Yonase Final Thesis
Yonase Final Thesis
Yonase Final Thesis
ADVISORS:
1. Mr. MEZGEBU YITAYAL (B.Sc., MPH/HSM)
2. Mr. ATINKUT ALAMIRREW (B.Sc., MPH/HI)
JUNE, 2012
GONDAR, ETHIOPIA
UNIVERSITY OF GONDAR
COLLEGE OF MEDICINE AND HEALTH SCIENCES
INSTITUTE OF PUBLIC HEALTH
Advisors:
1. Mr. Mezgebu Yitayal (B.SC., MPH/HSM) ________________________
2. Mr. Atinkut Alamirrew (B.SC., MPH/HI) ________________________
_____________________________ ________________________
Examiner
Acknowledgment
I would like to forward my deepest gratitude to my advisors Mr. Mezgebu Yitayal and
Mr. Atinkut Alamirrew for their constructive advice and valuable comments throughout
the whole processes of development of this thesis.
My sincere gratitude would also goes to Institute of Public Health, College of Medical
and Health Sciences, University of Gondar for providing this opportunity to conduct the
research and allowing me to undertake my area of interest in that specific place.
I would like to pass my heartfelt appreciation to Gamo Gofa zonal health department,
woreda health offices, and health extension workers who were participated in this study
for their cooperation.
My sincere gratitude would also go to Mr. Kassahun Assefa and all my instructors and
friends who were willing to give constructive comments and support in any kind.
I
Acronyms
II
Table of content
Contents
Acknowledgment .............................................................................................................. I
Acronyms ........................................................................................................................ II
Introduction ..................................................................................................................... 1
Objectives ....................................................................................................................... 7
Methods .......................................................................................................................... 8
III
3.6.1. Dependent /Outcome variable ...................................................................... 10
Results .......................................................................................................................... 15
Discussion ..................................................................................................................... 23
Conclusion .................................................................................................................... 28
Recommendations ........................................................................................................ 29
References .................................................................................................................... 30
Annexes ........................................................................................................................ 33
Declaration .................................................................................................................... 54
IV
List of tables
V
List of figures
VI
List of annexes
VII
Abstract
Introduction: : According to the assessment of the Ethiopian National Health
Information System done by Federal Ministry of Health and WHO result, Health
Information System resources, data management, and dissemination and use were
rated as “not adequate” among the six major components.
Objectives: The objective of this study was to assess data management Knowledge,
Practice and associated factors of Health Extension Workers working in Gamo Gofa
zone, Southern Ethiopia in 2011/12.
Results: Out of the total study participants, 245(58.2%) respondents have good data
management knowledge and almost all (98.1%) respondents have good data
management practice. Availability of reporting formats [AOR= 2.631, 95%CI: (1.331-
5.203)] and frequency of supervision (having overall significance, P-value = 0.024) were
factors to be associated with the data management knowledge of Health extension
workers. There was also statistically significant association among relevance of
feedback [AOR=11.78, 95% CI: (1.622-85.58)] and availability of reporting formats
[AOR: 21.70, 95% CI: (4.063-115.928)] with data management practice of health
extension workers.
VIII
Introduction
1.1. Statement of the problem
Since 2004, the government of Ethiopia has strengthened and expanded its Primary
Health Care (PHC) system by launching the Health Extension Program (HEP) whose
aim is to improve access and equity in health care through a focus on sustained
preventive health actions and increased health awareness(1).
Each rural kebele is expected to have one Health Post (HP) staffed by two female
Health extension Workers (HEWs)(2). For urban kebeles, training and deployment of
Urban HEWs has already in progress in Tigray, Amhara, Oromiya; SNNPR, Harari, Dire
Dawa; and Addis Ababa. Accordingly, these regions have trained and deployed a total
of 2,319 Urban Health Extension workers achieving 42% of the required number(3).
According to the assessment of the Ethiopian national Health Information System (HIS)
done by FMOH and WHO result, among the six major components1, three were very
weak. These were Health Information System(HIS) resources, data management, and
dissemination and use rated as “not adequate”(6).
Assessment done in North Gondar revealed that, out of 84.3% data collected daily only
22.5% of them utilized. Moreover among 45 units of HIV/AIDS in the study area, only
17.7% changed their data into information at district and facility level and used it for
immediate decision making. From the total study units only 13.2% properly document
their reports and registration books in the year 2005 to 2006(7).
1
These six components of HIS with which the assessment was conducted were; context and resources
for health information, identification of core health indicators, data sources and data collection methods,
information management processes, information products and data dissemination and use.
1
1.2. Literature review
According to the FMOH: HEWs are the first point of contact of the community with the
health system, delivering integrated preventive, promotive and curative health services,
with a special focus on maternal and child health(8).
In Ethiopia data quality and use remain weak, particularly at District Health Offices and
primary health care facilities. Five strategic issues have been identified as critical to
strengthen and continuously improve health sector Health Management Information
System (HMIS) /Monitoring and Evaluation. Capacity building, standardized and
integrated data collection and reporting, linkage between information sources,
information use, action-oriented performance monitoring and use of appropriate
technology(9).
In HSDP III, HMIS and Monitoring and Evaluation were set objectives to develop and
implement a comprehensive and standardized national HMIS and Monitoring and
Evaluation, and to ensure the use of information for evidence-based planning and
management of health services. The specific objectives were to achieve 80%
completeness and timeliness of routine health administrative reports and 75% evidence-
based planning by 2010(6).
2
An assessment of the existing paper-based HIS conducted by the Amhara regional
health bureau in collaboration with Essential Services for Health in Ethiopia project in
2004 showed that health data collection, reporting and analysis in the region is highly
fragmented, top-down, inconsistent, and poor quality and redundant data being reported
to higher levels(11).
