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Business Hours
Days Hours
 Monday - Friday  08:00 - 16:45
 Lunch Time  13:00 - 14:00
* We shall observe all holidays as stipulated by the Government of Swaziland

Contacts
Physical Address: Cooper Centre Office 106, Mbabane, Swaziland

Postal Address: P.O Box 5 Mbabane, Swaziland

Phone: 2404 7712

Fax: none

HMIS - Paper Based

The Health Management Information System (HMIS) unit under Strategic Information Department (SID) of Ministry of Health (MoH), Swaziland's Ministry of Health (MoH) uses different structures of data values within its tools.
"… the burden of data collection has been exacerbated by increased investments in other disease areas including TB, Malaria and Nutrition, and accelerated efforts within HIV and AIDs aimed at gaining 'quick wins' over the past 10 years, calling for revision of service-specific registers, inclusion of new data elements, and simply the lack of a coordinated process for designing data collection tools, and a lack of a matching level of investment in data collection personnel.", Rejoice Nkambule, Deputy Director of Health – Public Health, MoH 2012
HMIS Clinical Data:
  1. Definition of terms
  2. Structure of data values within tools
  3. Version Change Control System
  4. Confidentiality, privacy and security
  5. Stock management of data collection tools
  6. Training and support
  7. File management/registry system
Definition of terms
1. Facility based form: A facility based data collection tool placed in  ...more details...  different service points within health care facilities. This tool is used mainly as a trigger for the next health care service/encounter and can be moved from one service point to another within the clinic workflow in a facility.
2. Facility based register: It is a data collection tool placed in different  ...more details...  service points and used for accountability for service delivery in that specific service point. Unlike the form it cannot transcend along the clinic workflow in the facility.
3. Patient held card: It is a data collection tool kept by the client  ...more details...  and provides summarized clinical data.
4. Patient chart/file: This is a data collection tool that conveniently  ...more details...  keeps all clients clinical data recorded for service delivery. This data collection tool is a folder that keeps health care service data in different data collection forms accounting for care administered to the client during visits in the facility. This source document is kept in the facility after the client is discharged and only summary findings are recorded and given to the client.
5. Patient held forms: This is a data tool used to collect client  ...more details...  summary clinical data in a specific service point and is given to the client to take with after discharge. This tool acts as trigger for service on a subsequent visit in a health facility.
6. Programme based forms: These are data collection tools used  ...more details...  to collect data at facility level and community level as per the information need of a program, and is fully owned, controlled by the program since all data collected in this tool is used and only reported to the program not via the HMIS system. These forms are stored at the programs and others kept in the different health facilities.
7. Reporting tool: This is a data collection tool that records  ...more details...  records information whether aggregated or not, as long as the tool collects information which is then submitted to the next reporting level; contextually it would be the region, national, or program in the case of Swaziland's health care system levels.
8. Referral forms: This is a data collection tool that contains  ...more details...  data necessary for transferring a client from one health institution to the other. It could also be used to transfer clients within departments in health institutions.
9. Administrator: This is a person employed in a health  ...more details...  institution for the purposes of coordinating and managing resources which include human resources (non-medical), infrastructure and equipment.
10. Cough officer: This is an individual tasked to conduct  ...more details...  TB screening using a standard procedure, records suspects and refer as necessary.
11. Dispenser: This in an individual employed in a health  ...more details...  institution usually stationed at the pharmacy unit. This person gives and explains dosages and procedures for taking prescribed medication as needed.
12. Program officer: This is an individual working and  ...more details...  employed in a position designated in a program. This individual can be found at all the levels of the program: regional, national or facility.
13. Clerical officer: This officer performing secretarial duties to a  ...more details...  prescribed manager.

Structure of data values within tools (Adopted from HMIS Review 2013)
Unstructured fields: Most fields such as the patient name were  ...more details...  found to be non-structured fields, hence facilitating inaccurate recording of the first and last name data. The format of these data field values were found to be mostly in free text format, which then creates a breeding ground for data errors/data defects. For instance, in some tools, where next of kin or treatment supporter details are required, the fields would just be named "Next Contact Details" in free text format.
Date formatting: Date fields in most data collection tools  ...more details...  were not structured appropriately; they did not specify the date format (e.g. dd/mm/yyyy). As such, there was lack of input validation in terms of documenting date field data values.
Internal Patient Identification Numbers: Some programs and facilities generate their own unique  ...more details...  identifiers internally. There is, however, no clear guideline on the format in which the identification numbers should be generated and documented in the forms or registers (e.g. space for site code followed by a dash ("- ") and then a serial number etc.)
Units of measurement Some tools did not have a space for recording  ...more details...  the units of measurement for measuring data such as weight and temperature, and this creates a room for clinicians to document continuous data values without any units of measurement (e.g. weight can either be recorded as grams or kilograms. Depending on the age of the patient being managed, this can cause confusion to the next clinician, which in turn might lead to erroneous clinical practice like over-dosage of medication.
Using Age Vs. DOB: The assessment also revealed that there  ...more details...  were inconsistencies among tools in terms of provision for recording the Age data value and Date of Birth data value. One section of tools catered for Age data value documentation and others had provision for date of birth (DOB) documentation. Unlike the former, DOB is preferred in clinical data for managing patients since it provides progressive age over time (it is good for cohort management and analysis).

