I wish you success in the course and I hope you will find it both interesting and useful.

CHAPTER ONE UNIT 1

GLOBAL PERSPECTIVE AND HISTORY OF HEATH MANAGEMENT
INFORMATION SYSTEM –FROM THEN TO NOW
1.0 Introduction
Today, longitudinal patient records that capture a patient‘s medical information from a variety of
physicians, labs, clinics, hospitals and treatment sites not only provides a holistic view of the
patient‘s health history, but also provides a wealth of information that can be used to improve
care and outcomes.

Health information management is defined as the collection and analysis of healthcare data to
provide information for health care decisions involving patient care, institutional management,
health care policies, planning and research. The name of the function changed from medical
records management to health information management as enhancements in technology
expanded responsibilities from managing paper records to managing the full scope of the process
of collecting and sharing electronically-captured information among disparate entities.

The history of health information management begins with the simplest form of recording a
patient‘s symptoms, complaints and treatment for the use of one provider, to a comprehensive
aggregation, integration and harmonization of data to support collaboration among providers,
researchers and administrators.

2.0 Objectives of the units are to:- ‘

1. Discuss the Beginning from Health Record to Health Management Information

2. Explain how HMIS emerge from health record
3. Discuss global perspective of HMIS from 1900 to 2015
4. The Organization of Patient Information
5. From hardware to software

3.0 Main content

The Beginning from Health Record To Health Management Information
The First Medical Records
The earliest forms of medical records were narratives written by ancient Greeks to document
successful cures, share observations about symptoms and outcomes, and teach others who
provided medical advice through these case studies. While written reports describing patients‘
complaints and diagnoses predate the records of Simon Forman and Richard Napier – astrologers
who documented clients‘ medical questions and treatment – their records from 1596 to 1634
form the earliest complete collection of medical records in existence.

1900s; - The History of Health Information Management

Health information management is the process of acquiring, analyzing, and protecting medical
information (commonly called medical records) on patients each time they are seen by a
healthcare provider.

19

Ankucite Resources
In the early 1900s, very little patient information was recorded. Toward the end of the second
decade, healthcare professionals realized that their patients would benefit by keeping more
accurate records, as well as obtaining a complete medical history of their patients. Prior to the
computer age, maintaining health information was very labor intensive. All medical information
was prepared and stored manually. Imagine the paper used and hours of work involved to store
and maintain all of this information. What‘s more, it was quite difficult to retrieve past medical
information quickly, and accuracy and timeliness was a continual problem. Ultimately, patient
care suffered. Eventually all of the medical information that had been stored manually had to be
transferred to an electronic format, a new era in healthcare management information began.

The 1920s and health records

The HIM industry can trace its roots back to the 1920s, when healthcare professionals realized
that documenting patient care benefited both providers and patients. Patient records established
the details, complications and outcomes of patient care. Documentation became wildly popular
and was used throughout the nation after healthcare providers realized that they were better able
to treat patients with complete and accurate medical history. Health records were soon
recognized as being critical to the safety and quality of the patient experience. The ACOS
standardized these clinical records by establishing the American Association of Record
Librarians, a professional association that exists today under the name American Health
Information Management Association (AHIMA). These early medical records were documented
on paper, which explains the name ―record librarians.‖
Medical records in the information age
Paper medical records were steadily maintained from the 1920s onward, but the advancing
technology of the ‗60s and ‗70s introduced the beginnings of a new system. The development of
computers encouraged pioneering American universities to explore the marriage of computers
and medical records.
"The volume of data healthcare organizations are now collecting pales in comparison to the
amount of data that will be generated in a year."
These universities often partnered with large healthcare facilities. Patient information would be
generated and electronically recorded at a specific facility—and it was accessible only at that
healthcare location. This obviously restricted the software‘s usefulness and viability on the
market. Other hindrances to early electronic heath records included computer performance
limitations and exorbitant pricing. However, interest in computers continued to increase.
Individual departments of the healthcare industry—such as patient registration—recognized the
usefulness of keeping electronic records. Early EHR software began to be adopted within certain
departments. Healthcare software development continued to focus on these single application
uses into the early 1980s.
The 1920s
As healthcare advanced, physicians realized that the best way to continue improving diagnosing
and treating illnesses was to carefully document observations and actions while treating patients
– and share this information as a way to teach other health professionals. As early as 1600,
physicians offered advice on how to present information in a medical record, but it wasn‘t until
1928 that the American College of Surgeons (ACOS) took steps to standardize the growing
number of medical records by establishing the American Association of Record Librarians
(AARL) – known today as the American Health Information Management Association
(AHIMA). ―Record librarians‖ was the term used because early medical records were

20
documented on paper. Standardization of medical records and growth of complete record-
keeping continued from the 1920s through the 1960s, but records were paper-based.
1928; - The Organization of Patient Information
In 1928, the first official association relating to patient medical records was established by the
American College of Surgeons. It was originally called the Association of Record Librarians of
North America. Its primary goal was to "elevate the standards of clinical records in hospitals and
other medical institutions."

Over the years, the organization has evolved and changed into what is now AHIMA, or the
American Health Information Management Association. The association in its current form is a
strong group that affects the quality of patient information and patient care. Leaders of AHIMA
also serve as political liaisons and advise legislatures and lobbyists regarding healthcare issues.
The 1960s

The development of computers presented the opportunity to maintain records electronically, but
the expense of purchasing and maintaining a mainframe, and the expense associated with storage
of data, meant that only the largest organizations could use technology to handle medical
records. The field of health informatics, as it is known today, emerged when computer
technology became sophisticated enough to manage large amounts of data. One of the earliest
efforts took place under the jurisdiction of the American Society for Testing and Materials
(ASTM). These first standards addressed laboratory message exchange, properties for electronic
health record systems, data content, and health information system security.
The 1960s also saw the introduction of Medicare and Medicaid, which required nurses to collect
data to document care for reimbursement. While computers were increasingly used for
accounting and billing functions, the use of computers to collect and manage medical records
was not common.

In 1964, El Camino Hospital in Mountain View, CA worked with Lockheed Corporation to

develop a hospital information system that included medical records, but generally computer
manufacturers did not understand the healthcare industry‘s needs.Organizations that did opt for a
computer system that handled medical records offered limited access to records –access only
available at the site it was created. Records often only contained information about the hospital
stay and tests or treatments provided within the walls of the hospital.

Even though implementation of technology was slow, the need to standardize was recognized by
several organizations, with SNOP by the American College of Pathology developing what would
eventually become Systematized Nomenclature of Medicine (SNOMED) to systematize the
language of pathology. Also, the concept of a Uniform Minimum Health Data Set (UMHDS)
was formulated in an effort to develop national health data standards and guidelines.

The 1970s
As computers became smaller, software designed to support clinical functions for pharmacy,
clinical laboratory, patient registration and billing began to proliferate. The disadvantage of these
health information systems was their department-specific functions – they were not accessible by

21
other departments. The first attempt at a total, integrated health records system was implemented
in a gynecology unit at the University Medical Center in Burlington, Vermont in 1971. Based on
the problem-oriented medical record, the system was patient oriented – all disciplines included in
care made notes in the record to provide an overview of care to see the relationship between
conditions, treatments, costs and outcomes. Acceptance of the Problem Oriented Medical
Information System was not widespread due to resistance to share information across disciplines.
Although the idea for collaborative care was presented in the 1970s, the acceptance of
collaboration and enhanced communication supported by a holistic health record system did not
take place until the 1990s — with the advent of managed care.

The 1980s

The introduction of diagnosis related groups (DRGs) and data required for reimbursement
increased the need for hospitals to pull detailed information from clinical systems as well as
financial systems to ensure claims payment.
Because personal computers and widespread health-related software applications had grown in
popularity, hospital information technology (IT) staff were tasked with the responsibility to
integrate multiple, disparate systems. As network solutions were developed, IT departments were
able to connect financial and clinical systems – for limited functions. But as technology
advanced, in most cases, hospital departments still could not access information outside their
own silos – preventing data-sharing from disparate system.

The 1990s

The introduction of the master patient index (MPI), a database of patient information used across
all the departments of a healthcare organization in the 1980s laid the groundwork for initiatives
such as The Indiana Network for Patient Care (INPC), the foundation for today‘s Indiana Health
Information Exchange. In 2017, the health information exchange (HIE) leverages an internally
developed MPI that includes 100 hospitals, representing 38 health systems; 12,000 practices with
over 20,000 providers; 1,100 Veterans Administration sites and 12 million patients.

As competition in healthcare created consolidation of individual hospitals to form health

systems, the need for integration grew. Technology advances gave hospitals access to computing
systems that could share information across disparate systems to set the stage for data-sharing. In
recognition of the expanded scope of its members‘ role in health informatics and data
management, the organization that began in 1928 as AARL underwent its fourth name change –
to AHIMA. Health information professionals‘ responsibility now expanded beyond the data
included in a single hospital medical record to health information comprising the entire
continuum of care.

Using healthcare software in the 1980s and ‘90s

The ‗80s produced huge leaps in healthcare software development. The advent of computerized
registration meant patients were able to benefit from a more efficient electronic check-in process
for the first time ever. The introduction of the master patient index (MPI), a database of patient
information used across all the departments of a healthcare organization, was also a massive
success.

22
These wins encouraged software developers to continue creating with a new focus on individual
hospital departments. Departments like Radiology and Laboratory adapted well to the new
software, and computer healthcare applications began appearing on the market. However, these
applications still faced limitations. Computer applications were being used within healthcare
walls, but none of them could communicate with each other or be viewed by neighboring
departments. While technology flourished outside of the healthcare industry, computerization
within healthcare had hit a roadblock. Healthcare was without a communicative, cross-
departmental electronic record system. But the new millennium was about to change all that.

The 2000s

As hospitals continued to merge into larger health systems and to acquire individual physician
practices, the increased need for interoperability that supported data-sharing grew. The
importance of integrated electronic health records (EHRs) to enable providers to make better
decisions grew, and more hospitals and physicians implemented them to reduce the incidence of
medical error by improving the accuracy and clarity of medical records. In his 2004 State of the
Union Address, President George W. Bush called for computerized health records – the
beginning of the electronic health record (EHR) revolution. Adoption of fully-functional EHRs
grew more significantly with the passage of the American Recovery and Reinvestment Act
(ARRA) in 2009. One of the measures included in ARRA was the Health Information
Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act promoted the
concept of meaningful use of EHRs and supported financial incentives to encourage the
adoption of EHRs and the interoperability necessary to share data among providers.

In the 2010s
Increased focus on value-based care as opposed to fee-based care and a drive to improve patient
outcomes propel the growing accumulation of data to support clinical as well as operational
decisions in health care. Just as clinicians in the 1920s understood the importance of previous
health records as learning tools that would improve outcomes, healthcare professionals leverage
data to enhance care on a larger scale — using tools that analyze population health data. New
delivery models, such as accountable care organizations (ACOs), are implemented to contain
costs, promote collaboration and improve patient health care. While ACOs, HIEs and growing
health system networks have EHR and other systems to collect data, there is still a gap in
aggregating and harmonizing the information from various systems to produce data that can be
easily analyzed.

As of 2015;- 96 percent of hospitals and 87 percent of office-based physician practices were

using electronic health records (EHRs). Also, the introduction of cloud computing for a wide
range of industry, including healthcare, supported expanded networks that went beyond specific
sites and locations to tie all entities in a health system or HIE together without a significant
investment in new technology. The increased volume of data, ease of access to data and the need
for health information professionals to guide the management of health data has led to an
increasing reliance on health informatics, which is defined by the American Medical Informatics
Association (AMIA) as a field of information science concerned with the management of all
aspects of health data and information through the application of computers and computer
technology.

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4.0 Conclusion
The chapter and unit discuss the global perspective and background development of
HMIS from health record paper form to software electronic package
5.0 Summary
Global efforts especially American Medical Informatics Association (AMIA) as a field of
information science concerned with the management of all aspects of health data and information
through the application of computers and computer technology. Over 90% of health
practitioners are using electronic data systems due to volume of data

6.0 Self Assessed Exerceises

1. How does health record develop from the health record systems word wide?
2. What are the unique features in the History of Health Information Management in 1900

7.0 Tutor Marked Assignment

1. Explain the achievement of Using healthcare software in the 1980s and ‗90s
2.Whhat are the achievements of 2015 HMIS

8.0 Reference/Further Reading

1. Ball, M. J., & Hannah, K. J. (2011). Nursing informatics: Where technology and caring meet
(4th ed.). London: Springer. Department of Health and Human Services. (2001). Medicare
hospital prospective payment system: How DRG rates are calculated and updated. Retrieved
from https://oig.hhs.gov/oei/reports/oei-09-00-00200.pdf
2. Hebda, T. L., & Czar, P. (2012). Handbook of informatics for nurses & healthcare
professionals (5 edition.). Boston: Prentice Hall. Institute of Medicine. (2001). Crossing the
Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National
Academy Press.
3. Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2015). To err is human: Building a safer
health system. Washington, D.C: National Academy Press.
4. Poterba, J. M. (2018). Tax policy and the economy (Vol.12). Cambridge MA: MIT Press.
Retrieved from http://www.nber.org/chapters/c10911.pdf
5. Saba, V., & McCormick, K. (2015). Essentials of nursing informatics (4 ed.). New York:
McGraw-Hill Professional.
6. Waegeman, P. (2013). EHR vs. CPR vs. EMR. Health Informatics Online, 1–4.Retrieved from
http://www.providersedge.com/ehdocs/ehr_articles/EHR_vs_CPR_vs_EMR.pdf.
7. Monitoring Health information Systems a tool kit for strengthening health systems accessed
25th September 2019. Available online at https://www.who.int ›
EN_PDF_Toolkit_HSS_InformationSystems

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 CHAPTER TWO UNIT 2
NIGERIA PERSPECTIVE AND HISTORY OF THE HEATH MANAGEMENT
INFORMATION FROM THEN TO NOW
1.0 Introduction
With the global perspective on development of health management information systems HMIS.
The emerging trend and rapid grow in the field of HMIS from health record systems to software
package and e record systems. It therefore important to have an understanding of Nigeria
situation of how HMIS of yesterday different from today practices.
2.0 Objectives
The chapter will discuss among other things
1. Review emergence of HMIS from health record
2. Highlight the future of HMIS in Nigeria
3.0 Main Content
From Health Record to HMIS
Efforts were made by a handful of Medical Records Officers in the Country prior to the first
historic meeting in 1966. The meeting was held on the 8th June 1966 at Lagos University
Teaching Hospital. Those present at the memorable meeting were Messrs. Onasanya, Jagun,
Omigie, Okpala and Miss Shadare now Mrs. Adenubi. Mr. Omigie was asked to act as
Secretary/treasurer. The second meeting was held on 6th July 1966 when Mr. Akpabio joined his
colleagues mentioned above. The approved name of the Association was Nigeria Association of
Medical Records Officers which was in line with our British orientation. Unfortunately, there
were no further official meetings due to the Nigerian Crisis of 1966. However, a new effort was
made at a meeting of 3rd May 1969. The draft constitution prepared in 1966 but was not ratified
then, was tabled for discussion at a meeting held on the 12th July 1969. Those present at that
meeting were Messrs. Onasanya, Jagun, Omigie, Shoge and Mrs. Adenubi. It was decided that
another meeting be called for the purpose of taking final decision on the constitution. The
memorable meeting was held at University College Hospital, Ibadan on the 11th October 1969
which was attended by Messrs. Onasanya, Jagun, Omigie, Shoge and Akanji.
The main purpose of that meeting was to approve the constitution and set in motion necessary
machinery that would ensure effectiveness and to create the much-needed awareness generally in
Nigeria to train medical records personnel. Medical/Health Records/Health Information is as old
as medicine and obviously it should be as old as evolution of orthodox medicine globally. Before
the advent of colonial rule, traditional medicine was the main medical practice in Nigeria but
painfully, there was no written document (records) about the practice to a great extent. The
missionary organizations made meaningful contribution to the growth of medical work in
Nigeria. Indeed, they were the first to establish organized medical care in West Africa. For
example, the Roman Catholic Mission established the Sacred Health Hospital in Abeokuta which
was completed in 1875. We should also remember that some military hospitals were established
to cater for sailors, naval squadrons and colonial officers. There was also a tiny make shift
temporary civil hospital built in Asaba in 1888. In all these hospitals, medical records were
initiated by the hospital nursing sister or medical social officer (almoner) as they were called and
kept haphazardly. By the last decade or century, medical pioneers of the Anglicans, Sudan
Interior and Sudan United Missions started a well-organized medical work in Nigeria. Health
services including the building of both government and missionary hospitals continued to expand
progressively including some notable private hospitals. Then introduction of health record

25
system in University College, Ibadan as an establishment on the affiliate of the University of
London
The Future Prediction of HMIS in Nigeria
While there is no crystal ball to predict the future, it is safe to say that as health systems grow
and expand to include other hospitals, physician practices and outpatient clinics, and as the
volume of data grows with expansion, the need to integrate and harmonize data to make it
available to all users is critical. Finding the right platform to support and enable access to
structured and unstructured data across disparate systems is the first step to better preparing for a
value-based future. Interoperability, data-sharing and access to information will continue to be a
critical requirement for process improvement, accountable care organizations (ACO)
enablement, information exchange and development of population-specific care that improve
outcomes. Health information management is a critical role in healthcare today. To see how
effective management of patient data – clinical and financial – can help healthcare organizations
improve patient care and safety as well as operational processes, it will also improve clinical data
management on best practices and other ways on health informatics in transforming healthcare.

The Future of Health Information Management

Today‘s health information management industry is still based on the founding goal of the first
medical record librarians: to increase and improve the clinical documentation standards. The
industry has come a long way from keeping hard copies of health records, but the ultimate goal
of fully functional electronic health record (EHR) systems has yet to be realized. More changes
are in the works for the health information management industry even as they work toward fine-
tuning the EHR system. More important than the data itself is the ability to learn ―actionable
insights from the data,‖ says Geyfman. ―Traditional organizations will have to understand not
only how to collect data, but also to quickly and reliably process, analyze and deliver the data to
those who need it, to any device.‖

4.0 Conclusion
The chapter discussed from health record to HMIS and the future management of HMIS in
Nigeria
5.0 Summary
What use to be medical record systems evolved to HMIS in Nigeria. All started in 1966 at Lagos
University Teaching Hospital. The Medical Doctors and specialist felt it is important to captured
patients record systems. The Then Chief medical director established unit within the hospital and
later metamorphosized to Department. Which later gave rise to School of Health Record. Today
School of Health Management Information Systems is fully established and Degreed awarding
institutions in Nigeria.
6.0 Self Assessed Exerceises
1. How does health record develop from the health record systems word wide?
2. What are the unique features in the History of Health Information Management in 1900

7.0 Tutor Marked Assignment

1. Explain the achievement of Using healthcare software in the 1980s and ‗90s
2.Whhat are the achievements of 2015 HMIS
8.0 Reference/Further Reading
1. Health Records officers Registration Board of Nigeria http://www.hrorbn.org.ng/our-history

26
accessed in August 23, 2019
2. National Health Information Policy 2014.