A nurse in one of the health facilities visited in the Benishangul-Gumuz Regional State
expressed her frustration as follows: “we often spent many hours every week compiling
several forms for different health programs and yet we do not practically see the impact
of the data we are reporting in improving health care delivery in our community or
district”(11).
Another study showed that from the total interviewed (332) staff of Health Centers and
District Offices, 236(71.0%) reported they filled the format properly. The rest complains
that they did not understand the tools/formats due to non understandability, ambiguity
and they didn’t have any training supports. And also 170(51.2%) reported that there was
lack of training and technical support on HMIS, 91(27.4%) complained lack of computer
3
skills and unavailability of computer, while 71(21.4%) claimed inconsistency and
incompleteness of the reports(12).
Among 182 units/departments of Health Centers, only 5(3.0%) had computers. While
from the total of 150 units/departments of District Health Offices except 10(7.0%) all of
them had at least one computer. However all the facilities compiled, analyzed and
calculate the coverage of different essential services manually. Even those which had
computers lacked skilled personnel. Only three of the district head found with backup
their reports in soft copy by the assistance of their secretary(12).
According to the study of “Assessment of the Training of the First Intake of Health
Extension Workers”, most trainees had only lectures on Information Communication
Technology and never used a computer during their training time(14).
4
preceding the survey and that 75 percent of these health posts received feedback from
supervisors(17).
5
1.3. Justification of the study
The Federal Ministry of Health (FMOH) in 2004 started training of Health Extension
Workers (HEW), whose main work is on disease prevention and health promotion in
rural villages. HEWs trained to work mainly in the program were expected to help
accelerate the country’s progress in meeting Millennium Development Goals (MDG) 4, 5
and 6. Developing capable, motivated and supported health workers is essential for
overcoming bottle necks to achieve national and global health goals.
According to the assessment of the Ethiopian national Health Information System done
by FMOH and WHO result, among the six major components2, three were very weak.
These were Health Information System (HIS) resources, data management, and
dissemination and use rated as “not adequate”.
Considering the present poor management of data, achieving the expected goal of
Health Extension Program (HEP) will be a major challenge for Ethiopia. Increasing data
management knowledge and skill for HEWs is one of the areas that needs due attention
by all stakeholders.
In the past, HEWS knowledge and practice of data management has not been
conducted in the study area. Therefore, assessment of knowledge and practice of
HEWs and possible factors that determine data management in the study area will have
greater input to program managers for designing programs, proper implementation and
evaluation of their contribution.
2
These six components with which the assessment was conducted were; context and resources for
health information, identification of core health indicators, data sources and data collection methods,
information management processes, information products and data dissemination and use.
6
Objectives
2.1. General objective
To assess data management Knowledge Practice, and associated factors of HEWs
working in Gamo Gofa zone, SNNPR, Ethiopia in 2011/12.
7
Methods and Materials
3.1. Study design and period
Institution based cross-sectional study was conducted on health extension workers
employed in Gamo Gofa Zone from November 2011 to June 2012.
The study area was Gamo Gofa Zone, one of the zones of Southern Nation Nationality
and Peoples Regional (SNNPR) state of Ethiopia. The zone covers 12,003.79 square
kilometers ranging from low-arid to high-land (600m-4550m) areas. Gamo Gofa zone is
divided into 15 woredas and 2 town administration which are grouped into 448 rural and
34 urban kebeles. The total population of this zone is estimated to be 1,837,896
inhabitants, most of them living in rural areas(18).
Gamo Gofa zone is found at an altitude of 4550m (max) and 600m (min) above sea
level. The zone consists of one university, six health sciences colleges (governmental
and private), two TVET colleges (governmental and private), three zonal hospital, 65
health center, 466 health posts, 832 Rural Health Extension Workers (RHEWs) and 70
Urban Health Extension Workers (UHEWs)(18).
8
3.5. Sample size determination and sampling procedures
The sample size required for this study was determined using single population
proportion formula by considering the following assumptions:
Sampling procedure
Cluster sampling method was used, since the study covers wide geographical area,
using the other methods will be too costly. To obtain the desired sample size i.e. 457,
the total Health Extension Workers of Gamo Gofa zone (902) were divided in to clusters
(woredas) and hence the unit of selection was woreda. There are 15 woredas and 2
town administration in the zone. The estimated average number of Health Extension
Workers number per cluster is (902/17) 54. The number of clusters needed were
determined by dividing the sample size by the estimated size of the cluster (457/54=8)
9
and the clusters were selected by using lottery system. Therefore, total Health
Extension Workers in the selected 8 clusters were taken as a sample.
By using SRS
8 Randomly
selected clusters
10
3.7. Operational definitions
1. Data collection: is the act of planning for and obtaining useful information on key
quality characteristics(21).
2. Data processing: is the process of editing, coding, classification and tabulation of
collected data so they are amenable to analysis.
3. Data management: is a set of procedures for the collection, storage, processing and
reporting of data(22).
4. Have Good knowledge: HEWs who scored five points and above out of ten
questions prepared for assessment of knowledge.
5. Poor knowledge: HEWs who scored below five points out of ten questions prepared
for assessment of knowledge.
6. Good practice: HEWs who scored five points and above out of ten questions
prepared for assessment of practice.
7. Poor practice: HEWs who scored below five points out of ten questions prepared for
assessment of practice.
11
3.8.3. Data quality control
Pre -test of the questionnaire on 5% of health extension workers working in non-
selected woredas was conducted to check acceptability and consistency of the
questionnaires. In addition, the coordinators or supervisors were trained for one day on
issue related to the overall data collection procedure. Completeness of the
questionnaires was checked each day at field level after data collection by the
supervisor. Further supervision by the principal investigator was made as per needed.
