Implementing an Integrated Nutrition Programme - Health Systems ...

Clinics were also required to report on the number of cases of severe PEM and pellagra
which were seen at the clinic. Hospitals were not required to supply this information although
during this period most severely ill children would have bypassed the clinics and gone
straight to hospital.
The information was forwarded on a monthly basis to the district office in Kimberley. The
clinics did not receive any feedback.
1996 - 1998
From 1996, the forms were sent to the district office rather than to Kimberley. Nurses were
required to separate children into those enrolled on the PEM scheme for each weight and
age category and also identify how many children were showing signs of growth faltering.
This meant that each child who was weighed had to be classified into one of ninety-six
categories. The form also required each clinic to supply information regarding birth weights,
catchment population and clinic attendance (so that an estimate of the number of children
targeted for growth monitoring could be made) and information regarding the number of TB
patients and pregnant or lactating women seen at the clinic and whether or not they were
gaining weight.
Problems with this system of surveillance included:
‣ Only children who attended the clinic were included.
‣ Nursing staff complained that the system was extremely time-consuming – in particular
completion of the form at the end of the month.
‣ Although the district nutritionist collated the information on a monthly basis and each
clinic received feedback in the form of hand-drawn graphs each month, the information
was not used for planning and evaluation.
‣ It was not clear how the system fitted into to nutritional surveillance at a national level.
1998 onwards
At the beginning of 1998, a simplified version of the form was introduced with a total of 12
data items. A computer programme for analysis of the information has also been developed
and information has been entered into it for the past two years.
This process has occurred in parallel to other efforts to streamline and improve the District’s
Health Information System.
2.5 Support from other district level systems
Progress has been made in implementing the District Health System in the district and the
nutrition programme receives good support from the management systems in the district.
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