Improving cause-of-death statistics in health facilities

Transcription

1 Improving cause-of-death statistics in health facilities Multi-country workshop Dar es Salaam, July 2016 Workshop Report

2 WHO/HIS/IER/MBD/ World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website ( or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: ; fax: ; Requests for permission to reproduce or translate WHO publications whether for sale or for non-commercial distribution should be addressed to WHO Press through the WHO website ( The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Acknowledgements The Global Fund to Fight AIDS, Tuberculosis and Malaria sponsored the Tanzanian participants to the workshop. The workshop was conducted with a grant from Vital Strategies with financial support from the Bloomberg Family Foundation, Inc. The contents of the workshop are the sole responsibility of the authors and can under no circumstances be regarded as reflecting the positions of Vital Strategies.

3 Background information In 2015 WHO developed a Start-Up Mortality List (SMoL), a simplified list of broad cause of death fully in line with the ICD-10 structure. It contains 107 causes and 17 sub-categories. To facilitate the use of SMoL, WHO in collaboration with the University of Oslo have developed a module in the District Health Information Software (DHIS2) that comprises: 1. the Start-Up Mortality List (SMoL) 1 a simplified standard list of causes of death (107 causes and 17 optional subcategories) 2. WHO international form of the medical certificate of the cause of death 2016 version 3. a specific training manual for certifiers and coders 4. a user-friendly interface into DHIS2 to input and store the data in one place 5. the IRIS 2 automated coding tool 6. a dictionary of medical diagnostic terms 7. routine validation checks and statistical reports Objectives of the workshop The overall objective of the workshop was to empower low-resource countries of Africa in starting and improving their collection of cause of death information by: familiarizing participants to the various components of the module training certifiers in completing the medical certificate of the cause of death according to international standards training health management information officers and coders on the selection of the underlying cause of death according to a set of rules supporting countries in their implementation, integration and roll-out plan Participants The workshop was attended by 77 participants including facilitators and representatives from Bloomberg D4H, CDC and World Bank. A complete list of participants is included in Annex B. Thirteen countries participated in the workshop: Botswana, Cameroon, Eritrea, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Swaziland, Uganda, United Republic of Tanzania, Zambia and Zimbabwe. Each country delegation consisted of a mix of people from ministry of health, statistical officers, civil registries and WHO country offices and comprised doctors, statisticians, health information officers, coders, DHIS2 programmers and civil registrars. Structure and content The workshop was intended to be a training of trainers. During each of the two days, the workshop was structured with facilitators providing training instructions and country participants doing

4 practical exercises. At the end of each session, there was a review and discussion on the outcome of the exercises. The agenda of the workshop is found in Annex A. A USB key containing the presentations, SMoL training manual, certification and coding exercises and answers was given to participants to enable them to conduct similar national training. Workshop summary Day 1 The Chief Medical Officer of the Ministry of Health, Community Development, Gender, Elderly and Children and representative of WHO Country Office gave the welcoming remarks and affirmed the necessity for data in particular to measure the Sustainable Development Goals of the 2030 agenda, drive health policies and measure impact of interventions. A presentation on the situation in the African countries, common barriers to implementing ICD-10 and the fundamental steps to obtain cause-of-death data was given. Participants were instructed on how to complete the medical certificate of the cause of death according to ICD-10 and were requested to complete some of the said certificates from some case examples. In the afternoon sessions, participants were introduced to the concept of the Start-Up Mortality List and the DHIS2 CoD module. SMoL rules were explained with exercises to complete. The DHIS2 CoD electronic platform was presented. Day 2 Participants were provided with some genuine-completed medical certificates of the cause of death and requested to apply the SMoL rules to select the underlying cause of death. They also accessed the DHIS2 CoD electronic platform to practice entering the information as well as to get a sense of the integrated functionalities of the module. A briefing on the technical specifications required for integrating the CoD module into current DHIS2 was provided. Instructions were provided to participants focussing on the way forward following the workshop. After the workshop a meeting with the Tanzanian representatives of the health sector, RITA (civil registration) and international partners was held in order to have a common agreement on the way to move their CRVS agenda. Separately the Mozambique and Rwanda teams also met with WHO facilitators. Mozambique is willing to have a Brazilian version of the module. The Rwanda team expressed their interest in adopting the SMoL. Recommendations and next steps Some countries are already implementing ICD-10 in health facilities but their practices are not aligned with international standards and thus rendering the current data very limited in use to support health policies or monitor the impact of interventions. A priority for countries is to review their current form of medical certificate of cause of death to be in line with the WHO international form of the medical certificate of cause of death for doctors or certifiers to complete.

