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 Meeting - Minutes of the Meeting of the Task Force on Upgrading Health Information System (HIS) (UMCOR)

 Meeting date: 22.08.2000

Minutes of the Meeting of the Task Force on Upgrading Health Information System (HIS) (August 22, 2000)

MOH International Training Center, Reshid Behbudov Street 80

Organization Participants:

  1. State Statistics Committee, Rumiya Teregulova
  2. MOH, Natalya Tselikovskaya
  3. MOH, Rovsan Ahundov
  4. MOH, Gulia Dadasheva
  5. MOH, Naida Aliyeva
  6. MOH, Rauf Novruzov
  7. MOH, Algiz Orucov
  8. MOH, Orhan Ismayilov
  9. MOH, Samir Aliyev
  10. MOH, Rauf Novruzov
  11. MOH, Anver Kuchkarev
  12. Baku Municipal Health Department, Cemil Lemberanski
  13. Baku Municipal Health Department, Esmira Haciyeva
  14. Caspian Shipping company Health Dept, Agacefer Shixaliyev
  15. State Oil Company, Afet Aliyeva
  16. Azerbaijan Airlines, Valentina Petrovskaya
  17. Azerbaijan Airlines, Laura Alixanova
  18. Railway Authorities, Dilshad Askerova
  19. Railway Authorities, Svetlana Mamedova
  20. Mercy Corps International, Javansir Hajiyev
  21. Family and Society, Faiza Aliyeva
  22. Pathfinder International, Elvira Anadolu
  23. Relief International, Aurora Fermo
  24. Relief International, Sevda Allahverdiyeva
  25. UMCOR, Teraneh Melani
  26. UMCOR, Gahraman Hagverdiyev
  27. UNFPA, Ramiz Alekperov
  28. UNFPA, Mamed Guliyev
  29. UNHCR, Shafag Rahimova
  30. UNICEF, John Holley
  31. UNICEF, Nazim Agazade

Agenda:

  1. Annual report and quarterly reports of MOH
  2. Health Information System in PHC Reform districts
  3. Next Meeting

Outputs:

  1. The participants discussed MOH annual and quarterly reports and recommended to consider inclusion in the Annual Report issues of family planning, and in the quarterly reports non-routine information, such as surveys (particularly community based surveys), special health programs implementation, activities of Health Departments of other ministries
  1. Dr Javanshir Hajiev made presentation on Efficiency of Reform and Performance Indicators (attached). In the plenary discussions the participants recommended to discuss feasibility of monitoring the indicators of performance in the process of health system reform process.
  1. Next meeting is scheduled for September 12, at 10:00, in the MOH International Training Center, Reshid Behbudov Street 80.


Presentation on Efficiency of Reform and Performance Indicators (August 22, 2000)

Dr Javanshir Hajiev

Indicators of Access

Physical Access

  • Percent of (rural, poor) population residing within X kilometers of a health facility
  • Percent of (rural, poor) population residing within X kilometers of a health facility providing a package of basic health services
  • Percent of (rural, poor) population residing within X kilometers of a health facility staffed by a doctor
  • Percent of (rural, poor) population residing within X kilometers of a pharmacy
  • Percent of the population residing within X kilometers of a hospital
  • Percent of population residing within X kilometers of a hospital providing 24-hour emergency (obstetric) care
  • Percent of population served by 24-hour ambulance services
  • Percent of health facilities equipped with telephones or radios
  • Percent of population residing more than X kilometers from a health facility, who are covered by outreach services
  • Population per doctor
  • Population per nurse
  • Population per hospital bed

Economic Access

  • Average total private cost of professionally treated outpatient illness episode as a percent of monthly per capita household income for consumers in the lowest per capita income quintile
  • Average total private cost of medicines for a typical outpatient illness episode as a percent of monthly per capita household income for consumers in the lowest per capita quintile
  • Average total private cost of an average hospital stay as a percent of annual per capita household income for consumers in the lowest per capita income quintile
  • Average fee charged per outpatient visit by nearest government ambulatory health facility
  • Average cost per day of hospitalization at nearest government hospital

Indicators of Equity

  • Ratio of share of government health subsidies received to share of total income received by income group
  • Ratio of the Gini coefficient for public health care subsidies to that for total income (or total expenditures)