Logistic regression was used to assess the association between outcome and
explanatory variables. The strength of association between dependent and independent
variables was presented using adjusted odds ratios and 95% confidence intervals. P-
value less than to 0.05 was taken as cut off value to be significant.
12
Ethical consideration
Primarily, ethical clearance was obtained from Institutional Review Board of University
of Gondar, Institute of Public Health. A permission letter was also obtained from Gamo
Gofa zone health department and woreda health offices. Informed consent was
secured from each health extension worker and the right to refuse was respected. The
information collected from this research project was kept confidential and the collected
information was stored in a file, without the name of study participant, but a code was
assigned to it and was not revealed to anyone except the principal investigator and was
kept locked with key.
13
Dissemination of result
The final report was presented as partial fulfillment of the degree of Master of Public
Health to the Institute of Public Health, Gondar College of Medicine and Health
Sciences, University of Gondar. Gamo Gofa Zonal health Department and District
Health Office was officially be informed about the result of the study and recommended
to facilitate implementation of intervention measures. The findings of the study were
released to all public and private health sectors that are working in Gamo Gofa
Administrative Zone. Also the results were disseminated through publication in local or
international journals.
14
Results
4.1. Socio-demographic characteristics of health extension workers
From the total of 438 health extension workers in the selected eight clusters, 421
(96.1%) were responded adequately with non response rate of 3.9%. Respondents age
range from 18-35 years with mean age of 24.4 and standard deviation of 3.33 years.
The majority, 352(83.6%) were in age group of 21–29 years.
Out of the total respondents, 390(92.6%) belong to Gamo ethnic group. Place of
residence of most (90.5%) HEWs was rural kebele and the remaining 40(9.5%) live in
urban areas. Monthly income of 388(92.2%) respondents (RHEWs) was 908.00 ETH
Birr and 33(7.8%) respondents (UHEWs) were 1,233.00 ETH Birr.
More than half of the respondents (56.3%) had work experience of 4-6 years. Regarding
possession of radio or television, those respondents who have had radio or television in
their house accounts 223(53%) from the total HEWs and the remaining 198(47%)
HEWs do not have radio or television. The socio demographic characteristics of
respondents were summarized in table 1.
15
Table 1: Distribution of socio-demographic characteristics of health extension
workers in Gamo Gofa zone, Southern Ethiopia, June, 2012(n=421)
16
4.2. Data management Knowledge
Out of the total study participants, 245(58.2%) respondents have good knowledge on
data management and the rest 176(41.8%) have poor knowledge.
From the types of data collection methods 375(89.1%) respondents know interview as
data collection method followed by record review 161(38.2%) and observation
158(37.5%). Majority 403(95.7%) of the respondents know how to plan for data
collection.
Distribution of
data collection
methods ,
interview, Distribution of Distribution of
89.1% data collection data collection
methods , methods ,
record review, observation,
38.2% 37.5%
Almost two-third (65.6%) of the respondents agreed that to consider a given data as
complete data it must be submitted by all reporting facilities with all data items value
filled. Two hundred forty (57.0%) study participants responded that data are consistent
if the data are within the normal range. For 169(39.9%) respondents’ correctness of
data was absence of mathematical error.
17
4.3. Data management practice
Almost all 413(98.1%) respondents have good data management practice. Significant
number of respondents, 394(93.6%) keep document of the last survey whereas little
(6.4%) respondents do not keep their document in their office. Among the respondents
334(79.3%) agree that redundant or overlapping data affect the quality of data.
According to only 53(12.6%) respondents it is possible to make appropriate decision
without having timely information. For 354(84.1%) study participants most of collected
data were needed for the tasks they perform. Four hundred eleven (97.6%) respondents
can make report for the collected data by themselves.
Out of 421 respondents, 409(97.1%) respondents use information at their hand for day-
to-day activities. Out of which 302(73.4%) use the information usually, 68(16.6%) most
of the time and 39(9.5%) rarely in their daily activities. From 409(97.1%) respondents
that utilize information for their daily activities almost all 403(98.5%) HEWs have good
data management practice. This finding indicates that utilization of information at hand
increases the HEWs practice of data management.
The reason for those respondents who were not used information at their hand usually
for their daily activities were incompleteness of the information (6.7%), irrelevancy of the
information (5.2%) and inability to how to use it (4.8%).
18
Table 2: organizational factors of HEWs in Gamo Gofa zone Southern Ethiopia,
June, 2012 (n=421)
First, all relevant variables independently were tested using bivariate logistic regression
analysis. Secondly, those variables which are either significant in bivariate analysis or
whose p-values are less than or equal to 0.2 are again fitted in multivariate analysis.
Finally variables that are significant in multivariate analysis were presented as crucial
predictors.
20
regression analysis, data management knowledge was associated significantly only with
availability of reporting formats and frequency of supervision.
Thus, Health extension workers who had reporting formats in their office were 2.631
times more likely to report good data management knowledge than those who had no
reporting formats in their office [AOR= 2.631, 95%CI: (1.331-5.203)].
There was also statistically significant association (overall significance, P-value = 0.024)
between frequency of supervision and data management knowledge of health extension
workers. (See - Table 4).
21
4.7. Factors associated with data management practice of HEWs
In the bivariate logistic regression analysis, data management practice was associated
significantly with availability of registration book, transport, reporting formats, feedback
and relevance of feedback. However, in the multivariate logistic regression analysis,
data management practice was associated significantly only with availability of reporting
formats and relevance of feedback.
According to this study, those HEWs who have reporting formats in their office were
21.70 times more likely to perform good data management practice than those who
have no reporting formats [AOR: 21.70, 95% CI: (4.063-115.928)].
