Describe a healthcare setting (hospital/clinic/district health office/ministry of health) --- number/type of patients, size (i.e.in-patient/outpatient); number of employees (types – physicians, nurses etc.) Location/setting (large city, rural setting -- type of economy – i.e. agriculture – types of crops etc.;
Kombewa District Hospital is a government health facility with both inpatient and outpatient services.
The outpatient flow is approximately 70 – 100 people daily. The hospital has a bed capacity of 60.
Generally, the outpatients are diagnosed of preventable conditions and illnesses such as malaria, ARI,
Diarrhoea, skin infections and malnutrition. Inpatients are mainly referred from the 17 peripheral health centres. The staff here consist of 1 medical superintendent, 1 consultant medical doctor (in charge and therefore concentrates on management and administration), 2 public health nurse, 1 nutritionist, 1 records officer, 6 clinical officers, 10 registered nurses, 8 support staff. The hospital is the only referral hospital in the district. The facility is situated in rural Kisumu where the major source of income are subsistence agriculture and fishing. The main types of crops grown in the area are Maize, beans, sorghum, cowpeas, groundnuts and sweet potatoes.
2. Describe in detail the key challenges facing this setting in managing the healthcare needs of their clients (not specifically information systems but in general)
The major challenge in managing healthcare in this setting are; a) Health planning – the health plans are developed at the health centre level and collated at the district level. The district submits a district summary to the province. This is in turn submitted to the national level after summarizing. In the process, many issues that are unique to certain areas and/or certain districts get lost as the planners are keen to work with the most common problems. b) Healthcare financing – The services are subsided but there are frequent stock-outs. During the stock-outs, patients are given prescriptions to buy drugs from commercial pharmacies. Given that the facility is in a rural poor environment, the cost of drugs at these pharmacies are high.
Most people opt for less than the required dosage in a bid to relieve pain (many people have developed resistance to the firstline treatment drugs for common ailments like Malaria. c) Inadequate staffing – the staff are very few compared to the patient flow pattern. At the same time, the most senior medical staff are bogged down with administrative duties denying the people the skills that their illnesses dearly require d) Inadequate medical supplies – the hospital depends on the government logistics to access it’s medical supplies. This logistical process depends on the quota system and does not follow any disease pattern leading to perennial drug shortages. For instance, the area is Malaria endemic e) so the anti-malarial supplies often get finished within the first month of receipt while

3. Describe the current information systems (print or electronic) in place for managing: 1) the care of patients – in-patient and outpatient; 2) management of the facility (Management information systems..) 3) data reporting systems (donors? District health office? Ministry of health?)
For care of patients – There are different forms in use like registration form, doctor’s diagnosis sheet, laboratory request form, prescription form and referral form. All are kept in a file label for each patient.
The patients are asked to purchase a notebook where the doctor’s summaries and recorded. The patient is expected to carry the same notebook back on next visit (whether appointment of next illness)
MIS – I am not so sure here!!!
Data reporting systems – the ministry has key indicators being monitored each quarter. The hospitals get tally sheets which they fill in and forward to the national level. The reports from these summaries are often available towards end of the next year i.e. they are not used in developing annual operational plans for health in the districts. Most donors have their own reporting requirements which the staff adhere to (in addition to the national tools).
4. Describe at least one information management challenge with a particular focus on the interactions and approaches among the people trying to address the challenge (e.g. the views of the technical staff versus the views of the managers versus the views of clinical staff). Describe social, cultural or political issues that are impacting on the response to the challenge.
The notebooks with patient and consultation outcome summaries are supposed to be kept by the patient and should be presented in the next visit. However, this is rarely done. For this reason, the clinicians would like to have the files brought to them from the records office for reference during the next visit. The staff at the records office is overwhelmed and can rarely locate the appropriate file before appointments commences (yet the patient has not carried the notebook back). Hence lack of patient history except for the current complains. The patient buys the notebook at each visit. The managers see this recurrent purchase as income generation because when many patients buy notebooks, the hospital generates revenue. They have no problem with every time purchase by the patients.
For outpatients, many people hang on until market days so they can travel once to the centre. Of course, there are many wares to carry to the market that one cannot easily remember the “small” notebook which has meaningless information (remember nobody explains why the need to carry it to all health facility visits and/or the content).