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The results indicated that human resource for the health management information system was at low qualification. Only 29% of statistical staffs had graduation or post – graduate education, especially, the rate of personnel trained in statistic was very low (2.9%). The majority of staffs did the statistical activities as part-time job and the average number of years working in statistical field was 6.
JOURNAL OF MEDICAL RESEARCH CAPACITY AND PRACTICAL SKILL OF HEALTH STATISTICAL STAFF AND TRAINING NEEDS Nguyen Phuong Hoa¹, Pham Ngan Giang¹, Thanh Ngoc Tien¹, Hoang Thanh Huong² ¹Department of Family Medicine, Hanoi Medical University; ² Ministry of Health Objectives of the study were to assess the capacity and practical skills of the health statistical staff along with their training needs A cross-sectional study was conducted in health facilities of provinces Ha Nam, Bac Giang, Bac Ninh divided into three levels: province, district and commune 104 health statistical staffs completed questionnaires The results indicated that human resource for the health management information system was at low qualification Only 29% of statistical staffs had graduation or post – graduate education, especially, the rate of personnel trained in statistic was very low (2.9%) The majority of staffs did the statistical activities as part-time job and the average number of years working in statistical field was The capacity to use ICT for reporting and storing data was quite low at 12.4% and 7.9% respectively The capacity to analyze and use statistical data was poor, only less than 20% of total considered themselves “good” at data accuracy checking and interpreting the result Only 35.6 % of health staffs were able to interpret charts and a negligible amount of people could infer the reason of those findings In conclusion, it is important to provide new and qualified human resources and there is a large need for training the existing staff in order to improve the performance of the health statistical information Keywords: health information, health statistical staff, training needs I INTRODUCTION According to the UN Agencies framework [1], adopted by the Vietnam Ministry of Health (MOH) [2], information is one important component of the health system and plays a vital role in the development process of the health system Complete, timely, accurate and well-analyzed information not only meets the needs of management and Corresponding author: Nguyen Phuong Hoa, Department of Family Medicine, Hanoi Medical University Email: nguyenphuonghoa@hmu.edu.vn Received: 05 June 2017 Accepted: 16 November 2017 JMR 111 E2 (2) - 2018 administration of the health sector, but also those of scientific research activities, policy formulation and communication on healthcare for the population The health information system consists of six components: resources, indicators, data sources; management data; information product, dissemination, and use of information [3] Among those components, human resource development is the utmost importance [4 - 6] Until 2012, in Vietnam, although there were a number of policies from the government related to health statistics and infor95 JOURNAL OF MEDICAL RESEARCH mational activities, but so far there was no official document, that defines the health statistics professional career, including the training requirements for statistics staff Therefore, competency levels of health statistical personnel were also not assessed This was compounded by there not yet having a plan for human resources development in the health sector in Vietnam In order to improve better capacity, it is essential to develop a detailed training program Hence, to build capacity for health statistical staff, there should be specific assessments of their practical skills, qualification, and training needs [7; 8] Based on the above reasons, this study was conducted with the aim to assess the capacity and practical skills of health statistical staff, and their training needs at provincial, district and commune levels II SUBJECTS AND METHODS Subjects Health statistical staffs who worked in provincial, district and commune levels were selected Methods Locations This study took place in 2012 at health facilities of three provinces Ha Nam, Bac Giang and Bac Ninh Each province was divided into three levels: - At Provincial level: staffs from the Department of Health, Provincial General Hospital, Specialized hospitals, Provincial Preventive Medicine Centers, Reproductive Health Centre, and the HIV/AIDS Centre of these provinces 96 - At District level: staff from the District Preventive Medicine Centres and District Hospitals out of districts per each province districts were selected by the simple random method - At Commune level: staff from random CHCs out of each district selected Therefore, the total number of CHCs selected in each province was: 5CHCs x districts = 25 CHCs Size of the sample There were a total of 104 respondents - At Provincial level: + In each Department of Health (DOH) officers were selected: statistical officers and planning officer + In the Provincial General Hospital, or specialized hospitals and other health centres at provincial level, officers were selected (1 statistical officer, and planning officer) - At District level: + people were selected at the District Health Centre (one general statistics staff; one reproductive health statistics staff; and one planning staff) + At District Hospital: 01 statistical officer and planning officer were selected - At Commune/ ward level: only one person of each facility(the CHC/CHS heads) was selected to answer the questionnaire Study design Cross-sectional survey using self – administered mail questionnaire Data collection This survey used a structured questionnaire Self-administered questionnaire was used to collect the information on general JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH demographic characteristics, qualifications; capacity in collecting, aggregating data, and using information; and self-perceived training needs of staff doing statistical works and planning in health facilities Health staffs participating in this survey would complete the questionnaires under the direct supervision of the researchers Data processing STATA software was used for processing data The assessment of the capacity of analysing and using data ranged from 0% (“Incapable”) to 100% (“most capable”) For convenience, we subdivided the percentages into four different groups: a group of people with “weak” capacity (ranging from 0% to 30%); a group “average” capacity (40% - 60%); a group with “pretty good” (70% 80%) capacity, and a group with “good” (90% - 100%) capacity Regarding the assessment of statistical capacities related to health information, the respondents were observed and scored using some basic queries related to data analysis To analyze capacities related to specific statistical methods, scores were given to each respondent based on correct responses to statistical problems Ethics regarding the objectives of this assessment and the detail of collecting information Respondents completed autonomy in regard to participation, as well as were freedom to withdraw at any stage during the interview The collected data were used only for the purpose of research III RESULTS Human resources Table describes the demographic characteristics and qualifications of statistical staffs in our sample In general, the statistical staffs were mostly over 50 years old (44.2%) The higher the level of the facility, the older personnels were For example, the province level had the highest number of aged staffs, accounting for 67.5% There was a reversed age model at commune level with the officers over 50 years old only accounting for 9.5% of the total, while the highest pecentage belonged to the group of staffs from 30 to 50 years old (47.6%) In term of gender, although the distribution of male and female in provincial facilities were quite balanced, the overall pattern leaned toward female of (72.1%), mostly due to the big gap at the level of commune where 97.6% of workforce were female Respondents of this study all information JMR 111 E2 (2) - 2018 97 JOURNAL OF MEDICAL RESEARCH Table1 General information of the statistic personnel Province (n=43) (%) District (n=19) (%) Commune (n=42) (%) All locations (n=104) (%) < 30 9.2 10.5 42.9 23.1 30 - 50 23.3 21.1 47.6 32.7 50+ 67.5 68.4 9.5 44.2 Male 46.1 40.8 2.4 27.9 Female 53.9 59.2 97.6 72.1 Statistics 4.7 5.3 2.9 IT-ICT 7.0 5.3 3.9 Med/Pharm 32.6 26.2 18.3 Pub.Health 7.0 5.3 3.9 Middle or Secondary School 48.7 57.9 100 71.0 Full time 46.5 36.8 26.0 Part time 53.5 63.2 100 74.0 Characteristic Age group Sex Education Working time In provincial facilities, there was 51.3% of staff having graduate and post-graduate education However, out of the 43 people, only 4.7% of them had graduated in statistics and only 7.0 % in ICT disciplines Furthermore, all other locations had more than 50% of their statistical officers with middle or secondary level qualifications For instance, the district health facilities had 57.9%; at commune level, this rate was 100% Therefore, the officers specifically competent in managing the statistics and information workload were very, very few Overall, the 98 proportion of staff having middle-level education was high, about 71.0%, while the amount of staff specializing in statistics was critically low (2.9%) Another aspect of human resources is working time There was no level of health facility having over 50% of the statistical staffs working full-time The most optimistic circumstance came from the provincial facilities, where 46.5% of their statistical officers did statistical activities as their main daily work The overall survey results showed that 74.0% of 104 statistical officers responding to the questionnaires JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH were part-time mainly due to the absolute rate of part-time staff at the commune level In terms of experience in health statistics calculated by years, the average number was For more detail, the rate of three dimensions of experience, including ≤ years, - 10 years, over 10 years of experience were 54.2%, 30.1%, 15.7%, respectively This showed high staff turnover in health statistics Staff performance features Figure illustrates influencing factors on the quality of statistical reports, in the primary health care system Statistics showed personnel had compromising their work awareness of several critical factors which were ranked as followings: insufficient and unstable workforce with 64.5% of respondent agreeing that high percentages came from lack of supervision, untrained staff and too many forms accounting for 56.5%, 50.2% and 46.3% respectively 64.5 70 60 56.5 50.2 50 46.3 40 30 22.5 20 19.5 7.8 10 13.5 5.1 Figure Influencing factors on the quality of reports Capacity of using ICT Figure shows the situation and use of ICT in health information system concerning data processing and software applications There was a very high proportion (94.3%) of officers who