Data Crude OR
management
Variables (95% C.I.) Adjusted OR
Practice
Good Poor (95% C.I.)
Registration Available 398 6 8.844(1.646-47.516)
book Not available 15 2 1
Transport Available 71 4 0.208(0.051-0.850)
Not available 342 4 1
Feedback Received 349 4 5.453(1.330-22.365)
Not received 64 4 1
Relevance Yes 400 6 10.256(1.887-55.749) 11.78(1.622-85.58)*
of feedback No 13 2 1 1
Reporting Available 369 2 25.159(4.927-128.479) 21.70(4.063-115.928)**
formats Not available 44 6 1 1
* Significant at p <0.05, ** significant at p <0.0001
22
Discussion
This study attempted to assess data management knowledge and practice of both
urban and rural health extension workers and its associated factors in Gamo Gofa zone,
southern Ethiopia. However, there is little/no information available at the national and
local level in the scientific literature that quantifies data management knowledge and
practice of health extension workers to make comparison about some of the factors.
Also health extension program is an innovative program that exists only in Ethiopia, not
elsewhere; hence comparison will be made with other health workers.
The overall data management knowledge of 58.2% health extension workers was good
according to operational definition set for measurement of data management knowledge
and the remaining 41.8% respondents have poor data management knowledge. In this
study data management knowledge was assessed by measuring the capacity of health
extension workers for collecting, processing and reporting data. A research done in
Addis Ababa health bureau depicted that 78% of the respondents consider data
collection as part of their duty(23). And concerning data processing 60% of the
respondents have stated that they have no adequate capacity to process data(23). The
same study showed that 62% of the respondents have problems to prepare reports for
the collected data. In general, the result of this research is slightly lower than the one
conducted in Addis Ababa and the possible reasons for this difference might be the
difference of composition of study participants, ranging from technicians to physicians,
and also variation of health facility level.
This research showed that significant number (95.7%) of the respondents used data at
their hand for their daily activities. And 368(87.4%) of the respondents did not made
decisions without having timely information. Also 92.16% respondents keep the
documents of the last survey in their office to utilize the information in the future, when
need comes. In general, the practice of 98.1% health extension workers was
categorized as good based on the operational definition set to measure data
management practice.
23
In general, the nature of data collection method (use of self-administered questionnaire)
and social desirability bias raised (affected) status of data management practice of
health extension workers.
Registration book was the first and most data collection tool for both rural and urban
health extension workers. This study revealed that 404(96.0%) respondents were
supplied with registration book and only 17(4%) respondents lack it. According to
research conducted in north Gondar zone Amhara national regional state, 28.9% of
study units had no registration books and monthly reports(7). Some of the possible
reasons for this difference might be time gap and better attention given by government
for health extension program.
Health extension workers have satisfactory access to mass media. Out of the total
respondents more than two-third (68.2%) of health extension workers have reference
materials in their office. But according to study of the working conditions of health
extension workers in Ethiopia, the reference materials prepared by MOH are available
in almost all the Health post visited(23). This difference might be due to difference in
24
perception of reference i.e. some of the respondents do not consider manuals prepared
for each package by MOH as reference materials rather as text book.
The existing reporting formats were complex or difficult to understand for 105(24.9%)
respondents. This finding is in line with assessment of health management information
system(24) conducted in Addis Ababa health bureau (25%). This might be due to use of
uniform HMIS reporting formats throughout the country. As for the continuity of supply of
the reporting formats most (88.1%) of the health extension workers usually did not faced
shortage of it and few (11.9%) respondents faced shortage of formats. This result was
lower as compared to assessment of HMIS done in Addis Ababa(24). One of the
possible reasons for this difference might be geographical distribution of kebeles. Those
kebeles which are located far from woreda town face this problem than the nearby
ones.
In this study, frequency of supervision and availability of reporting formats were found to
be the crucial factor in predicting data management knowledge status of health
extension workers. Thus, Health extension workers who had reporting formats in their
25
office were 2.631 times more likely to report good data management knowledge than
those who had no reporting formats in their office [AOR= 2.631, 95%CI: (1.331-5.203)].
There was also statistically significant association (overall significance, P-value = 0.024)
between frequency of supervision and data management knowledge of health extension
workers. However none of the options were statistically significant association with data
management knowledge of Health extension workers. That means those health
extension workers who were supervised once in every year as compared to every
month, every 3 months or every 6 months have no significant difference in their data
management knowledge. Since the variable has strong association with data
management knowledge of HEWs there must be difference in their status of data
management knowledge. Hence this result indicates that the quality of supervision was
very poor.
According to this study, those health extension workers who have reporting formats in
their office were 21.70 times more likely to perform good data management practice
than those who have no reporting formats [AOR: 21.70, 95% CI: (4.063-115.928)].
26
Strengths and Limitations of the study
Strengths
Limitations
27
Conclusion
This study showed that data management knowledge of health extension workers was
not as such satisfactory as expected. On the other side, their data management practice
was very good. There was adequate and consistent supply of registration book to
record each activity they accomplish and this helped them to utilize the existing
information for planning and other daily activities.
28
Recommendations
29
References
1. Federal Ministry of Health: Health Extension and Education Center. Health extension
program in Ethiopia profile. Addis Ababa, Ethiopia.June 2007.
2. Bekele A, Kefale M, Tadesse M. Preliminary Assessment of the Implementation of
the Health Services Extension Program: The case of Southern Ethiopia.
EthiopJHealth Dev. 2008;22(3):302-5.
3. Federal Democratic Republic of Ethiopia Ministry of Health. Health Sector
Development Program IV 2010/11 - 2014/15 final draft. October 2010.
