quality index 2006-2011
Start HMIS web based Db
Communications E-Feedback
System • Phone call tracking
• E-Feedback system
in HMIS
• Update news in
HMIS
User Rate
0
20
40
60
80
100
120
140
User Daily Frequency Jan-Feb 2012
0
1000
2000
3000
4000
5000
6000
7000
HMIS Page Visit Daily Frequency Jan-Feb 2012
Top 10
Users
(public
facilities)
Data Use and
Analysis
User Rate
48.45 53.27 47.5861.94
48.631.18
47.41 45.92 50.16
29.58 33.67
54.8241.41
57.8642.23
33.93 39.74 47.7431.22
73.48 65.42 64.21
37.4
66.37
49.3455.78
49.16
59.54
47.31
35.3
49.7 48.1351.99
41.0544.71
53.54
50.21
56.05
54.71
41.4941.2
51.22
42.4
74.47
62.72 70.28
41.71
75.5
0
20
40
60
80
100
120
140
160
Bante
ay M
eanc
hey
Batta
mba
ng
Kampo
ng C
ham
Kampo
ng C
hhnan
g
Kampo
ng S
peu
Kampo
ng T
hom
Kampo
t
Kanda
l
Koh K
ong
Kratie
Mon
dul K
iri
Phnom
Pen
h
Preah
Vihea
r
Prey
Veng
Pursa
t
Rat
anak
Kiri
Siem
reap
Sihan
oukv
ille
Stung
Tre
ng
Svay
Rieng
Takeo
Odd
ar M
eanc
hey
Kep
Pailin
2010 2011
Delivery assisted by
trained health personnel
at health facility
National:
2010: 69.92%
2011: 71.66%
Top 10 main health problems reported
86746
84465
33555
31460
20055
18776
16377
11959
11737
11268
ARIs
Delivery
Tuberculosis
Diarrhea
All road traffic accidents(affectinghead excluded)
Other Injuries(mine & traffic acc.excluded)
Typhoid fever
Gynecological Pathology
High Blood Pressure
Road traffic accidents affectinghead
12
34
56
78
91
0
IPD main health problems in 2011
6293
2611
2435
2221
1909
1807
1792
1556
1037
744
Lower ARI
Diarrhea
Upper ARI
Cough > 14 days
High Blood Pressure
Other Injuries(Mines & trafficaccidents excl)
Mental Health
All Road traffic accidents(Headinjuries excluded)
Road traffic accidents affected head
Dysentery
12
34
56
78
91
0
OPD main health problems in 2011
Open Source
• Free licensee
• Power and control system
• Escape Vendor lock in (Users can customize)
• Greater security and quality
• Continuity-Source code available
• Patient registration database: – Open Source (PHP/MySQL)
– Standard platform
– Interoperability (more data sources)
– Unique ID as national scale
– Automatically report to HMIS
– National scale up (linked between hospital to hospital)
Technology
Information
Communication &
Technology
2
Health Management Information System: Cambodia
up-to-date Strengths
1. Degree of compliance with regard to
the two selected key indicators of
timeliness and completeness- 100%
timely reports
2. Overall increased capacity of HIS
staff at all level and maintain the
HMIS moving towards interoperability
system (integration).
3. Increased daily access and use of
health data with improved quality.
4. Increased mobile phone and internet
coverage
5. Strong supports from health
development partners at all levels.
Gaps/Weaknesses
1. Fragmented reporting systems due to
increasingly growing demand i.e.
diseases specific programs
2. Limited utilization of data at HC level
3. Data validation process /tools need
to be strengthened
4. Limited M-health technology , new
expertise of E-health in Cambodia
and lack of ICT skills at public health
sectors.
5. Lack of appropriate IT equipment and
materials at health facilities e.g health
center leading to heavy paper work.
Information Communication
& Technology
2
Health Management Information System: Cambodia
up-to-date
Priority activities Status
1. Vital Registration: (1) upgrade sub-degree on Civil registration to
become a law, (2) Develop Strategic Plan for Civil registration; (3)
further develop civil registration database and decentralize the system
operational to sub-national level .
planni
ng
2. Population based data collection e.g. survey, census
3. National Health Information :
3.1 Review & revised HSP2 M&E Framework,
3.2 Develop “ protocol for HMIS” ( use of national M&E framework,
access to web-based HIS, reporting and feedback, data quality
assessment),
3.3 Develop social health protection database
3.4 Health Account according to/depending on Public Financial
Management platform 2 of MoEF
On-
going
4. Capacity building requires for priority activity #1, #2 and #3, as well.
#3:
• DPHI (manage HMIS web based database, back-up data and
storage in a server at MoH/DPHI, maintain hospital patient
registration database )
• HIS staff as operational level (operational database system;
maintain, reporting & feedback, analysis, use,…..)
Planni
ng
On-
going
5. Increase investment : equipment and appropriate ICT On-
going