used a computer to process data, while only 5.7% recorded data manually With respect to data processing software, 70.3% of statistics personnel used JMR 111 E2 (2) - 2018 MS Access-based software and 60.7% of staff used software for statistical reports Pertaining to the way of reporting data, most of respondents said they sent their reports by post, only 7.3% sent reports via emails, and only 5.1% used web-based reporting Further investigation suggest the situation of report submission and data ar99 JOURNAL OF MEDICAL RESEARCH chive of CHC: reports were mainly in hard copies, (74.3%) followed by reporting via official government email system accounted at 5.89%; while via personal emails was 22.87% Furthermore, data archive of statistical and planning personnel was predominantly paper based, approximat- ing 80% About 70% of the total staff stored data on personal computers Server-based archive only accounted for 7.9% There were 96.18% of CHCs storing data on paper, and of those, 22.8% also stored data on their personal computers Figure Capacity of using software for processing, transfering and storing data Capacity of analyzing and using data The survey team requested the statistics personnels to report on their self-perceived capacity to conduct several type of data analysis The findings are presented in Table Table Self assessment of capacity of analysing and using data Statement - 30% 40 - 60% (Weak) (average) 70 - 80% 90 - 100% (fairly (good) good) Mean SD Check out data accuracy 4.9 38.8 36.9 19.4 67.0 17.7 Calculate percentage 3.9 30.1 31.1 35.9 72.1 18.3 Plot data by months or years 9.9 39.6 23.8 26.7 64.5 22.8 Analyze trends from bar charts 15.5 33.0 35.9 15.5 60.0 24.1 Interpret the data and their implications 11.8 37.3 32.4 18.6 61.2 24.1 Use data for cost estimation 3.9 25.5 40.2 30.4 71.7 18.2 Use data in planning 8.9 34.7 33.7 22.8 65.8 20.4 100 JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH Capacity of analyzing and using health statistical data The results were not encouraging Many respondents were not able to indicate the reasons for data collection, not able to describe ways of assessing the data quality not able to list activities for removing the causes of the poor data quality In fact, the mean of the respondents was below one point in four out of six queries Moreover, the remaining two questions also received similarly, low scores: the first question obtained a mean of 1.21 points, while the last one had a mean of 1.20 56.3% of staffs claimed that their capacity of checking data accuracy was “fairly good” or “good”; more than 65% considered themselves able to calculate percentages for interpreting data and its implications; and rates well or fairly well but less able to plot data by months and years More than 50% considered themselves able to calculate trends and interpret bar charts and the same percentages; more than 70% considered themselves “fairly good” or “good” in the use of the data for cost estimation; and 67% of the staffs “fairly good” at using data for planning These were maybe too optimistic results Table Assessment on statistical capacities related to health information Mean SD Max ≤ score (%) Why collect data on diseases 1.21 0.74 62.4 Why collect data on immunization 0.91 0.74 78.9 Why collect population data by age groups 0.83 0.49 95.2 Listing at least methods to check data quality 0.97 0.80 60.2 Defining not accurate data and their causes 0.10 0.33 99.0 Listing tentative activities to be implemented 1.20 0.89 10 69.2 Questions on The overall percentage of correct calculations was 72.5% Approx 71% were able to make a bar chart However only 35% of health staff were able to explain the chart findings, and less than 10% of them were able to interpret the meaning of the chart Table Assessment on capacity related to specific statistical examples and calculations Mean SD Max score (%) ≥ score (%) Capacity of calculation 0.69 0.5 27.5 72.5 Plot data in a bar chart 0.71 0.46 28.9 71.1 Interpret findings from this bar chart 0.61 0.89 64.4 35.6 Statement JMR 111 E2 (2) - 2018 101 JOURNAL OF MEDICAL RESEARCH Infer the possible reasons for the results of the example chart Training needs Most of the staff, 84.2 %, working on statistical information had not been trained Out of this total, the health workers at commune level accounted for the highest percentages of not trained, more than 90% At the level of the province and district, the rates of untrained staffs are lower, but still account for relatively high percentages, 80% and 77.8% respectively Table lists 11 training topics offered by statistical personnel working on three levels of health facilities Among these numerous demands of training, the basic statistics subject was the most needed, about 77%, and also the highest proportions of demand at all three levels Next requested topics were synthesizing report and data interpretation, (60.4%) and using data for evaluation and analysis (48%) Several topics with a rela- 0.09 0.28 91.4 8.6 tively high rate of request (> 40%) were statistics on morbidity and mortality by ICD10, population statistics or using software for data management and reporting Noticeably, there were considerable differences between levels in some training needs In regard to population statistics and health related statistics on socio-economic problems, commune health workers requested to be trained at high rates (71.1% and 65.9%, respectively), while officers at higher levels (25%) didn’t pay as much attention to these issues Reversedly, in three areas as using data