4. Girma S, G/Yohannes A, Kitaw Y, Ye-Ebiyo Y, Seyoum A, Desta H, et al. Human
Resource Development for Health in Ethiopia: Challenges of Achieving the
Millennium development Goals. EthiopJHealth Dev 2007;21(3):216-31.
5. Ye-Ebiyo Y, Kitaw Y, G/Yohannes A, Girma S, Desta H, Seyoum A, et al. Study on
Health Extension Workers: Access to Information, Continuing Education and
Reference Materials. EthiopJHealth Dev. 2007;21(3):240-5.
6. CSA, Federal Democratic Republic of Ethiopia Ministry of Health and WHO.
Assessment of the Ethiopian National Health Information System Final Report. 2007.
7. Andargie G and Addisse M. Assessment of utilization of HMIS at distrinformation
commuincation technology level with particular emphasis on the HIV/AIDS program
in North Gondar Amhara Region Ethiopian Public Health Association (EPHA),
Extract of MPH theses. 2007;(3):50-62.
8. Banteyerga H. Ethiopia’s Health Extension Program: Improving Health through
Community Involvement. MEDICC Review July 2011;13(3):46-9.
9. Federal Ministry of Health: HMIS Reform Team. Health Management Information
System (HMIS) /Monitoring and Evaluation (MONITORING AND EVALUATION)
Strategic Plan for Ethiopian Health Sector HMIS Reform Team. January 2008.
10. Snelling S, Malaviarachchi D, Bennett A. Public Health Data and Information
Management Capacity Survey ToolUser’s Guide. Revised October 2008 edJune
2007.
11. Mengiste, A. S. Analysing the Challenges of IS implementation in public health
institutions of a developing country: the need for flexible strategies. Journal of Health
Informatics in Developing Countries. 2010;4(1):1-17.
30
12. Abajebel S, Jira C, Beyene W. Utilization of health information system at
distrinformation commuincation technology level in Jimma zone Oromia regional
state, south west Ethiopia. Ethiop J Health Sci August, 2011;21(special issue):65-
76.
13. Teklehaimanot A, Kitaw Y, G/Yohannes A, Girma S, Seyoum A, Desta H, et al.
Study of the Working Conditions of Health Extension Workers in Ethiopia.
EthiopJHealth Dev. 2007;21(3):246-59.
14. Kitaw Y, Ye-Ebiyo Y, Said A, Desta H, Teklehaimanot A. Assessment of the Training
of the First Intake of Health Extension Workers. EthiopJHealth Dev. 2007;21(3):232-
9.
15. Kadzandira J, Chilowa W. The role of Health Surveillance Assistants (HSAs) in the
delivery of health services and immunization in Malawi. Lilongwe: Ministry of Health
and Population & UNICEF. Health Policy and Planning. 2007; 22(6):404-14.
16. Independent Review Team. Ethiopia Health Sector Development Programme HSDP
III 2005/06 – 2010/11 (GC) (1998 – 2003 EFY) Mid-Term Review component report
By the Independent Review Team 05th May – 5th June 2008 Final Report. Addis
Ababa: 12th July 2008.
17. Carter Center. Evaluation of the Quality of Training of Health Officers and Quality
and Utilization of Health Learning Materials. Report of an Independent Assessment.
Addis Ababa: 2009.
18. Gamo Gofa Zone Health Department. Gamo Gofa zone Health Department first
quarter acitvity performance report. Arba Minch, Ethiopia: December 2011.
19. Degu G, Tessema F. Lecture notes for Health Sciences Biostatistics2005.
20. Simba DO, Mwangu MA. Factors Influencing Quality of Health Management
Information System (HMIS) Data The Case of Kinondoni Distrinformation
commuincation technology In Dar Es Salaam Region, Tanzania. East African
Journal of Public Heath April 2006;3(1):28-31.
21. Brassard M. The Memory Jogger, A Pocket Guide of Tools for Continuous
Improvement.1988.
22. WHO. Assessing the national health information system : an assessment tool. –
version 4.00. Geneva, Switzerland: WHO Press; 2008.
31
23. Awash Teklehaimanot YK, Asfawesen G/Yohannes, Samuel Girma, Aklilu Seyoum,
Hailay Desta and Yemane Ye-Ebiyo,,. Study of the Working Conditions of Health
Extension Workers in Ethiopia. EthiopJHealth Dev. 2007;21(3):246-59.
24. Alganesh Ghebre Hiwot. Assessment of health management information system in
Addis Ababa health bureau. June 2005.
