DATA SOURCES
BY
DR. DC TSHIBANGU
March 18, 2016
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SESSION OBJECTIVES
• Define what is a health information
system (HIS) and understand its
components
• Define routine health data/information
• Discuss routine data collection methods
• Define non-routine data
• Discuss methods of collection for nonroutine data
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SESSION OBJECTIVES
To help M & E OFFICERS to:
• Appreciate the varied sources & forms of information on specific
project/program/service
• Develop a toolkit for thinking about the complexity of information and
its uses
• Assess the completeness, accuracy, relevance and timeliness of
available information
• Decide which types of information are most appropriate for a particular
activity within a project/program
• Make optimal use of information which is not ideal, and assess the
effects of its departure from perfection
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FROM REALITY TO ACTION
Real world
(Collection, coding)
Data
(Processing, interpretation, presentation)
Information
(Politics, commitment)
Action
Source: Oxford Handbook of Public Health Practice
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USE OF WORDS ‘DATA’ & ‘INFORMATION’
• DATUM (singular) or DATA (plural) refers to raw
numbers or other measures, usually discrete
and gives objective facts about events.
• INFORMATION refers to what emerges when
data are processed, analyzed, interpreted and
presented. Information is data transformed
(contextualized, categorized, corrected,
calculated, condensed) into a message
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WHEN TRANSFORMING DATA
Always bear in mind the issues that affect the quality of the data:
• Validity - are the data capturing the concept or
quantity you intended?
• Selection bias – where the data mislead because
they are not representative of the population
• Classification bias – where there is a non-random
effect on putting data into groupings (non-blind
assessments of any outcome)
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KINDS OF DATA SOURCES
In most countries, there are many different sources of information on any
Specific project/program/service and different types of information vary in their
C.A.R.T:
• Completeness
• Accuracy
• Relevance and/or Representativeness
• Timeliness
DATA SOURCES also vary in the ease with which a
base population can be identified, for use in the
denominator, for calculating rates.
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WHAT DOES THE DATA SOURCE DESCRIBE?
This depends on the goals/ objectives of program and may
include information such as:
• Demographic & Socioeconomic features of the studypopulation: age, sex, education, occupation, mobility and
geographical distribution.
• Health status: health service use data (diagnoses,
interventions, procedures, health outcomes of interventions), morbidity,
mortality (TB, Malnutrition, HIV/AIDS, co-infections and OIs)
• Programmatic: inputs, process, outputs, outcome & impact
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HOW IS THE INFORMATION COLLECTED?
Information can be Routine or Specially collected
• Routine refers to collected, assembled, and made
available regularly, according to well-defined
protocols and standards.
Such data are usually available at regular intervals
They intend to allow tracking over time
They are codified using national or international
standards (ICD)
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HOW IS THE INFORMATION COLLECTED?
• Specially collected refers to collection for a particular
purpose, without the intention of regular repetition or
adherence to standards (other than those needed for the
specific study or tasks); such data are usually:
- aimed at a specific , time-limited study or tasks;
- codified according to the goals in hand and the
wishes of the investigators.
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CLASSIFICATION OF INTRINSIC TYPES
OF DATA
Sometimes data are categorized as hard or soft:
Hard data: are precise (or intend to be precise):
They are often numerical; if not, then coded according to
a protocol;
They are reproducible, and likely to be similar even if the
data collectors are varied.
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CLASSIFICATION OF INTRINSIC TYPES
OF DATA
Soft data: tend to be:
- qualitative, attempting to capture some of the
subtlety of human experience;
- often narrative or textual form, at least as
they are collected;
- Imbued with some subjectivity, due to the
complexity of the personalities of the data
collectors and the individuals studied.
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THE UTILITY OF THE INFORMATION
Neither hard nor soft data are intrinsically better than the other.
The utility of the information (in terms of better decision making)
often comes from combining the two:
• Harder data usually allow more precise analysis and
comparisons, but may fail to capture subtleties.
• Softer data usually capture more of the ‘truth’ about the world,
but often at the expense of emphasizing the uniqueness of the
circumstances, and are less likely to allow comparisons and
conclusions.
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DATAWISE WHAT DO YOU NEED TO
ASSESS?
You need to assess ‘the fitness for purpose’
by asking the following question:
Are the existing or proposed sources of data
fit for the purpose for which they are intended,
the conclusion to be drawn or the decision to