CHAPTER THREE UNIT 3

DEFINITIONS OF TERMINOLOGIES USED IN HEALTH
MANAGEMENT INFORMATION SYSTEM
1.0 Introduction
Since you have gone through the course guide, you are probably familiar with what this unit is
about. In this unit, you will acquire understanding of the definition of basic concepts of Health
Management information System. First let‟s has a view of what you should learn in this unit as
outlined in the objectives below

2.0 Objectives
At the end of this unit, you should be able to:
Define the main terms used in Health Management Information System.

3.0 Definitions of Terminologies used in Health Management Information

System
1. Health: World Health Organization defined Health as a state of complete physical mental
and social well-being and not merely the absence of disease or infirmity.
2. Management: The process through rules, regulations and procedures by which goals are set
and achieved.
3. Information: The outcome of processed health data which increases knowledge about
health
4. System: A system can be defined as a complex whole formed from many parts that are
made to relate with each other or a combination of related parts organized into a complex
whole in order to achieve objectives.
5. Health Information System is defined as 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.
6. Data: Data can be defined as items, quantities and characters used as a basic for making
inferences.
7. Data collection: the process of gathering data. Many methods are available for doing this
effectively eg Forms, Interviews, Focal group discussion etc
8. Data source: the origin of health data
9. Data type: Primary data are those used for the primary reason they were collected and
Secondary data if used for reasons other than that they were collected
10. Monitoring is a systematic process of collection and analysis of data to track project
implementation and use of the information in project management and decision making.
11. Evaluation on the other hand is a systematic process of collecting and analyzing
information to assess the effectiveness of the programme organization in the achievement of its
stated goals.
12. Disease surveillance: The ongoing systematic collection and analysis of data and the
provision of information which leads to action being taken to prevent and control a disease,
usually one of an infectious nature.
13. Result: the final outcome or conclusion of a search, research, programme or activity.

27
 14. Reporting: Making results of activities, programmes or research available to limited
audience who are probably part of or sponsor of or stakeholders.
15.Dissemination: Making outcome of activities, programmes or research available to a larger
audience. This may involve having an expanded theme meeting or a seminar or scientific
meetings.
4.0 Conclusion
In this Unit you have learnt the basic and functional definition of Health, Management,
Information, System, Health information System, Data, Data collection, Data source, Data
type, Monitoring, Evaluation, Disease surveillance, Result, Reporting and Dissemination.
You should at this point be able to define these basic concept of Health Management
Information System (HMIS)

5.0 Summary
This unit has focused on the definition of the conceptual terminologies in HMIS. Subsequent
units will build on them and show their relevance in the operations of HMIS.

6.0 Tutor Marked Assignment

Without looking back on these definitions, take a sheet of
paper and write down the basic terminologies in this unit. Repeat this until you get at least 10
correctly.

7.0 Self Assessed Exerceise

Attempt at writing down the definition for each. Review and
repeat until you have at least correct definition to at least 10 of the terminologies.

8.0 References
1. World Health Organization (1948) Official Records of the World Health Organization
Geneval no. 2 pp.100
2. Basic Tool for Process Improvement
http://www.balancedscorecard.org/Portals/0/PDF/datacoll.pdf
3. Araoye MO 2003 Research Methodology with statistics for Health and Social Sciences pp 1
- 286

28
 CHAPTER THRREE UNIT 4
EXPANDED DEFINITION AND CONCEPT OF HEALTH
1.0 Introductions
Since you have gone through the course guide and successfully learnt the
definitions in the last chapter, you have acquired the requisite foundation on which
we can build in the next couple of units. This unit will help you acquire basic
understanding of what health is about and the use of the definition in different
circumstances. Before we get into that let‟s look at the unit objectives.

2.0 Objectives
At the end of this unit, you will be able to:
a. Accurately define what Health is.
b. Mention the use of that definition in various circumstances.
c. Differentiate the various situations that affect Health status of a given population
and
d. List Health needs and Forces that influence health

3.0 Main Content

World Health Organization defined Health as a state of complete physical mental and
social well-being and not merely the absence of disease or infirmity. This is the
definition contained in the preamble to the Constitution of the World Health
Organization as adopted by the International Health. Conference, New York 19-22
June, 1946; signed on 22 July 1946 by the representatives of 61 States and entered into
force on 7th April, 1948. This definition has not been changed since 1948 and it is
applicable to individuals and his affiliations. The import of this definition can easily be
seen in linking what ordinarily is not a health issue to health so long as they may affect
the physical, mental and social wellbeing of the individuals. A man without social
support is not healthy, A man without adequate food and clothing is also not healthy.
People living under fear of war or attacks of natural or man-made events are not
healthy and so virtually everything that affect human life could then be capturable as
health information which are important in Health
Management Information System.

Application and intervention needs

When it comes to general application, one may apply this definition to personal,
family, community, National Regional and Global Health situation. Both from the
Gross Global Situation to a micro-level of personal circumstances, critical appraisal
will enable one to understand the wide-scope of the catchments of National Health
29
Management Information System (NHMIS). The following are very central to the
achievement of Health.
a. Socio-economic Situations
b. Demographic Situation
c. Epidemiological Situation
d. Health Resources
e. Human Capital
f. Health Services
g. Sectoral Situations: Education, Agriculture, Mineral Resources, Water
Resources, Transport, etc.
Force that influence Health
To achieve health involves the interplay of several forces which include Governance,
Social Cohesion, Integrity, Resource generation and distribution.
a. Social-Economy Situation:
Printing specific population group like infant, women of childbearing age, workers,
rural poor, the physically challenged and the unemployed young adults. Also priority
certain health challenges like malaria, measles, malnutrition, meningitis.
b. Demographic Situation
Population estimation and projection by Ages & Sex Estimating vital rates such as
Births and Deaths and differential distribution of these births & deaths between both
rural and urban population.
c. Epidemiological Situation
To identify and analyse public health problems, their distribution, prevalence‟s
and Trends. There will generate the following indicators:
 Nutritional indicators: Weight for-age, weight for height or Body Mass
Index (BMI)
 Infant Mortality Rate in both Urban versus Rural
 Child Mortality Rate
 Life expectancy at a given age
 Age specific death rate
 Morbidity and Mortality rates.
d. Health Resources,
Health Human Capital and Health Facilities directly affect service delivery to the
appropriate person of the right place and right time.
Health Intervention need to Health is a complex issue so also intervention is similarly
complex. The strategy must integrate efforts of many other disciplines and
professionals like Medicine, Nursing, Psychology, Sociology, Anthropology,
Engineering, Economics, Political Science, Biology, History, Law, Demography and
others as relevant.
Intervention need to:

30
1. Focus on generic social & behavioral determinants of disease, injury and disability.
2. Use multiple approaches (e.g. Education, Social Support, Laws, incentives,
Behavior Change Programme) and address multiple level of influence
simultaneously (i.e. Individuals, families, Communities, Nations.
3. Take account of the special needs of target groups (i.e based on age, gender, race,
ethnicity, social class)
4. Take the ―long view‖ of health outcomes, as changes often take many years to
become established and
5. Involve a variety of sectors in our society that have not traditionally been
associated with health promotion efforts, these will include Law, business,
education, social services and the media.
4.0 . Conclusion
In this unit you have learned what health is and it application in several situations.
You have also found out that there are mult-disciplinary approach to health
intervention. At this point you should be able to without mistake define health and
list various intervention approaches.

5.0. Summary
This unit is a build up for the last one and it has expanciated on the initial
definition of health in the last unit.

6.0 Tutor Marked Assignments

List the various disciplines involved in health interventions

7.0 Self Assessed Exerceises

List the different types of health listuations

8.0 Refrences
1. Smedley BD & Syme SL (1997) Promoting Health Intervention Strategies
from social & behavioural research pg. 1-472.
2. Park K Park‟s Textbook of Preventive and Social Medicine, eds. M/s
Banasidas Bhanot; India 2000
3. Federal Republic of Nigeria, National Health Policy, 2016
4. World Health Organization (WHO) www.whoint.org

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 CHAPTER THRREE UNIT 5
EXPANDED CONCEPT AND DEFINITION OF MANAGEMENT
1.0 Introductions
Most things have limitations. Either limitation in quantity, quality, time-usefulness,
resources etc. Hence the need for management. Also, everything good or successful require
good logistics and therefore demand effective management. HMIS is not different. No good
health information just happens or become available without management support system.
Therefore, in this unit you will look at application and impact of management. However, it
will be desirable to look at the objectives as set out below.
2.0 Objectives
At the end of this unit, you should be able to
Define Management and
List the expected achievement of good management
3.0 Main Content
Definition of Management
Management can be defined as follows:
a. The process, rules, regulations and procedures by which goals are set and achieved.
b. A set of functions such as planning, organizing, staffing, directing and controlling.
Management requires specific skill and know-how for effective utilization of scarce
resources and leading the direction for achieving a common or corporate goal. In the
content of HMIS, it's the process of managing health information to improve service
delivery and achieve set health policy.
c. Efficient management of the health information is necessary. This can be service
delivery, service utilization, outcome measures or input indicators etc. Nigeria has a
National Health Policy to create an administrative framework for a universal access
to comprehensive Health Services. This will focus on achieving optimal service
delivery and utilization that is progressively improving the physical and mental
health of the people and incorporating both preventive, curative and rehabilitative
components.
3.2 What Management is expected to achieve
Within the context of HMIS, Management achieves the following:
a. Conduct survey to determine a community's health challenges.
b. Determine in partnership with community leaders, the priority ranking of health
challenges
c. Assess demographic characteristics and decide which of the priority health challenges
can be realistically solved.
d. Select intervention programmes directed at these health challenges.
e. Set objectives for intervention programmes with the participation of the community.

32
f. Secure and utilize the resources needed to implement programmes.
g. Decide the types and numbers of staff needed for effective implementation of the
programmes.
h. Set job description and targets for staff
i. Organize appropriate trainings, either in-house or external facility.
j. Set the necessary indicators of achievement to be used in evaluating intervention
programmes.
k. Decide the frequency, regularity and priority areas for operation Research.
4.0 Conclusion
In this unit you have learned that good management will conduct survey, encourage
partnership with community leaders, help assess demographic characteristics, select
intervention programmes,set objectives for intervention programmes, secure and utilize the
resources needed, decide the types and numbers of staff needed, set targets for staff,
organize appropriate trainings, either in-house or external facility. The unit also explained
the need to evaluate intervention programmes and the frequency, regularity and priority
areas for operation Research for continuous service improvement.

5.0 Summary
This unit main thrust is defining management and expected achievement of effective
management. The next unit will build on another concept.

6.0 Tutor Marked Assignments

List 7 major expected outcome of good management in Health Management Information
System

7.0 Self Assessed Exerceises

How will youu explain managmnt in context of HMIS

8.0 References
1. Federal Ministry of Health 2000, Manual for certificate in Health Planning and
Management P. 1- 40
2. Osibogun A. Operation Research as a tool for the management of Health
services. Nigerian Journal of Pharmacy Practice and Continuing Education,
1,1:27-30, 1998
3. Federal Republic of Nigeria, national Health Policy, 1996

33
 CHAPTER THREE UNIT 6
EXPANDED CONCEPT AND DEFINITION OF INFORMATION
1.0 Introductions
Information is power. That is what we need to plan, to forecast, to effect behavioural
change. We therefore in this unit take a more critical look at information and what is real
information. You will also learn what is the relationship between Data and health
information as stated in the objective below.
2.0 Objectives
At the end of this unit, you will be able to
 D e f i n e In f o r m a t i o n , t h e r e t r i e v a l a n d H e a l t h Information System
 Describe how to generate health information
 Explain the relationship between Data and health information
3.0 Main Content
3.1 Definition of Information and Health Information System
Information can be defined as the communication or reception of knowledge or intelligence.
Such knowledge as obtained from research, investigation or study or instruction.
Information retrieval: the techniques of storing and recovering and often disseminating
recorded data especially through the use of computerized system. Health Information
System is defined as 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. Data can be defined as items, quantities and characters used as a basic
for making inferences. Data usually occur as raw materials (Fact) that require processing.
Data becomes information when processed and gets to the right person, in an appropriate
form in a timely manner and in a form that can be utilized. Examples of data are as follows:
a. Mira weighed 12kg when the Nurse saw her in the well-baby clinic yesterday.
b. James had a length of 65cm in the last clinic attendance.
c. Mira attended the well-baby clinic at the age of 12months and weighed 12kg, his last
diarrhoea episodes were 4months ago and mother said she feeds well.
Explanation: a and b contain Data, c information
a. provided the Name, the weight of Mira and the fact that a well-baby clinic
b. opens. It is difficult to make use of such ―data‖ b. also tell us that James‟ length was 65cm
and also the clinic opens. These cannot be used to infer
c. anything about the health of these children (Mira and James).
However, c, gives utilizable data (Information) Mira at the age of 12 months weighs 12kg. This
is good information. Why?
To estimate the normal weigh for any infant use this formula
N plus Eight divided by Two, That is

34
=N+8
2
N = Age in months.Mira who is Twelve months old should weigh Twelve plus
Eight divided by Two, that is = 12 + 8
2
= 20
2
= 10kg.
Therefore, should have a weight of Ten Kilogram. The fact that we know that Mira has
passed the expected weight for age is a good information of good health status. Also, the
fact that she had the last diarrhoea episodes 4 months ago and eats well were information
about contributing factor for the health status achievement.
Relationship between Data and Health Information
1. Data becomes information if it is in a useable form and is used appropriately
2. Data forms the basis for information. Data is raw fact about an entity.
3. Data are quantitative or characters while information (processed data) pursues decision
making process directed at identifying problems, evaluating outcomes and getting ready for
improvement in service delivery.

4.0 Conclusion
In this unit you have acquire necessary understanding of the definition of information,
information retrieval and health information system. You have also learned how to generate
health information from material available to you. The unit also stress the relationship between
data and health information. You should by now be comfortable with defining information
terminologies and generate health information from the observations in the community.

5.0 Su mmary
This unit has focused on Information, its retrieval and generating health information. The unit
stressed that information is as good and reliable as the data set that produce it. The next unit
will further build on this.

6.0 Tutor Marked Assignments

In Egbejila Village of Ilorin Kawra State Nigeria, school children were clinically examined for
evidence of malnutrition and oral health staus in a UNICEF supported project. It was found that
80% of the primary school children were underweight, 20% had angular stomatitis and 40 %
were stunted. Oral examination shows that 75% had poor oral hygiene and 20 % had dental
caries. What is the health information you could draw from the above?

7.0 Self Assessed Exerceise

What are the relationship between Data and Health Information?

8.0 References
1. The Merriam-Webster dictionary 2010
2. Mercedes de O. The WHO Child Growth Standards. In Koletzko B. Eds. Pediatric
Nutrition in Practice. Basel, Karger, 2008. Pp 254-269
3. Park K Park‟s Textbook of Preventive and Social Medicine, eds. M/s

35
 Banasidas Bhanot; India 2000
4. Federal Republic of Nigeria, national Health Policy, 1996
5. World Health Organization (WHO) www.whoint.org
Further reading
6. WHO Multicentre Growth Reference Study Group: WHO Child Growth Standards
based on length/height, weight and age. Acta Paediatr Suppl 2006;450: 76- 85.

CHAPTER THREEE UNIT 7

EXPANDED CONCEPT AND DEFINITION OF SYSTEMS
1.0 Introductions
Achieving most things in life requires more than one step. So also, the health care services
delivery required. The working together at such steps for a wholesome service delivery is what
is referred to as a system. Even the making of a household lunch for a family require multiple
steps to complete. A system is as good as the functionality of the components. This is what
you will learn in this unit. However, it will be better for you to review the unit objectives as set
out below.
2.0 Objectives
At the end of this unit, you will be able to
a. Define what a System is
b. Explain the types of System
c. Explain how vaccine delivery qualify as a System
d. List the elements of the health information system
3.0 Main Content
3.1 Definition of System
A system can be defined as a complex whole formed from many parts that are made to relate
with each other or a combination of related parts organized into a complex whole in order to
achieve objectives. Health Management Information is a complex whole that are integrated to
function as a system. Health Service provision is a system that works together as whole to
deliver the necessary services to a community.
3.2 Example of System In Vaccine Delivery
Look at the Immunization Programme: To deliver an antigen e.g. Tetanus Toxoid, to a child
requires the following: -
a. The Producing factory
b. The Packaging Company
c. The Cold-Chain Department
d. The Shipment
e. The Storage (National Cold Stores, State Cold Stores, Zonal Cold Stores, L.G.A or
Community Cold Stores
f. Transport for pick-up to the community
g. Vaccinating Team to deliver the antigen to the child
The interlinking and effective working together just defines what a system is. All the

36
 component parts must be working optimally. An organization is said to have open system if
it exchanges information, energy or material with the environment.
Open Systems
▼To
Information & Energy & Materials
▼To
Environment
The chart above shows continuous flow of information, Energy and material from the
system to and fro the environment based on interaction between components. Remember
that the Environment is the sum total of the condition within which organisms live. We can
also have closed or semiclosed systems which either does not exchange information at all
with the outside or exchanges information at limited volume or time.
The Elements of any Health Management Information System Includes:
a. Health data – Information or data on patients and their complaints, drug supplies, hospital
facilities, budget, epidemiological and demographic data etc.
b. Personnel: Staff who collect or process health data, usually medical records officer, doctors
who attend to patient‘s health planning officers, Nurses or Community Health Officer etc.
c. Tools for collecting, processing and presenting health data – forms, Registers, Admission
cards Tally Sheets, Ledgers etc or Data processing machines such as hand-calculators,
computers search engines, intranet and internet.

4.0 Conclusion
In this unit you have learned what a system is and what an open system does by allowing
free exchange of information with the environment. You have also appreciated the various
elements of the health information system. By now you should have no major challenges
with how a system operates.

5.0 Summary
The unit has focused on the definition of system, open system, and essential elements of
health information system which includes health data, personnel and tools needed for
collecting the data. You will be able to build you knowledge further in the next unit.

6.0 Tutor Marked Assignments

Within the community, think out 2 major systems that delivers good services to the people.

7.0 Self Assessed Exercise

What are the components of this systems?

8.0 References
1. Health Management Information System www.distance.jhsph.edu/hmis/
2. T M Akande and J O Monehin Health Management Information System in private
clinics in Ilorin Nigerian Medical Practitioner vol 46 No 5. 2004 (103 - 107)
3. Federal Ministry of Health 2000, Manual for Certificate in Health Planning and
Management Course.

37
 CHAPTER FOUR UNIT 8
INSTRUMENTS FOR MEASURING HEALTH DATA
1.0 Introduction
Health data may be collected on a regular basis and on ad hoc systems, the sources of theis data
may be primary sources or secondary from Federal agencies such as (FMOH, FOS, Teaching
Hospitals, etc:). International agencies that provide health data (WHO, UNICEF. UNFPA, etc.)

