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2.7 Health information management
2.7 Health information management
2.7.1 Information systems The current national HIS consists mainly of the information inputs obtained from the state health service, supplemented by other government sources. The present sub-systems of HIS include curative/hospital information systems, preventive health information systems, administrative and operational information systems, population census, civil registration and vital statistics system, and periodic population-based health and other surveys, e.g. Demographic and Health Survey (DHS), STEPwise approach to surveillance (STEPS) and Household Income and Expenditure Survey (HIES).6 Taken together, these sources provide information on population growth, births, marriages, morbidity and mortality, health-care access, health-care coverage, utilization, human resources for health and their distribution, health financing and other health-related data.
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Sri Lanka has a history of census-taking dating back to 1871 and there have been decennial censuses except during times of war and armed conflict within the country. The most recent was in 2011–2012. These provide accurate geographically referenced health and health-related data and other social determinants of health.
In addition, the Department of Census and Statistics (DCS) carries out health and health-related surveys such as the DHS, the first of which was held in 1987. This is repeated every four to six years, the last being in 2016. The HIES conducted every three years provides health-related costing information. All these surveys are sampled to provide disaggregated district-level data. In 2014, a National Survey on Self-reported Health in Sri Lanka was conducted by the DCS, which provided information related to chronic illnesses.
Health data related to services provided by the MOH and team are available through the Reproductive Health Information Management System (RHIMS). The majority of the MOH areas are congruent with administrative boundaries at the divisional level. This information is linked to the services offered by the MOH and is fairly robust, with vaccination, antenatal care (ANC) and institutional deliveries being near-universal in Sri Lanka. The planned primary curative care reform7 and information system will provide community-based, geographically referenced morbidity and mortality data.
6 Health information systems are detailed in Chapter 4. 7 Detailed in Chapter 6.
2.7.1.2 Civil registration
Sri Lanka has had a long history of registration of vital events based on Ordinance No.18 of 1867, which came into operation in June 1868. This was optional at the outset but was made compulsory in 1897. The system covers births, marriages, deaths and stillbirths. Stillbirths are registered only in “proclaimed areas” where a medically qualified person is the registrar of deaths. An assessment of the production, quality and use of vital statistics in Sri Lanka (Gamage et al., 2009) has shown that the coverage of births and deaths is high.
The death registration system of the country provides population-based mortality information. The events are reported by place of occurrence as well as by place of usual residence of the deceased individual. The completeness of the reporting of events has been shown to be high; however, reporting of the cause of death needs considerable improvement. Nearly 50% of deaths take place in hospitals and the notification of death (death declaration) giving the immediate, underlying and related morbidity is reported by MOs. The death declaration is submitted to the registrar of deaths for the issue of a death certificate. Shortcomings are seen in the death declaration as well as in the death registration and coding of causes of death at the level of the registrar general’s office, both regional and central (Gamage et al., 2009). Many initiatives have been undertaken and are continuing to improve the quality of cause of death information, including training regarding medical certification of cause of death based on the International Classification of Diseases, tenth revision (ICD-10) for the relevant officers and the use of verbal autopsy to verify the cause of death. These have resulted in improvements in the certification of the cause of death (Hart et al., 2020).
2.7.1.3 Institution-based health information
Morbidity and mortality data from patients seeking treatment as inpatients in government allopathic medical-care institutions are available from a paperbased quarterly return sent to the medical statistics unit of the Ministry of Health. The degree of accuracy and coverage of the data is variable. Although the diagnosis should be based on the ICD-10 classification of disease, the quality of the information is variable. In spite of efforts taken to improve the quality of diagnosis given in the patient records, there is still a large group of patients for whom the medical statistician reports symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified.
Information from most of the outpatient services of government institutions is limited to attendance numbers only. Information from the private sector, including private hospitals, general practitioners, hospitals under the armed
forces and police, prison hospitals and indigenous treatment centres, are not included. As an initial step to overcome these inadequacies in the current system, a web-based electronic Indoor Morbidity and Mortality Reporting (e-IMMR) system has been introduced, limited at present to selected large hospitals in the government sector.
For MCH activities, the country has a well-established information system extending from the grass-roots level to the central level, which has evolved over nearly a century. The current RHIMS was initiated in 1986 by the Family Health Bureau under the MoH for monitoring, evaluating and planning of MCH services in Sri Lanka. Some of the core indicators that are used by the MoH are based on this information system. To improve the quality of this system, the MoH is currently developing a web-based electronic reproductive health information management system (eRHIMS) to complement and gradually replace the existing paper-based system.
Sri Lanka is reputed as a country having a very strong immunization programme. The Epidemiology Unit of the MoH is responsible for EPI surveillance. The information is collected through the web-based immunization information system. With near-universal coverage of EPI, the information system is robust and covers the entire country. In addition to this, the Epidemiology Unit is responsible for the surveillance of communicable diseases and gets its information through the notification system of communicable diseases, which currently tracks data on some 28 conditions (Epidemiology Unit, 2008). This information is collected through the network of MOH offices covering the country. A tested and proven system is in place to monitor these disease conditions at the level of MOHs, districts, provinces and at the national level.8 In addition to these notifiable conditions, the Epidemiology Unit gets regular information through the severe acute respiratory illness (SARI) surveillance for influenza-like conditions through some 34 sentinel sites across the country. Some conditions that have not been included in the list of notifiable diseases are collected through the respective public health campaigns maintaining specific information systems through registries and databases.
There are several other information systems maintained by national focal agencies for administrative and operational purposes. The MoH maintains the Human Resources Management Information System (HRMIS), Health Facility Survey (HFS), Medical Supplies Information System and a Blood Transfusion Management System for operational support purposes. Both the HRMIS and the HFS do not have the latest and most updated
8 Detailed in Chapter 5.