for evaluation, using management software and evidence based planning, statistical personnels in provincial and district health facilities demanded remarkably more than their colleagues at the commune level Table Training needs recommended by staff No Training topics Province (n = 43) District (n = 19) Commune All location (n = 42) (n=104) Basic statistics 77.2 65.3 81.5 76.8 Population statistics related to health 24.1 26.4 71.1 43.5 Statistics on morbidity and mortality by ICD10 44.6 35.9 50.8 45.5 Statistics and nutrition and lifestyles 14.1 13.7 42.1 25.3 Synthesizing report and data interpretation 58.5 49.9 67.1 60.4 Statistics on workforce and health services 37.9 24.4 59.1 44.0 102 JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH Health related statistics on economics, society, and environment 25.1 18.2 65.9 40.3 Using data for evaluation and analysis 67.3 45.1 28.4 47.5 Evidence based planning 57.8 41.5 25.6 41.8 39.6 39.9 31.2 36.3 58.0 47.3 23.7 42.2 10 Basic IT knowledge 11 Using management and reporting software IV DISCUSSION This study provides useful statistics to assess thoroughly the current situation of Vietnam's health information system, paticularly the practical capacity of statistical staff at primary health facilities Situation of human resources There was a reverse pattern in the age of staff between commune level and the higher level health facilities While at province and district level, about two third of statistic personnels were over 50 years old, those at commune level were mostly young This finding was similar to some previous reports [9; 10] This could be explained differences in the main daily tasks of the workforce While at the commune level, due to lack of human resource, statictical staff had to other missions It created the demand of young people who were better poised to accomplish all activities On the other hand, officers working in provincial or district facilities professionally practiced statistical activities as their main task, so experienced staff were needed This trend was also similar to some previous studies [1; 11] To some extent, the high rate of aging statistical personnels may affect negatively the quality of health information reports JMR 111 E2 (2) - 2018 Many staffs of higher age working in statistics are not willing to improve their capacity and are often committed to the outmoded ways of collecting, analysing and reporting information [11] With increasing challenges in the healthcare area, information relating to health is increasingly complicated, and if the statistical officers are not trained to meet these demands, there will be a messy meaningless pile of data In terms of sex, there was no significant disparity between male and female at province and district level, but at the commune level, very few males did statistical work This phenomenon may come from the mobilization of CHC/CHS staffs mentioned above, where many are female officers In recent years,the qualification of staff working on statistical information has improved but this process has been slow [2] Until now, the majority of the statistical workforce (71%) only had middle or secondary school qualification, very few have attended statistical training courses Drastically, at commune level, there was not any statistical personnel having graduate training and this influenced directly the quality of the report due to insufficient professional 103 JOURNAL OF MEDICAL RESEARCH capacity Moreover, the number of statistical experience years of our sample was quite low, below years This is another negative impact on the quality of their work In order to well perform, not only are education qualifications necessary, but also necessary are the experience and skills in collecting and processing data Normally, staff having many years of experience can acquire the expertise to collect, process, analyse data Capacity of statistical workforce Pertaining to the ability of using ICT, similar to findings from some other authors, this study found that despite the high rate of computer and software usage for processing data, few individuals processed information through internet and web-based reporting and data storing service [7; 11 13] This limitation can be clarified by some following reasons According to the existing regulations, leaders of health facilities must duly sign and stamp all reports to guarantee the legality of the document, consequently, reports sent by emails were not legally accepted In addition, only health facilities signing up to Government Gateway System have Electronic mail boxes, the rate of those still now only accounts for 10.6%, resulting in the low use of internet for reporting statistic data [3] Moreover, the majority of aged staffs as discussed above struggled to learn how to use the internet, especially the online applications With regards to the capacity of analysing and using data, about two third of respondents self-assessed to be fairly good or good at almost all types of data analysis and use This was an overestimation Why staff filling in the questionnaires themselves 104 may mark higher may be due to their fear of being judged as not capable, a risk to their promotion, more alarming was when approx 60% of respondents scored below point in queries on health statistical data Moreover, when the practical skills of respondents were tested by concrete problem, in spite of favorable self-assessments more than 60% of participants weren’t able to explain the findings and few people could interpret the chart they had just drawn As seen, the