2.0 Objectives
The unit seek to
1. Describe regular routine health information systems
2. describe instrument used for measuring health data
3. describe the validity and consistence of data systems
3.0 Main Content
A regular or routine health information system; of data collection usually consists of a
mechanism (a registration procedure) for collecting the data as they become available.
Examples
 a vital statistics registration system to collect data on births, deaths, marriages and
divorces;
 a disease notification system to collect data on cholera, yellow fever, whooping cough,
etc.;
 a reporting system for cancer cases (cancer registry);
 registration systems in health care facilities, to collect data on patients attending the
various clinics.
Ad Hoc
collection of data is usually in the form of a survey of collect data that is not available on regular
basis. The data collected may be for research or administrative purposes.
Examples
a. a national health manpower survey;
b. a survey to estimate the proportion of children with malnutrition in a defined population;
c. a study to investigate whether or not the use of hormonal contraceptives affects the
nutritional status of the user; an investigation of breast-feeding practices among women
who registered a birth in the previous year.
Instruments for measuring health data and Type
There are three main types:
a. Apparatus: Measurement is done with a purely mechanical device, e.g. weighing scales,
thermometers, spectrophotometers and sphygmomanometers.
b. Human: Measurement is done by persons, with little or no involvement of apparatus, e.g.

38
 oscillating a heart, grading spleen enlargement, taking a patient's history;
c. Mixed: Combination of human and apparatus, e.g. reading of X-ray film, reading of
blood films.
Two Desirable Characteristics of Instruments for Measuring Data are: -
1. Reliability And
2. Validity.

1. Reliability deals with the inherent performance of the instruments. A reliable instrument
is one, that gives consistent results when it is applied more than once on the same unit
under similar conditions.

Major factors affecting consistency are:

I. Inherent variation of the instrument itself, e.g. fluctuating zero mark in a weighing scale,
non-stability of reagents used to construct a mechanical instrument;
II. Fluctuations in the substance being measured, e.g. patients answer depending on their
understanding of the questions;
III. Observer error: a single observer may get different results in repeated measurement on
the same unit. e.g. repeated blood measurement, age determination (when date of birth is
not known), repeat microfilaria count on a stained slide;
IV. Inter-observer error (observer variation): differences between observers, e.g. blood
pressure measurements, reading of X-rays, reading of blood films.

2. VALIDITY: - A measurement has validity if it is indicative of the, condition that it is

supposed to measure. Example
Fever may not be valid (sufficient) indicator for malaria in areas with low malaria transmission
levels; answers obtained from oral interviews in some societies may not be indicative of local
abortion practices; childlessness may not be valid indicator of infertility.
Sensitivity and specificity are two important components of validity.
Sensitivity
Sensitivity of a test is ability of test to be positive when the disease is present. The sensitivity of
a test, a procedure, or a measuring instrument, is in general the quotient of the change in an
observed measure and the corresponding change in the value of the quantity or the factor that is
being measured. The larger the value of the quotient the grater the sensitivity. For example, if
concentration is being measured, and if a small change in concentration produces a large change
in the measurement given by a test then the test is said to be sensitive.

Sensitivity in this sense, does I1Qt refer to the smallest amount or value that a given procedure
will detect (which is correctly referred to as the limit of detection of the procedure). In
epidemiology, sensitivity is defined as the proportion of true positives correctly identified by a
test and is given by the formula a/(a+c), where a = no of positives correctly identified, and c = no
of false negatives given by the test.

Specificity is defined as the extent to which a test a procedure, or a measuring instrument, gives
a response for the presence of a given variable and is "dead" to the presence of all other
variables. In epidemiology, specificity is defined as the proportion of true negatives correctly
identified by a test, and is given by the formula d/(b+d) where d = no of true negatives correctly

39
identified, and b = no of the false positives given by the test.

4.0 Conclusion; -
There is different type of Instrument for measuring data. Such instrument should be reliable and
valid to measure the presence or absence of disease entity
3.0 Summary-
Health data may be collected on routine or ad-hoc method. On the routine data collected through
registration of birth, vital statistics, cancer registration. While the ad-hoc may be survey carried
out. There is different type of instrument used in measuring health data e.g weighing scale. B.P
apparatus. All of the instrument is not free from error which include inherent factors, observers
and inter-observer errors. Majorly, such instrument factors measured are the reliability and
validity. An instrument is reliable when it same results is obtain at different time under same
conditions. While an instrument is valid in term of sensitivity and specify. A sensitive
instrument or test is positive when the disease or health condition is present while a Specify is a
test is negative if diseases or health condition is not present.

6.0 Tutor marked

1. What are the different between routine and ad-hoc data
2. Enumerate instrument used in measuring health data.
3. What are the major factors affecting consistency are:

7.0 Self-assessment Exercise

1. Differentiate between Sensitivity and Specificity

8.0 References
1. Parrish RG. Measuring population health outcomes. Prev Chronic Dis 2010;7:A71.
2. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the
methodological quality of studies on measurement
properties of health status measurement instruments: an international Delphi study. Qual Life Res
2010;19:539–49.
3. Bottomley A, Pe M, Sloan J, et al. Moving forward toward standardizing analysis of quality of
life data in randomized cancer
clinical trials. Clin Trials 2018;15:624–30.
4. Kovic B, Jin X, Kennedy SA, et al. Evaluating progression-free survival as a surrogate
outcome for health-related quality of life in
oncology: a systematic review and quantitative analysis. JAMA Intern Med 2018;178:1586–96.
5. Dodge R, Daly A, Huyton J, et al. The challenge of defining wellbeing International Journal
of Wellbeing 2012;2:222–35.

40
 CHAPTER FOUR UNIT 9
TYPES AND SOURCES OF HEALTH DATA
1.0 Introduction
There are two main types of health data:
1) those from health services-based sources and
2) those from population-based sources.
Data from health services-based sources are of three types:
(a) data that are collected routinely in the course of services delivery,
(b)data collected via periodic assessment of the health services delivery systems, and
(c) data collected disease monitoring and surveillances.
Data from these sources are usable for assess the context, inputs, process and outputs of health
services delivery.
Population-based data are data that are obtained routinely or periodically from communities.
The specific types are surveys, censuses and vital registration. Information from these sources
are useful for assessing outcomes and impacts of heath service delivery. In addition to the
above, various ministries such as education, agriculture, water resource, information, and
housing contribute to health. Data generated from these sources must be integrated to give a
total picture of health situation in the community, and enhance the quality of information
derived from the health community
2.0 Objectives; -The unit seek to
1. Explain different type of health data
2. Discuss various sources of health data
3. Specifically explain census of population, Registration of births and deaths. Morbidity and
mortality data.
4. Enumerate limitation associated with the sources of data collection
3.0 Main Content- Sources of health data
3.1 Census of Population
Before we can assess the magnitude of the public health problem posed by a specific disease or
the impact of an intervention programme, we must have an idea of the size of the community we
are dealing with, its composition with respect to various demographic characteristics, and the
magnitude of population changes in relation to vital events (e.g. births and deaths). From the
census (total enumeration) of a population, data may be collected about the following
characteristics of members of the population: age, sex, marital status, place of residence
(address), literacy, occupation, economic activity, relationship within a household, etc. The
composition or distribution of the population affects the need for, and utilization of, the various

41
health facilities in the country.
3.2. Registration of Births and Deaths
It is important to report and register births and deaths:
 for individual (personal) documentation;
 for legal and civic purposes (e.g. establishing citizenship, evidence of which may be
needed for social and welfare services);
 to maintain a balance sheet for the population.
There may be problems with registration of births and deaths.
 in applying the definition of a live birth (especially in connection with severe congenital
malformations).
 in applying the definition of the foetal death especially in connection with determining
correctly the period of gestation);
 early neonatal deaths may not be reported and registered as births (although they may be
recorded as such); there may be lack of motivation in the general public to register an
event such as a birth or death.
3.3. Morbidity and Disability Data
1. Routine health services records (e.g. medical records) provide general morbidity and
disability data, by diagnosis or symptomatology, in accordance with the sophistication of
the institution compiling the records.
2. Routine data collection and notification systems of government and private institutions
provide, among other things, data on new cases of communicable diseases through their
notification.
3. Occupational health institutions provide occupation related morbidity and disability data.
4. Patients' Groups (e.g. diabetics) provide detailed disease - or condition-specific data on
individual patients.
5. Disease Registries (e.g. for cancer or mental disorders) provide detailed information on
the group of diseases or conditions covered by the registry.
6. Surveillance Records of selected diseases (primarily for detection of outbreaks) provide,
for instance, data on time course of diseases under surveillance.
7. Reports from Volunteer workers contain secondary and generally crude data on
morbidity and disability.
8. Reports to Ministries of Health and International Organizations contain summary data on
morbidity and disability, usually also with demographic data on the reference
populations.
3.4 Mortality Data
1. Vital registration system
2. National sample surveys
3. Special health surveys - Hospital records
4. Notification of infections diseases
5. Government health institutions
6. Voluntary (or private) health institutions
7. Revenue agencies
8. Police
9. Village/Community Councils
10.Reports of national and international organisations.
4.0 Conclusion; -

42
There are different sources of data form of collection. Which vary from routine to population
based. The vital events are measure through registration of birth, census and morbidity and
mortality data. There is uniqueness with sources in term of advantages and limitations.
3.1 Summary-
Before we can assess the magnitude of the public health problem posed by a specific disease or
the impact of an intervention programme, we must have an idea of the size of the community we
are dealing with, its composition with respect to various demographic characteristics, and the
magnitude of population changes in relation to vital events (e.g. births and deaths)It is important
to carry out census for for individual (personal) documentation; for legal and civic purposes (e.g.
establishing citizenship, evidence of which may be needed for social and welfare services);

6.0 Tutor marked Assignment

1. Question: What are the limitations of census data?

7.0 Self-Assessment Exercise

1. Differentiate between Morbidity and mortality data

8.0 References
1. Lorente S, Vives J, Viladrich C, et al. Tools to assess the measurement properties of quality of
life instruments: a meta-review
protocol. BMJ Open 2018;8:e022829.

2. VanderZee KI, Sanderman R, Heyink J. A comparison of two multidimensional measures of

health status: the Nottingham health
profile and the RAND 36-Item health survey 1.0. Qual Life Res 1996;5:165–74.

3. Saka, M.J. Jimoh A.G. Saka, A.O. & Latinwo, A.W.O. (2011): Menopause Perception and
Care of Menopausal Women in Nigeria. The Nigeria Journal of Guidance and Counseling.
16(1); 28-37, Published by Faculty of Education, University of Ilorin, Nigeria. Available online
at https://www.ajol.info/index.php/njgc/about

4. Saka, M.J. Akande, T.M. Saka, A.O. Odusolu, P.O. Olatinwo, A.W.O. Jimoh A.A.G. & Raji,
H.O. (2011): Assessment of Expectation, Knowledge and Adjustment Behaviours of
Menopausal Women, North Central Nigeria. The Tropical Journal of Health Sciences. 18 (2);
59 – 64, Published by College of Medicine University of Ilorin, Nigeria. Available online at
https://www.ajol.info/index.php/tjhc/about

43
 CHAPTER FOUR UNIT 10
HEALTH SERVICES-BASED DATA SOURCES
1.0 INTRODUCTION
Health services-based data sources are varied from primary health facility treatment
records, hospital-based treatment records

2.0 Objectives
the unit seek to
1. Describe health services-based data sources. the record system within the hospital
2. List Examples of the types of data produced from routine health services-based data
3. Describe health and disease surveillance
4. Health facility Assessment (HFA)

3.0 Main Content

Primary Health Facility Treatment Records
Data generated from the primary health care dispensaries, clinics, comprehensive health centres,
traditional birth attendants, village health workers provide information on health situation in the
community, and help in determining the effectiveness of PHC services. Records of clients and
services are kept at every primary health care facility, and properly kept overtime. PHC facility-
based data provides information on:

Hospital-Based Treatment Records

Treatment records from both government and private hospitals are important sources of health
information. However, because of difficulties of collecting information from private clinics,
information collection is often limited to government-based hospitals or, at most, to government
and the large NGO hospitals. However, including all private clinics will ensure the
completeness of data. Hospital records are important in health services monitoring and
evaluation. Adindu (1996) noted that hospital data provide insights into the effectiveness of
health interventions in the community.
Examples of the types of data produced from routine health services-based data
I. health and disease pattern in the community;
II. health services utilization; drug consumption;
III. types of drugs frequently dispensed;
IV. effectiveness of primary health interventions;
V. cost of interventions and revenue generated;

44
 VI. human resource requirement;
VII. materials and equipment utilized and needed
Health and Disease Surveillance
Health and disease surveillance are the routine collection of epidemiological data to track
trends in disease incidence or prevalence over time. Data are collected through seroprevalence
surveys or through the routine reporting of cases seen by health facilities. Surveillance data
collected from health facilities or community level are aggregated through the administrative
units to arrive at national or sub-national estimates. Surveillance data set is an important
source of data for M&E but it should not be confused with, or substituted for, actual program
monitoring, rather surveillance data should be linked with other sources of programmatic data
in a monitoring system.
Health Facility Assessment (HFA)
Health facility assessment is the systematic investigation conducted in health facilities to
ascertain health service capacity, availability and quality. HFA, are of different types:
surveys, censuses and qualitative assessments. Within each type, HFA, may differ in:
(1) the level of investigation (national, district or health facility level);
(2) extensiveness/ depth of data collected (e.g. integration: single versus multiple subject
surveys); and
(3) types of people conducting it ( e.g internal, health workers versus external, experts).
Usually a combination of these is best for producing credible and valid data. The most
important usefulness of data produce in the health facility are used for determination of
quality and availability of services. The quality of services been rendered and support
mechanism.
Usefulness of Data Produced From (HFA). Examples
I. Quantity and availability of services
a. Location of service delivery points
b. Types of services available
c. Quantity and frequency of services
d. Staffing (numbers/qualifications/staffmg patterns)
II. Quality of services
a. Are there guidelines for standards of care?
b. Are health workers adhering to the guidelines?
c. Are needed diagnostics and client records available and maintained?
III. Support mechanisms
Condition of building and infrastructure (water, sanitation, electricity). Availability and condition
of equipment
a) Availability of supplies and medications
b) Management systems and practices
c) Existence of coordinating mechanisms among key services and
programs: outreach services, community workers, linkages with community
4.0 Conclusion
Combination of health data record systems in the hospital are very useful and is best for
producing credible and valid data. The most important usefulness of data produce in the health
facility are used for determination of quality and availability of services. The quality of services
been rendered and support mechanism

45
5. Summary
The unit describe health services-based data sources. Primarily the record system within
the hospital. Various examples of the types of data produced from routine health services-based
data. Issues on health and disease surveillance was also described and the importance of
health facility assessment (HFA).

6. Tutor marked Assignment

What are the Usefulness of data produced from (HFA). Examples
7. Self-Assessment Exercise
Describe how hospital record can help in supportive services with quality and quantity of
services and

8. References
1. Faria CD, Teixeira-Salmela LF, Nascimento VB, et al. Comparisons between the
Nottingham health profile and the Short Form-36 for assessing the quality of life of
community-dwelling elderly. Rev Bras Fisioter 2011;15:399–405.
2. Saka, M.J. Abdul, F.I. Saka, A.O. Odusolu, P.O. Okesina, B.S. & Bako, I.A. (2012):
Assessment of Infrastructure and Community Supply in Nigeria Private Health Facilities:
Implication on the implementation for Maternal and Child health Care Policies. The
Tropical Journal of Health Sciences. 19 (1); 31-34, Published by College of Health
Sciences University of Ilorin. Available online at https://www.ajol.info/index.php/tjhc/about
3. Saka, M.J. Akande, T.M. Saka, A.O. Musa, O.I. & Abdulrahim, A. (2015): Marketing
Anti Malaria Drugs by CTC-MS in Kwara State Nigeria. Ilorin Journal of Marketing. 2(2);
35-48, Published by Faculty of Management Sciences University of Ilorin Available online
at http://www.unilorin.edu.ng/ejournals/index.php/ijm

46
 CHAPTER FOUR UNIT 11
FACILITY AUDIT AND TOOLS IN ROUTINE HEALTH DATA
1.0 Introduction
Data collection and tool are at varying section in the hospital for data collection which is very
much in sed in facility audit
2.0 Objectives
The unit seek to
1. Explain what facility audit is all about
2. explain tools in routine health data collection and reporting
3.0 Main Content
Facility Audit: This method consists of the utilization of structured questionnaire to obtain
information on infrastructure, staffing levels, services offered, management and support systems
in place.
Health data collection occurs in two stages; -
1. First, health facility' representatives, particularly the in charge, are first interviewed regarding
whether resources: infrastructure, equipment, staffing, etc, are actually present in functional
capacity. The information obtained is then crosschecked by actually checking the presence of
those resources physically.
2. This visual inspection constitutes the second stage in facility audit. Information collected is
usable for assessing health facility readiness to provide services.
I. Patient medical record review
II. Provider interview
This method is similar to the interview method in population-based sample surveys. It
consists of the use of structured questionnaire to obtain information on provider attitude,
knowledge, and behavior as regards health service delivery. Information obtained using this
technique is important for improving health worker motivation and performance.
III. Observation of provider-client interaction
Compliance with recommended treatment guidelines is important to health service delivery
and outcomes. Observation of provider-client interaction entails the use of observation
methods to assess health provider competence vis-à-vis the norm in service delivery.
IV. Exit interviews
Exit interviews is interview conducted at the health gate as clients are exiting the facility

47
premises. The interview can be conducted with open or close ended questions. In general, the
information is qualitative; inferences based on data are, however, not applicable beyond the
sample context studied, unless under controlled rigorous study and sampling design. Data
obtained from exit interviews are relevant for assessing client satisfaction with the services they
are provided.
Tools in Routine Health Data Collection And Reporting
I. Community Based Summary Form, includes NHMIS Forms 000.
II. Health Facility Community Outreach Forms.
III. NHMIS Summary Form 001A and B.
IV. Health Facility Based Forms.
V. NHMIS Summary Form 001.
VI. NHMIS Summary Form 002 for LGA.
VII. NHMIS Summary Form 003
These forms capture data on antenatal care and pregnancy outcomes; immunisation;
family planning services and commodity utilisation; growth monitoring and child health
promotion. Others are in-patient cases; in-patient deaths; outpatient cases; disease
surveillance and notification; pharmaceutical services and drug inventory/ utilization;
laboratory services; and occupational health services.
Tools In Health Disease Surveillances
I. ANC HIV Sero-Prevailenc Surveys,
II. Integrated Bio Behavioral Surveys (IBBS),
III. Behavioral Surveillance Survey (BSS), etc
Selected Tools In Health Facility Assessments:
I. Services Provision Assessment (SPA) MEASURE DHS
II. Service Availability Mapping (SAM) WHO
III. HF based Human Resource for Health (HRH) assessment Abt Associates
IV. Rapid-Health Facility Assessment (R-HFA) CSTS+/MEASURE Evaluation
V. Assessing Integration Methodology (AIM) (used mostly in operational research settings)
VI. Population Council
4.0 Conclusion; -
There is various tool for facility audit, which are used in health diseases surveillance and in
health facility assessments
5.0 Summary; -
Facility audit is mean of collection of data on activities or services within the hospital good
measure of Two method are First, health facility' representatives and visual inspection. The later
are further broken down into
I. Patient medical record review
II. Provider interview
III. Observation of provider-client interaction
IV. Mystery client approaches TBD
6.0 Tutor Marked Assignment
1. What are the two methods used in facility audit?
2. Discuses in details visual inspection used in facility audit
7.0 Self Assignment Exercise
Differentiate between Tools in routine health data collection and reporting
8.0 References

48
1. Wiklund I. The Nottingham Health Profile-a measure of health-related quality of life. Scand J
Prim Health Care Suppl 1990;1:15–18.
2. McDowell I. Measuring Health: a guide to rating scales and questionnaires. 3rd ed. New
York: Oxford University Press, 2006.
3. Saka, M.J. Adisa, T.S. Saka, A.O. & Abdulraheem, I.S. (2016): Close to Community Health
Care Providers; The Operation and Performance of Patent Medicine Vendors in
Management of Malaria in Kwara State, Nigeria. Centrepoint Journal (Science Edition).
22(2);91-101, Published by The Library and Publication Committee University of Ilorin, Ilorin.
Nigeria. Available online http://www.unilorin.edu.ng/centrepoint e-jour

CHAPTER FOUR UNIT 12

POPULATION-BASED DATA SOURCES
1,0 Introduction
This is a methods of data collection within the population. Population census is the official
process of systematically using standardized tools and procedures to collect, compile, and
disseminate demographic, social, and economic data on people in a country at a particular
time

2.0 Objectives
The unit describe population-based data with the ultimate aim to; -
1.discuss population census
2. explain resident population
3. describe sample survey
3.0 Main Content
Vital Registration
Routinely collected data on birth, death, marriage, and migration are essential sources of
demographic information. The quality of tools, procedures, and consistency in data collection
require serious attention to ensure accuracy and usefulness. Births, and deaths outside the
primary health care system must also be captured.
Population Census
Population census is the official process of systematically using standardised tools and
procedures to collect, compile, and disseminate demographic, social, and economic data on
people in a country at a particular time. Countries conduct population census
periodically to determine size, composition, and spread of the population in order to effectively
plan for them; and serves as indices for understanding health situation.
Enumerators are properly trained to use standardised national data collection instruments to
collect data for population census from every household, and individuals living in the
household, and data aggregated at village, community, local government, state, and national
levels.
Enumerated population census captures the actual people present in an area on census day,
and does not distinguish temporary from permanent residence. This may give false picture of the
population if people moved into the specific area just to be counted.
Resident population census captures all permanent residents who live in the area of census.