Version Change Control System

Version Change Control
HMIS Review 2013 - Findings:
Version control, revision history, and version numbers in tools are critical for managing updates and introduction of new tools. The team identified one facility based form and 4 facility based registers that had version numbers. The results suggest a necessity for version control system to facilitate systematic update of tools and version coding. Such a system will facilitate proper referencing of tools and minimize the introduction of unnecessary tools, and data elements as it would be possible for users and tool developers to track changes.

HMIS Review 2013 - Recommendation:
  • Develop version control systems that facilitate systematic update of tools and versioning;

Confidentiality, privacy and security

Confidentiality, privacy ...
HMIS Review 2013 - Findings:
Confidentiality is one of the key principles in health data handling that must be embraced by all health data collectors/frontline data collectors and data handlers at all levels of data flow. It is against this backdrop that the assessment also set out to establish whether patient clinical data files are maintained according to set confidentiality guidelines/protocol. The assessment revealed that there was lack of standard national confidentiality guidelines that can be used consistently across all facilities by all health care service data handlers. However, some facilities have institutional confidentiality guidelines for handling patient files and medical records. Such guidelines provide for handling of patient files only by health care workers, data management staff and expert clients. The same guidelines also provide for keeping files in lockable and secured file cabinets.

In some facilities the PMTCT confidentiality guidelines were adopted and implemented as the guidelines for ensuring that confidentiality protocol is followed as they handle patient medical records. However, it was observed that confidentiality was not maintained in some public health centers and clinics.

HMIS Review 2013 - Recommendation:
  • Develop and operationalize standard national confidentiality guidelines that can be used consistently across all facilities by all health care service data handlers;

Stock management of data collection tools

Stock management...
HMIS Review 2013 - Findings:
The Ministry of health has guidelines and procedures for introducing, reviewing and distributing data collection tools. However, enforcement of these procedures is minimal at facility level which exasperates the cycle of controlling supplied and introduced tools in different health care facilities.

Nonetheless, the supply of operational data collection tools to health facilities is done by the HMIS Unit, Facilities, Programs, Development Partners and the M & E unit. Findings from this study also reveal that most of the tools used in public hospitals are supplied by programs, development partners, and some are custom designed tools within hospital departments, which are designed to meet specific requirements. Officers from the supply departments are assigned to distribute these tools to the various health facilities across the country. Unlike the public sector, private hospitals get supplies of tools from external vendors/suppliers, and these tools are designed to meet specific needs for specific private facilities. The results also show that tools used in public health clinics are mostly supplied by the M & E unit with support from programs and implementing partners. To ensure that confidentiality is maintained, all completed data collection tools are kept within the facilities and only patient cards are retained by patients for follow up purposes.

The assessment also revealed that there was inconsistent supply of data collection tools (standard registers and forms). As a result some facilities reportedly experience data collection tools' stock-outs and such stock-outs are a function of the mushrooming custom tools.

HMIS Review 2013 - Recommendation:
  • Put in place a mechanism that will ensure a consistent supply of data collection tools (standard registers and forms);

Training and support

Training and support
HMIS Review 2013 - Findings:
Training of health care workers (frontline data collectors) was reportedly insufficient. Although there are a lot of training strategies that were found in place, there was lack of operationalization and implementation of these training strategies. Staff shortages escalated this problem. The results suggest a rapid training need assessment for a targeted group of data originators and data handlers (health care providers). Once the need assessment is done, there will be need for development of appropriate curriculum and identification of appropriate users of data collection tools.

HMIS Review 2013 - Recommendation:
  • Conduct a rapid training need assessment for a targeted group of data originators and data handlers (health care providers), and develop an appropriate curriculum as well asidentify appropriate users of data collection tools for training.

File management/registry system

File management...
HMIS Review 2013 - Findings:
A questionnaire was used during the assessment to understand patient file management system in health facilities. The results show that all 7 hospitals that were part of the sampled facilities had some kind of filing management and security system in place, although the system and practices were not standard across all hospitals. Some facilities were reported to be retrieving and storing files at the beginning and end of the day, respectively whilst others reported that they store files into filing cabinets immediately after each daily clinic service. The assessment team also observed that there was not enough space or rooms for filing as the case-load for patients was increasing on an alarming speed. In some of the facilities filing cabinets were not lockable and secured.

There is need for the introduction of proper filing management and security procedures that will ensure proper storage and retrieval of patients' charts/files. An electronic system can also reduce bulk paper-based files/chart by keeping longitudinal medical records, and these records can be printed as per need or for back up purposes.

HMIS Review 2013 - Recommendation:
  • All structured data forms in use should adopt a standardized and harmonized patient demographics section. To accommodate the introduction of electronic information systems, a space should be reserved on these forms to affix a bar-code label for scanning patient identification information. All demographic data elements should be designed according to best practices to improve data quality and consistency. Some examples of this are already in use that can be examples to adopt throughout Swaziland.
  • The use of multiple patient held health registration cards for a range of service points should be replaced with a single facility based registration card that supports the patient through all health services.