32
Annexes
Annex – 1: Conceptual frame work
Socio-demographic
factors
• Age of HEWs
• Marital status
• Educational status
• Religion
• Length of employment
• Salary of HEW
• Place of residence
• Possession of radio/Tv Improved Practice
Knowledge
factors • Data collection
• Data Processing
• Data collection • Data reporting
Technical Factors • Data Processing
• Complexity of reporting • Data reporting
forms
• Data quality checking
skills
Organizational Factors
• Career development
• Training
• Supervision
• Resource availability
33
Annex 2: English version Questionnaire
Institute of Public Health, University of Gondar, College of Medicine and health sciences
Questionnaire for data collection on assessment of data management knowledge and
practice of HEWs in Gamo Gofa zone, southern Ethiopia in 2011/12
Identification
Name of the institution: ___________________woreda: _____________ Kebele:
________________ Category: Rural HEW / Urban HEWs Questionnaire code
no. ______ Date: ______________
34
Instruction
Encircle the choice of your answer (possible to encircle more than one choice in
some cases)
35
09. Service year ( ) year
10. Do you have radio or television in 1. Yes
your home? 2. No
36
17. Do you know to whom you report the 1. Yes
performed activities? 2. No
18. What does complete data mean? 1. submission by all (most)
reporting facilities with all
data items value filled
2. if there is no
mathematical errors
3. if the data are within
normal ranges
19. When we say the data are correct? 1. If it is submitted by all
(most) reporting facilities
2. if there is no
mathematical errors
3. if the data are within
normal ranges
20. How can we know the data are 1. If the data are from all
consistent? reporting facilities
2. if there is no
mathematical errors
3. if the data are within
normal ranges
37
25. Can you make report for the collected data? 1. Yes
2. No
26. Do you use the information at your hand for your 1. Yes
day-to-day activities? 2. No
27. If yes, how frequently do you use the information for 1. Usually
your day-to-day activities? 2. Most of the
time
3. Rarely
28. If no, why don’t you use the information for your day- 1. I don’t know
to-day activities? how to use it
2. It is incomplete
information
3. Most of them
are irrelevant
information
29. Can you construct a table for your data? 1. Yes
2. No
30. Do you able to draw appropriate graph for your data? 1. Yes
2. No
31. Does the data collection tend to address the 1. Yes
management objectives of the health unit? 2. No
38
35. Do you have telephone? 1. Yes
2. No
36. Does the health office provide pen & 1. Yes
pencil for you? 2. No
39
3. Through regular
meetings
4. If other specify ____
46. If no, do you think that obtaining 1. Yes
feedback from higher officials is 2. No
mandatory to improve your
performance?
47. Have you ever participated in data 1. Yes
management trainings? 2. No
48. Do you have clear information about 1. Yes
your career development? 2. No
40
2. Abbreviations
3. Formats are
inconsistent
4. If other, specify_____
55. Is there definite time for report submission? 1. Yes
2. No
56. If yes, how timely do you send your 1. usually
reports? 2. Sometimes delayed
3. Usually delayed
That is the end of our questionnaire. Thank you very much for taking your time to
answer these questions. We appreciate your help.
41
Annex- 3: Information Sheet and consent form
Information Sheet and Consent form prepared for health extension workers who are
going to participate in the research project, assessment of data management
knowledge and practice of Health Extension workers in Gamo Gofa Zone, Southern
Ethiopia in 2011/12.
Name of the Organization: Institute of Public Health, Gondar College of Medicine and
Health Sciences, University of Gondar.
Introduction
This information sheet and consent form is prepared with the aim of explaining the
research project that you are asked to join by the group of research investigators. The
main aim of the research project is to assess data management knowledge and practice
of HEWs in Gamo Gofa Zone, southern Ethiopia. The research group includes 11
trained Supervisors from Arba Minch College of Health Sciences and G/Gofa zonal
health department, and two advisors from University of Gondar.
42
Purpose of the Research Project
The aim of this study is to assess data management knowledge and practice of HEWs
in Gamo Gofa Zone, southern Ethiopia. Assessing the HEWs knowledge and practice of
data management and associated factors which determine collection, organization,
processing and reporting of data will show the gap/problem in the data management
system among currently working HEWs.
The results of this study will be used as a basis, especially in the study area, to design
appropriate intervention programs to address the problem.
In the past, assessment of data management knowledge and practice of HEWs has not
been conducted in the study area at all. So, this study will be expected to focus in
assessing data management knowledge and practice of HEWs in the zone.
Procedure
As this study involves currently working HEWs for assessment, you are selected to be
one of the study participants if you are willing to take part in this study. You are selected
for this study because you are currently working HEWs and permanent residents of this
kebele. In order to assess data management knowledge and practice of HEWs in Gamo
Gofa zone, we kindly invite you to take part in our project. If you are willing to practice in
our project we are so happy for you to participate in this study and we need you to
clearly understand the aim of this study and to sign the consent form .Then; you are
kindly requested to give your response to the data collectors. All the response given by
participants and the result obtained will be kept confidentially by using coding system
whereby no one will have access to your response.
43
Benefits
If you are participating in this research project, there may not be direct benefit to you but
your participation is likely to help us in showing the HEWs data management knowledge
and practice gap/problem in the zone. And this in turn will help us in developing better
data management system.
Incentives/Payments for Participating
You will not be provided any incentives or payment to take part in this project.
Confidentiality
The information collected for this research project will kept confidential and information
about you that will be collected by this study will be stored in a file, without your name,
but a code number assigned to it. And it will not be revealed to anyone except the
principal investigator and assistants will be kept locked with key.
Person to contact
This research project will be reviewed and approved by the ethical committee of the
University of Gondar. If you want to know more information you can contact the
committee through the address below. If you have any question you can contact any of
the following individuals and you may ask at any time you want.
1. Mr. Sewunet Sako: Arba Minch college of Health Sciences.
Mobile: 09 23 48 82 88 / e-mail: [email protected] or [email protected]
2. Mr. Mezgebu Yitayal, (BSc, MPH): University of Gondar
Mobile: 09 20 25 27 61 / e-mail: [email protected]
3. Mr. Atinkut Alamirew, (BSc, MPH): University of Gondar
Mobile: 09 11 31 35 78 /e-mail: [email protected]
44
Annex 4: Amharic version questionnaire
ጎጎጎጎ ጎጎጎጎጎጎ ጎጎጎጎጎጎ ጎጎ ጎጎጎጎ ጎጎጎ
ጎጎጎጎጎጎ ጎጎ ጎጎጎጎጎ ጎጎጎጎጎጎ
ጎጎጎ
በበበ በበበበ?
