Computer-based support for maternal and child care at primary health centres

• Health infonnation systems are reported to be weak and inadequate in supporting public health programs, since at the primary health centre, which is the level of first contact, the information infrastructure is weak. This thesis reports a health systems research effort to strengthen the infonnation infrastructure, specifically to develop an application software to support the delivery of maternal and child care at the primary health centre. Technical advances have made micro-computers affordable, which is directly due to the trend toward lower prices. However, there is still a lack of flexible low cost software for large scale implementation. This health systems research used methodologies based on empirical findings combined with the engineering process of design and development. Based on the shared characteristics of the sites and the human component requirements, an application software was developed and tested.The investigation had three distinct stages, the first of which was a prerequisites analysis to assess the human issues of acceptance and attitudes using a questionnaire based study. The results demonstrated that responding physicians were interested in using computers, but an information gap existed. Respondents with somecomputer experience and prior information accepted the potential of the computer as a decision support tool, but those without experience had reservations (I). The first stage also included a literature review to identify the values of infonnation justifying computer role rather than manual methods used in a primary health centte (II). The second stage was a multi~centre systems analysis study using questionnaires and site visits to identify the common base for development of an application software. Analysis by contingency tables showed diversity in socio-organizational factors between the sites (III), while commonality was observed in the data collection records and this was confinned by the site study. The site study further identified that a core data set is shared by all levels of administration and care providers in delivery of a health programme. Development of a common application software requires identification of the core data set (IV). The third stage was to design and develop the software. For this the Essential Data Set for the selected domain of Maternal Health Services was defined by means of infological modelling, A software prototype was developed, and using rettospective data entry from a Swedish maternal health centre records the acceptability of the data set and applicability of the software were tested (V). The software developed, which was independent of organizational behaviour, provided us with a package that could be used by different health organizations. It was implemented differently by different organizations using their own economic resources. The results demonstrated that the software provided the foundation for microplanning, and that the management at a site was able to identify the needs and lacunae. At another site the target group for family planning motivation was fine tuned to a subset, and the action resulted in 25% of the subset accepting a permanent method. The database will also be an asset in quality assurance by ensuring continuity in care and the resultant large database based on a prospective common data collection protocol will be a base for health outcomes research. A further observation is the economic loss due to dropouts from the immunization programme. The approximated cost per fully immunized child is estimated at US$ 15. As a result of dropouts from the cohort the cost rose to US$ 54 per fully immunized child, but with computer supported follow-up the dropouts decreased and the cost fell to US$ 22 per fully immunized child (VI). The economic benefits are proof that such systems are not an expenditure but are instead an investment.

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MEDICIN

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