Identificación de procesos

Annual health statistics yearbooks or reports are one of the routes through which health information is transferred from data producers to end-users or decision makers

WHO 2007: 2

As discussed previously, HIS are comprised of a number of components, ranging from resources and indicators, to standards for data management and dissemination. Annual Reports, one aspect of HIS, represent ‘information products’: the formatting and packaging of information into readily available formats such as dashboards, reports, queries and alerts (HMN 2008). Reports are generally comprised of numerical data on the characteristics of people using healthcare facilities and the services provided, and often contain a wealth of raw

Page | 29 data (AbouZahr et al 2007; WPRO 2003). Information on the types of diseases, number and sex of newborns, characteristics of deaths, and service utilisation are all commonly contained in Annual Reports. Such information can be used to inform comparisons of past and present performance and health status; planning; assessing the work performed by providers; and funding requirements (WPRO 2003). Annual Reports also play an important role in monitoring and evaluation (Boerma et al 2001; WHO 2007).

In their workshop on country best practices, the WHO (2007) formulated three broad ‘types’ of Annual Reports:

• Type 1: Raw Data. These reports include detailed tabulations of data on health

facilities and health service performance, including monitoring progress towards health goals and health service use. These reports are of limited use other than to researchers.

• Type 2: Statistical Reports. Basic summary statistics with an analysis of the data in terms of comparisons between groups and areas, and overall trends. Also included are activities conducted within the health sector, and operational descriptions of health care facilities.

• Type 3: Summary Report with Interpretation and Analysis. This type of report

includes characteristics from the previous two, as well as information on the program and policy implications of data and is suitable to a non-technical audience. It reflects, in essence, the ‘best practice’ approach to reporting.

While content differs between countries, Annual Reports are generally comprised of three elements: health status, service provision, and health management/health system

Page | 30 information. Also included are program specific data, for example progress reports on HIV or malaria campaigns. Reports also differ in their stated purpose. The purpose of Annual Reports on Public Health in England, for example, are to provide regular epidemiological assessments of population health; act as a basis for policy development; provide information for joint planning with other agencies; and set targets against which improvements in public health can be measured (Chambers & Bevan 1990). Similarly in Australia, the Department of Health and Ageing Annual Reports have specific reporting obligations, as set out in the Public Service Act 1999, Requirements for Annual Reports. The primary purpose of each report is to provide a useful and informative picture of performance over the past 12 months, in line with their core value and commitment to accountability (DOHA 2009).

The National Health Care Quality Report from the Department of Health and Human Services is published to report on progress and opportunities for improving the health of the American population (AHRQ 2009). The report is part of a growing knowledge base on three key areas: the status of healthcare quality in America; where healthcare quality improvement is most needed; and how the quality of healthcare delivered to American’s is changing over time. The report is comprised of over 200 measures across the four dimensions of effectiveness, patient

safety, timeliness and patient centeredness (ibid).

2.1.1 Annual Reports in the Pacific

Annual Reports in the Pacific serve a broad range of purposes including compliance with legislative requirements; donor accountability; the provision of information to the public; planning; and international reporting agreements. In the three countries reviewed, all addressed the reporting requirements as set out by their respective Public Health Acts, in relation to the notification of infectious and ‘dangerous’ conditions (which ranged from

Page | 31 dengue fever and HIV/AIDS, to conjunctivitis and polio). Both Fiji and Tonga also have specific legislation regarding the development and dissemination of Annual Reports; requiring them to provide a summary of action taken during the year and an update on the health status and health services of the country.

The intended purpose, use and audience of reports are varied: the Cook Islands is the only country to clearly state that Annual Reports are to ‘provide key health statistical information for the Cook Islands’, which can be used by the Ministry of Health or any other interested party (Cook Islands Annual Report 2005: ii). Fiji and Tonga both provide a range of different purposes, ranging from providing a summary of occurrence of vital events; performance against health outcomes and MDG indicators; showcasing the roles and functions of particular health units; to providing indicators by which the Government’s progress in policy/strategy implementation can be monitored and measured (Fiji Annual Report 2004-2008; Tonga Annual Report 2007). Overall, while reports in the Pacific all generally contain information on the health status of their populations, and detailed operational information on the performance of their health system; the intent, and as such content, of each report are as varied as the countries making up the Pacific Region are themselves.

2.1.2 Common limitations and weaknesses

While data published annually by most countries are assumed to be meaningful, this is not always the case (Shibuya 2008). A vast amount of data is collected within HIS, yet only a small amount is synthesised, analysed and used. In the case of Annual Reports, data is often collected and presented in crude formats, with limited attempts at analysing the data for use in day-to-day management and planning (HMN 2008). While, ‘there is little point in engaging in the time- and resource-consuming process of data collection if there is no commitment to

Page | 32 analysing the data, disseminating the information and using it to improve health system functioning’ (HMN 2008: 14), many Annual Reports seem to do just that. As remarked by WPRO (2003) in their publication on improving the quality of reports, many Reports only present work done during the reporting period, which is not particularly useful for problem identification or decision-making. They argue that reports comparing a select number of indicators over time are far more useful for such purposes.

There are many reasons for the poor quality of Annual Reports, ranging from issues of incomplete, inaccurate or insufficient source data; to poor transfer of data from one document to another; inaccurate coding; and the lack of standard terms (WPRO 2003). Further, the use of different sources, definitions and methods reduces data comparability between countries and within reports over time (AbouZahr & Boerma 2005). As such, assessing trends becomes difficult, and opinion, extrapolation and estimates are favoured above the reported data itself: a pattern clearly demonstrated in the limited international (and national) use of Pacific- generated data. Annual Reports are primarily comprised of administrative data: data that is the by-product of delivering services to people. However, as argued by Iezzoni (1997), such data was never intended to assess outcomes; it is only due to its readily available and inexpensive nature that the use of administrative data has taken on a wider role in reporting. The HMN (2008) also comment on the limitations of administrative data due to its inherent bias in only reporting on the population using health services.

Annual Reports often serve multiple purposes, including the development of statistical databases and acting as basic public health reports. More importantly, they act as the sole or main outlet for the dissemination of facility-based data: yet there is no standard reporting system guiding the content of such reports, or the processes around data analysis or

Page | 33 presentation (WHO 2007). More often than not, lower level managers are required to report on a vast quantity of data to higher levels: data for which they receive no feedback and data that is rarely used at higher levels, due to what AbouZahr and Boerma (2005) refer to as ‘information overload’. As such, processes for improving quality revolve around preparing reports in a logical, useful and meaningful manner; checking data for face validity and consistency; proof-reading; and explicitly defining the purpose, objectives and scope, through asking questions such as ‘what information does the user want’, ‘what information is available’, and ‘what is routinely collected or will require additional work’ (WPRO 2003: 56).