45
በበበ በበበበ በበበ በበበበ __________
ጎጎጎጎ
ጎጎጎ ጎጎጎ ጎጎጎ ጎጎጎጎጎ ጎጎጎጎጎ ጎጎጎጎ
(ጎጎጎ ጎጎጎጎ ጎጎጎ ጎጎጎጎ ጎጎጎ ጎጎጎ ጎጎጎጎ ጎጎጎጎ)
46
ጎጎጎ 2. ጎጎጎ ጎጎጎጎጎiጎ ጎጎጎጎጎ ጎጎጎ ጎጎጎጎ ጎጎጎጎጎ ጎጎጎጎጎ ጎጎጎጎጎ
11. በበበ በበበበ (data management) 1. በበበ በበበበበ (data
በበበ በበ በበበ በበ? collection)
2. በበበ በበበበበ (data
processing)
3. በበበ በበበበ በበበበ (data
reporting)
4. በበበ በበበበበ
12. በበበ በበበበበበ በበበበ በበበበ 1. በበ በበበበ (interview)
በበበ? 2. በበበበ (observation)
3. በበበበበ በበበበበ (record
review)
4. በበ በበ በበበበ
13. በበበ በበበበበበ በበበበ በበበ 1. በበበበበ
በበበበበበበ በበበበ? 2. በበበበበ
14. በበበ በበበበበ (data 1. በበበበበ በበበበ “2”
processing) በበበበ? 2. በበበበበ በበበ በበ
በ.በ 17
በበበበ
15. በበበበ በበበበበ በበበ በበበ 1. በበበበበበበበ በበበ በበበ
በበበበበ (data processing) በበበበ
በበበ በበ በበበ በበ? 2. በበበበበበበበ በበበ በበ
በበበበ
3. በበበበበበበበ በበበ በበበበበ
በበበበበ
4. በበበበበበበበ በበበ በበበበበበ
በበበበበ
5. በበ በበ በበበበ
16. በበበ በበበበበ (data 1. በበበበ በበ በበ በበበ
processing) በበበ በበበበበ? በበበበበበበ
2. በበበበበ/በበበበበ በበበ
በበበበበ
3. በበበበ በበበበg በበበበበበ
4. በበ በበ በበበበ
17. በበበበ በበበበበ በበበ በበበበ 1. በበበበበ
በበበበ በበበበበበበ በበበበ? 2. በበበበበ
18. በበበበ በበበ (complete) በበበ 1. በበበበበ በበበበ በበበበ
በበበ በበበበበ በበ በበ? በበበበበ በበ በsበበ በበበ
በበበበ በበበ
2. በበበበ/በበበበ በበበበ
በበበበበ
3. በበበበ በበበበበበ በበበ በበበ
በበበበ በበበ
47
4. በበ በበ በበበበ___________
48
በበበበበበ? 2. በበ በበ
3. በበበ በበበ
28. በበበበ በበበበበበ በበበ በበበበበበበበ 1. በበበበ በበበበ
በበበበበ በበበበበ? በበበበበበ በበበበበበ
2. በበበበ በበበ በበበ
በበበበበ
3. በበበበበ በበበ በበበበ
በበበበበበ በበበበ
4. በበ በበ በበበበ
29. በበበበበበበበ በበበ በበበበበ በበበበበ 1. በበበበበ
በበበበበ በበበበ? 2. በበበበበ
30. በበበበበ በበበበበ በበበ በበበ (graph) 1. በበበበበ
በበበበበ በበበበ? 2. በበበበበ
31. በበበበበበበ በበበ በበበ በsበበ በበበ በበበበ 1. በበበበ
በበበበ? 2. በበበበበ
ጎጎጎ 4. ጎጎጎ ጎጎጎጎጎiጎ ጎጎጎጎጎ ጎጎጎ ጎጎጎጎጎ ጎጎጎጎጎጎ ጎጎጎጎ ጎጎጎጎጎጎጎ ጎጎጎጎ
(Organizational Factors) ጎጎጎጎጎ ጎጎጎጎጎ
32. በበበበ በበበh በíበበበ (reference) 1. በበ
በበበበ? 2. በበበ
33. በበበበ በበበበ በበበበበበበበ በበበበ 1. በበበ
በበበበ? 2. በበበ
34. በበበበበበበ በበበበበበ በበበበ? 1. በበበ
2. በበበ
35. በበበ በበበበ? 1. በበበ
2. በበበበ
36. ê/በበ በበበበበበበ በበበበ በበበበበበበ? 1. በበበበበ
2. በበበበበበ
37. uu=a ¾Ó^ý ¨[kƒ ›Kƒ? 1. በበ
2. በበበ
38. በበበበበ በበ በበበበበበበበ ¨[kƒ ›Kƒ? 1. በበ
2. በበበ
39. T`Ÿ` ›Kƒ? 1. በበ
2. በበበ
40. በበበበ በበበ በበበበበበ በበበበ? 1. በበ
2. በበበ
41. በበበበበ በበበበበበበበበ በበበበበበ በበበበ? 1. በበበ በበበበ “2”
2. በበበበበበበበ በበበ በበ በ.በ
44 በበበበ
42. በበበበ በበበ በበበ በበበ በበበ በበ 1. በበበበ
በበበበበበበ? 2. በበበበበ በበ
3. በበበበበበ በበ
4. በበበበበ
5. በበ በበ በበበበ
49
43. በበበበበበበበ በበበ በበበበበበ በበበበበበ? 1. በበበ
2. በበበበበበበ
44. በበበበበ በበበበበ በበበበ በበበ በበበ 1. በበበ በበበበ “2”
በበበበበ በበበበ? 2. በበበበበበበ በበበ በበ በ.በ
46 በበበበ
45. በበበበ በበበ በበበ በበበ በበበበ በበበበ 1. በበበ
በበበ በበበ በበበበበበ? 2. በèበበ
3. በበበበበ በበ
4. በበ በበ በበበበ
46. በበበ በበበ በበበበ በበበበ በበhhበ በበበበበ 1. በበበ
በበ በበበ በበበበ? 2. በበበበበ
47. በበበበበ በበበበበ በበበበ በበበበ በበበበበ 1. በበበበበበ
በበበበ? 2. በበበበበበበበ
48. በበበበበ በበበ በበበበ በበበበበበ በበበበበ 1. በበ
በበበ በበበበ? 2. በበበ
ጎጎጎ 5. ጎጎጎ ጎጎጎጎጎiጎ ጎጎጎጎጎ ጎጎጎ ጎጎጎጎጎ ጎጎጎጎጎጎ ጎጎጎጎ ጎጎጎጎጎ ጎጎጎጎ
(Technical Factors) ጎጎጎጎጎ ጎጎጎጎጎ
49. በበበበበ በበበበ በበበበ በበበበ 1. በበ በበበበ “2”
በበበበበበበበ በî/በበበ በበበበ? 2. በበበ በበበ በበ
በ.በ 55
በበበበ
50. በበበበ በበ በበበ በበበበበ በበበበ 1. በበበ
በበበ በበበበ በበበበበ በበበበ? 2. በበበበበበበ
51. በበበበ በበበ በበበ በበበ በበበ 1. በበበበ
በበ በበበ በበ በበበበ 2. በበበ በበበ
በበበበበበበ?