be made?
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KEY ISSUES FOR ASSESSING APPROPRIATENESS
AND USEFULNESS OF DATA & DATA SOURCES
Here are some guiding issues but none is absolute, and the
balance of advantage & disadvantage must be assessed using
judgment.
• Technical issues
- Are the definitions clear and appropriate?
- Are the target and study population clear?
- Are the data collection methods clear and sound?
- How complete, accurate, relevant, and timely are the data?
How much does this matter?
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KEY ISSUES FOR ASSESSING APPROPRIATENESS
AND USEFULNESS OF DATA & DATA SOURCES
• Issues relating to outcome or decision involved
- Is the study population sufficiently representative of the target
population for the purpose of the decision?
- Do you need absolute or relative estimates, to make the best
decision ?
- Would existing data source suffice, by using comparative
data or by extrapolating with care?
- Would qualitative information suffice, when habit automatically
suggests quantitative data?
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Health Information Systems (HIS)
• Health system
– All resources, organizations and actors that are
involved in the regulation, financing, and provision of
actions whose primary intent is to protect, promote or
improve health.” (WHO, 2000)
• Health Information System (HIS):
– A system that provides specific information support
to the decision-making process at each level of an
organization (Hurtubise, 1984)
– Similar to a health management information system
(HMIS)
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What is the problem with many existing
routine health information systems
(RHIS)?
• Irrelevance and poor quality of the data collected
• Fragmentation into “program- oriented”
information systems: duplication and waste
• Centralization of information management
without feedback to lower levels
• Poor and inadequately used health information
system
infrastructure
March
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As a result…
• Poor use of information by users at all
levels: care providers as well as
managers
• “Block” between facility and community
health information systems
• Reliance on more expensive survey data
collection methods
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What characterizes a good HIS?
• Regular production of good quality data
• Continued use of health data for improving
health system operations and health status.
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What influences data quality and
use?
·Standard indicators
·Data collection forms
·Appropriate IT
Technical
factors
·Data presentation
·Trained people
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What influences data quality and
use?
·Resources
·Structure of the
health system
·Roles, and
responsibilities
System and
environment
factors
·Organizational
culture
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What influences data quality and
use?
·Motivation
·Attitudes and values
·Confidence
·Sense of
responsibility
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Behavioral
factors
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SYNOPSIS OF SOME HEALTH & SOCIAL
PROGRAMS
•
•
•
•
•
•
•
•
Malaria Program
TB Program
HIV Program
Nutrition Program
Family Planning Program
Immunization Program
Tobacco Prevention Program
Poverty Alleviation Program
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M & E MANAGERS
• Are likely to get involved in all or some of these
programs
• The selection/choice of appropriate Data
Sources depends upon the type of program one
is involved in.
• Some selected examples are provided below:
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M & E HIV/AIDS MANAGERS
Are likely to get involved in
• Preventive Programs and/or
• Care & ART Programs and/or
• Support Programs
and
The selection/choice of appropriate Data Sources is
dictated by the type of HIV programs.
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M & E POVERTY PROJECT
MANAGERS
Are likely to get involved in
• Designing and Implementing Poverty-targeted
programs
and
The selection/choice of appropriate Data Sources
depends on whether one needs to determine who
should qualify for services and who should not.
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FIVE MINUTE EXERCISE
1. Choose any population/health/nutrition
program
2. Define one objective of that program
3. List 3 data sources and 3 reasons why
you have selected them
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DATA SYSTEMS
• TWO TYPES OF DATA SYSTEMS:
 ROUTINE: Health information systems
 NON-ROUTINE:
- Surveys
- Research programs
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ROUTINE DATA SOURCES
• Such as HIS (Health Information System)
and its subsystems that are collected as
part of an ongoing system
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CHARACTERISTICS OF HIS
• A health system is not a static phenomena. It is in
a continuous process of change due to pressures
from both outside and within the system
• HIS is an integral part of the health system
• HIS generates the data to measure the change of
a health system
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NON-ROUTINE DATA SOURCES
Such as
• DHS
• Special Surveys
• Program or Project Evaluation
• Clinical trials
• Epidemiological Surveys
(Descriptive/Analytical)
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Non-Routine Data Sources by Levels

