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Task 2: Establish a minimum data set
Once the indicators are mapped, a minimum data set can be identified, based on what Once the indicators are
is feasible. This requires determining what minimum data are required to provide mapped, a minimum data
substance to the identified set of indicators (i.e. operationalizing the identified set can be determined.
indicators). For example, if an identified indicator was the annual number of admissions
in mental hospitals per 100 000 population, the minimum data required for that indicator
would be:
> Number of annual admissions to mental hospitals in the identified catchment area
during a year.
> Population of the catchment area.
Figure 5 illustrates the relationship between indicators and minimum data, using the
example of admission rates.
Formula
A useful set of questions for operationalizing the indicators include the following (Bodart Several key questions may
& Shrestha, 2000): be used to operationalize
the indicators
> What are the sources of the data (numerator and denominator)?
> At what frequency should the numerator and denominator be collected?
> At what frequency should the indicator be processed and analysed?
> Who will actually use the indicator?
> What is the target (objective) of the indicator that needs to be achieved?
> What is the threshold (i.e. the maximum or minimum value of the indicator) that
should trigger action?
> What action will need to be taken, based on the measurement of the indicator?
Table 6 below summarizes these questions, using an example that measures the
inpatient resources available for mental health in general health care. The purpose of
this indicator is to measure the percentage of general hospitals having inpatient
psychiatric facilities. This is important in the context of efforts to downscale psychiatric
asylums and integrate inpatient mental health care into general health care.
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Table 6. Example of operationalizing indicators: measuring the inpatient resources
available for mental health in general health care
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Box 12. Task 2 example: Minimum data set required to assess integration of
mental health into primary health care
> Percentage of training hours > Numerator: Number of training hours for PHC
devoted to psychiatry or doctors and nurses devoted to psychiatry/mental
mental health during health during specialization in primary care/family
specialization of PHC doctors medicine/general practice
and nurses in primary care, > Denominator: Total number of training hours for
family medicine or general PHC doctors and nurses during specialization in
practice primary care/family medicine/ general practice
> Percentage of primary care > Numerator: Number of primary care doctors and
doctors and nurses with at nurses with at least two days of in-service
least two days of in-service refresher training in psychiatry/mental health in the
refresher training in past year
psychiatry/mental health in > Denominator: Total number of primary care
the past year doctors and nurses working in primary care clinics
in the past year
> Percentage of primary care > Numerator: Number of primary care clinics with
clinics with assessment and assessment and treatment protocols in place
treatment protocols for key > Denominator: Total number of primary care clinics
mental health conditions
The next task is to map the information flow within the MHIS (collection, processing,
analysis, dissemination and use). The MHIS framework (above) needs to be
supplemented with flow charts showing how the information should flow. To illustrate
this, Box 13 below gives an example of a flow chart from the Gauteng MHIS in South
Africa (Figure 6).
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Box 13. Task 3 example: Mapping the information flow, Gauteng MHIS,
South Africa.
The movement of information begins with collection and compilation by the mental
health worker (e.g. the primary health care nurse). The facility and system data are then
sent to the clinic head nurse, who compiles and checks the quality of the data. The
system data are then forwarded to the regional mental health coordinator who collects
the data from all the clinics in the region, checks quality and then forwards the data to
both the health information system’s regional coordinator and the provincial Mental
Health Directorate. The HIS regional coordinator enters the data on a computer,
forwarding the data in electronic format to the provincial level HIS Directorate. The HIS
regional coordinator also generates a clinic summary and returns this to the regional
mental health coordinators. They then return the clinic summaries back to the clinic
head nurses who in turn forward them on to the mental health workers.
At the provincial level, the HIS directorate receives data from all the regional HIS
coordinators, and generates a regional summary. The mental health regional summary
is then forwarded to the Mental Health Directorate, which reviews and analyses the
summaries. It then disseminates the findings and their implications for planning and
service management back to the mental health regional coordinator.
At each point at which the data are disseminated after having been analysed, action is
taken in various aspects of planning, management and service delivery, depending on
the service level. For example, at the level of the mental health worker, receiving the
clinic summary from the clinic head nurse may indicate a need for better time
management with patients in clinics. For the mental health regional coordinator, the
regional summary may indicate inequalities in service utilization between clinics within
a region, and the need to either redistribute staff or recruit more staff in one area. In
short, the dissemination of information always leads to decision-making and action
(Centre for Health Policy, 1998).
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