49
1. Population census provides data for understanding: population structure; size, and age
structure shows proportion of people in each age group within the population;
2. sex distribution, proportion of males to females in the population, and in each age group;
3. geographic distribution, number of people in an area, and population density; and
4. housing, health status, literacy level, occupation, and economic and social status of
households.
5. Census figures provide denominators for calculating rates for a population at risk; the
denominator captures all people with or without a disease or problem, while the numerator
captures those with the disease or problem.
6. Population data are used to calculate population density, population growth, fertility rate,
crude birth rate, crude death rate, infant mortality rate, and child mortality rate.
7. Population size refers to all people who live in a country or specified geographical area at a
specific time. Population density is expressed as the average number of people per square
kilometres. Population density in a country varies from one area to another city, rural area,
low-income area, industries, soil fertility, human fertility, cheap housing, and jobs.
Sample Surveys
Population based surveys are sample surveys conducted in the community Examples of
population-based surveys include Demographic and Health Surveys.

Methods for collecting data collections

a. Self-administered Questionnaire
b. Individual Interview
c. Group Interview (focus group)
d. Observation

Self-Administered Questionnaire
Questionnaire is simply a list of questions to be asked by the researcher to elicit responses. The
questionnaire is administered by mail, hand delivered to respondents, or respondents are brought
together at one point to complete the questionnaire. The critical distinction is that the
questionnaire is completed by the respondent with no assistance from the investigator beyond the
instruction given on the questionnaire. Clear instructions are also required on the purpose of data
collection: who is collecting data, how to complete the questionnaire, and level of confidentiality
involved.

The questionnaire may be structured or unstructured. Structured questionnaires have close-

ended questions, restricting responses to selected options. Ustructured questionnaire consists of
open ended questions, and allows free responses. An open-ended question allows the
respondents to give all the possible options. A questionnaire that restricts the responses of some
questions while allowing free responses of others is semi-structured. Usually, a good
questionnaire should contain elements of both open- and close-ended questions.

Individual Interview
Interviews: structured and unstructured are important qualitative research data collection
technique. Unstructured interviews involve probing, with open-ended questions. Key informant
interview involves the use of experts to obtain critical information, which gives deeper insight
to the issue at hand.

50
Focus group discussion (FGD) or group in-depth interview is used because group interaction
stimulates richer responses; researcher is able to observe discussion for primary insight into
respondents' behaviour, attitude, language, and feelings. FGD promotes idea generation, problem
identification and definition, generates rich qualitative data, inexpensive and fast. Although the
number of groups is determined by topic and hypotheses being tested, conduct at least two groups
for each variable being tested, and in each geographic region where meaningful differences seem to
exist.

Group Formation
Focus groups are generally conducted among homogenous target population, variables for
consideration are social class, life cycle, level of expertise and experience, education, age,
marital status, cultural differences, and sex.
Observation
Observation provides clearer picture of social life more than obtainable by other methods.
Researcher purposefully selects and examines phenomena, people, and objects, systematically
observing and recording according to procedures, which allows for replication. Social science
classifies systematic observation into participant, and nonparticipant. Investigators engaged in
participant observation typically become part of the natural setting observing, interviewing, and
actively involving in what goes on in the environment.
In non-participant observation, the researcher observes behaviour of others in a natural setting and
records without participating in the behaviour under scrutiny, sometimes done.

without the people knowing they are being observed. The use of qualitative methods is necessary in
the study of all aspects of health care. Examining the process of health care through participant and
non-participant observation as services are delivered; the interaction between health workers and
patients, the effectiveness of such relationships, which questionnaire cannot capture should be
considered alongside quantitative methods.

Types of Surveys
The types described below apply to both population and facility-based surveys:
Analytical surveys attempt to test theory, and causal relationships by applying the logic of
experimentation outside the laboratory, dependent, independent, and extraneous variables are
specified. The control of extraneous variable is achieved through reliability in data collection and
the use of statistical techniques.
Cross sectional surveys study people at one point in time (weeks or months) and provide
prevalence data, and important that incidence of what is being investigated does not change
during the period.
Descriptive survey is a type of cross-section survey concerned with particular characteristics of a
specific population of subjects, at a fixed time or at varying times for comparative purposes,
secures a representative sample of the population from which accurate assessment and
generalisation is possible.
Longitudinal surveys collect data about all the new cases or events happening over a period to
provide incidence data.
Examples of the main tools and resources for conducting household surveys and
censuses in the Nation
I. Demographic and health Surveys: Sample survey conducted among women 15-49

51
 years old and their spouses to ascertain fertility, sexual and reproductive health
and their determinants. DHS is led by the NBS with support from Macro
Internation, Beltsville, MD, USA.
II. MICS Surveys: Sample survey conducted among children under five years to
assess health & nutrition status. MICS is led by National Population Commission
with support from UNICEF.
III. National AIDS and Reproductive Health Surveys (NARHS)

4.0 Conclusion
Population based data is a form of data collection that provide insight into respondents' behaviour,
attitude, language, and feelings. FGD promotes idea generation, problem identification and
definition, generates rich qualitative data, inexpensive and fast.
5.0 Summary
Population based data does not limited to vital registration, it also includes population-based
surveys which are sample surveys conducted in the community Examples of population-
based surveys include Demographic and Health Surveys. The data can be collected
through Self-administered Questionnaire, Individual Interview, Group Interview (focus
group) and Observation

6.0 Tutor Marked Assignment

1. How does population census carry out?
2. What important s attach to Resident population census?

7.0 Self Assignment Exercise

What do you understand by sample survey?
What are the methods of data collection in a sample survey?

8.0 References
1. Lee S. Self-Rated Health in Health Surveys. Johnson TP, Handbook of health survey
methods. 1st edn. Hoboken, New Jersey: John Wiley and Sons, Inc, 2015.

2. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven

community studies. J Health Soc Behav 1997;38:21–37.
3. Saka, M.J. Salman A. & Saka, A.O. (2017): Health Care Financing For Victims Of Child
Trafficking In Nigeria: Trends And Analysis Of the Cost Of medical Treatment Per Victim
Per Year. Ilorin Journal of Administration and Development. 3(2):114-123. Published by
Faculty of Management Sciences, University of Ilorin. Available online at
http://www.unilorin.edu.ng/Ijad

4. Saka M.J. (2017): Governance and Corrupt Practices in Healthcare Systems in Nigeria.
Ilorin Journal of Administration and Development 3(1):112-122. Published by Faculty of
Management Sciences, University of Ilorin. Available online at
http://www.unilorin.edu.ng/Ijad

5. Saka, M.J. Akande, T.M, Olarinoye, A.O. Raji, H.O. & Saka, A.O. (2018): Comparative
Assessment of Health Workers Performance and The Performance Factors at Primary,

52
 Secondary and Tertiary Hospitals in Kwara State, Nigeria. The Tropical Journal of Health
Sciences. 24(4);30-35. Published by College of Medicine, University of Ilorin, Ilorin,
Nigeria, Accessible at https://www.google.com/search?client=firefox-b-
d&q=Comparative+Assessment+of+Health+Workers+Performance+and+The+Per%C2%A
Cformance+Factors+at+Primary%2C+Secondary+and+Tertiary+Hospitals+in+Kwara+State
%2C+Nigeria

CHAPTER FIVE UNIT 13

STEPS IN CONDUCTING SURVEY/CENSUSES
1,0 Introduction
A public health officer must should be able to carry out survey census and other form of research
inn data collection. The unit is a form of primary data collection method.

2.0 Objectives
The goal of the unit to improve knowledge on how primary data are derived and specifically to;
1. Define the problem
2. Delineate Objective of The Survey
3. State the Hypothesis
4. Review Current Knowledge
5. Select Sample For Health Survey
6. Methods for Selecting the Sample

3.0 Main Content

a. Define the problem
Clearly defining and stating the problem is the first important step in the survey because a clear
statement of problem is basis for delineating objectives, methodology, survey plan, and budget.
Think about the aim of the survey, the health issue, the population, skills, time, and cost. The
statement of problem briefly and concisely covers health status and the health system in the
context, socio-economic and cultural characteristics of the people. Brief description of the
nature of the problem, scope, distribution, and severity, convincing analysis of factors
contributing to the problem, solutions tried in the past, and results of such attempts.

b. Delineate Objectives of the Survey

Objectives flow from statement of problem, provide direction, help in organizing the study,
and collecting only necessary data. Survey objectives are therefore statements of
measurable results, derived from the problem statement, and must be clearly stated,
specific, measurable, appropriate, realistic, and time bound (SMART). Objectives are
coherent and sequentially address different aspects of the problem; operationally phrased,

53
 saying exactly what is to be done, and use action verbs (to compare, to describe, to
calculate, to identify, to establish etc). Once objectives are clearly defined, data to be
collected for each item and procedure for data collection are easily determined.

c. State Hypothesis
Hypothesis is an informed guess about what the researcher thinks may be happening, based on
previous reading, research, and observation. A statement of expected relationships between
variables from which conclusions could be drawn. Hypothesis is not a must, but thinking and
having hunches helps in deciding the research approach (analytical or descriptive) and in
framing research questions.

d. Review Current Knowledge

Before conducting the survey or indeed any scientific study, read up what others have
written on the problem. Systematic library search provides ideas about research design,
key issues, instruments, and methods of data collection. Literature review summarizes
results of previous studies carried out on the topic, and those closely related, stating the
name of the researchers, problem studied and date, population, sample and methodology,
results and conclusions. Literature review helps: in defining and fine-tuning the scope of
the survey; in generating good hypothesis; phrasing research questions; and helps us not to
repeat mistakes made by others.

e. Select Sample for Health Survey

i. Population sample is a subset of the reference population.
ii. Clear statement of the problem and objectives help in defining the reference population,
and basis for sampling, developing sampling frame and sampling procedure.
iii. Sampling frame establishes the complete population for sampling.
iv. Sampling makes it possible to study representative of the population rather than
everyone in the population, but in a way that each person in the population has equal
chance of being part of the survey.
v. Sample size and sampling methods are then determined using tested scientific
approaches.
vi. Typically, the sample size depends on the prevalence of the problem under survey and
the level of accuracy desired in the results.

Methods for Selecting the Sample

Probability Sampling
Random or probability sampling means selecting survey sample such that each unit in the
sample frame be it village, community, household, or individual has equal chance of being
selected and included in the sample.
Simple random sampling, establish
I. the sampling unit,
II. the sampling frame, and
III. the sample size.
Randomly pick the desired number of units from the sampling frame using a method that
ensures each unit equal chance of being selected for the survey. Ballot or use a table of random
numbers. Calculation of estimates is easy, and assures representative sample because every unit
in the reference population has equal chance of being selected for the survey.

54
Systematic random sampling, after the first level of random selection of units, the next units
are systematically selected. For instance, select every third house, or person. This method has
great advantage in the sense that sample is evenly spread over the reference population, which
assures representation. It is easy to establish sample frame, and to select the sample.

Stratified random sampling, first, divide the reference population into groups or strata based
on a chosen characteristic (age, sex, educational level, location etc). Then, select a simple
random sample from each stratum using the same sampling fraction. This allows every unit in
each stratum equal chance of being selected, and proportionate representation of characteristic
stratified. However, the sampling fraction could be varied between strata for special reasons,
for instance to ensure sufficient numbers of critical subgroups, an advantage that could also
introduce some bias.

In cluster sampling, each unit selected consists of a group of villages, households, or persons
rather than individuals. The population is first divided into clusters of homogenous groups, a
sample of each cluster is then selected, and all units in selected clusters are studied. This cuts
down cost but introduces higher sampling error.

Multistage sampling is done in three or four stages until final sampling unit is arrived at for
study. Cuts cost with higher sampling error.

Non-probability Sampling Methods

Convenience sampling is when sampling units available at time of data collection are included
in the study sample for the sake of convenience. For example, a public health student wants to
study the prevalence of leg deformity among leprosy patients in a community, and decides to
include all patients admitted in the hospital for three months due to limited number of patients.
The main disadvantage is not having representative sample of the population.

Quota sampling ensures certain number of sample units from different categories, with specific
desired characteristics are in the sample. The health student suspects that fewer females have
leprosy, and even fewer want to visit the leprosy centre. The student decides to include more
females than males by 5%. The sample is not representative of the reference population.

Attributes of good questionnaire

Good survey research depends on the structuring, focusing, and phrasing understandable
questions, which minimize bias, and provide analyzable data. Important issues in questionnaire
design are focus, phraseology, form of response, question sequencing, and presentation.
I. Questionnaire focus ensures that questions cover the various aspects of the research
problem adequately and in sufficient detail, and that all questions are relevant.
II. Phraseology is a term that describes the extent to which questions are clear, and
understandable to respondents without variation in interpretation. Phraseology
ensures questions are free from jargon, ambiguity, esoteric terminology, and
inappropriate assumptions. Phrase question such that they are free of offensive,
embarrassing, and insensitive language.

55
 III. Question sequencing ensures questions do not lead to bias, start with general less
sensitive questions before going to more sensitive ones. Ask the right questions in
order to measure research variables; appropriate for intended statistical analysis,
IV. data from the questionnaire must be analysable. It helps to ask questions
systematically, with flow in logical order, using research questions and objectives as
guide.
V. Present the questionnaire for easy completion, as if you were the respondent, be
concise, ask only necessary questions; have suitable introductory statement, state
purpose of the research, confidentiality, time, and how grateful you are.
Conclusion
In survey method in collection of primary data, which can come in form of census.
The problem for this is define with hypothesis well stated. Then the sample size and
techniques inn form of probability and non-probability.

Summary
The unit clarified the steps needed in data collection most especially in d efine the
problem, delineate objective of the survey, state the hypothesis, review current knowledge, select
sample for health survey and methods for selecting the sample. The census can proceed on
probability and non-probability method of data collection. Which in the first case in probability
everybody has qual chance of being selected which may be inform of random, systematic,
stratified, cluster and multi-stage sampling technique.
6.0 Tutor Marked Assignment
1. Write short note on random sampling techniques
2. What are the main ingredient of Select Sample for Health Survey

7.0 Self Assignment Exercise

What are the difference between probability and non- probability sampling technique

References
1. Ishaq, F.A. Olayinka, R. B. Momoh, A. Yusuf, M.K. & Saka, M.J. (2002): Effectiveness
of Information Education and Communication (IEC) On Public Acceptability of Unsafe
Abortion Solution. Trop j. Obstet Gynaecul. 19(1); 12-16, Published by Society of
Gynecology and Obstetrics of Nigeria (SOGON). Available online at
http://www.ajol.info/index.php/tjog/article/view/14361
2. Saka, M.J. & Aremu, M.A. (2006): Marketing Communication Mix as a Means of
Enhancing HIV/AIDS Education in Nigeria. Journal of Administration. 1(3); 14-24,
Published by Nasarawa State University Keffi. https://nsuk.edu.ng/administration/.
3. Adepoju, F.G. Omolase, C.O. & Saka, M.J. (2006): Applanation Biometry in Ilorin,
Nigeria. Nigeria Journal of Ophthalmology. 14(1); 18-21, Published by
Ophthalmological Society of Nigeria. Available online at
www.ajol.info/index.php/njo/article/view/116
4. Bernhard J, Sullivan M, Hürny C, et al. Clinical relevance of single item quality of life
indicators in cancer clinical trials. Br J Cancer 2001;84:1156–65.

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 CHAPTER FIVE UNIT 14
STEPS IN PROCESSING HEALTH DATA
1.0 Introduction
Major steps in processing data collected at any level of the health system to produce information
involve planning for data collection, collecting data, inputting, processing, storing, and
outputting. These steps are applicable to manual and computerised systems.

2.0 Objectives
The unit aim at looking at the steps in processing of health data, with specific objectives to
1. describe the planning what health data depend on
2. discuss data processing methods and
3. describe the reporting method

3.0 Main Content

1. Planning
Every health data collection process starts with proper planning. It is necessary to decide what
data are required for particular programme planning, assessment, or evaluation; for management
of the unit or organisation to avoid collecting massive data that are not utilised, wasting money,
and time.
Health data depends on defined objectives, and proper planning helps .in determining:
i. number of people, educational level, and skills required;
ii. materials, equipment, and data collection tools needed;
iii. procedures t6 be followed in data collection;
iv. money needed to buy materials and equipment, produce documents, and data collection
tools, train and, pay personnel, transportation, accommodation, subsistence, allowance; and
v. time required for training, data collection, processing and reporting.
In developing data collection plan, attach summary plan with activities, time, and budget. Data
collection requires appropriate techniques, tools, and procedures, informed by the intended
purpose and use of data.

2. Data Processing
When inputting and editing, health data are captured in form suitable for processing, organized
systematically in files for manual systems or fed systematically into the electronic device for

57
computerized systems. Data given by client are edited to eliminate error. Data editing is a
continuous process but must start early in the process in order to ensure that all possible errors
are eliminated.
The following are the specific operations involved in the processing of health data: classifying,
calculating, summarizing, storage, and comparing.
I. Classifying involves categorising health data collected from client as male or female,
according to problem, medical, surgical, respiratory, and cardiovascular. Appropriate
variables are used to classify the community, or client such as population, age, sex
distribution, diseases, affected population, and so on.

II. Calculating involves all standard arithmetic operations that are deemed necessary,
addition, subtraction, multiplication, and division, in order to arrive at meaningful
summary of data.

III. Data are summarised by condensing calculated data into totals that give more meaning
and easier to understand. Logical comparison is carried out on two sets of data to
determine their differences and similarities.

