An Assignment on Quality Assurance and Health Service Management in Nepal

SUBMITTED TO:

Asst. Prof. Binjwala Shrestha Department of Community Medicine and Family Health

Maharajgunj, Kathmandu

SUBMITTED BY: Sanjay Kumar Shah Roll no 322

Sareeta Duwal Roll no 323 BPH,21st Batch

IOM, Maharajgunj Medical Campus Maharajgujnj, Kathmandu

Discuss the importance of health management information system and

monitoring the quality of care. Give appropriate examples.

“The quality of technical care consists in the application of medical science and technology

in a way that maximizes its benefits to health without correspondingly increasing its risks.

The degree of quality is, therefore, the extents to which the care provided is expected to

achieve the most favorable balance of risks and benefits.”

Avedis Donabedian, M.D., 1982

The quality of health care is defined as “Health care services that produce desired health

outcomes and fulfill consumer’s needs, with optimum use of available resources, provided

by trained and competent providers as per the national norms and standards with

minimizing the risk for service providers as well as consumers.

Quality health care is about delivering the best possible care and achieving the best

possible outcomes for people every time they deal with the health care system or use its

services. Essentially, it means doing the best possible job with the resources available.

Monitoring is a process of collecting, analyzing, evaluating and disseminating the results

of medical procedures to improve health care outcomes or results through a collaborative

effort by all players of the health care system. Monitoring system consists of the regular

collection and analysis of a core set of indicators. Its purpose is to provide data to assess a

situation, make decision to improve it and monitor the progress.

There are various types of tools for monitoring the health care system among them Health

Management Information System (HMIS) is a major tool for measuring the quality of care.

Health information is an integrated part of the national health system. It is a basic tool of

management and a key input for the progress of any society. with the restructure of

Ministry of Health and Population (MoHP) and reinstate of Department of Health Services

(DoHS) during the fiscal year 1993/1994 , a central Management Information System

(MIS) was established in order to develop integrated Health Management Information

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System(HMIS) at all levels for better co-ordination, planning, monitoring, evaluation of

the ongoing programs integrated at various level.

Health information system is defined as “a mechanism for the collection, processing,

analysis and transmission of information required for organizing and operating health

services, and also for research and training.”

The primary objective of a health information system is to provide reliable, relevant, up-to-

date, adequate, timely and reasonably complete information for health managers at all

levels (i.e. central, intermediate and local) and at the sharing of technical and scientific

information by all health personnel. At the same time, provide data at periodic intervals,

showing general performance of the health services, and to assist planners. Besides these,

to provide information that can be used to monitor and improve the quality of care is an

important objective of HMIS. The importance of HMIS in monitoring the quality of care

can be highlighted by the following points:

HMIS is designed to provide information on service related indicators such as facility

utilization rate, referrals, immunization, maternal care, family planning and many more.

These information facilitates the analysis of quality of care at grassroots health service

delivery points of SHP, HP, PHCC, Hospital, through DHO/DPHO.

It also facilitates the monitoring of programs performance by providing the periodical

feedback in term of achievement, coverage, continuity and quality of services through co-

ordination with program divisions/canters, managers and service providers.

It provides the information that can be used to improve quality of health services and

management capacity to all level of health institutions by quarterly feedback.

Information of HMIS is used to prepare Annual Report of DoHS to disseminate the

information for users as well as providers.

Its information assist in the identification of specific regional and district on general health

service component gaps that need supervision and correction.

It also avails necessary information to policy makers for developing appropriate health

policy guidelines, standards and protocols for improving quality of care at various levels in

various services.

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It also provides gender specific information, which can be used to plan the most effective

delivery of health services also on equity basis.

It also facilitates the linking of data/ information to all centers and division for timely use.

Besides, the information are collected to support the Planning, Monitoring and Evaluation

(PME) cycle of all health programs in each health institutions.

The quality of immunization programme can be assessed by immunization coverage, drop out

and vaccine wastage rate. There are different recording and reporting tools which helps to

monitor quality of immunization programme. On the basis of HMIS data, National Immunization

Programme monitors the coverage, drop out, AEFI (Adverse Effect Following Immunization)

and vaccine wastage rate against pentavalent and measles at all levels and sends its feedback to

the area of concern. Thus the information received through HMIS are analyzed at different levels

and used for corrective action. Use of immunization monitoring chart and monthly monitoring

profile of HMIS helps to monitor quality of care in National Immunization Programme and also

helps to take corrective action in order to improve quality.

Similarly, the quality of antenatal care (ANC) can be assessed by the type of provider, the

number of ANC visits and the timing of the first visit. Antenatal care can also be monitored

through the content of services received and the kind of information given to the mothers during

their visit. The information about number of visits and timing of the first visit are obtained from

HMIS. The information provided by HMIS is useful to monitor the quality of care in ANC.

Increase in first and fourth ANC visit says that there is improvement in quality of care in ANC

service which is monitored through HMIS in Nepal. Increase or decrease in utilization of

available service is directly related with quality of care such as institutional delivery, average

length of hospital stay; bed occupancy rate, etc are monitored through HMIS.

HMIS is one of the most cost-effective tools for monitoring quality of care. HMIS helps to

monitor quality of care at different levels and of different health institutions such as hospitals,

PHCC, HP and SHP and used for corrective action. From the above discussion it is concluded

that HMIS is very important in monitoring the quality of care and is an integral part of health

service management in Nepal.

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