Joint External Evaluation of the Health Sector in Tanzania: Draft ...

The Quality of Annual Health Statistical Abstracts
Due to reported staff shortages, the HMIS team has not had enough time for supervision
of data collection at field level and has not been able to produce a health statistical abstract
for every year during the evaluation period. From 1999 to 2006 only two Abstracts have
been compiled, one covering 2000/01 (published in 2002), the other covering 2004/05
(published in 2006). The quality of the abstracts has clearly improved over time. The most
recent includes a narrative description, comparisons and analysis, where the previous one
only contained tables.
Completeness and Reliability
Despite improvements there is a persistent issue with the completeness of HMIS data
submitted to the Health Information and Research Section (HIRS) at MOHSW. The main
problem seems to be that many facilities fail to provide data on time, leading to large gaps
in information and limitations in the resulting analysis.
Reasons mentioned for this delay include: time constraints at the HF hampering prompt
filling of forms, lack of IT facilities and/or IT experience at the district level (although
software for data analysis and reporting exists), and non-functional RHMTs, delaying data
checks and forwarding to the MOHSW. If CHMTs and RHMTs had access to electronic
mail, the electronic forwarding of data could no doubt speed the process greatly.
On the other hand, reviews of HMIS books at facilities level and discussions with health
workers indicate that the HMIS system has become more understandable and easier to use
over time. This more positive view seems to be related to understanding the importance of
data collection and the ability to analyse and utilise it. Still, HMIS focal persons complain
about the time spent on correcting mistakes due to lack of both training of new HF staff
and refresher training for existing staff as well as insufficient supportive supervision in
some districts.
Where the focal person is active, all staff has been properly trained, and supportive
supervision and regular meetings to discuss data with the in charges of HFs take place, the
quality of data and utilisation can improve. In Mwanza for example the completion rate of
HMIS reports has increased from 60-70 % in the 1990’s to 90 % at present.
So despite its ongoing shortcomings, there is evidence that the HMIS has been
strengthened during the evaluation period and that it is understood and used at health
facilities including dispensaries, health centres, and district and regional hospitals.
Analysis of Data and Utilisation of Information
All districts superficially use the HMIS data for the CCHP, but the collected information is
largely forwarded without in-depth analysis at the lower level. The district self-assessments
found that only five out of sixteen districts claim that the HMIS enhances planning while
six out of sixteen claim that it facilitates drug procurement.
Based on interviews in the districts, one likely reason for lack of data analysis and utilisation
of information is that the focal person and other CHMT members, including the DMOs,
do not have sufficient expertise to optimally benefit from the system.
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