IV. Health data must be properly stored to prevent damage, loss, or unauthorised access,
involves protecting, indexing, and updating. A computer, card file, file drawers, or folder
may be used to store health data, and measures taken to protect data from unauthorised
retrieval, erasure, or modification. This is important in the health system where sensitive
personal data are stored either in a computer or in paper files.

V. Indexing is used to create and maintain systems that show physical storage location of a
particular piece of data, and facilitates the retrieval process. Card files are normally used in
manually operated information systems. Updating involves adding, deleting or changing
stored data to reflect new events. For easy retrieval, a system is established to move data to
the central processing unit for use when needed.

3.Data Reporting:
Data processing culminates in the production of health information, which can be reported or
displayed, and made available to management. A report is typically produced on paper or other
media often summary of processed data, which provides management with information for
decision-making. In presenting health information and reports, consider the audience or users and
tailor the report contents, format, and style to suit them. Organize report methodically, logically,
and ensure accuracy of information

4.0 Conclusion
Health data processing begins with proper planning which helps in determining the number of
people, educational level, and skills required among others. Then the data processing and
reporting.

5.0 Summary
In health data processing there is need to describe the planning what health data depend on,

58
discuss data processing methods and describe the reporting method

6.0 Tutor Marked Assignment

1. Discuss parameter for health data proper planning
2. Describe data reporting

7.0 Self Assignment Exercise

What are the steps in data processing?

8.0 References
1. Zengin N, Ören B, Gül A, et al. Assessment of quality of life in haemodialysis patients: a
comparison of the Nottingham Health Profile and the Short Form 36. Int J Nurs Pract
2014;20:115–25.
2. Saka, M.J. Saka, A.O. Latinwo, A.W.O. & Raji, H.O. (2011): The therapeutic value of
adjustment practices and coping with grandchildren for menopausal women in Nigeria.
Publication of Gender and Behavior. 9(2); 3916-3924, Published by International Society
of Psychological Studies OAU Ile Ife Nigeria. Available online at
http://www.ajol.info/index.php/gab/article/view/72119.
3. Salaudeen, A.G. Ojotule, A. Durowade, K.A. Musa, O.I. & Saka, M.J. (2013): Condom
use among HIV sero-concordant couples attending a secondary health facility in North-
Central Nigeria. Nigeria Journal of Basic and Clinical Sciences. 10(2);51-56, Published
by College of Health Sciences, Bayero University Kano. Available online at
http://www.njbcs.net/article.asp?issn=0331-
8540;year=2013;volume=10;issue=2;spage=51;epage=56;aulast=Salaudeen

59
 CHAPTER SIX UNIT 15
HEALTH DATA QUALITY ASSURANCE STRATEGIES
1.0 Introduction
Quality information is vital for effective planning, management, and decision-making in health
care. Poor coordination of information structure affects the quality of information management
process and outcomes. The purpose of information system must be consistent with the goals, and
information needs of the health organization. Assessing the quality of health information system
requires careful planning informed by agreed criteria.

2.0 Objectives
The unit aim is to describe the importance of data quality and assurance strategies. Specifically, to
1. Explain the characteristics of quality health information
2. Enumerate Factors that Contribute to Good Quality Health Data
3. Itemize suggestions that will improve the quality of data collected:
4. Explain Assuring Quality Health Information

3.0 Main Content

Characteristics of Quality Health Information
The characteristics in data quality assurance are the following: (RAT C)
I. Relevance,
II. Accuracy
III. Reliability,
IV. Timeliness,
V. Complete, Clarity and Cost Effectiveness, and
VI. Utilization
Relevance is ability of the information system to provide required information relative to the
information needs of health managers. Health organizations are dynamic therefore, available
information must reflect current and long-term needs of decision makers and managers at all
levels of the organization. Sound principles and techniques in data gathering and processing are
necessary, and those involved in data collection and analyses trained to do the right things.

Accuracy in data and information is the ratio of correct information to the total amount of

60
information over time (Dixon, 1990). The degree information is free from error, the more
accurate the higher the quality of information, fit for purpose and relied upon by users.
Management level affects data collection process, and desired information accuracy related to
decision at hand. Operational health managers need to make decisions based on accurate,
detailed, comprehensive information with high degree of accuracy. At the strategic level,
insight, creativity, and judgement are essential in decision-making, and health managers require
quality information for this purpose.
Reliability connotes confidence in the information. Effective decision-making, planning, and
management depend on the use of reliable information. Reliability depends on the capacity of
data collectors, appropriateness of instruments, application of sound principles and techniques
in data gathering and processing, recording and reporting should be consistent at all points with
no variation. This means that instruments and procedures for data collection give consistent
results. Observer error affects reliability leading to inconsistent results from one person using
the same instruments for repeated measurement.
Timely information for health care decision-making. It is important to provide the right
information to the right person, and at the right time. Delay at any point in data collection,
processing and reporting could transform vital information into worthless figures. Indeed,
information has life cycle, it is produced, refined, communicated, stored, organized, used, reused,
and eventually discarded. Information arriving after the decision for which it is needed has been
made is of no use to the health manager. Prompt production of needed information is, therefore, an
important attribute of quality information.
Information must be understandable.
The understanding facilitates transformation of data to information. Data become information
when recipient is able to understand and use the knowledge derived. Presentation, language,
knowledge are factors that affect the ability to understand and interpret information which is key to
decision making. Complex reports often mask rather than reveal important information, limiting
use. In addition, tools should be meaningful and simple. The attributes of good questionnaire are
presented below:

Complete information
Complete information is always required for important tasks, or a problem to make appropriate
decision, missing parts reduces value of the information. Generating information is expensive
involves human, material resources, and time; the value gained should not be less than cost. In
certain situations, it is difficult to determine the cost and value of information, as much as possible
ensure that cost does not outweigh benefit. Information supports all operational and managerial
functions; use the most appropriate and effective approach that ensures effective flow of
information in the organisation, enabling prompt access to essential data and information at all
times. At the end of each patient encounter information is documented, stored, and accessible to
others. Health professionals' reluctance to document care provided, and client folders often
misplaced or destroyed are abstruse?
Cost effectiveness, collection and processing of data costs money and a piece of
information has its relative value. When information costs far much more than the value derived
from its use, it is not cost effective. In certain situations, it is difficult to determine the cost and
value of information, in general, information should be processed to ensure that cost does not
outweigh benefit.
Effect of Quality Health Information

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Quality Leads to improved Results in
information
Sample Reliable Planning Decision Making Management Better Care
Relevant Resource Use Quality Service
Accurate Patient Satisfaction
Understandable Employee Satisfaction
Relevant Accurate

These quality attributes are attainable where organizational objectives and those for the
information system are clearly defined, and understood. Martin and Powell (1992) suggest the
need to select desired characteristics most relevant to each situation, because information
systems do not stand alone, but are designed to fit organizational structure and objectives.

Factors that Contribute to Good Quality Health Data

Health data may be of good quality if informed by the following:
I. good planning;
ii. data collectors properly trained;
iii. resources and tools for data collection are adequate;
iv. appropriate data collection instruments;
v. complete routine health service records;
vi. well organized facility data collection systems;
vii. selective capturing of client information; and removing inconsistencies in data collection
processes

Assuring Quality Health Information

Characteristics of quality health information discussed earlier relevance, accuracy, reliability, timeliness, clarity,
and completeness, are not achievable all the time. Information producers and users must agree information
attributes essential for particular needs and local decision-making. Training of health workers must address the
adverse effect of inaccurate and unreliable data or organizational performance and health outcomes. Assuring
quality means every health worker is responsible and accountable for data generated in providing services.
Solution starts by local stakeholders acting collectively to:
i. define local information objectives, indicators, and information needs;
ii. restructure the information system in view of needs;
iii. plan effectively, developing appropriate tools for data collection;
iv. address and setting up quality systems for the information system;
v. develop realistic quality standards that guide all health workers;
vi. train health workers on quality measures, and personal accountability;
vii. train politicians, related agencies, tertiary, and secondary health facility workers on the
integrated community health information system, their contributions, and how to utilise data
generated for local decision making;
viii. establish mechanisms for monitoring and tracking data;
ix. ensure effective feedback systems;
x. provide needed equipment, materials, and transportation; and
xi. encourage, and support frontline staff until the right attitudes are nurtured.

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The following suggestions will improve the quality of data collected:
a. Strengthen hospital medical records departments through training programmes.
b. Create awareness among primary health data generators of their important role as
contributors of primary data.
c. Encourage all health workers to use health-related information in support of their
activities.
d. Feedback information to health institutions, thus showing to those involved in generating
the data the results of their contributions.
e. Make reports more comprehensive, so that the summary information is complete,
meaningful, and useful.

Conclusion; - quality data is an essential ingredient in improving health information systems. In

fulfilling the criteria, the data must be relevance, completed, and collected with minimal cost,
reliable and with accuracy.

Summary
The criteria generally used to assess the quality of data include. (RAT CU);- ie Reliability ,
Relevant, Accuracy, Timeliness, Clarity, Completeness, Cost and Utilization. Relevance: the
data should be organised in such a way as to be relevant to the types of decisions to be made.
Usefulness: the data should be presented in a form which enables it to be used directly.
Accuracy: as far as possible, the data must be free of errors. Necessity: the data should contain
only what is required. Sufficiency: the data should contain all that is required, as far as possible.
Timing: the data should be up-to-date and should be available at the right time and the Costs:
produces; the data should not cost more to obtain than the benefit its knowledge Health data may
be of poor quality for a number of reasons, including the following:

6.0 Tutor Marked Assignment

1. Write in detail characteristics of Characteristics of Quality Health Information
2. Factors that Contribute to Good Quality Health Data

7.0 Self Assignment Exercise

Discuss how you will improve the quality of data collected

References

1. Saidu, R. Euna, M. Amina, P. Saka, M.J. & Jimoh, A.A. G. (2013): An assessment of
essential maternal health services in Kwara state, Nigeria. African Journal of
Reproductive Health. 17(1); 41-48, Published by the Women's Health and Action
Research Center University of Benin, Benin City Nigeria. Available online at
www.jstor.org/stable/23486136?seq=1#page_scan_tab_contents
2. Saka, M.J. Saka, A.O. & Akinwale, A.S. (2017): Quality of Life of Children with
Cerebral Palsy: Accumulative Effect of Physiotherapy Intervention in North Central and
South West Nigeria. African Journal of Physiotherapy and Rehabilitation Sciences.
9(6);28-34, Published by College of Medicine University of Ibadan Nigeria. Available
online at https://www.ajol.info/index.php/ajprs/article/download/181281/170677

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 CHAPTER SEVEN UNIT 16
HEALTH DATA INVENTORY AND DOCUMENTATION: MEANING, PROCESSES
AND TOOLS
1.0 Introduction
Meaning of data inventory and documentation
Health data inventory is the process of listing, profiling, and cataloguing data using standards tools. The
process ensures the preservation of data attributes are preserved overtime and dissemination via both
electronic and print media so that data are available for widespread use.
2.0 Objectives; -the unit seek to explain the meaning of data inventory and documentation process and
to;-
I. Enumerate the main rationale for data inventory
II. Explain data documentation process
III. Describe Cataloguing the data
IV. Data Profiling and documentation
V. Describe Anonymization
VI. Describe documentation and utilization of data
VII. Discuss the Tools in health data inventory and documentation
VIII. Discuss the benefit of data inventory

3.0 Main content

The specific objectives of the data inventory and documentation are to:
I. Facilitate use of information to improve planning, policy making, and programs
execution by the MOH and its partners; availability tends to spur utilization
II. Facilitate the ability of the MOH or the National Statistical Agency (NSO)and its
partners to respond to requests for information from national and global sources.
III. Management control over data by centralizing information in one location
IV. Forster coordination; data is an important platform around which to coordinate
partner's efforts.
V. Help FMOH, associated agencies, the partners involved in this effort, and the
donors coordinate investment in data development and reduce duplication.

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VI. Facilitate integration or interoperability of information, achieved when data
from different sources collected using different approaches and tools are
documented and archived using same methodology.
VII. Promote the use of data for decision making
Data Documentation Processes
Inventory of completed surveys/censuses/assessments: - The inventory consists of a simple
listing and profiling of all surveys that have been conducted in specific agencies. Using our
phased plan, these will be agencies in Phase 1. Inventory and profiling are conducted using a
simple tool that has been developed for this purpose. To learn more about this tool visit
MEASURE Evaluation web site.
Cataloguing the Data
This involves documenting basic information about each survey inventory. Information
recorded at this stage includes name, the producing organization, a simple description of the
data, and contact addresses for follow up. The profiles are prepared using simple excel programs
developed for this purpose. The result is disseminated as metadata catalogue for use by all
classes of data users.
Data Profiling and Documentation
This is the extensive documentation of survey and data attributes for ease of
preservation and archbiving. Types of data documented include any households,
institutions, or community surveys such as:
 Service Provision Assessment (SPA); Service Availability Mapping (SAM); RCA;
HRH Assessment Abt Associates; Evaluation of Long Acting and Permanent
Methods Services Suite (ELMS) Engenderhealth (ACQUIRE Project) (HF readiness
to deliver LAPM); Rapid-Health Facility Assessment (R-HFA) MEASURE
Evaluation/ICF Macro; Assessing Integration Methodology (AIM).
 DHS, NARHS, IBBSS, ANC Sero-Prevalences survey
Anonymization
Anonymization simply consists of removing identifiers and attributes that makes it easy for
users to identify the units, be they persons and facilities, from which the information was
obtained. The operation should not make the data of less value for analysis but users need to
apply caution when interpreting modified variables. Anonymization may also be achived by
restricting physical access to data that which presents a potential disclosure risk to scrutinized
users only; restriction guidelines are stated in the data access guidelines. Anonymization is
recommended to protect the national statistical agencies and their respondents particularly when
data are disseminated for widespread use. For standards in data anonymization, students‘
participants are encouraged to contact WHO recommendations.
Dissemination & Utilization
Data documented are disseminated to:
I. those who plan public health programmes;
II. those who develop local, regional, national and even international policies;
III. those who implement intervention and carry out public health action;
IV. public, who need to have information in order to evaluate public health practice;
V. those who need the information for personal action for their health and well-being
VI. Academic professionals, students and researchers for teaching and research.

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Data dissemination increases the quality, access to, and use of data by:
I. Creating awareness of available data and potential ways for utilization
II. Increasing the potential to use data to inform policy and programs.
III. Reducing the costs of data collection and the burden on respondents; awareness
created by dissemination should reduce duplication of efforts by avoiding the need
for researchers to undertake their own surveys;
IV. Demonstrating transparency and credibility 'n data production, which are at the heart of
good governance; and
V. Permitting the incorporation of users' feedback to future data collection; by so doing data
quality is improved
Data dissemination could expose data producers to criticism, violates respondent
confidentiality or increase the potential for such violations. However, the impact on data
quality and data use of making data accessible to users outweighs those risks. Access to
microdata is a right but guidelines should exist that defines boundaries of what users can do
wth the data. For instance, such a policy can emphasize that the data is to be used for statistical
and research purposes only.

Tools in health data inventory and documentation

Inventory checklist: a simple checklist developed for listing completed data and tracking news
ones. The inventory checklist is available in both hard and electronic copies
Note: Demonstrate the inventory checklist
Data profiling program: this is the simple excel program developed for the profiling and
cataloguing data.
Note: Demonstrate the excel prog ram
Microdata Management Toolkit (MMTK) : this is a suite of tools developed for writing
survey and data attributes into forms that are then available for widespread dissemination.
MMTK is an international best practice developed by several organizations, led by the World
Bank. The approach consists of two standard Frameworks: the data documentation initiative
(DDI) and the Dublin Core Metadata documentation Initiative (DCMI). The DCMI is an
organization dedicated to promoting the widespread adoption of interoperable metadata
standards and standard metadata vocabularies for describing resources that enable more
intelligent information discovery systems. The DDI is an inter rational XML-based standard for
content, presentation, transportation, and preservation of documented datasets. In addition, DDI:
I. provides a straightforward means to record and communicate to others all the sa'lent
characteristic of Micro-datasets;
II. facilitates the sharing of structured data across different information systems,
particularly via the Internet.
Components of MMTK
a) Metadata Editor Allows the user to add survey metadata and create the ddi.xml and as a
nester study document. Data are documented using standard templates
output files are produced in several formats: NESSTAR, XML (using DDI), and PDF.
NESSTAR allows the browsing and accessing of data in a user-friendly manner.
b) CD-ROM Builder Allows the user to generate HTML outputs from the study that can
be published on a CD or on the Internet for dissemination.
c) NADA Standalone- Standalone search engine that allows the user to import the

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 ddi.xml and search for variables and view metadata on the desktop.
d) NADA Server- Server-based search engine that allows the user to import the ddi.xml
and search for variables and view metadata on the internet
e) Statistical tool: An associated toolkit that allows the production of basic statistics on
the fly, if micro data is available MMTK is supported by FMOH, NBS, and
MEASURE Evaluation.
Benefits of Data Inventory and Documentation
I. Data availability; accessible from your pc; availability will spur utilization
II. Enables data to take advantage of ICT
III. Data interoperability
IV. Better data management practices
V. Enhances performance monitoring and evaluation
VI. Facilitates data sharing/exchange with government and other users/researchers
VII. Reduces fragmentation & duplication in data collection
VIII. Enables data mining, further analysis, comparability/ coordination
IX. Increases Credibility for the NSO

Challenges to Data Documentation

I. Poor political will and support
II. Lack of funds
III. Difficulties reaching organizations data.

Conclusion
Most organization and data collection agencies simply do not want to let go off their data. So
just acquiring the data for inventory and documentation is very difficult and require protracted
negotiationg
Summary
The unit discussed the main rationale for data inventory with documentation process. Cataloguing of
the data was describe which also include profiling and documentation of data. The
anonymization and utilization of data. The tool in health data inventory and documentation along
with the benefit of data inventory

6.0 Tutor Marked Assignment

1. What are the main rationale for the data inventory and documentation
2. What is MMTK
7.0 Self Assignment Exercise
Explain the Benefits and challenges of Data Inventory and Documentation

References
1.National Bureau of Statistics NBS data access policy 2019.
2. Klevsgård R, Fröberg BL, Risberg B, et al. Nottingham health profile and short-form 36
health survey questionnaires in patients with chronic lower limb ischemia: before and after
revascularization. J Vasc Surg 2002;36:310–7.
3. Meyer-Rosberg K, Burckhardt CS, Huizar K, et al. A comparison of the SF-36 and

67
nottingham health profile in patients with chronic neuropathic pain. Eur J Pain 2001;5:391–403.

CHAPTER EIGHT UNIT 17

ETHICS IN HEALTH INFORMATION
1.0 Introduction
All health disciplines medical, nursing, pharmacy, laboratory technology, medical records,
health service management, and others have code of ethics and principles that guide practice.
Ethics is a study of ideas about right and wrong (Beckner, 2004). Computerised information
systems are yet to permeate health systems in Nigeria, nonetheless, health managers must ensure
adherence to ethics in the running of manually operated health information systems at all levels.