52. በበበበ በበበበ በበበበበ 1. በበበ በበበበ “2”
በበበበበበ? 2. በበበበበበበ በበበ በበ
በ.በ 55
በበበበ
53. በበበበ በበበ በበበበ በበበበበ 1. በበiበ በበበበበ በበበ በበበበ
በበê በበበበበበበ በበበ በበበበ በበበ
በበበበበ በበበ በበ? 2. በበበበበ በበ በበበ በበበበ
በበበ
3. በበበበ በበበበበ በêበበ
በበበበበ በበበ በበበበ በበበ
4. በበበ በበበበበ በበበበበ
በበበ በበበበ በበበ
54. በበበበ በበበበ በበê በበበበበበ 1. በበበበበበ/በበበበበበ በበበ
በበበበበ በበበበበ? በበበበበበ
2. በበíበ በበ በበበበበበበ
3. በበበበ በበበበበ በበበበበበበ
4. በበ በበ በበበበ_____
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55. በበበበ በበበበበበበበ በበበበበ በበ 1. በበ
በበ? 2. በበበ
56. በበ በበበ በበ በበበበበበ 1. በበበበ
በበበበበበ በበ በበበ በበበበበበበ? 2. በበበበበ በበበበበበ
3. በበበበ በበበበበበ
ጎጎጎጎ
51
በበበበ በበበ በበበበ በበበ በበበ በበ በበ በበበበ በበ በበበበiበ በበበበበ በበበ
በበበበ በበበበበ በበበበ በበበበ በበበበ በበበ በበበበiበ በበበበበ በበበበበ በበበበ
በበበበ በበበበበ በበÕበ በበበበበበ በበበበ በበበ በበበበ በበበበ በበ በበበበiበ
በበበበበ በበበበ በበበበበበ በበበበበ በበ በበበበ በበበበ በበበ በበበ በበበበ
በበበ በበበበ በበበበበ በበበበ በበበ በበበበበበበ በበበ በበበ በበበ በበበበበ
በበበ በበበበበበበ በበ በበ በበበበ በበበበ በበበበ በበበበበ በበበበበ በበበበበ
በበበበበ በበበበበ በበበበበበ በበበበበ በበበ በበበበበበበ
በበበበ በበበበ በበበ በበ በበበበiበ በበበበበ በበበ በበበበ በበበበበ በበበበ በበበ
በበበ በበበ በበበበበበበ በበ በበበበ በበበበበበበበ በበበበ በ¤ በበበ በበበበበበበ
በበበ በበበ በበበበ በበ በበበበiበ በበበበበ በበበ በበበበ በበበበበ በበበበ በበበ
በበ በበበበበበ
ጎጎጎጎ
በበበበ በበበ በበበ በበበበ በበበበበ በበበበ በበበበ በበበበበ በበበ በበበበ
በበበበበበ በበበ በበ በበበበበ በበበበ በበበ በበበ በበበበ በበበበ በበበበበ
በበበበ በበበበ/በበበ በበበበበ በበበበበበበ በበ በበበ በበhhበ በበበበ በበበበ
በበበበ በበበበበበ በበበበበበበ
ጎጎጎጎጎጎ
በበበበ በበበ በበበ በበበበ በበበበበ በበበ በበበበ በበበበበ በበበ በበበ
በበበበበበበበበ
ጎጎጎጎጎጎጎ
52
በበበ በበበ በበበበበ በበበበበበ በበበበበ በበበበ በበበ በበበበበበበበ በበበበበ
በበበ በበበበበ በበበበበበ በበበበበበበ በበበ በበበበበ በበ በበíበበበ በበበ በበ
በበበበበ በበበ በበበበበ በበበበ በበበ በበበበበ በበበበበበ በበበበበ በበበበ
በበበበ በበ በበበበበ በበ በበበበ በበበበበ በበበ በበበበበበ በበበበ በበ በበî
በበበበበበበ
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Declaration
I, the undersigned, senior health informatics student declare that this thesis is my
original work in partial fulfillment of the requirement for the Master of Public Health in
Health Informatics.
Name: _________________________
Signature: ______________________
This thesis work has been submitted for examination with my/ our approval as university
advisor(s).
Advisors
Name signature
1. ______________________________ _________________
2. ______________________________ _________________
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