Policy or program level

Facility/Service delivery point level

Client level

Population level
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LEVELS OF INFORMATION WITHIN THE
IDENTIFIED DATA SOURCES
The next quest is to identified the level of
information one is interested in within identified the
Data sources
• FIVE LEVELS OF DATA:
1. Policy or Program level
2. Population level
3. Service Environment level
4. Client level
5. Spatial/Geographic level
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POLICY/PROGRAM LEVEL
• This is policy/legislation formulation level,
Sources of:
- Official legislative & administrative documents
- National budgets or other related data
- Policy inquiries
- Reputational rankings (program efforts scores)
• Tools:
- Indexing questionnaires (for country specialists
and rankings)
- Special/contract studies
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FACILITY LEVEL

Facilities-services, infrastructure, etc.
Audits/inventories
Facility surveys
Health care providers, other staff
Performance reviews, competency
measures
Training records





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POPULATION LEVEL
Where you need to know the size/composition of a population.
Sources such as:
- Population census bureau; - Sentinel surveillance systems
- Vital statistics system (birth & death certificates)
- Sample households or individuals; - Special population samples
(demographic/occupational group, or geographic sector)
Tools:
- Birth/Death certificates
- Census questionnaires
- Household/Individual Special Surveys
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SERVICE ENVIRONMENT LEVEL
This is a complex level requiring different types of data from
Sources such as:
- Administrative records (service stats, HMIS data, financial & transport
data)
- Service delivery point information (audit information, inventories, facility
survey data)
- Staff information (performance assessments, training records, provider
data, quality of care data)
- Client visit registers
Tools:
- Health Service Information Systems; - Facility Sample Surveys; - Facility
records; - Performance Monitoring Reports
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INDIVIDUAL LEVEL
“Individual” in this context refers to a client, participant,
patient or documents related to a single person as can
be obtained from
• Sources such as:
- Medical records; - Interview data; - Case Surveillance (epidemiology of
disease)
- Provider-Client interactions
Tools:
- Case reports; - Survey questionnaire; - Client register analysis
- Patient flow analysis; - Direct observation
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INDIVIDUAL LEVEL
Can measure “program exposure” represented
by utilization, as well as service experience,
quality of care/service delivery, disease
surveillance
– Is the volume increasing?
– What is the service mix?
– Who are the clients?
• How does it vary by public/private sector?
– What are their consultation experiences?
• Would they return/recommend the service?
Other questions?
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INDIVIDUAL LEVEL
1.
2.
3.
4.
Client Exit Interviews
Case surveillance (epidemiology)
Provider-client observation
Service Delivery Point records and
registers
5. Patient-flow analysis
6. Others?
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MEASUREMENT TOOLS
•
•
•
•
•
•
•
Facility audits, Inventories
Facility surveys
Provider interviews
Provider-client observation
Provider training records
Situation analysis
Others
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Some Strengths and Weaknesses of Facility
Surveys as a Source of M&E Data
• Strengths
– Can cover both public and private health facilities
– Timing can coincide with program implementation
– Can combine with population survey for outcome
monitoring and impact evaluation
• Limitations
– Survey sampling design and analysis may be
complex
– Expensive, time-consuming
– Information rapidly outdated, unless repeated
• Others??
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Surveys: When are they appropriate?
• Surveys especially useful– when other data are not available or inadequate
– when they can be tailored to fit specific measurement
objectives
• Yield cost-efficient data on population and services
• Good sampling techniques produce representative
results for facilities, providers and clients
• Surveys are expensive, but versatile and widely used
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Rapid Appraisal / Qualitative Methods
• Key Informant Interviews
• Focus Group Discussions
• Community Interviews
• Direct Observation
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COMPONENTS OF DATA SYSTEM
• A sound Data System is likely to have:
1.
2.
3.
4.
Multiple, operationally defined indicators
A variety of Appropriate Data Sources
Baseline and Target Values
Feasible Data Collection Plan and Budget:
- Specified Frequency
- Identified Responsibility
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GEOGRAPHIC LEVEL
These are modern and specialized
sources that include:
- Cadastral maps (land ownership)
- Land Demarcation Department with:
- Satellite Imagery and Area Photography
- Digital Line Graphs and Elevation Models
Tools:
- Global Positioning System
- Computer Software Programs (GIS)
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CONCLUSION: DATA SOURCES and
YOUR M&E PLAN
• Assess the type of information your program/project needs
• Assess what information is already available and from what
sources and levels
• Use those sources to help developing your M&E Plan
• Decide what gaps need to be filled and plan accordingly
• Diagram the flow of data through the M&E system
(collection to analysis)
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THANK YOU
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