2.0 Objectives
To discuss the three fundamental issues on ethics in health information
3.0 Main Content
Three fundamental issues that are applicable to all health care practitioners and health care
consumers are confidentiality, access, and accuracy of information.
1. Health professions advocate confidentiality, and privacy of patients' medical.;- Professionals, and
other health workers are expected, and bound by moral, ethics, and code of practice to protect
information about patients, treatment procedures, and results of diagnostic interventions. Poor
enforcement of professional codes on confidentiality results in public discussion of patient
problems with people outside the health care team, and immediate family without client's consent.
Maintaining confidentiality in a health institution appeals greatly to the moral conscience of health
care practitioners, and understandably, in some cases information on patients are reported to family
members in order to protect the family and the community at large.
2. Easy access to patient files in manually operated systems makes enforcement difficult. Unless
health managers regard privacy, and confidentiality as important part of quality health care, and put
systems in place for enforcement, and sanction.

3. Managers and health professionals using computerized health information systems are often
unaware that health information stored in national databases are accessible to organizations and
groups outside the health organization. Increasing demand for accurate information for decision-

68
making, and the level of competition for survival compel health organizations to use all means
to access health information.

4. Access to and confidentiality of health information are closely related. Once health information
is obtained and stored in files and filing cabinets or in mechanical systems, health care
organizations are ethically bound to protect such information from unauthorized access, and
patients assured that information are utilized for medical purposes only. This is particularly
important in Nigeria where people are stigmatized and ostracized for contracting certain diseases.
4.0 Conclusion
Ethical issue in health is an important criterion in health systems. When adequately
considered it bring in confidence and continuous utilization of health care facilities in
Nigeria.
5.0 Summary
There are many identities to ethical issues in health information some which include
confidentiality, and privacy of patients' medical, and health information.

6.0 Tutor Marked Assignment

1. What do understand by ethical issues in health care services

7.0 Self Assignment Exercise

1. Explain the Autonomy in data management
2. Explain confidentiality
3. What are the importance of complying with ethical standard of HMIS.

8.0 References
1. Saka, A.O. Saka, M.J. Odunewu, M.A. & Akinwale, S.G. (2017): Cost Analysis and
Policy Implication of Physiotherapy Management of Cerebral Palsy in Nigeria. Bayero
Journal of Evidenced -Based Physiotherapy. 3 (2); 1-6, Published by Faculty of Allied
Health Sciences, Department of Physiotherapy, Bayero University Kano, Nigeria.
www.college.buk.edu.ngq=node4
2. Saka, A.O. Saka, M.J. & Sa‘aidu, L.O. (2018): Evaluation of Children With Protein
Energy Malnutrition And Level of Malaria Parasitemia in Kwara State, Nigeria. Annals
of Africa Medical Research (AAMR). 1(33);54-57, Published by College of Medical
Sciences, Abubakar Tafawa Balewa University, Bauchi, Nigeria. Accessible at
https://www.aamronline.org/index.php/aamr/article/view/33
3. Prieto L, Alonso J, Ferrer M, et al. Are results of the SF-36 health survey and the
Nottingham Health Profile similar? A comparison in COPD patients. Quality of Life in
COPD Study Group. J Clin Epidemiol 1997;50:463–73.
4. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of
Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting
observational studies. Int J Surg 2014;12:1495–9.

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 CHAPTER NINE UNIT 18
HMIS LEADERSHIP AND GOVERNANCE IN HEALTH SYSTEMS
1.0 Introduction
What is a health system?
A health system consists of all organizations, people and actions whose primary intent is to
promote, restore or maintain health. This includes efforts to influence determinants of health as
well as more direct health-improving activities.

2.0 Objectives:
At the end of this module, participants should be able to:
1. explains health system as a concept
2. describe the goals of health systems
3. identify where health management information system is situated within the health
system building blocks

3.0 Main Content

A health system is therefore more than the pyramid of publicly owned facilities that deliver
personal health services. It includes, for example, a mother caring for a sick child at home;
private providers; behaviour change programmes; vector-control campaigns; health insurance
organizations; occupational health and safety legislation.-It include inter-sectoral action by health
staff, for example, encouraging the ministry of education to promote &tr education, a well-
known determinant of better health.' (Source- WHO 2007)
Health system goals
Health systems have multiple-goals. The World health report 2000 defined overall health system
outcomes or goals as: improving health and health equity, in ways that are responsive, financially
fair, and make the best, or most efficient, use of available resources. There are also important
intermediate goals: the route from inputs to health outcomes is through achieving greater access
to and coverage for effective health interventions, without compromising efforts to ensure
provider quality and safety.

70
The six building blocks of a health system are:
1. Leadership and Governance for Health.
2. Health Financing
3. Health Human Resources.
4. Health Services.
5. Health Information System.
6. Medical Products, Vaccine and Technology.
Leadership and Governance involve ensuring strategic policy frameworks exist and are
combined with effective oversight, coalition building, the provision of appropriate regulations
and incentives, attention to system-design, and accountability.
A good Health Financing system raises adequate funds for health, in ways that ensure people
can use needed services, and are protected from financial catastrophe or impoverishment
associated with having to pay for them.
A well-performing Health Workforce is one which works in ways that are responsive, fair and
efficient to achieve the best health outcomes possible, given available resources and
circumstances. i.e. There are sufficient numbers and mix of staff, fairly distributed; they are
competent, responsive and productive.
Good Health services are those which deliver effective, safe, quality personal and non-personal
health interventions to those who need them, when and where needed, with minimum waste of
resources.
A well-functioning Health Information System is one that ensures the production, analysis,
dissemination and use of reliable and timely information on health determinants, health systems
performance and health status.
A well-functioning health system ensures equitable access to essential medical products,
vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their
scientifically sound and cost-effective use.

4.0 Conclusion
Health Management information systems need to function in an environment of functional
health system which consists of all organizations, people and actions whose primary intent is
to promote, restore or maintain health

5.0 Summary
The environment needed for the functional health systems include all the six-building block
from leadership/governance to the services. It major component include health management
information systems

6.0 Tutor Marked Assignment

1. explains health system as a concept
2. describe the goals of health systems

7.0 Self Assignment Exercise

identify where health management information system is situated within the health system
building blocks

8.0 References

71
 1. Polit D. Nursing research: principles and methods. 7th edn.Philadelphia: Lippincott
Williams and Wilkins, 2014.
2. van der Molen T, Postma DS, Schreurs AJ, et al. Discriminative aspects of two generic
and two asthma-specific instruments: relation with symptoms, bronchodilator use and
lung and lung function in patients with mild asthma. Qual Life Res 2017; 6:353–61.
3. Saka, M.J. (2008): Development partner and achieving the goal of primary health care. In
Primary Health Care 30 Years After Alma Atta Declaration Adetokubo Lucas, Azuzu,
M.C., and Obionu C.N (ed.) 270- 280. Nigeria: Published by Health Reform Foundation
of Nigeria. http://www.herfon.org.ng.
4. Saka, M.J. (2008): Policy and practice of water supply in Nigeria: An Element of Primary
Health Care. In Primary Health Care 30 Years After Alma Atta Declaration Adetokubo
Lucas, Azuzu, M.C., and Obionu, C.N(ed.) 136- 156. Nigeria: Published by Health
Reform Foundation of Nigeria. https://www.herfon.org.ng.

CHAPTER NINE UNIT 19

STEPS IN ESTABLISHING HEALTH INFORMATION SYSTEM
1.0 Introduction
The operational, strategic, specific purpose, and data modeling are four basic approaches to
developing health management information systems. Often organisations tend to apply more
than one approach.
2.0 Objectives
To discuss the steps needed in establishment of HMIS and specifically describe the;-
1. operational approach
2. specific purpose approaches
3. strategic approach
4. file approach and
5. database approach
3.0 Main Content
OPERATIONAL APPROACH
A health care organization that develops information systems for transaction processing such as
personnel, payroll, order entry, accounts receivable and accounts payable, has adopted an
operational or bottom-up approach, several independent systems are designed to meet needs of
different users. The health information system can be built up gradually from this basic level if
necessary. The main advantage is in the gradual development of the health management information
system, and fundamental weakness is the lack of data integration as the system evolves. Different
systems that are not integrated, and do not communicate with each other tend to emerge.
SPECIFIC PURPOSE APPROACH
This approach also known as the adhoc approach focuses on solution of specific problems of the
health care organization. In planning for the health management information system, analysis is
carried out only on specific identified trouble areas rather than considering information needs of the
entire health care organization. Such piecemeal approach leads to data redundancy, inefficiency, and
non-integrated database.
STRATEGIC APPROACH

72
Top managers in the health organization are actively involved in the health management information
system strategy planning, and ensure that system design is consistent with strategic plans of the health
organization. Factors that guide planning for the health Information system are objectives, data
requirement, and information technology necessary for implementing the system. The health
care organization that adopts this approach must have clear organizational policies, goals, and
strategies along which to develop the information system. Analysis may reveal deficiencies,
waste, and inefficiencies that could lead to restructuring the health care organization or changing
operations, which cannot be carried out without top management involvement.
FILE APPROACH
The file or manual approach to information processing and management is the traditional
approach widely used in Nigeria. With this approach, each application has a master file and
transactions. For instance, the Admission, the Obstetrics and Gynaecology, and Surgery
Departments collect and store the same information separately on one patient with no
mechanism for integrating or sharing data. A health organization using this approach faces
data redundancy, high cost, and difficulty in data management. Collecting and storing the
same health data at so many points overload the system and increases cost of data storage
and maintenance.
DATABASE APPROACH
Data modeling develops a common database that pulls data from different sources to
accommodate information needed in the health care organization. Data are stored in
different locations in the health care organizations, mechanisms for integration built into
the system, allowing communication, common update, retrieval, and manipulation of data.
A health system database is therefore collection of data or stored information organized
independent of any particular application, organized to serve more than one user.
Information from different sources are stored in a data bank from which employees and
managers access information needed for decision-making. Database for a health care
organization can be built gradually and may even comprise several databases that are
interrelated and communicate with one another. It is a dynamic system controlled and
managed by the health database management System (HDBMS), which eliminates data
redundancy by storing data from different sources at one point, accessible to different
users. This helps patients‘ managers, and employees, reduces confusion, and cost,
enhances communication among users and the system; makes information‘s retrieval
easy; and increase security of data.

4.0 Conclusion
The combination of strategic approach and data base approach were used in designing the
National Health Management Information System.

5.0 Summary
The establishment of HIMIS unit will achieve among other things the policy and
Management Planning Issues, the HIS assessment or Statistical Analysis (needs assessment,
application, data documents, design and testing. The Computing System development and
implementation. And project Plan Preparation. The HMIS project Implementation (training,
information and funding. The Maintenance, review and enhancement (settling down the new
Health Care Activity Information system, continuing support of field and system staff.
initiating routine reporting programme, newsletter, post implementation review and Strategic

73
Work-Plan

6.0 Tutor Marked Assignment

You are, required to set up HIS unit in your organization. How do you go about it?

7.0 Self Assignment Exercise

1. What are the steps in establishing HMIS unit?
2. What are the issues involved in maintenance, review and enhancement.

8.0 References
1. NHP and Strategy Document 2018 Federal Ministry of Health, Lagos, October
2. Two-way Information Support in the Local Health System, WHO WP
SHS/EC/85/WHO/11A.
3. NPA document on Child Survival, Protection and Development 2019.
4. NHMIS Policy, Programme and Strategic Action Plan (2018)
5. HMIS Working documents for Kaduna, Rivers, Yobe and Edo States 2017.
6. Guidelines for establishing HMIS PHC M & E Manual 2019

CHAPTER NINE UNIT 20

STRUCTURE, ROLES & RESPONSIBILITIES OF GOVERNMENT IN HMIS
1.0 Introduction
The philosophy, background, goal(s) and objectives of a health information system (using the
National Heat1h Management Information System programme as a case study). The
development of national management information system and national health indicators.
Discussion of the national health policy indicators, health status indicators, socio-economic
indicators, provision and utilization of health care indicators.

2.0 Objectives
The unit seek to review structure along with the role and responsibilities of different tiers of
government in the establishment of HMIS in Nigeria and specifically to;-
1.Describe the structure and elements of HMIS
2. Hierarchical Structure of HMIS
3. Review the relationship and data flow including the procedures
4.Discribe roles and responsibilities of tiers of government in HMIS

3.0 Main Content

STRUCTURE OF HMIS
Reviewing the structure of the National Health Management Information System is Nigeria.
It shows the institutional framework of hierarchical levels from which health data and information
are to be obtained. At the apex of the structure is the NHMIS branch of the Department of Health
Planning, Research & Statistics. The branch relates horizontally with the National Bureau of
Statistics (NBS), the National Population Commission (NPopC), other ministries, international health
organizations and other key health data generating agencies in the public health sector, such as the
National Primary Health Care Development Agency (NPHCDA), National Agency for Food, Drug
Administration and Control (NAFDAC), the National Health Insurance Scheme (NHIS), etc. The
relationships with these bodies are illustrated in the expanded operational diagram of the NHMIS

74
above. Similarly, the NHMIS branch relates and co-ordinates health information related-activities of
FMOH departments, parastatals, agencies and professional bodies.

The NHMIS branch interfaces through established protocols with health information related
activities of SMOHs, LGAs and all health facilities, public and private. Health data from
communities is collected and streamlined into the structure through health facilities rendering
services to communities. This structure indicates that the hub of health information at the state level is
the State HMIS unit located in the Department of Health Planning, Research & Statistics while the LGA
Department of PHC M&E serve the same function at the LGAs. These Departments coordinate data
from different sources at their levels. In doing so, they have to collaborate with the different health
programmes and even with other departments outside health generating health related data e.g.
education.

Roles & responsibilities of tiers of government; - Federal Responsibilities

1. Data storage, analysis, publication and presentation
2. Documentation and publication services
3. User services
4. Clearing house for health information
5. Survey operations
On-line services
1. Technical assistance
2. Database development
3. Informatics services
4. HMIS Forms reproduction
5. Computerization
6. Training.
State Responsibilities
1. Data storage, analysis, publication and presentation
2. Documentation and publication services
3. User services
4. Clearing house for health information
5. State Health Profile
6. HMIS Forms reproduction
7. Training
LGA responsibilities
1. Data storage,
2. Analysis, presentation
3. Data forwarding
4. User services LGA Health Profile
5. HMIS Forms reproduction
6. Training
Health facility responsibilities
1. Data collection daily in registers and monthly in facility summary forms
2. Data storage
3. Data forwarding
4. Data sharing

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5. Data usage
6. Training

4.0 Conclusion
The structure of HMS followed same pattern at both federal, state and LGAs level. However, the
function at the federal level include policy formulation. the service and training which are also
part of State and LGAs function for HMIS

5.0 Summary
The institutional framework of hierarchical levels of HMIS from which health data and information
are to be obtained. At the apex of the structure is the NHMIS branch of the Department of Health
Planning, Research & Statistics. At both the federal and State level

6.0 Tutor Marked Assignment

1. Critically review the HMIS Structure in your organization
2. Draw a typical organizational chart of HMIS and explain the in-built relationship.
3. Structure is a sequence of procedures. Relate this to data flow and procedures of HMIS.

7.0 Self Assignment Exercise

1. With an illustrated Figure, describe the structure of HHMS
1. At the Federal level, is the structure of HMIS adequate? Give reasons for your answer.
2. Draw an organizational chart of any HMIS Structure and explain its working system.

8.0 References
1. Desroches CM, Charles D, Furukawa MF, Joshi MS, Kralovec P, Mostashari F, Worzala, C.,
Jha, AK. Adoption of electronic health records grows rapidly, but fewer than half of US hospitals
had at Least a basic system in 2012. Health Affairs (Project Hope) 2013; 32 (8): 1478-1485.
Epub 2013/07/11.
2. Furukawa MF, Patel V, Charles D, Swain M, Mostashari F. Hospital electronic health
information exchange grew substantially in 2008–12. Health Affairs (Project Hope) 2013; 32 (8):
1346-1354. Epub 2013/08/07.
3. Patel V, Jamoom E, Hsiao CJ, Furukawa MF, Buntin M. Variation in electronic health record
adoption and readiness for meaningful use: 2008–2011. J Gen Intern Med 2013; 28 (7): 957-964.
Epub 2013/02/02.
4. Canada Health Infoway. The emerging benefits of electronic medical record use in
community-based care. Ontario, Canada: PwC; 2013 [cited 2014 Jun 13]; Available from:
http://www.pwc.com/ca/en/healthcare/electronic-medical-record-use-community-based-
care.jhtml.

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 CHAPTER TEN UNIT 21
COMMUNICATING HEALTH INFORMATION FOR ACTION
1.0 INTRODUCTION
The essence of health data collection and processing is to obtain health information. Health
information must in turn, be properly communicated to the appropriate quarters in order for health
programmes to receive guidance through sound decision making. Health information
communication is said to be effective when the recipient understands it, respond to it and able to
use it to bring about a positive change. In this module we shall be discussing factors that enhance or
inhibit effective health information communication, the nature of health information at the different
levels of use and the tools to communicate health information effectively.

2.0 OBJECTIVES
At the time the student completes this unit on communicating health information for action, he
or she should be able to:
1. Define or explain health information communication
2. Explain what message is all about
3. List some of the pre-requisites for effective health information communication.
4. List the Challenges to Health Information Communication

3.0 MAIN CONTENTS

MEANING OF HEALTH INFORMATION COMMUNICATION
Communication is the process of transmitting information and understanding between two or more
people. Communication is part of every function of management and of health service: Studies have
shown that most executives in public and private organizations spend as much as 75 % of their time
communicating. Communication is a vast subject. It is much more than words. It includes behaviour,
gestures, dress, music, art as well as perceiving and listening. It is a two-way process between people.
It may be between two people or between one person and a group. of people. Communication is
successful only when there is understanding of the message between the sender and the receiver.

77
In communication, a message is passed from the sender, through a transmission process to the
receiver.

WHAT IS A MESSAGE?
A message is any idea, feelings, information, emotions, facts etc. that an individual or a group wants to
convey to another individual or group for an anticipated behaviour. The extent to which that anticipated
behaviour is achieved determines the success and effectiveness of the communication. For effective
communication to occur, messages must have only one major idea, presented in simple language.

Pre-requisites for Effective Health Communication

a) Make sure that people hear, see and understand the message (ideas, information and
feelings) that is being shared with them.
b) Use few words that people will understand (avoid technical words).
c) Use few words as much as possible. A long lecture will bore people. They will forget the
message.
d) Use aids that people are familiar with in conveying your message.
e) Give message and listen to responses or ideas or interests expressed by people.
f) Check to know if people heard your message correctly and also if you heard their
responses correctly.
g) Encourage people to identify their own problems.
h) Encourage participation.
i) Avoid prejudice and bias.

Challenges to Health Information Communication

a. Biases against people
b. Pre judgement of the sender of the message
c. Inability to listen
d. Habits, values and traditions
e. Arrogation of status or prestige
f. Use of inappropriate language

4.0 Conclusion.
Health communication is effective when it take place between two or more people with feedback.
Most executives in public and private organizations spend as much as 75 % of their time
communicating. Communication is a vast subject. It is much more than words. It includes behaviour,
gestures, dress, music, art as well as perceiving and listening

5.0 Summary
The unit discussed health information communication the meaning of communication, what the
message is all about, including the pre-requisite for effective health communication. Health
information communication is effective when there is assurance that people hear, see and
understand the message (ideas, information and feelings) that is being shared with them. Some of the
challenges include arrogation of status or prestige

6.0 Tutor Marked Assignment

1. How is communication different from message

78
 2. Define health information messages with example

7.0 Self Assignment Exercise

1. Explain the pre-requisite for effective health information communication
2. What are the challenges in health information communication?

