District Health Barometer (DHB)

What is the District Health Barometer?

The District Health Barometer (DHB) contributes to improved quality and access to primary health care through monitoring, over time, important aspects of the health system at district level . Analysis of a carefully selected range of health indicators, from which comparisons between and among districts (across provinces) can be made, facilitates identification of areas of poor quality and appropriate corrective measures.

The DHB is a tool designed to assist with making functional information available for the monitoring of progress in health services delivery at the district level as a means to help improve health systems organisation and delivery. It is linked to district, provincial and national strategic plans in that it measures similar indicators, but the DHB still functions as an independent ‘watchdog' to provide input and pinpoint where there are serious gaps or performance issues.

The DHB aims to improve the quality, capacity and use of health information at all levels in the governmental health sector. It is also intended to provide the public, other sectors such as Treasury, the international health community, and donors with greater access and insight into the public health sector in South Africa through pooling the best available data and providing it in an easy to understand and use format.

Why a District Health Barometer?

The vision of the District Health Barometer project is to assist in the transformation of the culture and use of health information in the public health sector in South Africa. It provides a product in which key health statistics are easily understood and used for decision making.

Its goals are to improve the quality and transparency of health systems information in South Africa, to house an authoritative and accurate database of key health and health-related indicators and to produce an annual publication of health sector performance data covering several years, therefore enabling ongoing monitoring and evaluation.

Managers at all levels of the health system need appropriate information to analyse the health situation, set relevant objectives and develop plans susceptible to monitoring. Currently the consensus is that there is an abundance of information available, but that it is not that useful and often difficult to consolidate. Tools such as the District Health Barometer therefore provide a carefully seclected set of health and socio-economic indicators to aid decision making in the health sector.

Impact

The District Health Barometer publications have been well received by all levels of the public health sector.

• External evaluation of the District Health Barometer Project

Highlighting performance

What the DHB provides is not ‘new' information on public health management. However, the information is presented in such a way that has caught management's eye, which is something that the same information presented in other reports and tables has not been able to do. The Barometer is also a useful tool to point out areas that need further investigation.

Data Quality

The DHB has helped in the pursuit of more reliable information. There is a slowly growing awareness by districts that if data collected at base level is not accurate, the information presented in the DHB will also be skewed, thus showing the incorrect ranking of the district(s).

The DHB has increased focus and attention on the importance of the District Health Information System and the quality of its data which needs ongoing maintenance, quality control and validation in order for it to be useful. There is need for leadership and commitment from national level for this.

Building Capacity

The DHB has accentuated awareness of the need for capacity building in information systems on all levels but especially at management level.

Definitions and Targets

The spectre of reliable data driven inter-district comparison has led to a realisation that there is a definite need to standardise indicator definitions and agree on and publish a formal set of achievable targets.

The Next Phase

The success of the DHB reports, and in particular the perception of health sector managers that it is a valuable tool, emphasises the need to continue refining and developing it.

DHB Web based GIS facility

A website displaying the DHB indicators via a GIS (geographic information system) has been developed and can be accessed online at http://webgis.hst.org.za:8081/. It is unique in South Africa (there being nothing similar available at the moment) as it provides South African district health indicator information on the World Wide Web by geographic area. One may view district(s) geographically on the SA map and also displayed as time series data by way of tables and charts, colour coded according to the GIS quintiles.

Capacity Development

In order to contribute to strengthening capacity at a provincial and district level, ongoing workshops, presentations and meetings will provide an opportunity to discuss the findings and implications of the DHB. At the same time this will build capacity to understand indicators and how they can assist management to improve equity and quality of care at PHC level.

Benefits

A number of benefits to health information systems, and thereby to health systems broadly, are expected from the DHB, including:

• integration of information from a number of sources into a single, accessible repository in the public domain
• strengthening integration in the health information system
• assisting managers at all levels to improve the quality and use of health indicators
• providing trend data to monitor change
• identifying gaps in data collection
• identifying problems with information systems or data quality
• strengthening existing information systems and the culture of information use and feedback
• improving and developing skills in analysis and interpretation of health indicators.

The District Health Barometers are freely downloadable and include full colour graphs, league tables and GIS maps: