ASPECTOS TEÓRICOS DEL MODELO DE EVALUACIÓN 360 GRADOS

Increase quality of the data.

Use or collect complementary information from other sources to assess the accuracy of HIS data. This includes the numbers of events (such as deaths by age) and the denominator used to calculate rates (population size by gender and age group). Other characteristics of data quality include completeness (data or reports), simplicity and timeliness.4

Figure 2-36: Suggestions for improving data quality

Rates calculated by the HIS are sensitive to changes in the denominator—the size of the population. Continuously review and adjust population numbers to reflect in- and out-migration. Triangulate population numbers used by HIS with other data sources. For example, a vaccination campaign will often be the best source for the number of persons in the target age group (e.g., six months to fifteen years for measles vaccination). A vaccination coverage survey can be used periodically to validate the vaccination coverage statistics provided by HIS where the number in the target group is estimated.

For mortality reporting, a centralised mortality register is recommended to improve the quality of death reports.28 _{A centralised mortality register can improve the accuracy of}

reporting by standardizing what constitutes a death (e.g. do not include late term abortions or stillbirths) and eliminating double counting of deaths from different sources (assuming sufficient information about deaths are available). To help prevent double counting of deaths and improve ability to report deaths by gender and more age groups, the following data about each death is recommended:

ƒ Name;

Health systems and

infrastructure

ƒ Date of death;

ƒ Date of birth (or age of death if unknown);

ƒ Sex;

ƒ Origin (displaced vs. local);

ƒ Cause; and

ƒ Location of death.28 Increase coverage of data.

Health Information Systems (HIS) based only on data collected at health facilities can lead to underreporting of events such as mortality.28 _{Underreporting may be across the}

whole population or for certain segments of the population (e.g. women, children). Expand the sources of information, especially mortality and nutrition information beyond camp health facilities to the community (e.g. home visitors) and referral hospitals, clinics and institutions (e.g. the police) outside the camp.

Evaluate the use of data.

The assessment of HIS should include how data is used. The purpose of HIS is to make decisions about priorities (whether or not to intervene, what interventions are needed, etc.) and make decisions about whether or not changes are needed in how interventions are carried out. Look for evidence that data from HIS is being used to make these decisions, correctly and at an appropriate frequency.

Continue to refine the HIS as indicated.

This is a continuous process that should begin in the emergency phase. To help identify emerging health problems and vulnerable groups better, the following data about each death is recommended:

ƒ Name;

ƒ Location of residence;

ƒ Date of death;

ƒ Date of birth (or age of death if unknown);

ƒ Sex;

ƒ Origin (displaced vs. local);

ƒ Cause; and

ƒ Location of death.28

Include more detailed information in the morbidity surveillance system such as age by month for under-fives, location of residence, sex and origin.

Include information in the system about chronic or less fatal diseases such as sexually transmitted infections, TB, diabetes, and hypertension and injuries.32 _{Consider dropping}

from the information system that information that is not worth the effort of collecting. Based on assessments of the HIS described above, changes will also be continuously needed to improve the quality and use of existing data.

Task 2: Increase use of surveys and qualitative data collection

methods

Increase use of surveys.

Surveys provide information that is difficult to collect at health facilities. A survey can provide information about the home such as oral rehydration of simple diarrhoea or care- seeking for malaria. Surveys also provide information on a population level that can be used to cross-check facility-based information. A vaccination coverage survey can be used to cross-check vaccination rates provided by the routine Health Information Systems (HIS). Mortality survey can also be used to cross-check crude and under-five mortality rates provided by routine HIS. As noted in other sections, persons with experience are required to conduct quality surveys.

Health systems and

infrastructure

Increase the use of qualitative and participatory data collection methods.

In the emergency phase, defined by doubling the mortality rate, the priority is to reduce mortality. Once mortality rates have substantially declined to or near to the baseline, the ‘return to normalcy’ goal becomes increasingly important. This leads to the question ‘what are the priorities in the post-emergency phase?’ A more important question might be ‘whose priorities?’ Qualitative and participatory data collection methods are well- suited for helping humanitarian workers to listen to the beneficiary population about their needs and desires and priorities for a ‘return to normalcy.’ As with surveys however, experienced persons are required to implement these methods adequately.

Figure 2-37: Using participatory methods

Participatory methods are especially useful for helping beneficiary populations participate in defining priorities, deciding actions to meet priorities and determining which local capacities should take action. Humanitarian agencies should strive to give beneficiary populations the capacity to do things for themselves. This means defining with the beneficiary population what the role of humanitarian agencies will be in the ‘return to normal.’ Weiss et al. (2000) provide a practical, Internet-available guide to participatory learning and action to address perceived needs of refugees and internally displaced persons.38

Sphere indicators

Figure 2-38: Sphere indicators for Health Information Systems

ƒ A standardised Health Information System (HIS) is implemented by all health

agencies to routinely collect relevant data on demographics, mortality, morbidity and health services;

ƒ A designated HIS coordinating agency or agencies is identified to organise and

supervise the system;

ƒ Health facilities and agencies submit surveillance data to the designated HIS

coordinating agency on a regular basis. The frequency of these reports will vary according to the context, e.g. daily, weekly, monthly;

ƒ A regular epidemiological report including analysis and interpretation of the data, is

produced by the HIS coordinating agency and shared with all relevant agencies, decision-makers and the community. The frequency of the report will vary according to the context, e.g. daily, weekly, monthly;

ƒ Agencies take adequate precautions for the protection of data to guarantee the rights

and safety of individuals and/or populations;

ƒ HIS includes an early warning component to ensure timely detection of and response

to infectious disease outbreaks; and

ƒ Supplementary data from other relevant sources are consistently used to interpret

Health systems and

infrastructure

Appendix 2-1: Sample RHA from International

Rescue Committee (IRC)

Rapid health assessment for Pakistan earthquake