8.0 References
1. Ishaq, F.A. Olayinka, R. B. Momoh, A. Yusuf, M.K. & Saka, M.J. (2002): Effectiveness of
Information Education and Communication (IEC) On Public Acceptability of Unsafe
Abortion Solution. Trop j. Obstet Gynaecul. 19(1); 12-16, Published by Society of
Gynecology and Obstetrics of Nigeria (SOGON). Available online at
http://www.ajol.info/index.php/tjog/article/view/14361
2. Saka, M.J. & Aremu, M.A. (2006): Marketing Communication Mix as a Means of Enhancing
HIV/AIDS Education in Nigeria. Journal of Administration. 1(3); 14-24, Published by
Nasarawa State University Keffi. https://nsuk.edu.ng/administration/.

CHAPTER TEN UNIT 22

METHODS OF HEALTH INFORMATION COMMUNICATION
1.0 Introduction
There are different methods of health communication. Whereas, health information
is communicated either by modern or natural methods. Any of the method used are
important ways of expressing ideas and feelings. They are basically used in giving
people health knowledge and facts.

2.0 Objectives
At the end of the unit the students is expected to be able to;-
1. Describe modern method of health information communication
2. Describe natural method of health Information communication

3.0 Main Contents

The Audience
Communication is directed to an audience. The audience could be an individual, a family, small or large
group. Whatever the type of audience you are directing a message to, the characteristics of the audience
must be known and studied. You must know the following: age, educational level, occupation, Socio-
economic class, culture health problems, feelings and so on of the audience. When the health worker
becomes aware of the characteristics of the audience, he could package and send appropriate health
message that will produce the desired effect to the target audience.

Channels
Channels are media through which messages are sent to target audience. A channel therefore could be
defined as the object or thing through which a message is transmitted. Examples of channels are radio,
television, newspapers, air, posters, etc. Communication media are channels through which messages
are conveyed to individuals or groups, and they usually:

a) support or reinforce message reach audiences that the sender can not reach.

79
 b) it is therefore recommended that multiple channels be used in conveying messages, as this will
reinforce the impact of the message.
The extent to which anticipated behaviour is achieved determines the success and effectiveness
of the:
(a) audience
(b) Communication/
(c) skill
(d) performance
Skills needed for good communication should be such that it makes sure people hear, see and
understand the message. It however, should not include any of the following.
(a) discouraging people to identify their own problems.
(b) along, boring lecture.
(c) give message but not listening to responses or ideas of people.
All these are communication channels include:
(a) radio
(b) Newspapers
(c) Water

To Reinforce the Impact of Conveying A Message, It Is Advisable To Use

(a) multiple channels
(b) As many channels as possible.

4.0 Conclusion
For health information communication the audience must be segmented using appropriate channels to
expressing ideas and feelings of the clients or health care providers. To reinforce the impact of
conveying a message it is advisable not to use one channel. for the method to be effective only
one major idea presented in simple language.

5.0 Summary
Communication media are channels through which messages are conveyed to individuals or groups,
and they usually support or reinforce message reach audiences that the sender cannot reach and it is
therefore recommended that multiple channels be used in conveying messages, as this will reinforce
the impact of the message.

6.0 Tutor Marked Assignment

1. How is method of health information communication channel different from audience
communication different from message.
2. List and explain different health communication channel you know.

7.0 Self Assignment Exercise

Explain in detail audience segmentation in health information communication methods

8.0 References

80
 1. Furukawa MF, Poon E. Meaningful use of health information technology: evidence
suggests benefits and challenges lie ahead. Am J Manag Care 2015; 17 (12 Spec No.):
SP76a-SP.
2. Canada Health Infoway. Progress in Canada. [cited 2014 Jun 13]; Available from:
https://www.infoway-inforoute.ca/index.php/progress-in-canada.
3. Whipple EC, Dixon BE, McGowan JJ. Linking health information technology to patient
safety and quality outcomes: a bibliometric analysis and review. Inform Health Soc Care
2013; 38 (1): 1–14. Epub
4. Salaudeen, A.G. Ojotule, A. Durowade, K.A. Musa, O.I. & Saka, M.J. (2013): Condom
use among HIV sero-concordant couples attending a secondary health facility in North-
Central Nigeria. Nigeria Journal of Basic and Clinical Sciences. 10(2);51-56, Published
by College of Health Sciences, Bayero University Kano. Available online at
http://www.njbcs.net/article.asp?issn=0331-
8540;year=2013;volume=10;issue=2;spage=51;epage=56;aulast=Salaudeen

CHAPTER TEN UNIT 23

TRADITIONAL METHODS OF HEALTH INFORMATION COMMUNICATION
1.0 INTRODUCTION
The methods in this section are based on natural ways of expressing ideas and feelings. They
are basically used in giving people health knowledge and facts. The value in using traditional
approaches in communication are basically two. First, it is part of people's culture and.
secondly, it will be easily understood by people from that particular culture (W.H.O.).

2.0 OBJECTIVES
The unit will explain the traditional method of health information communication and
specifically to;-
1. Explain the meaning of health talks
2. Guidelines for preparing a talk
3. Educational use of proverbs educational use of proverbs
4. Dance and song and
5. Characteristics of good story
3.0 MAIN CONTENTS
Health Talks
The most natural way of communicating with people is to talk with them. In health areas, we
have many opportunities to talk with people. We can do this with an individual, a small or large
group.

Guidelines for Preparing A Talk

The following points must be considered carefully in preparing a talk:
(a) know the group you will meet
(b) select a topic that is appropriate to the group.

81
(c) Be sure you have correct and up to date information on the topic.
(d) Prepare a list of the points you will make.
(e) Write what you will actually say.
(f) Think of visual aids
(g) Practice your talk.

Proverbs
Proverbs are common sense saying that are handed down from generation to generation. They
grow out of experience of people in each culture. They are like advice on how best to behave
Proverbs are used to support or illustrate health information or idea that you want to get across.

Educational Use of Proverbs

Proverbs can be combined with talks, demonstrations, stories, dramas or put on posters and flip
charts. When you use a proverb correctly, people will be impressed that you understand their
culture. They are more likely to follow your advice.

Dance
People communicate ideas through the movement of their bodies. This happens when you move
your hands or wink your eyes. In some cultures, traditional dance is used to tell stories. Dance
generally, tend to bring people together in fellowship and happiness. It also provides feeling of
support in addition to the ideas communicated.

Song
People sing to express ideas and feelings. There are songs about love and sadness. Song may tell
the story of famous person or event. Some songs are religious and others are patriotic. Songs are
sung to help children fall asleep or celebrate special occasion. They can also help to educate
people. Singing comes naturally in certain cultures, but not so in others. Songs can be used to give
people ideas about health. If the tune is attractive people will remember the song and the
information it contains. Depending on the local culture, songs can be used at the beginning of a
health talk, a meeting or any other organised programme, to create enthusiasm and interest. They
can also make a meeting end on a happy note.
Stories
Stories may tell about the brave deeds of a village ancestor or heroes. An older person, instead
of directly criticizing the behaviour of a youth, may tell; a story to make his points. Story can
entertain and make the points. Story can teach history, spread news and information as well as
gives lesson about behaviour. Stories can be used to give information and ideas to encourage
people to look at their attitudes and values, to help people decide on how to solve their
problems.

Characteristics of Good Story

1. The story should be believable
2. The story should be short
3. The story should make a clear point at the end.

Case Study
Case studies are real life experiences. They are based on facts and present events as they really
happened. Case studies help people to learn how to solve problems. By reading and listening

82
 to a case (problem) that was faced by another community, people can begin to think of
themselves and how to solve their own problems. They will learn from the successes or
mistakes of other people in case studies.

How To Use Case Study

Give copies of the case study to the group to read, if they are literate. If the group cannot read.
you must read the case study to them. Read slowly and repeat the reading, if there is need.
Encourage discussion of the problems raised in the case study by' members. of the group.
Encourage everyone to share opinions.

4.0 Conclusion
The traditional methods of health information communication are many some of which include
health talks, song, stories, proverbs and case study.

5.0 Summary
Public health students should be able to know explain the meaning of health talks, provide the
guidelines for preparing a talk. It is also important to be able to have educational use of
proverbs educational use of proverbs. Discussing the dance, song and understand characteristics of
good story. Which include but not limited to the story been short, should be believable and the
story should make a clear point at the end. One of the factor to considered in preparing a talk should
include knowing the group you will meet and select a topic that is appropriate to the group.

6.0 Tutor Marked Assignment

1. Explain how is traditional method of health information communication different from
modern method.
2. What are the characteristics of a good story.

7.0 Self Assignment Exercise

List and explain traditional method of health information communication

8.0 References

1. Saidu, R. Euna, M. Amina, P. Saka, M.J. & Jimoh, A.A. G. (2013): An assessment of
essential maternal health services in Kwara state, Nigeria. African Journal of
Reproductive Health. 17(1); 41-48, Published by the Women's Health and Action
Research Center University of Benin, Benin City Nigeria. Available online at
www.jstor.org/stable/23486136?seq=1#page_scan_tab_contents
2. Saka, M.J. Saka, A.O. & Akinwale, A.S. (2017): Quality of Life of Children with
Cerebral Palsy: Accumulative Effect of Physiotherapy Intervention in North Central and
South West Nigeria. African Journal of Physiotherapy and Rehabilitation Sciences.
9(6);28-34, Published by College of Medicine University of Ibadan Nigeria. Available
online at https://www.ajol.info/index.php/ajprs/article/download/181281/170677
3. Saka, A.O. Saka, M.J. Odunewu, M.A. & Akinwale, S.G. (2017): Cost Analysis and
Policy Implication of Physiotherapy Management of Cerebral Palsy in Nigeria. Bayero
Journal of Evidenced -Based Physiotherapy. 3 (2); 1-6, Published by Faculty of Allied

83
 Health Sciences, Department of Physiotherapy, Bayero University Kano, Nigeria.
www.college.buk.edu.ngq=node4

CHAPTER TEN UNIT 24

HEALTH INFORMATION COMMUNICATION TOOLS/MEDIA

1.0 Introduction
In health information communication, there are different types of tool or methods
used in dissemination of health information

2.0 Objectives
At the time the student completes this unit on health information communicating tools/methods
for action, he or she should be able to:
1. Describe appropriate communication methods, media and techniques for presenting
various health information and facts etc.
2. Explain methods of presenting health messages to individuals and groups.
3.0 Main Content
Audio Visual Aids
Audio visual aids should be used to reinforce, clarify and give a health talk. or an explanation to
clarify relationship and simplify demonstration. They are called AIDS because their role is to
support the message.
Flip Charts
Flip chart is a number of posters grouped together that are meant to be shown, one after the
other. In this way, several aspects or steps of a central topic can be presented.
Examples of topics that could be put on flip charts include:
(a) prevention of burns

84
 (b) How to dress a small wound.
(c) Human reproduction
(d) Information and instructions.

How to Use Flip Chart

1. Each chart or poster must be discussed completely before you turnup to the next one.
2. Make sure that everyone properly understands each idea.
3. At the end, go back through the charts and review them. Help people remember the talk
or information already learnt.

Many types of charts are used to explain relationships.

(a) Anatomical charts, showing basic structure of cells, tissues, organs and systems of organs
tha: are available for the use of older students. They enable the class to discuss body structure
since structural relationship can be pointed out for all to see.
(b) Organisation charts - show the relationship of the different divisions of health department or
other flow of materials, services or functions by means of arrows from one section to another.

Posters
The posters present an idea at a glance. It reminds, it calls attention, it suggests actions very
quickly, it arrests attention and presents a sound, true, timely important and appealing message.
A good poster is large enough to be read at the back of the lecture rooms. It has contrasting or
striking col ours, clear lettering and wording which is immediately understood. Its message is
easy to remember. The health message should be sound and its presentation

Photographs
Photographs are useful educational tools. They produce reality. Photographs can show people
new ideas or skills. The following points should be noted in using photographs to communicate
messages.
1. The people and the surrounding in the photograph should look similar to the people who are
looking at the photograph, except where a contrast is the desired message.
2. The photograph should focus on one clear idea.
3. A series of photographs could be used to show different scenes in a story.
4. Community events such as drama and clean-up campaigns are good subjects for
photographs.
Flash Cards
These are usually made on cardboard and consist of words or pictures which can be flashed by
hand for quick identification or for memory drills. They are useful in health education in the
study of words meaning and for strengthening the immediate recognition of foods with different
nutritional values as well as for the study of harmful insects, poison ivy, and other poisonous
plants. They can also help to distinguish between poisonous and harmless snakes or mushrooms
in situations where this knowledge is important.
Maps
Maps showing limited geographical details may be used to demonstrate many health situations. A
spot map of neighbourhood or state can be made to show the distribution of diseases in time of
epidemics. A neighbourhood map shows the exact location of an accident. State or national map can
be made to show areas of food production, concentrations of population or which states have
specific laws or regulations. They bring events from other parts of the world to the classroom. They

85
present only the things the students should see. They do not confuse important with unimportant
details. Projected materials are also useful in underlining the most important points in a talk or
lecture, show motion analyses rapid movements, stop motion speeds of an activity like the growth
of bacteria which is too slow to watch through the microscope. Dramatic films motivate as well as
inform:
Chalkboards
Chalkboards, coloured for effective Contrast with chalk provide the most used medium in
presenting visual impressions. They are used for word list diagrams, charts, graphs and sketches.
Most classroom and lecture rooms are equipped with chalkboards or other boards that serves the
purpose of a chalkboard.
Bulletin-Board Or Tack-Board
This is is usually made of cardboard pressed fibres, soft wood or self-healing cork, Bulletin
boards may be devoted to an extensive series of clippings, pictures, charts, maps, and graphs
related to current health topic, such as 'Aids". Bulletin boards in the corridors, cafeterias libraries
and other rooms may be used for carrying health messages.
Flannel-Boards
Flannel-board is made by covering a sheet of maisonette or similar board with flannel cloth. Cut
out flannel figures and pictures mounted on a card with a sand paper back will stick to the surface
of the flannel. The ease with which it can be put up and taken down makes the flannel board an
interesting device for the presentation of health ideas either directly or connection with class
discussion. The flannel board is useful at all levels of instruction and particularly valuable in
illustrating series of events or activities in a discussion period. Flannel boards provide a good
method for presenting and discussing balanced meals, the basic food groups, the production and
distribution of milk, seasonal clothing needs and routes, through which communicable diseases
are transmitted.
Magnetic-Board
This is similar in purpose and use to flannel boards. They are metal sets, to which either
magnetic pieces or material attached to magnets will adhere.

4.0 Conclusion
The unit describe appropriate communication methods, media and techniques for presenting
various health information and facts etc. They include audio Visual Aids, flip chart, the
method and types of flip charts. Others are posters, photography, flash card , maps
and ranges of boards.

5.0 Summary
Traditionally, in methods of presenting health messages to individuals and groups are many.
Depending on circumstances and situation for the presentation of health information messages. In
certain condition magnetic board, flannel board, bulletin-board or tack-board, chalkboard may
be used.

6.0 Tutor Marked Assignment

1. Classify tool used in health information communication
2. How will you use flip chart to present health information messages to the group of people.

7.0 Self-Assignment Exercise

86
The was an outbreak of cholera epidemic in your community. You were part of the investigating
team How will you present your findings to the LGA council members to support in combating
the outbreak?

8.0 References
1. Saka, A.O. Saka, M.J. & Sa‘aidu, L.O. (2018): Evaluation of Children With Protein
Energy Malnutrition And Level of Malaria Parasitemia in Kwara State, Nigeria.
Annals of Africa Medical Research (AAMR). 1(33);54-57, Published by College of
Medical Sciences, Abubakar Tafawa Balewa University, Bauchi, Nigeria. Accessible
at https://www.aamronline.org/index.php/aamr/article/view/33
2. Baker, Bert, "How to communicate effectively" California; Kogan Page, 2018 Lewis Roger
and John Inglis, "Report writing, the secrets of successful reports", Cambridge National
Extension College Trust Ltd, 1992.
3. Tim. Q'Shullivan, "Key concepts in communication" London: Routledge, 2019.
Wright, Andrew, "How to communicate successfully" Cambridge; University
Press. 1987.
4. Saka, M.J. (2008): Development partner and achieving the goal of primary health
care. In Primary Health Care 30 Years After Alma Atta Declaration Adetokubo
Lucas, Azuzu, M.C., and Obionu C.N (ed.) 270- 280. Nigeria: Published by Health
Reform Foundation of Nigeria. http://www.herfon.org.ng.
5. Saka, M.J. (2008): Policy and practice of water supply in Nigeria: An Element of Primary
Health Care. In Primary Health Care 30 Years After Alma Atta Declaration Adetokubo
Lucas, Azuzu, M.C., and Obionu, C.N(ed.) 136- 156. Nigeria: Published by Health
Reform Foundation of Nigeria. https://www.herfon.org.ng.

CHAPTER ELEVEN UNIT 25

THE MODELS AND TYPES HEALTH INFORMATION UNITS
1.0 Introduction
A health management information unit needs to be well managed if it is to achieve the purpose for
which it is established. Such a unit does not stand alone but usually mainstreamed within the structure
of an organization. It is therefore affected by the organization's policies and managerial process.
Many factors affect the effectiveness and efficiency of a health management information unit.
Operators of health management information units are required to observe in-country legislation on
protection of classified documents, copy right laws and official secrecy act.

2.0 Objectives
This unit explains the organization of a health management information system unit and specifically to
1. know how HMIS unit operate
2. define HHMIS as a system

3.0 Main Contents

In understanding this, we need to know that an HMIS unit operates as a system which simply can be
defined as "a set of units or parts or entities which interact with one another to perpetuate the functional
existence of the whole system". It is a set of interrelated elements brought together to achieve a purpose in
the environment in which the system exists. It is a group of elements which are related (persons, procedures

87
 organization‘s, equipment, concepts etc.) in such a way that they influence each other and the behaviour of
the elements as a whole. For example, the National Health Information System is a set of people,
Type of Model for HMIS
Procedure and equipment for the purpose of providing information when necessary and
required, in a suitable, form for programmes, and international exchanges of health information.
Its function is to supply the necessary information for management of the national health
programmes at all levels.
In terms of organising the health information system, there are basically two models
a) Decentralised model
b) Centralised model
a. Decentralised model has a hierarchy of levels at which data is collected and information
generated for decision making. It has a pyramidal shape from the periphery where much
information is collected and used to the apex where less data is generated but strategically
used.
Federal Level ………………………………………..

State level ……………………………………….

Local Government Areas…………………..

