UNHCR Handbook for Emergencies - UNHCR eCentre

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Monitoring and Surveillance: The Health
Information System
9. From the earliest stages of an emergency,
a health information system should be put in
place under the responsibility of the UNHCR
Health Coordinator. The health information
system should be simple, reliable, and action
oriented, and its use will be essential to:
i. Quantify the health and nutritional status
of the refugee population;
ii. Follow trends in health status and monitor
the impact and outcomes of the relief programme;
iii. Detect epidemics;
iv. Evaluate programme effectiveness and
service coverage;
v. Ensure that resources are targeted to the
areas of greatest needs;
vi. Re-orient the programme as necessary.
10. Annex 1 sets out the tables and forms for
collecting health-related information. However,
to have a more comprehensive idea of
the situation, information regarding water,
food, sanitation, shelter and availability of
soap should also be collected and analyzed
(see the relevant chapters on water, nutrition,
sanitation, and physical planning).
11. The health information system should be
kept simple. The information to be collected
should be adapted to suit the collectors’ qualifications.
Overly detailed or complex reporting
requirements will result in non-compliance. In
addition, only data that can and will be acted
on should be collected. Communication and
exchange of views among all the actors in the
health information system are essential to
secure the functioning of the system.
Only simple arrangements are effective in
emergencies.
12. Health information in the initial stages
of an emergency should concentrate on:
i. Demography (see chapter 11 on registration,
also paragraph 4 above, and table 1
of Annex 1);
ii. Mortality and its causes (see tables 2.1 and
2.2 of Annex 1 and paragraph 14 below);
iii. Nutritional status (see Annexes 4 and 5 of
chapter 15 on food and nutrition);
iv. Morbidity (see below, and table 3.1 of
Annex 1).
13. Only when the situation stabilizes can
the system be made more comprehensive. Information
on mortality and morbidity should
be collected as follows:
Mortality
14. Each health facility should keep a log
of all patient deaths with cause of death and
relevant demographic information. This information
should be summarized in tables 2.1
and 2.2 of Annex 1, reported centrally and
consolidated with other data. Because many
deaths occur outside the health-care system, a
community-based mortality surveillance system
should also be established. Such a system requires
identifying sites which people are using
as cemeteries, employing grave watchers on a
24 hours basis, routinely issuing burial
shrouds, and using community informants.
Deaths that occur outside hospitals with unknown
causes should be validated through
verbal autopsy by health workers specifically
trained for this task.
Morbidity
15. Each health facility providing out-patient
services (including clinics for under five’s and
selective feeding programmes) should keep
daily records. These records should be in the
form of a log book or tally sheets at least, and
should at least record the patient’s name, age,
sex, clinical and laboratory diagnosis and
treatment. This information should be summarized
in the forms set out as tables 3.1. in
Annex 1 and reported centrally.
16. Diseases recorded in the health information
system must have a case definition (i.e. a
standard description) which will guide health
workers in their diagnosis and ensure the consistency
and validity of data. Where possible,
case definitions that rely on clinical signs and
symptoms (e.g. malaria) should be checked
against a laboratory standard test (e.g. blood
test for malaria).
17. In addition, the patient should be issued
a health record card (or “Road to Health”
card) on which the date, diagnosis, and treatment
are recorded. Every contact a patient has
with the health-care system, whether for curative
or preventive services, should be noted on
the health record card retained by the patient.
18. The health information system should be
periodically assessed to determine its accuracy,
completeness, simplicity, flexibility, and timeliness.
The way programme planners and key