The main aims and objectives of this study are, to explore the procedures, tools and problems related to primary health care data collection, storage, use and information flows and to offer ideas and suggestions on how to improve the systems of routine data collection, storage, analysis and use of information and more generally to improve the flows of information and health care information systems. The study also provides a comparison between the results of the field studies in two developing countries: Tanzania and Mozambique.
The study employed qualitative research methods, including ethnographic methods; interviews, observations in the health facilities settings, analysis of patient records for varying recording tools and content, reviews of documents, and the analysis of existing computer systems within the health information systems in study. The study was carried out in Xai – Xai district, Chokwe district, Chibuto district and Bilene district in Gaza province, inMozambique (April to May 2002), and Kibaha district in Coastal region, in Tanzania (June to August 2002).This research focuses on the various information flows originating at the local health facility, how the data are collected and stored, use or/and non-use of data, sharing or communication of important information between primary health care and hospital levels, data flows from the health facilities to the districts to the region or province and to the national level. The research shows that the system of data collection and vertical data flow is rather complex; a number of data collection tools are in use: patient cards, registers, tally sheets and forms. The data collection tools and flows of information reflect the needs of the various health programmes: Community Health, Maternal and Child Health (e.g. family planning,antenatal care, deliveries), communicable diseases, Tuberculosis and Drug programmes.
The study’s empirical findings are discussed in relation to the literature review. The literature review ranged from various writings on existing health information systems (HIS) in developing countries, socio-cultural factors shaping the HIS, the role of Information andCommunication Technologies (ICT) in health systems in developing countries, and decentralization of information management toward the district level as a way of restructuring the health information system in the broader process of health sector reform.My discussion is to a large extent based on the social systems perspective; information systems should be conceptualized as social systems in which technology is only one of the elements. Changing an information system involves the change not only of a technicalsolution but of a social system. Through a cross-case analysis of my empirical data and discussion, I found that there are several problems related to the use and management of information at local levels within the HIS. In summary, the availing problems can be grouped into three broad categories:
1. Lack of clear understanding of the purpose of data collection.2. Information flows reflecting the requirements of higher levels without addressing the local level’s information needs.3. Poor and inadequate resources and infrastructure for health care activities.
To improve the use and management of information at local levels within the HIS the following should be done: Local learning and discussion of essential HIS needs, and the role of routine data collection in meeting those needs. Establishing an information culture in HIS and health care organizations. Investing in health data collection, use and management of health information at local levels within the HIS.