Academic journal article Bulletin of the World Health Organization

A Data Warehouse Approach Can Manage Multiple Data Sets

Academic journal article Bulletin of the World Health Organization

A Data Warehouse Approach Can Manage Multiple Data Sets

Article excerpt

Development of essential national indicators and data sets--or national standards--is regarded as the key issue in country health information system reform. Most countries, however, fail to achieve this goal. The reasons are: fragmentation (difficulty in reaching agreement on standards across health programmes); focus on reporting rather than on use of data and information; constantly changing needs (e.g. with regard to HIV/AIDS); and standards that are "cast in stone" (software and paper tools are difficult to change).

Despite these problems, South Africa has managed to develop national standards that are flexible enough to "absorb" local innovations and changes over time. The following points may help to explain why this is so.

* The "hierarchy of standards" ("information needs" in Shaw's figure) has been a powerful tool to negotiate a balance between the national needs for control with the local (e.g. province or health programme) needs for flexibility or more data. While all health units are required to collect and report the core national data, they are at the same time allowed to collect their own additional data.

* Use of information is highlighted by linking data sets to targets and indicators.

* The flexible approach to standards following the hierarchy makes it easy to absorb and implement changes over time; there is no "final" data set. Local innovations are allowed for and may eventually be included in the national data set.

* The flexibility of the South African District Health Information System (DHIS) database application is crucial to managing the ever changing national and local data sets. Data elements, indicators and data sets are added, edited and managed by the health services themselves, thus making it possible to manage multiple data sets at district level. This "data repository" or "warehouse" approach may be a key to how the lessons from South Africa could be applied in other countries. …

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