Doctoral Degrees (Health Systems and Public Health)

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Browsing Doctoral Degrees (Health Systems and Public Health) by browse.metadata.advisor "Dudley, Lilian"

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    Evaluating the process and output indicators for maternal, newborn and child survival in South Africa : a comparative study of PMTCT information systems in KwaZulu-Natal and the Western Cape
    (Stellenbosch : Stellenbosch University, 2015-04) Nicol, Edward Fredrick; Dudley, Lilian; Bradshaw, Debbie; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health.
    ENGLISH ABSTRACT: The prevention of mother-to-child transmission (PMTCT) of HIV is a key maternal and child health intervention in the context of the HIV/AIDS pandemic in South Africa. Accordingly, the PMTCT programme has been incorporated in the District Health Management Information System (DHMIS) that collects monthly facility-based data to support the management of public health services. To date, there has not been a comprehensive evaluation of the PMTCT information system. By comparing the experiences in two health districts, using the Performance of Routine Information System Management (PRISM) framework and tools, this study seeks to evaluate the availability, quality and use of process and output indicators for monitoring PMTCT interventions. A comparative analytical and observational study was undertaken using a multi-method approach which included: a self-administered survey of health information personnel to assess confidence and competence levels for routine health information system (RHIS) tasks, an assessment of the routine PMTCT data for quality, completeness, accuracy, and data use; and a facility survey of RHIS processes and resources. In addition, in-depth interviews with 22 key informants and observations in health facilities were conducted. Data were collected from 57 health facilities in a convenience sample of two health districts, and also from 182 health information personnel in the 57 health facilities, three sub-districts, and two district offices. Descriptive statistics, χ2-test, correlation and multiple regression analyses were conducted using STATA® Version 13. A general inductive approach was also used to analyse the qualitative data, which was used for triangulation. The study revealed considerable data quality concerns for the PMTCT information with an average accuracy between the register and routine monthly report of 51% and between the routine monthly reports and DHMIS database of 84% suggesting that the primary point of departure for accurate transfer of data is during the collation process. The importance of human factors was emphasised by the observation that the average confidence level for performing RHIS-related tasks (69%) was not commensurate with the average competence levels (30%). Education was found to be associated with competence, implying that levels of education may be associated with the level at which RHIS competencies are acquired; and that three years or more of post-matriculation education is necessary. Motivation, on the other hand was not associated Stellenbosch University https://scholar.sun.ac.za iv with competence. The study observed the absence of processes such as data-quality checks and data-analysis in place in facilities. There was a general absence of a culture of information use, as a result of lack of trust in the data, and the inability of programme and facility managers to analyse, interpret and use information. We observed differences in the data accuracy by organisational authority, and multivariate analysis and qualitative information suggested that feedback may be an essential process to ensure quality. Although the PRISM framework has been developed from a multi-disciplinary evidence base, this study has been able to validate some of the internal assumptions but has also found some aspects that were not supported such as motivation and data display. Data collected from a larger number of facilities will be required to investigate this further. Institutional capacity to improve RHIS processes, ensure core competencies for RHIS-related tasks are needed, and in the longer term, measures to tackle problems associated with low pass rates in numeracy subjects among high school learners are needed. Further exploration of the possible factors that may influence data accuracy, such as supervision, training and leadership are needed as well as investigating the relationships between human and institutional agency-related aspects, in particular, how individual actions can bring about changes in institutional routines. Further study is needed to determine how decision for planning and evaluating key programmes such as PMTCT are made, and what informs such decisions if not routine data.