The effect of incongruity on quality of health information systems : Bama, Nigeria PHC case study
Generally, organisations mobilise information from varying sources on which policies, plans, objectives and organisational management are predicated. indeed, everyone within organisation needs information to perform tasks, it is thus indispensable and its use so pervasive that a methodical approach for collection and processing is imperative. In health care organisations, involved with people and life, this is even of greater significance, in many instances allowable margin of error is narrow and can be devastating.Accurate and reliable information in clinical care for example cannot be compromised.On the other hand, adequate assessment of health services quality,effectiveness and efficiency depends on quality of information generated by the system, that is, accurate, relevant, timely, understandable and complete information. To achieve this, appropriate system design and operation is essential. Adoption of primary health care (PHC), in many developing countries in response to the Global 2000, necessitated establishment of chanisms for monitoring and evaluating effectiveness of services and programmes.Accordingly, in 1986 PHC was adopted in Nigeria, concomitantly, system monitoring and evaluation or the PHC Management Information System was effexted.The information system was envisaged to ameliorate the lack of reliable health information that has persisted since nception of modern health services in Nigeria. Findings in this and other studies indicate that existing health information systems have failed to provide accurate and reliable information, systems of data generation and processing are ineffective.The aim of this was to identify and understand factors that have contributed to the seemingly intractable and insalubrious information problem within the Nigerian health care system. It would be a herculean task for a lone researcher to undertake study of the entire health system, within resource and time limitations, data collection was therefore narrowed to the PHC level. Quality of the PHC management information system was assessed, with Bama Local Government as a case study. Focus was on understanding the information system's structure from a broad perspective to include, policies, objectives,established procedures; physical, material and human resources, in terms of their quality and quantity.Data collection was carried out using both qualitative and quantitative techniques. The structure, process and outcome models provided a framework for in-depth data collection, through observation, interview, review of records and administration of questionnaire, as well as for organisation and analysis of research data. The PHC MIS was followed through, from the village, health facility, local government, state and national levels.Study results suggest general ineffectiveness due to pervasive incongruity in the information system. In the first instance design of the MIS did not reflect information needs of community health workers and the community in general,who to the most part limited appreciation of the MIS structure, objectives to be achieved. Local and regional information need was not delineated, data collected had little relevance to local information needs, resource for systems operation was abysmal, skilled personnel and training provided severely inadequate.Consequently, data collection and processing was hampered, information produced often inaccurate, untimely, immense, irrelevant and unreliable. Data collected were neither analysed nor utilised. The information system was short of being integrated since 60% of functional units within the PHC department as well as related health organisations in the community ran parallel information systems.Research data point to serious incongruity in the organisation and management of the information system. Incongruity that resulted from factors within the organisation as well derived from events within the wider social environment, which however culminated in an effective and dysfunctional information system.Chapters one to three of the thesis deal with conceptual issues related to management information systems, organisational design and quality respectively. In chapter four methodological issues surrounding data collection were discussed. Empirical data and analysis are presented are presented in chapters five to seven. In chapter eight, an attempt was made to develop a model of organisational incongruity, applied to explicate research findings.Chapter nine focuses on measures toward establishment of an effective PHC information system in Nigeria, contributions of this study and suggestions for future research.