Health Facilities…………………………..
Communities ………………………..
Fig 25.1
b. In a decentralised system as above, each level has specified responsibilities.
At central level (the apex of the triangle) duties of the health Information unit include:
1. co-ordinating, centralising, analysing, updating sorting and disseminating health
information.
2. designing standard procedures and mechanisms for the notification, recording
and use of data.
3. compiling data by special survey meeting national and international commitment
concerning health information.
At the intermediate level (state level) duties include:
1. centralising health units reports.
2. analysing, compiling and processing statistical data.
3. notifyingthose concerned of important events which may call for immediate action
At the local levels (LGAs, health facilities, communities)
1. collection of data
2. analysis and information generation
3. use of data
Refer to chapter nine unit 20 on structure, roles & responsibilities of the different levels of
government in management of the National Health Management Information System (NHMIS)

5.0 Conclusion

88
There are different models of HMIS unit. Which may be decentralized and centralized models. The setting
up of HMIs unit is a part of systems. That are usually interact with each other.

6.0 Summary
Health management information unit of centralised model does not have such hierarchies of data
management. The provision of health information is a central function.

6.0 Tutor Marked Assignment

1. Classify different models of managing HMIS unit
2. What are the main characteristics of decentralized model

7.0 Self-Assignment Exercise

List and explain different level of decentralized model

8.0 References
1. Saka, M.J. (2010): Overview of cancer and cancer registration. In Non-Communicable
Disease in Nigeria: The Coming Epidemic Adetokubo Lucas, Akinkugbe O.O,
Onyemelukwe G.C. (ed.) 249-252. Nigeria: Published by Nigeria Health Reform
Foundation of Nigeria https://www.herfon.org.ng.
2. Saka, M.J. (2010): Violence Against men. In Non-Communicable Disease in Nigeria:
The Coming Epidemic Akinkugbe O.O. Adetokubo Lucas, & Onyemelukwe G.C. (eds.)
249-252. Nigeria: Published by Nigeria Health Reform Foundation of Nigeria.
https://www.herfon.org.ng.

CHAPTER ELEVEN UNIT 26

BASIC CONCEPTS IN MANAGEMENT OF HEALTH INFORMATION UNITS
1.0 Introduction
Health management information systems is an important section of health care delivery services. As such
it should be recognize to have a separate unit or department in an hospital set up. This is necessary for
optimal function in provision of base line data or evidence-based health information that physician needed
to treat the clients.
2.0 Objectives
The unit will discuss basic needs for establishment of HIMIS unit or department and concept of health
management information systems. It specifically describes the;
1. Basic requirements needed for set up of HMIS unit or department
2. The form of HMIS operations
3. The basic concept of HMIS
3.0 Main Content
The choice of the type of organization depends on
i. Availability of funds;- The decentralized model obviously requires more
resource to function than the centralized model.
ii. Availability of skilled personnel;- The decentralized model requires that skilled

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 personnel be placed at different levels of data management for the units to
function effectively.
iii. Availability of basic equipment to facilitate data management.
iv. The structure of the health care system. In a decentralized health care system, the
different levels have roles to play to maintain a functional health information unit.
v. Roles specified for health management information system within a national health
policy.
The Health Management Information System in its operation may be
i. Paper based: Here the entire system of data collection, storage, processing will rely on
paper- based data collection tools. This is costly to operate as data collection tools have to
be continuously available. It is recommended where the IT skills of operators are minimal.
ii. Automated: Using computers with specialized software for all the steps in data
management. It requires highly skilled personnel and high cost of initiating it.
iii. Mixed: This means that some levels rely on use of paper while from other levels processes
are automated. The National Health Management Information System practices the mixed
type where automation s recommended from LGAs upwards and in big hospitals that have
skilled personnel to do this.
In whatever model we choose, let us bear in mind that
approximate information supplied in time is better than
exact information supplied too late.

Basic Concepts in Management of Health Information Units

Artificial Intelligence: The concept that computers can be programmed to assume some
capabilities normally thought to be like human intelligence, such as learning, adaptation and self-
correction.
Compatibility: The ability for computer programs and computer readable data to be transferred
from one hardware system to another without losses, changes or programming.

Configuration: The particular choice of hardware and its connection making up a computer
system.
Data Base Management System: A set of programs for establishing, sorting, searching and
otherwise manipulating the database. It generally permits further calculations and the production
of reports.
Data dictionary: The set of standard descriptions of data items and entities which are used in all
programs in an organisation. It includes definitions, codes, validation rules, ownership right of
access, right of updating.
Decision Support System (DSS): A management information system in which significant
analysis is done in order to present reports in a format directly useful for decision.
Distributed data base: A data base which, though conceived as one whole, is held in more the
computer. Normally, most of the data files are stored closest to the main user but shared by all.
Duplex: A transmission system allowing data to be transmitted in both directions
simultaneously.
Informatics: A comprehensive term covering all aspects of the development and operation of
information systems, the supporting computer methodology and technology, and the supporting
telecommunication links.
Information Centre: An organization entity charged with providing general support services for

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users of information systems.
Information retrieval: The action of recovering information on a given matter from stored data.
Interface: The boundary between two hardware or software system across which data are
transferred. An overall term to refer to the physical linkages and procedures, codes and protocols
that enable meaningful exchange of programs, commands or data between two computerised
systems or devices.
Local area network: A high speed geographically constrained (e.g. office complex)
communications arrangement between computing equipment permitting data transfer, sharing of
common resources and convenient physical connections to the users.
Network: A set of computers and peripherals connected by communications links.
Office automation: The use of computer-based technology for the purpose of increasing
productivity of office workers.
Off-line: Pertaining to the operation of a functional unit when not under the direct control of the
computer.
On line processing: Processing performed on equipment directly under the control of the central
processor while the user remains in communication with the computer.
Protocol: The formal rules governing the exchange of information in a communication link
including format, timing, sequencing and error control.
Secondary Storage: Storage or memory which is not located in the central processor of the
computer but is in peripheral media such as tapes, disks, diskettes etc.
Security: The establishment and application of safeguards to protect data, software and
computer hardware from accidental or intentional modification, destruction or disclosure.
Telematics: The use of computer-based information processing in telecommunications and the
use of telecommunication to allow computers to transfer programs and data to one another.
Telemedicine: The use of Telematics to transmit medical data.
Validation: A process of testing data by applying criteria to them to determine whether they are
suitable for entry into a database.

Work station: A specialised terminal with some independent data processing capability.

4.0 Conclusion; -
In establishment of HMIS certain fundamental needs or resources needed for
management function include Human (specialized HMIS officer), Money and equipment
with another accessory needed.

5.0 Summary
In the section we are able to describe Basic requirements needed for set up of HMIS unit or
department. The form of HMIS operations and the basic concept of HMIS

6.0 Tutor Marked Assignment

1. What factors determine the extent of centralisation and/or decentralisation of the health
management information system.
2. Explain the following concept in Finagle's Law "The information you have is not what you want; the
information you want is not what you need; the information you need is not what you can get; the information
you can get costs more than you want to pay

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7.0 Self-Assignment Exercise
How will you explain the requirement needed for establishment of HMIS unit in an
organization?

8.0 References
1. Saka, M.J., (2019): Financing for Efficient and Qualitative Primary Health Care in
Nigeria. Proceedings of 2nd National Health Conference. M.C Azuzu, Oshotimehin, B.
Obionu, C.N. Okediran W. and I.Y Oloriegbe (eds) 2; 80-89, Published by Health
Reform Foundation of Nigeria and Department for International Development (DFID).
https://www.herfon.org.ng.
2. Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med
2013; 348 (25): 2526-2534.
3. Dixon B, Grannis S. Public Health Informatics Infrastructure. In: Magnuson JA, Fu JPC,
editors. Public Health Informatics and Information Systems: Springer London; 2014. p.
69–88.

CHAPTER ELEVEN UNIT 27

THE MINIMUM PACKAGE FOR HMIS UNIT
1.0 Introduction
For the functioning of HMIS units, basic requirements and infrastructure need to be specified as
standards. The establishment and management of an effective NHMIS, requires substantial investment
by levels of data management or by a central unit in infrastructural development and in technical
assistance within and between the levels. Thus, as part of the overall strategy to improve the quality
and quantity of health data and information available for decision-making, HMIS units are to be
provided with a threshold of minimum package to enable them function effectively.
2.0 Objectives
The ultimate aim of the unit is to provide basic requirements needed for the minimum package for
health management information unit with the specific objective are to provide
1. Federal level requirement for setting up HMIS
2. State level requirement for setting up HMIS
3. LGA level requirement for setting up HMIS
3.0 Main Content
A good example of threshold of minimum package is provided by the National Health

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 Management Information System programme for the decentralised levels of data management
as
shown below.
FEDERAL NHMIS UNIT REQUIREMENTS
1. NHMIS Working Document (plan)
2. NHMIS Operational Manual
3. Adequate office space
4. Office furniture
5. Micro-computers for data processing and storage (10)
6. High capacity printers, photocopiers
7. Full complements of desktop publication (DTP) equipment
8. Appropriate software
9. Telematics: telephone lines (2) with fax, network system, internet, website, VSAT
10. Vehicles: 4-WDR (2), Utility bus (1)
11. Binding machines
12. Digital camera and projectors
13. Power backup and/or Generator
14. GIS Software
HMIS STAFF
1. National Expert/Consultant (1),
2. HMIS specialist (3)
3. Epidemiologist (2),
4. Public Health Specialist (1),
5. Computer Programmer (2),
6. System Manager (1),
7. User-services staff (1),
8. Data Entry and Processing Clerks (6),
9. Office assistance (3)
10. Statistician (2),
11. System Administrator (1).
STATE HMIS UNIT REQUIREMENTS
1. State HMIS Working Document (plan)
2. NH MIS Operational Manual
3. Adequate office space
4. Office furniture
5. Micro-computers for data processing and storage (6)
6. High capacity printers, photocopiers Full complements of DTP equipment
7. Appropriate software
8. Telematics: telephone lines (2) with fax network system, internet, website.
9. Vehicles: 4-WDR (2), Utility bus (1)
10. Binding machines
11. Digital camera and projectors
12. Power backup and/or Generator
13. GIS Software
HMIS STAFF
1. HMI Specialist (2)

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 2. Epidemiologist (1),
3. Public health specialist (1),
4. Computer Programmer (1),
5. System Manager (1),
6. User- services staff (1),
7. Data Entry and Processing Clerks (3),
8. Office assistance (3)
9. Statistician (2),
10. System Administrator (1).

LGA HMIS UNIT REQUIREMENTS

LGA HMIS Working Document (plan)
1. NHMIS Operational Manual
2. Office space Office furniture
3. Micro-computer (1)
4. Dot Matrix printer (1), photocopier (1)
5. Telematics: telephone lines (1) with fax
6. Motorcycles (2)
7. Binding machines
8. Power backup and/or Generator
9. Geographical Position Machine (GPS)
10. PHE M&E Coordinator

HMIS STAFF.
1. HMIS Specialist (1)
2. PHC Monitoring and Evaluation Coordinator (2),
3. Assistant Monitoring and Evaluation Coordinator (3)
4. System Manager (1).

4.0 Conclusion
In the unit we had discussed a good example of threshold of minimum package is provided by the
National Health Management Information System programme for the decentralised levels of
data management as shown below

5.0 Summary
Minimum package needed for setting up of HMIS unit at booth Federal, State and LGA levels are very
similar. The major resources needed are not only materials, it also included human resources.
Importantly, the must be HMIS officers, epidemiologist, systems managers and Mentoring and
Evaluation coordinator

6.0 Tutor Marked Assignment

1. For the functioning of HMIS units, basic requirements and infrastructure need to be specified as
standards. The establishment and management of an effective NHMIS, requires substantial investment
by levels of data management or by a central unit in infrastructural development and in technical
assistance within and between the levels

94
What are the important personnel needed to be functioning at
(a) Federal level
(b) State level
(c) LGA level
2. Explain how HMIs officer make use of infrastructure needed for HMIS minimum package

7.0 Self-Assignment Exercise

List and explain requirements for Federal, State and LGA Level HMIS minimum package

8.0 References
1. Aishatu, B. G. Saka, M.J. & Oladayo, B. (2013): Co-morbidity Factors Associated with
Influenza in Nigeria: Online Journal of Public Health Informatics. 5(1):203-213,
Published by School of Public University of Illinois at Chicago Library Available
online at https://journals.uic.edu/ojs/index.php/ojphi/article/view/4403
2. Saka, M.J. Aremu, A.S. & Saka, A.O. (2014): Soil-Transmitted Helminthiasis:
Prevalence Rate and Risk Factors Among School children in Ilorin, Nigeria. Journal of
Applied Sciences and Environmental Sanitation. 9(2); 139-145, Published by
Department of Environmental Engineering, Sepuluh Nopember Institute of Technology
(ITS) University Indonesian, Bogor Available online at
www.trisanita.org/jase/index.html

CHAPTER TWELVE UNIT 28

MONITORING AND EVALUATION
1.0 Introduction
When you read that the prevalence of low birth weight in a country is 20%, have you ever
wondered how this calculation was derived?
Or when you hear that the percentage of married women of reproductive age in a rural area using
a modern contraceptive method rose from 52% to 73%, do you wonder how people know this?
These types of statistics and other similar information result from ―monitoring and evaluation‖ or
―M&E‖ efforts. M&E is the process by which data are collected and analyzed in order to provide
information to policy makers and others for use in program planning and project management.
2.0 Objectives
The unit will describe and discuss monitoring and evaluation process as it applies to an
organization or programme evens. Specifically, to
1. define and describe monitoring and evaluation

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 2. define and describe evaluation
3. provide examples of programs with monitoring and evaluations interventions
3.0 Main Content
What is Monitoring?
Monitoring* of a program or intervention involves the collection of routine data that measure
progress toward achieving program objectives. It is used to track changes in program
performance over time. Its purpose is to permit stakeholders to make informed decisions
regarding the effectiveness of programs and the efficient use of resources.
Monitoring is sometimes referred to as process evaluation because it focuses on the
implementation process and asks key questions:
 How well has the program been implemented?
 How much does implementation vary from site to site?
 Did the program benefit the intended people? At what cost?
Monitoring is counting, tracking, tracing and collecting of clients for examples
1. Counting clients seen or number of health workers trained
2. Trancing condom distributed
3. Tracking programe events
4. Collecting data on clinic clients
Monitoring:
 is an ongoing, continuous process;
 requires the collection of data at multiple points throughout the program cycle, including
at the beginning to provide a baseline; and
 can be used to determine if activities need adjustment during the intervention to improve
desired outcomes.
What is Evaluation?
Evaluation measures how well the program activities have met expected objectives and/or the
extent to which changes in outcomes can be attributed to the program or intervention. The
difference in the outcome of interest between having or not having the program or intervention is
known as its ―impact,‖ and measuring this difference and is commonly referred to as ―impact

Evaluations require:
 data collection at the start of a program (to provide a baseline) and again at the end,
rather than at repeated intervals during program implementation;
 a control or comparison group in order to measure whether the changes in outcomes can
be attributed to the program; and
 a well-planned study designs
Monitoring or evaluation?;- Check to see if you know whether the following
situations call for “monitoring” or “evaluation.”
I. The National Population Commission wants to know if the programs being carried out in
district A are reducing unintended pregnancy among adolescents in that district.
II. USAID wants to know how many sex workers have been reached by your program this
year.
III. A country director is interested in finding out if the post-abortion care provided in public
clinics meets national standards of quality.
HERE ARE THE ANSWERS:

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 I. The National Population Commission wants to know if the programs being carried out in
province A are reducing unintended pregnancy among adolescents in that province.
This is evaluation because it is concerned with the impact of particular programs.
II. USAID wants to know how many sex workers have been reached by your program
This is monitoring because it is concerned with counting the number of something (sex
workers reached).
III. A country director is interested in finding out if the post-abortion care provided in public
clinics meets national standards of quality.
This is monitoring because it requires tracking something (quality of care).
Why Is Monitoring and Evaluation Important?
Monitoring and evaluation help program implementers:
a. make informed decisions regarding program operations and service delivery based
on objective evidence;
b. ensure the most effective and efficient use of resources;
c. objectively assess the extent to which the program is having or has had the desired
impact, in what areas it is effective, and where corrections need to be considered;
and meet organizational reporting and other requirements, and convince donors that
their investments have been worthwhile or that alternative approaches should be
considered.
d. meet organizational reporting and other requirements, and convince donors that their
investments have been worthwhile or that alternative approaches should be
considered.
When Should Monitoring Evaluation (M&E) Take place?
I. M&E is a continuous process that occurs throughout the life of a program.
II. To be most effective, M&E should be planned at the design stage of a program, with the
time, money and personnel that will be required calculated and allocated in advance.
III. Monitoring should be conducted at every stage of the program, with data collected,
analyzed and used on a continuous basis.
IV. Evaluations are usually conducted at the end of programs.
However, they should be planned for at the start because they rely on data collected
throughout the program, with baseline data being especially important.
Do you know that the rule of thumb is that 5-10% of the total budget should be
Monitoring and Evaluation
4.0 Conclusion
Monitoring and evaluation are important components of programe events, while monitoring look
at the event that is ongoing the evaluation measure at the end of the events.
5.0 Summary
Monitoring is said to occur when you count, track or trace or measure process programme or
events or activity in relation to objectives. However, when how well a program interventions
outcome is achieved evaluation is said to have taken place. So also, when observed differences in
outcome of programme in relation to intervention is measure evaluation is said to have taken
place.

6.0 Tutor Marked Assignment

1. With aid of diagram explain monitoring and evaluation
2. Why is monitoring sometimes call process evaluation

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7.0 Self-Assignment Exercise
1. What are the differences between evaluation and Monitoring

8.0 References
1. Monitoring and Evaluation fundamentals a self-guide minicourse MEASURE Evaluation
Carolina Population Center University of North Carolina at Chapel Hill 206 W. Franklin St.
Chapel Hill, NC 27516 USA. Edition 2019.
2. Bertrand JT, Escudero G. Compendium of Indicators for Evaluating Reproductive Health
Programs. MEASURE Evaluation Manual Series No. 6. Chapel Hill, NC: MEASURE
Evaluation project, Carolina Population Center; 2016.
3. Marsh D. Results framework & performance monitoring [online slides]. Save the Children,
1999. Accessed September, 2109 at http://www.childsurvival.com/tools/Marsh/sld001.htm.
4. MEASURE Evaluation. A Trainer’s Guide to the Fundamentals of Monitoring and Evaluation
for Population, Health, and Nutrition Programs. MEASURE Evaluation Manual Series No. 5.
Chapel Hill, NC: MEASURE Evaluation project, Carolina Population Center; 2012. Available
at: http://www.cpc.unc.edu/measure/publications/html/ms-02-05.html.
5. Mosley WH, Chen LC. An analytical framework for the study of child survival in developing
countries. Popul Devel Rev. 2019;10(Suppl):25-45.
6. Rossi PH, Freeman HE, Lipsey M. Evaluation: A Systematic Approach. Thousand Oaks, CA:
Sage Publications; 2019.
7. International Fund for Agricultural Development. Annex A. Glossary of M&E Concepts and
Terms. A Guide for Project M&E. Available at:
http://www.ifad.org/evaluation/guide/annexa/index.htm
8. United Nations Development Programme. Glossary. Handbook on M&E for Results.
Available
at:http://stone.undp.org/undpweb/eo/evalnet/docstore3/yellowbook/glossary/glossary_d_e.htm
9. United Nations Population Fund. Programme Manager‘s Planning, Monitoring & Evaluation
Toolkit. Tool Number 1: Glossary of Planning, M&E Terms. March 2014. Available at:
http://www.unfpa.org/monitoring/toolkit/glossary.pdf

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