背景:对于基于证据的决策,需要质量,及时,卫生系统每个级别的相关和可获取的信息。据报告,在卫生系统的每个级别上有限地使用当地数据是低收入和中等收入国家基于证据的决策的主要挑战。尽管有证据表明当地数据的及时性和质量,我们对它如何用于卫生系统不同级别的决策知之甚少。因此,本研究旨在评估数据使用水平及其对数据质量和卫生系统不同层级的共同责任的影响.
方法:在2017年1月至9月期间,使用关键信息和文件审查进行了一项实施科学研究。共从社区代表中选出二十一名主要举报人,数据生产者,从社区到区域一级的数据用户和决策者。审查的文件包括设施报告,地区报告,地区报告和地区监督反馈。对定性数据进行了专题内容分析。
结果:受访者报告说,用于常规决策的常规数据使用率很低。所有卫生机构和卫生办公室都有一个绩效监测小组,但这些并不总是起作用的。意识差距,缺乏激励措施,支持性监督的不规范,人们发现,缺乏社区参与卫生报告核查以及卫生专业人员技术能力差是数据使用的主要障碍。该研究还表明,没有关于与健康数据有关的问责机制的机构或国家一级的法规或政策。社区一级的健康发展军方案被认为是一种强有力的社区参与方法,可以在社区数据来源处进行数据核查。
结论:发现在当地使用常规数据进行决策的文化程度很低。加强卫生工作者和业绩监测小组的能力,引入数据使用的激励机制,让社区参与数据验证和引入卫生数据问责机制对于改善数据使用和质量至关重要。
BACKGROUND: For evidence-based decision-making, there is a need for quality, timely, relevant and accessible information at each level of the health system. Limited use of local data at each level of the health system is reported to be a main challenge for evidence-based decision-making in low- and middle-income countries. Although evidence is available on the timeliness and quality of local data, we know little about how it is used for decision-making at different levels of the health system. Therefore, this study aimed to assess the level of data use and its effect on data quality and shared
accountability at different levels of the health system.
METHODS: An implementation science study was conducted using key informants and document reviews between January and September 2017. A total of 21 key informants were selected from community representatives, data producers, data users and decision-makers from the community to the regional level. Reviewed documents include facility
reports, district
reports, zonal
reports and feedback in supervision from the district. Thematic content analysis was performed for the qualitative data.
RESULTS: Respondents reported that routine data use for routine decision-making was low. All health facilities and health offices have a performance monitoring team, but these were not always functional. Awareness gaps, lack of motivating incentives, irregularity of supportive supervision, lack of community engagement in health report verification as well as poor technical capacity of health professionals were found to be the major barriers to data use. The study also revealed that there are no institutional or national-level regulations or policies on the
accountability mechanisms related to health data. The community-level Health Development Army programme was found to be a strong community engagement approach that can be leveraged for data verification at the source of community data.
CONCLUSIONS: The culture of using routine data for decision-making at the local level was found to be low. Strengthening the capacity of health workers and performance monitoring teams, introducing incentive mechanisms for data use, engaging the community in data verification and introducing
accountability mechanisms for health data are essential to improve data use and quality.