Diagrama de procesos

Despite almost every country in the globe preparing health reports, representing a significant investment of efforts and resources (WHO 2007), very little systematic research into the content, quality, utilisation and potential areas for improvement of Annual Reports has been conducted. An exception to this is during the early 1990s in England, when Annual Reports on Public Health became a central topic of discussion and debate. In 1972, after the regular publication of Annual Reports for 100 years, public health authorities were ‘released’ from their reporting requirements due to rising uncertainty over their value in improving health, and the considerable resources needed to produce them (Black 1989; Watt et al 1993). However by 1988 the reports were reintroduced with a new sense of optimism about their potential value (Fulop & McKee 1996). Annual Reports were argued as having a key role in improving and maintaining quality public health practice, clarifying responsibilities of health

Page | 41 authorities, contributing to accountability and focusing attention on important health problems (Black 1989).

Following on from this emphasis on the importance of Annual Reports in public health, a number of researchers turned their attention to the issue of the quality of their contents. In their analysis of 28 different Annual Reports, Chambers and Bevan (1990) found the content and style of reporting varied significantly and that few reports met the legislative requirements for reporting. Overall, they concluded that while most reports were simple and easy to read, with well displayed compendiums on vital statistics, most reports were of a descriptive rather than analytical nature; only two reports made specific recommendations that could be used in planning; and the majority did not provide any basis for the joint planning of programs related to improving public health. Furthermore, information held on computerised National Health System databases were seldom used; there was little similarity in indicators presented; few reports attempted to link data (such as childhood immunisation with disease notification data); and most reports did not include data on the most vulnerable sections of the population, including the elderly, disabled or mentally ill (Chambers & Bevan 1990).

Fulop and McKee (1996) went on to argue the central problem with such reports is their fundamental disagreement over who their audience is – funders or the public. They also stated that while reports have the potential for great impact, political and financial pressures are major limiting factors. In their study into the use of Annual Reports for identifying health promotion activities, Anderson and colleagues (2003) concluded that local government reports are a useful source of information that can provide knowledge on the priorities and capacities of local authorities. They also remarked that reports are one of the only pubic sources of information stating political intentions.

Page | 42

2.3.1 Increasing global attention

In July 2010, representatives from ten countries4 _{and a number of international agencies}

(including GAVI, WHO, World Bank, CDC and Global Fund) convened a technical meeting to assess current country reporting practices. The review centred on the following themes:

• Well chosen and balanced indicator selection

• Appropriate data sources

• Quality assessment and processes

• Sufficient capacity for analysis and synthesis, and

• Effective communication of results to key audiences (WHO 2007).

Main findings from this review were that while most countries had a list of core indicators, in some cases this included more than 100 indictors and they were often skewed towards

particular elements in the results chain (ibid). The challenge here, reviewers argued, is to

ensure an appropriate balance across the range of input, output, outcome and impact indicators. In terms of data sources, most countries were found to include references to the origin of the data, which ranged from administrative sources to household surveys. While the data contained within each report varied between countries, a common characteristic was the lack of systematic quality assessments, resulting in biased, incomplete, and late data. Capacity for analysis and synthesis was also limited, with most countries relying on external consultants.

Other issues related to the production of Annual Reports reviewed included numerous reporting requirements, challenges between the demand from donors and available supply of data from countries, continued data gaps, and limited capacity at every point in the system

Page | 43

(ibid). Furthermore, challenges affecting the use of reports in decision making ranged from

issues with completeness and coverage; comprehensiveness; data quality and triangulation; data standards; timeliness; capacity to respond to different demands; and ability to cater to

diverse audiences (ibid). Finally, in terms of communication and use, it was found that Annual

Statistical Yearbooks, Abstracts or Reports were the most common mode for transferring information from data producers to end users. However, despite the considerable effort and resources invested in producing reports, they remain underutilised in the health and development community due to poor presentation (such as long and complex tables), limited accessibility (unavailable or un-downloadable from websites) and poor timeliness.

A similar workshop facilitated by WHO was held in South Africa in October 2010, with the intent of enhancing the analytical capacity of countries to conduct comprehensive health progress and performance reviews in the context of national health plans and related global health goals. Furthermore, a third workshop is due to be held in Bangkok in March 2011 and it is planned to have representation from both Asia and, for the first time in this arena, the Pacific. Overall though, despite the growing international attention Annual Reports have received in recent years, little follow-up action has occurred (such as the production of country guidelines or training on data analysis that were due for publication by WHO in 2008) and no work has been carried out in the Pacific as yet.

2.3.2 Pacific examples

Despite the lack of academic research on Annual Reports in the Pacific, one country provides us with an example of their own internal review and critique of reporting methods. As part of the World Bank funded Tonga Health Sector Support Project, work was carried out during 2005 to improve the HIS of Tonga, including revising the ‘main information product of the Ministry

Page | 44 of Health’: Annual Reports (Tonga Annual Report 2006: 17). As well as focussing significant efforts on improving data quality, information management processes and reporting procedures, a main goal of the project has been to accelerate an ‘information culture’ within the Ministry of Health and Vaiola Hospital. Specific recommendations to update Tonga’s reports include:

• Removing duplication

• Reporting against planning objectives

• Simplifying the format

• Standardising statistical presentation and accompanying narrative

• Establishing a clear link with the National Strategic Development Plan.

Apart from this one example, no other research on Annual Reports from the Pacific was located: highlighting once more the paucity of information on HIS in the Region. Furthermore, despite the vital importance of quality assessments, due to the limited academic rewards and substantial efforts required, evaluations of data quality are not regularly featured in academic journals (Mudde & Schedler 2010), and no evaluations of the quality of Annual Reports from the Pacific, or globally, were located. This is endorsed by Brouwer and colleagues (2006) in their research on data quality improvement in general practice clinics. They remark on the explosion of data being collected by general practitioners over the past decade, and the general acknowledgement among collectors and end-users that such data still has ample space for improvement. However, despite the recent attention on quality and consensus over the need for improvement, they also remark on the surprisingly few studies dedicated specifically to the topic of quality improvement (Brouwer et al 2006). Furthermore, while striving for

Page | 45 ‘completeness’ is regarded as the first broad step in improving the quality of general practice records, there remains no criteria on the acceptable level of quality, and no ideas on what is

‘good’ or ‘high’ quality, nor ‘good-enough’ or ‘high-enough’ (ibid). Overall, the area of Annual

Reports, and specifically the quality of data within Annual Reports, is an under-researched area and this lack of research is even more pronounced when assessing reports from Pacific Island Countries and Territories.

Page | 46