Indicators of Quality

Structural Indicators

  • Existence of national standards for professional qualifications of health manpower, including enforcement mechanisms
  • Proportion of health workers possessing basic professional qualifications, including skills for specific primary healthcare services
  • Existence of national facility standards, including enforcement mechanisms
  • Proportion of health facilities meeting basic structural standards, based on the services to be provided
  • Presence of clear national standards for high priority health services
  • Proportion of facilities in which current diagnostic and treatment guidelines are available in writing
  • Presence of a national quality assurance program, including trained staff and established procedures for quality design, monitoring, and improvement
  • Routine review and updating of technical standards
  • Effective methods for communicating standards to the field level
  • Routine application of methods for comparing performance with standards
  • Routine application of data-based problem-solving methodologies
  • Routine application of methods for incorporating community input into system design and management
  • Proportion of health facilities that did not experience drug stockouts during the preceding three months
  • Proportion of cases in which all recommended drugs are available

Process Indicators

  • Proportion of clinics in which services are fully integrated, per national standards
  • Proportion of health workers receiving appropriately timed and effectively conducted supervision, per national policy
  • Proportion of patient contacts in which treatment received is consistent with national diagnostic and treatment protocols, including guidelines for client-provider interaction
  • Proportion of referrals made and consummated in accordance with national guidelines and standards
  • Proportion of clients who know and understand essential actions needed to complete treatments and avoid future preventable conditions
  • Proportion of clients who follow through to completion of recommended treatments (dropout rate)
  • Client satisfaction
  • Proportion of clinics in which services are fully integrated, per national standards

Indicators of Health Systems Efficiency

  • Outpatient visits per hour of physician labor (or per physician)
  • Outpatient visits per hour of nurse labor (or per nurse)
  • Ratio of outpatient visits to personnel costs (i. e., unit personnel costs)
  • Cost per outpatient visit (or Operating cost per outpatient visit)
  • Cost per hospital bed-day (or per hospital admission or per hospital discharge)
  • Percent of outpatient visits obtained from the private sector
  • Private hospital beds as percent of total
  • Personnel expenditure as a percent of total recurrent health expenditure
  • Expenditure on drugs and supplies as a percent of total recurrent health expenditure
  • Number of nurses per doctor
  • Number of nurses per hospital bed
  • Number of doctors per hospital bed
  • Ratio of average salary of government health worker (e.g., doctor, nurse, technician) with a given level of experience, to the income of a comparable private sector health worker
  • Salaries of government health workers are paid on time (yes/no)
  • Adequate performance incentives exist for government health personnel (yes/no)
  • Government health workers are permitted to engage in private practice (yes/no)
  • Generic drug expenditure as a percent of total drug expenditure
  • Government health system uses basic drug list for procurement (yes/no)
  • Percent of government recurrent health budget spent on public health services
  • Primary health care expenditure as a percent of recurrent costs
  • Percent of total government drug expenditures allocated to primary care facilities
  • Fees are charged in all facilities (yes/no)
  • Fee levels promote efficiency (yes/no)
  • Referral system functions effectively (yes/no)
  • Fees are charged in all facilities (yes/no)
  • Fee levels promote efficiency (yes/no)
  • Referral system functions effectively (yes/no)
  • Percent of insured enrolled in plans which use copayments and deductibles, managed care plans, or plans subject to global budgeting

Indicators of Health Systems Sustainability

  • Percent of total health system financed by tax revenue
  • Percent of government health system financed by tax revenue
  • Government health expenditure as percent of total government budget
  • Government health expenditure as percent of GDP
  • Percent of total health spending financed by donors
  • Percent of government health spending financed by donors
  • Percent of government recurrent health spending financed by donors
  • Percent of government health expenditure directed to primary care
  • Percent of government health expenditure directed to preventive care
  • Percent of government health expenditure directed to MCH services
  • Foreign doctors as a percent of all doctors
  • Number of months of foreign technical assistance funded by donors
  • Donor expenditures on technical assistance as a percent of all donor health expenditures

Criteria for evaluating individual indicators

  • Validity. Does it measure what it supposed to measure? Is it valid indicator of a particular dimension of health care performance?
  • Precision. Is indicator clearly defined? F.e. if indicator refers to expenditures, should it be based on recurrent expenditure, capital expenditures, or total expenditures?
  • Reliability. Will two measurements of the indicator for the same health system produce the same result?
  • Timelines. Is the indicator available on the annual basis and without undue delay?
  • Comparability. Can the indicator be used to compare the health system meaningfully across the countries?
  • Additivity. Can the indicator be readily applied to sub-regions, to population subgroups (gender, income, etc,.)
  • Interpretability. Does it indicate whether health system performs better (or worse)?
  • Cost. Is the cost manageable?


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