5 Countries should strengthen their collaboration among national institutions, the health sector, civil registration office, ministry of justice or interior as key to the implementation of SMoL. Many countries raised concerns about disjointed data collection system, for e.g. the Maternal Death and Surveillance Response (MDSR) and Integrated Disease Surveillance System (IDSR) are not linked to the DHIS2 HMIS system where general mortality information is captured, creating duplication of recorded deaths. The importance of system linkages was constantly stressed during the workshop. At the same time the specific collection of data such as MDSR would be excellent entry point to improve the overall cause-of-death data collection. For the few countries not using DHIS2, the essential components of the SMoL could be applicable in a different format but some programming investment would be required. Overall feedback from workshop participants was highly positive. The SMoL is seen as accessible and realistically applicable and scalable in the low-resourced countries. WHO will collaborate with other international partners to provide support to countries in implementing the SMoL.

6 Annex A. Agenda Day 1: 25 July 2016: Workshop for improving cause-of-death statistics in health facilities Organized by Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania and WHO, July 2016 Time Session Presenter : Registration All participants 08:20: 08:30 Introduction Moderator 08.30: Welcome Note Remarks from WHO Welcome Opening speech Word of thanks Ag. Director of Policy and Planning WHO Representative, Tanzania Chief Medical Officer, Tanzania Ministry of Health, Community Development, Gender, Elderl Ag. Assistant Director Monitoring and Evaluation (M&E) : Introduction to workshop Doris Ma Fat, WHO : HMIS, Mortality and Cause of Death Collection -Overview the Status Doris Ma Fat, WHO : 11:00 Medical certification Linda Best, WHO 11.00: Coffee break : Medical certification: exercises All participants : Lunch : Feedback on exercises Linda Best, WHO : Introduction to Start-Up Mortality List Doris Ma Fat, WHO (SMoL) : DHIS2 CoD platform Olav Poppe, WHO : 15:30 Coffee break : SMoL : rules 1-7 Linda Best, WHO 16.00: SMoL: exercises Group work 16.30: Feedback on SMoL exercises Linda Best, WHO

7 Day 2: 26 July 2016 Time Session Presenter : Recap of previous day discussions Doris Ma Fat, WHO : SMoL: remaining rules Linda Best, WHO 10.30: Coffee break 11.00: Exercises: Specific to remaining rules covering all SMoL rules Group work 12.30: Feedback on SMoL exercises : Lunch 14.30: Integrating SMoL into DHIS2 Olav Poppe, WHO 15.00: Coffee break 15.30: Meeting with Tanzania Ministry of Health and Social Welfare: plans for implementation and roll-out 16.15: 17:00 Meeting with participants from other countries: project planning Closure of workshop WHO, Tanzania and partners WHO and partners

8 Annex B. List of participants Participant Name Organization/Title 1 Eritrea Dr Semere GEBREGIORGIS WHO NPO/MPN-Eritrea GOITOM 2 Dr Goitom Mebrahtu Director of Health Facility Management-Eritrea 3 Dr Kifle Tesfamichael Director of HMIS-Eritrea 4 Cameroon Dr Serge Marcial BATALIACK WHO, AHO/rSIS-Cameroon 5 Dr Jeannette AFOUNDE Ministry of Public Health-Cameroon 6 Guy Martial, EKANI NDONGO Ministry of Public Health Cameroon 7 Rwanda Candide Tran Ngoc WHO-Rwanda 8 Andrew Muhire MOH, HMIS Lead Specialist-Rwanda 9 Patrick Nshimiyimana CRVS Statistician, National Institute of Statistics of Rwanda 10 Kenya Martin Chabi Jeseph WHO MCH-Kenya 11 Samuel Cheburet MOH, CRVS Head-Kenya 12 Nancy Amayo MOH, Health Information Manager-Kenya 13 CDC Kenya Frank Odhiambo Consultant, CDC, Kenya 14 Anthony Waruru Consultant, CDC, Kenya 15 Malawi Francis Regis, Magombo WHO, NPO/MPN-Malawi 16 Tonera Chiume Kamuzu Central Hospital, Doctor, Medical Registra-Malawi 17 Simeon Luka Yosefe MOH, Chief Statistician-Malawi 18 Botswana Dr Lucy Sejo MARIBE WHO, NPO/FHP-Botswana 19 Diemo Ninkie Motlapele MOH-Botswana 20 Ethiopia Mr Sintayehu Abebe Woldie MOH, Maternal Health Case Team Leader- Ethiopia 21 Mr Solomon Abay Nirea FMOH, HMIS officer-ethiopia 22 Ramzia Abdulwehes Yusuf FMOH, W/o, Policy and Planning Head, Hareri Health Bureau-Ethiopia 23 Mozambique Silvia Bignamini WHO, Monitoring & Evaluation, CRVS focal- Mozambique 24 Rosa Rene Internal Medicine, Maputo Central Hospital- Mozambique 25 Cidalia Baloi MOH, Head of HMIS-Mozambique 26 Swatziland Mrs Khosi Mththwa MPN WHO-Swaziland 27 Ms Dudu Dlamini FHP WHO-Swaziland 28 Ms Zanela Simelane MOH, HMIS Lead Specialist-Swaziland 29 Ms Makhosazane Mokoena MOH, HMIS Analysis, Facility-Swaziland 30 Dr Shabangu MOH, Senior Medical Officer-Swaziland

