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Editorial

Our new constitution of the Republic of South Africa declares under Chapter 10, Section 195 on Basic Values and Principles Governing Public Administration that: Transparency must be fostered by providing the public with timely, accessible and accurate information.

This mandate can only be realised if we have an appropriate and effective information system at all levels of the health system that provides accurate information on the health status and trends in health status of the population.

Fortunately, judging from the initiatives of the Department of Health since 1994, health information is firmly on the list of priorities at least at national level as evidenced by, among others the formation of the NHIS/SA committee and the establishment of the national and provincial information structures. The NHIS/SA committee, which is a sub-committee of the Provincial Health Restructuring Committee, was established in order to facilitate the development of a national strategy for the implementation of a national health information system for South Africa.

Whereas health information at national and provincial level seems to be a priority, it is sad that at the district level it seems it has not been near the top list of priorities. Progress on the establishment of district health information systems has been slow, district level health information systems are still fragmented, much of the data that is collected is not processed or not used, and there is no unanimity as to what data to collect at clinics. What is required from a national level is clear guidance as to what the national minimum data set is. This minimum data set should flow from a minimum list of indicators that the national Department of Health wants to monitor throughout South Africa.

Districts may add to this list indicators which are relevant to their setting. Since districts are the building blocks and form the core of the South African health system, managers at this level must be empowered with relevant skills and accurate information to make appropriate decisions on the efficient use of the countrys finite health resources. Where necessary, training should be taken to make health personnel, especially managers, aware that appropriate information is a strategic resource for proper planning and decision-making and to be able to use information to inform decision-making.

What is depressing is that most districts and regions in South Africa do not have health information personnel or people responsible for health information. Yet experience from the Free State should tell health managers in the rest of the country that the key to establishing an effective health information system is the availability of skilled personnel and support from managers to have such a system.

It is therefore not surprising that the Free State is the only province that has developed a standard format of routine data collection at primary health care level. What we urgently need at this stage is a task team to clearly define the problem and suggest solutions. We also need a forum, e.g. a discussion group on health information, to share experiences particularly from the various initiatives of those districts that have tried to develop action-led health information systems.

HealthLink could provide the platform, but those in remote areas must have a telephone and computer to participate in such discussion. Again, our ignorance on the number of clinics and hospitals that do not have telephones clearly reflects the inadequacy of our health information system. But one hopes that T elkoms Vision 2000 will ensure the availability of this basic communication tool in all public health facilities before the turn of the country.

In line with the official policy of the Department of Health that private sector information should be integrated with district information, I feel it is very appropriate to commend the initiatives of SASPREN to develop a health surveillance system involving private practitioners. One only hopes that all private practitioners would be willing to contribute their data and knowledge to their district health information system. There are major challenges ahead of all of us to develop a comprehensive health information system that covers both the private and public sectors. And what we need are clear strategies that address both technical and budgetary issues as well as training needs at all levels of the health system.