Production and use of estimates for monitoring progress in the health sector: the case of Bangladesh

Abstract

Background: In order to support the progress towards the post-2015 development agenda for the health sector, the importance of high-quality and timely estimates has become evident both globally and at the country level. Objective and Methods: Based on desk review, key informant interviews and expert panel discussions, the paper critically reviews health estimates from both the local (i.e. nationally generated information by the government and other agencies) and the global sources (which are mostly modeled or interpolated estimates developed by international organizations based on different sources of information), and assesses the country capacity and monitoring strategies to meet the increasing data demand in the coming years. Primarily, this paper provides a situation analysis of Bangladesh in terms of production and use of health estimates for monitoring progress towards the post-2015 development goals for the health sector. Results: The analysis reveals that Bangladesh is data rich, particularly from household surveys and health facility assessments. Practices of data utilization also exist, with wide acceptability of survey results for informing policy, programme review and course corrections. Despite high data availability from multiple sources, the country capacity for providing regular updates of major global health estimates/indicators remains low. Major challenges also include limited human resources, capacity to generate quality data and multiplicity of data sources, where discrepancy and lack of linkages among different data sources (local sources and between local and global estimates) present emerging challenges for interpretation of the resulting estimates. Conclusion: To fulfill the increased data requirement for the post-2015 era, Bangladesh needs to invest more in electronic data capture and routine health information systems. Streamlining of data sources, integration of parallel information systems into a common platform, and capacity building for data generation and analysis are recommended as priority actions for Bangladesh in the coming years. In addition to automation of routine health information systems, establishing an Indicator Reference Group for Bangladesh to analyze data; building country capacity in data quality assessment and triangulation; and feeding into global, inter-agency estimates for better reporting would address a number of mentioned challenges in the short- and long-run.

Perceptions and experiences with district health information system software to collect and utilize health data in Bangladesh: A qualitative exploratory study

“…Because the DGFP MIS is not connected to DHIS2, data collected under the DGFP cannot be accessed and analyzed with DHIS2. This lack of synchronization creates parallel reporting systems (40) . The study participants highlighted this duplicity in reporting and mentioned the di culty of managing multiple forms and reporting the same RMNCAH indicators in different formats for different stakeholders.…”

Under-reporting of TB cases and associated factors: a case study in China

“…Like China, the health information management systems in many low-and middle-income countries are fragmented and often include multiple vertical systems designed to meet the requirements of the national government or international organizations/donors. As a result, similar problems occur in other low and middle-income countries (2,17,(22)(23)(24)(25)(26)(27)30). For example, in Indonesia, the reporting forms in each health center are different, which results in missing data and hampers the data standardization process (2,17,30).…”

“…Research on Indonesia found that its private health sector hardly reports TB cases, as required by its national health legislation (22). Similarly, there is also evidence that India, Namibia, and Thailand all suffer from a lack of national data standardization and accessibility (22)(23)(24)(25)(26)(27)(28), and might not accurately report the number of confirmed TB cases. It is also reasonable to assume that many other low-and middle-income countries without high functioning health information management systems could face similar problems.…”

“…Furthermore, the lack of accountability and adequate supervision evident in the Chinese hospitals are apparent in other countries. For instance, India has no independent authority to oversee data quality (23) and Bangladesh does not enforce data quality assurance and assessment systems (27,29).…”

“…This is particularly hindersome in China where there are a high number of internal migrant workers, such hierarchical information systems make it difficult to trace the TB patients moving from one place to another especially as TB treatment regimens take many months to complete. In other lowand middle-income countries, accessing data is a common problem (22)(23)(24)(25)(26)(27). In India, health institutions generate inconsistent and duplicated health data, and there is no comprehensive HIS to provide government offices and researchers with essential information for analyzing and surveilling data quality (22).…”