statistical staff were still weak at data interpretation [11; 13] It is supposed that the health statistical information had not been applied effectively and comprehensively, therefore, the meanings of these documents were not paid much attention to As a result, statistical staff only imitate others’ experience to finish the required reports without any willingness to explore the data or improve themselves in applying the findings effectively Training needs A small proportion of staff working on statistical field had been trained This situation is similar findings in some previous surveys [1; 4; 11] From above discussed shortcomings, it is really urgent to focus on training of health statistical staff To make this step effective, training should begin at the most practical demands A lot of topics were listed However, training basic statistics was the most wanted, then followings were topics on data interpretation, synthesizing report and skill to use ICT Similar recommendation were also stated in several other studies [7; 14] On further analysis each level, there was a discrepancy in priority need between commune level and higher level facilities As discussed above, JMR 111 E2 (2) - 2018 JOURNAL OF MEDICAL RESEARCH at provincal and district level, statistical officers did their job professionally, as their mission was to supply general statistical information to establish governmental plans, to build up a national strategy, and to figure out other macroscopic orientations Consequently, they needed to be trained more specifically in statistic activities such as data interpretion, evaluation, and analysis On the other hand, at the commune level, the Population Officers (Collaborators) were included in the CHC staff, therefore the CHC took the charge of this duty CHCs need population data for the planning of health services provision, such as immunisation services, reproductive health care, health care for children and old people, etc That is why, compared with provincial and district facilities, the demand of training in areas relating to population and socio-economic issues were higher at the commune level [4; 5] V CONCLUSION The situation of the health statistical personnel was severely unsatisfactory This survey describes in detail some of the biggest problems affecting the HIS performance and the dissemination of timely, reliable information for users and citizens The results of the survey pointed out a critical situation and several problems about the human resources and their capacity, especially in the field of health statistic The priority solution for this is to implement training courses which meet the needs of each level of health facilities Acknowledgements JMR 111 E2 (2) - 2018 We would like to appreciate the Provincial Health Departments of Ha Nam, Bac Giang and Bac Ninh provinces for giving their support during data collection process We greatly thank all staffs from health facilities for their enthusiastic participation in our study REFERENCES Shakerishvili, G (2009) Building on health systems frameworks for developing a common approach to health systems strengthening Prepared for the World Bank, Global Fund to Fight AIDS, Tuberculosis and Malaria, and GAVI Alliance, TechnicalWorkshop on Health Systems Strengthening, 25 - 27 MOH (2010) Five-year Health Sector Development Plan 2011 - 2015 WHO/HMN (2008) Framework and Standards for Country Health Information Systems Mutale, W., et al (2013) Improving health information systems for decision making across five sub-Saharan African countries: Implementation strategies from the African Health Initiative BMC Health Services Research, 13(Suppl 2), S9 - S9 Nahm, E.S., et al (2007) Outcomes assessment of clinical information system implementation: a practical guide Nurs Outlook, 55(6), 282 - 288 Obembe T.A., O.K.O., Olumide E.A et al (2014) Staffing situation of primary health care facilities in Federal Capital Territory, Nigeria: implication for attraction and retention policies Am J Soc Mgmt Sci, 5(2) 105 JOURNAL OF MEDICAL RESEARCH Rahimi, B and V Vimarlund (2007) Methods to evaluate health information systems in healthcare settings: a literature review J Med Syst, 31(5), 397 - 432 Lippeveld, T., R Sauerborn, and S Sapirie (1997) Health information systems-making them work World Health Forum, 18(2), 176 - 184 MOH-DPs (2012), Joint Annual Health Review 2012, www jahr.org 10 Moazzam Ali, Y.H (2002) Situation analysis of health management information system in Pakistan Pakistan J.Med Res, 41(2) 106 11 Nguyen Thi Tinh, N.T.H., Josie B Perez (2017) Report on Capacity Building for Vietnam's HMIS 12 WHO/HMN (2007) Assessment Tool Guidelines, version 2.0 13 MOH, D., HS Division (2006), Vietnam Health Information System Review and Assessment 14 Talat Mehmood, T.A., Syed Fawad Mashhadi et al (2011) Health management information system in district health care Pakistan Armed Forces Medical Journal, 61(4) JMR 111 E2 (2) - 2018 ... qualification, and training needs [7; 8] Based on the above reasons, this study was conducted with the aim to assess the capacity and practical skills of health statistical staff, and their training needs. .. urgent to focus on training of health statistical staff To make this step effective, training should begin at the most practical demands A lot of topics were listed However, training basic statistics... Centre (one general statistics staff; one reproductive health statistics staff; and one planning staff) + At District Hospital: 01 statistical officer and planning officer were selected - At Commune/