Individual Medical Records (IMRs)

Common IMRs:

 Integrated individual Folder  Tracer card

 Individual Summary Sheet  RH/ANC card

 Patient Card  Woman’s Card

 Service ID Card  Appointment card

 Master Patient Index  Others (Vital sign sheet , Order

sheet, laboratory forms etc…)

Two types of registers

 Serial (Case) Registers: Each subsequent visit is registered as a new

entry. E.g. OPD, VCT, Abortion registers...

 Longitudinal Registers: Each client is stayed in the register so long as

s/he is in the service. E.g. EPI, ANC, FP, ART , TB...

There are:

 36+ Registers, MCH: 14, Disease Prevention & Control: 12 and Others: 11
 15+ tally sheets

1. MCH registers (14):

1. Family Planning Register 8. Infant Immunization & growth Monitoring

2. Long acting FP Removal Register 9. TT Register

3. ANC Register 10. Human Papilloma Virus (HPV) immunization

Register
4. Delivery register
11. Pregnant and Lactating Women (PLW)
5. PNC Register Nutrition Screening register
6. PMTCT Register 12. Therapeutic Food Program (TFP) Register
7. Abortion care Register
13. Neonatal and Intensive Care Unit (NICU) 14. Comprehensive and Integrated Nutrition
Register Screening (CINuS) register

MCH tally sheets (8):

1. Family Planning Service Tally 5. Pregnancy testing tally

2. Family Planning Methods Dispensed Count 6. Abortion Tally

Tally
7. Immunization tally
3. ANC Tally
8. Comprehensive and Integrated Nutrition
4. PMTCT tally Service (CINuS) Tally

MCH cards
1. Woman’s Card

2. Integrated RH card

2. Disease Prevention and Control (DPC) Recording Tools

2.1 HIV registers (4):

1) VCT Register

2) ART register

3) Pre ART register

4) PEP (post exposure prophylaxis) FU register

HIV tally sheets (4):

1. VCT Tally

2. Provider Initiated HIV Counseling and Testing (PIHCT) Tally

3. Clinical Care Tally

4. Currently on ART and Regiment Tally

2.2 TB and Leprosy registers (7)

1) TB register 4) DR-TB RX Supporter Card (የመድሀኒት
የተላመደ ቲቢ ህክምና መከታተያ ቅጽ)
2) DR TB Register
5) DR-TB Treatment Card
3) DR TB FU Register
 6) TB Contact Screening and LTBI 7) Leprosy register
treatment follow up Register

3. Other registers
1. OPD Abstract Register 7. Drug -Dispensing Register
2. IPD Register 8. Intensive Care Unit (ICU) register
3. Operation register 9. Ambulance Service Register
4. Referral Registration 10. Central Register
5. Emergency Register 11. Data Quality & Performance Monitoring
6. Trachomatous Trichiasis (TT) Surgery Log Book
Register

Other tally sheets

1) Patient/Client tally sheet

2) IPD service tally sheet

3) Tracer drug availability HC/Hosp tallies

Reporting formats
By Type:

• Service delivery report forms

• Disease (Morbidity & Mortality) report form

• PHEM reports

By Health institution:

• Health post, Health center, Hospital , clinics and WorHO/ZHD/RHB

By reporting Period:

• Immediate/ Weekly report

• Monthly /Quarterly/annual administrative report

Reporting hierarchy of public health facilities

Reporting Report Frequency of

From Comment
level arrival date reporting

HP HC Monthly & Annual

20th of the month closing Monthly, Quarterly

Health facility WorHOs
26th of the month & Annual

ZHD / Monthly, Quarterly Including private

WorHOs 2nd of the month
RHB & Annual health facilities

Monthly, Quarterly Including private

ZHD RHB 7th of the month
& Annual health facilities

Monthly, Quarterly Including private

RHB FMOH 15th of the month
& Annual health facilities

Ethiopian HMIS Core Indicators

Total HMIS Indicators = 131
C1: Improve Access to Health P3. Evidence Based Decision making
Services (97) (3)

C2: Community Ownership (3) CB1. Health Infrastructure (4)

F1. Resource Mobilization and CB2. Human Capital and leadership

Utilization (4) (4)

F2. Health Insurance (3) CB3. Regulatory System (1)

P1. Quality of health Services (8)

P2. Pharmaceutical Supply and

Services (4)
  NCoD have 22 chapter and broken down to 216 disease group.
 At primary level health care level = 616 Disease list
 At Secondary level = 1848 Disease list
 At Tertiary level/Reference = 1848 Disease list

1. Maternal and Child Health, including nutrition • TB/HIV (4 indicators)

(50 indicators)
• Malaria (5 indicators)
• Maternal Health (14 indicators)
• Neglected tropical diseases (2
• PMTCT (7 indicators) indicators)

• Child Health including Expanded  Non Communicable diseases (3 indicators)

Program on Immunization (21
indicators) 5. Community Ownership (3 indicators)