9 Participant Name Organization/Title 31 Dr Cora Mutoke MOH, Doctor-Swaziland 32 Uganda Mr Nasan Matseri WHO, Data Management-Uganda 33 Mr John Kissa WHO-Uganda 34 Ms Caroline Kyozira MOH, Biostatistician-Uganda 35 Mr Charles Kabugo Senior consultant physician-uganda 36 Doctor Livingstone, Makanga PRINCIPAL MEDAICAL OFFICER, MOH-Uganda 37 Zambia Mr Solomon Kagulura WHO NPO/MPN-Zambia 38 Mr Peter Moyo MINISTRY OF HOME AFFAIRS, Zambia 39 Zimbabwe Vengai Jacha Health information officer, MOH 40 Ottias Tapfumaneyi Data manager, MOH 41 Bloomberg Gregory Kababi D4H liaison person Tanzania MOH 42 Tanzania Irene Mwogo WHO AHO/rSIS-Tanzania WHO 43 Dr Theopista Kabuteni. WHO -Tanzania 44 World Bank Maletela Tuoane-Nkhasi WB-USA 45 WHO EMRO Afify Ahmed WHO EMRO, Information Specialist 46 Dr Azza Mohamed BADR WHO EMRO, Technical Officer 47 WHO HQ Doris MA FAT WHO HQ, Statistician Cause of Death 48 Olav Poppe WHO HQ, Technical Officer 49 Linda Best WHO HQ, WHO Consultant 50 Mozambique Adelino Pedro Jembi, Mozambique 51 CDC Malawi Emily Cercone Consultant, CDC, Malawi 52 Tanzania Joyce Mugasa MNH-Tanzania 53 Geofrey Semu MNH-Tanzania 54 Rehema Mwaipaja MNH-Tanzania 55 Dr Leonard Mboera NIMR-Tanzania 56 Dr Richard A. Amaro Hai DC-Tanzania 57 Dr. Gwamaka Edward NHIF -Tanzania 58 Susan Rumisha NIMR-Tanzania 59 Dr Hemed Yusuf LFA-Tanzania 60 Angela Anatory RITA-Tanzania 61 Cuthbert Simalenga RITA-Tanzania 62 Neema Ngure NBS-Tanzania 63 Dr. Mwendwa Mwenesi MOHCDGEC-Tanzania 64 Wilfred Yohana MOHCDGEC-Tanzania 65 Anchila Vangisada MOHCDGEC-Tanzania 66 Franklin Frederick MOHCDGEC-Tanzania 67 Trust Nyondo MOHCDGEC-Tanzania 68 Claud J. Kumalija MOHCDGEC-Tanzania 69 Joyce Chitalika MOHCDGEC-Tanzania 70 Mariam Mkomwa MOHCDGEC-Tanzania 71 Zuwena Mkanza MOHCDGEC-Tanzania 72 Khadija Kigoto MOHCDGEC-Tanzania 73 Joyce Magona MOHCDGEC-Tanzania

10 Participant Name Organization/Title 74 Dr. Chacha Mangu NIMR-Tanzania 75 Dr. Mercy Chiduo NIMR-Tanzania 76 Dr. Bazil Kavishe NIMR-Tanzania 77 Dr. Lucas Matemba NIMR-Tanzania