• Nutrition (8 indicators) 6. Resource Mobilization and Utilization (4

indicators)
2. Hygiene and Environmental (2 indicators)
4. Prevention and Control of Diseases (45 7. Health Insurance (3 indicators)
indicators) 8. Quality of health Services (8 indicators)
 All diseases (3 indicators) 9. Pharmaceutical Supply and Services (4
 Communicable diseases (39 indicators) indicators)

• HIV/AIDS (10 indicators) 10. Evidence Based Decision making (3 indicators)

• Tuberculosis (15 indicators) 11. Health Infrastructure (4 indicators)

• Leprosy (3 indicators) 12. Human Capital and leadership (4 indicators)

13. Regulatory System (1 indicator)

 Dimensions of data quality are:

Dimension 1: Accuracy Dimension 3:
and Validity Completeness

Dimension 2: Dimension 4: Timeliness

Consistency
Dimension 5: Legibility:
 Dimension 6: Dimension 8: Precision
Accessibility
Dimension 9: Integrity
Dimension 7:
Dimension 10:
Confidentiality
Relevance

Completeness
For meaningful understanding, interpretation and action:

 All required data should be present and

 the medical/health record should contain all pertinent documents with

complete and appropriate documentation

 all required data should be present on recording, reporting formats.

 all reporting units have to sent their reports

Two forms of completeness:

Content completeness

 Data Completeness on data recoding tools (Registers, cards/forms)

 Data completeness on reporting formats

Representative Completeness

Data Completeness on data recoding tools (Registers, cards/forms and

report forms)

 This refers all necessary data elements on registers/forms/cards should be filled

immediately after provision of the service by the care provider.

Example of documents to be complete

 Individual medical record (individual folder, forms, ….)

 Recording tools (registers, tally sheets)

 Reports (service and disease)

 Health facilities monthly to do self assessment to measure content completeness
of tools (registers, tallies cards/forms) and reporting from the units. The
findings should be discussed during PMT meeting

Timeliness
Timeliness is sending and receiving of reports on predefined time schedule

It is also about documenting patient information at the right time

Example of timeliness

 A patient’s identifying information is recorded at the time of first attendance

 On discharge or death of a patient in hospital, his or her medical records are

processed & completed, coded and indexed within a specified time frame.

 All expected reports are checked, verified and sent to the next level with in a
due date.

Timeliness is a concept beyond sending and receiving of reports on predefined

time schedule

NB: All health facilities and administrative health units should have timeliness
and completeness tracking logbook. If the facilities have electronic version of
report tracking mechanism, they should use that one and keep the print-out as a
record.

Techniques of data quality assurance

Health facility assessment

Data Quality Checks using LQAS method

Administrative level data quality assessment

Routine Data Quality Assessment (RDQA)

  DHIS2 has three data entry apps

o Routine Data

o Plan Setting

o Gross Disease Registration

Data Analysis

 Data can be summarized and presented using:

 Statistically: Summary measures

o (Mean, ratio, rate, percentage, proportion etc)

 Graphically

o Tables ( Pivot tables)

o Scorecards;

o Graphs/charts (Bar graphs, Histogram, Pie chart, Line chart etc

o Maps

Steps to analyze data using Pivot Table …

1. Go to the App and click on Pivot Table

2. Go to the top left and select the Data (Data elements, indicators,
dataset, etc.) for analysis (Move your selection from Left to Right).

3. Go to the Period and select [relevant] fixed or relative period.

4. Select relevant organizational unit for the data analysis.

 5. Click on the Layout at the top-middle of the presentation area and
decide the way the data should be presented.

6. Click Update button. The table appears in the presentation area.

7. Save the Table Favorites to facilitate reuse of the analyzed data.

Data visualize

 Supports dynamic and attractive analysis

 Translates numeric forms into pictorial representation

 DHIS-2 currently supports nine types of charts

o Column Chart

o Stacked Column Chart

o Bar Chart

o Stacked Bar Chart

o Line Chart

o Area Chart

o Pie Chart

o Radar Chart

o Speedometer Chart

 Bar/Column Chart

o To show a comparison among different items/ items over time

 Multiple/Grouped bar graph

o Depicts distribution pattern of more than one variable, it is used when

two or more categories of qualitative data put alongside each other.

 Stacked Chart
 o A stacked chart can be used to convey a greater amount of
information in a single picture. Bars/columns represent the frequency
of observations in two or more different subgroups are placed on top
of one another.

o Stacked Column Chart

o Bar Chart

o Stacked Bar Chart

o Line Chart

 Data Visualizer has three dimensions:

o Series: A series is a set of continuous elements which you want to

visualize in order to emphasize trends or relations in its data.

o Categories: A Category is a set of elements for which you want to

compare its data.

o Filter: Since most charts are two dimensional, a filter must be used on
the third dimension in order to use only a single element for the chart
to become meaningful.