Cause specific mortality and NCDs


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  • Before moving forward – provide some context on cause-specific mortality: discuss a health information system
  • Key aspects: system – integrated, components working together information – meaningful collection of facts and data use – influence policy making it is as much about using information as it is about collecting, storing and analysing beyond specific disease programs to embrace the health system and its component parts in its entirety as the basis for effective use of resources
  • Link to policy brief handoutWhat are the alternatives? Decisions made on political interests, anecdotal evidence, external agendasNeed to move away from DATA and focus on INFORMATION
  • What does a HIS look like – more importantly; what does it mean in terms of NCDs?Brief description on each componentHIS resources – HR: do we have enough NCD staff (diabetes nurses), where are they located? Finance – do we have enough money? NHAs. Services: what are we providing? Sufficient?Indicators – topic of discussion over forum. What are we measuring, collecting, reporting on? Are they telling the right ‘story’ of NCDs in our country? What needs to be improved?Data sources – where do we get our NCD data from? Civil registration – cause of death dataManagement – how do we link records over time, between providers? Chronic, long-term nature of NCDsInformation – how are we reporting on NCDs? Is it integrated?Dissemination – how are we using information to make evidence-based decisions on NCDs?
  • Cause-specific mortality: data generated by a civil registration system based on certified cause-of-death (link to Yvan)
  • Specifically for death registration – which is crucial for an effective response to NCDsData quality – correct reporting of age, location, cause-of-death
  • If we look at three points at bottom:Exposure to risksMorbidity and mortality by causeEffectiveness of programs... AND
  • Proposed indicators for NCD monitoringThey all rely on quality mortality dataIf we don’t get this right from the start, will be very hard to monitor progress towards achieving targetsMORE THAN THAT – will be impossible to base policy decisions on evidence
  • Fiji and Tonga; medical certification reviewKiribati; development of annual report
  • Example of research – practice – policy Tonga – 100 certificates – 79% not useful for public policyExamples not to shame – most countries would be the sameShow the significance and impact of a relatively simple interventionTwo very important examples of work that is ongoing on improving cause-specific mortality in the region
  • Pacific Health Information Network – PHINWorking to improve health information systems in the Pacific; development of regional strategic planPresident and other members here – encourage to take this time to work together to bring HIS approaches in line with NCD plans
  • Cause specific mortality and NCDs

    1. 1. Cause-specific mortality and non-communicable diseasesProfessor Alan D. LopezExecutive Director,HIS Knowledge HubHead,School of Population HealthPresented by: Nicola Hodge
    2. 2. Pacific Health Information Network Tonga, Fiji, Solomon Islands, Cook Islands, Papua New Guinea, Vanuatu, KiribatiFederated States of Micronesia, Hawaii, Marshall Islands, Nauru, Palau, Samoa Health Information Systems Knowledge Hub | 2012
    3. 3. Outline of presentation• What is a health information system (HIS) and why is it important• Why strengthening HIS is crucial for monitoring and evaluating responses to NCDs• Opportunities for improving health information systems• Current work on cause-specific mortality in the region Health Information Systems Knowledge Hub | 2012
    4. 4. What are health information systems?• ‘A system for the collection/processing of data from various sources, and using the information for policy making and management of health services’ (World Bank)• ‘Integrated efforts to collect, process, report and use health information and knowledge to influence policy making, program action and research’ (WHO)• A collection of components that work together to improve health services management through optimal information support (Sauerborn & Lippeveld) Health Information Systems Knowledge Hub | 2012
    5. 5. Why are health information systems important?• Without health information systems to inform decision-makers of where health problems are and if the health of the population is improving or getting worse – sound judgements cannot be made• Accountability – to the population, to donors, to other organisations• Evidence-based decisions• Resource allocation Health Information Systems Knowledge Hub | 2012
    6. 6. Components and standards of a health information system Health Information Systems Knowledge Hub | 2012
    7. 7. Why is cause-specific mortality important to NCD prevention and control? • Policy should be informed by accurate and timely data • Provide information on patterns of leading diseases and trends • Identify emerging health problems • Monitor and evaluate the effectiveness of health programs and policies Health Information Systems Knowledge Hub | 2012
    8. 8. Common issues with mortality dataParticularly problematic in countries where themajority of deaths occur outside health institutions:• Not all deaths are medically certified• High proportion of ill-defined deaths• Frequent use of “garbage codes”• Mode of death (i.e. the immediate cause) is reported instead of the underlying cause• Not all births/deaths are registered – lack of resources, incentives, legislation• Data quality issues Health Information Systems Knowledge Hub | 2012
    9. 9. Monitoring NCDs• HIS in the Pacific currently do not give Pacific decision makers enough information to address the information needs for NCD prevention and control• Pacific NCD decision makers need information on: • The magnitude of the public health problem posed by NCDs • Levels and trends in the prevalence of risk factors and in NCD conditions/mortality • The impact of current policies and programs on these trends Health Information Systems Knowledge Hub | 2012
    10. 10. Indicators and targets for the global monitoring of NCDs Health Information Systems Knowledge Hub | 2012
    11. 11. What is currently being done in the Pacific to improve mortality data?• Capacity-building • Over 200 doctors from Asia and the Pacific have been trained in correct cause-of-death certification practices • Three doctors from the Pacific have been trained as cause-of-death instructors • Development of handbook for doctors • Over 100 health information professionals from the Pacific have been trained in a HIS Short Course (being transferred to FNU) • Civil registration and vital statistics course in development• Assistance to countries to investigate own data• Pacific Vital Statistics Strategy • Training for all countries involved in strategy – late 2012 • Comprehensive and rapid assessment of civil registration systems• ICD-10 training offered by QUT and online via WHO Health Information Systems Knowledge Hub | 2012
    12. 12. Cause of death certification in Fiji Dr Iris Wainiqolo, FNU• Reviewed 500 death certificates in 2011• 60% of death certificates gave information that was not useful for public planning and policy • Clinically improbable sequence of death • Mode of death or immediate cause reported• Lack of knowledge on how to complete death certificates correctly and poor understanding of ‘underlying cause-of- death’• Training provided to doctors• Handbook developed• FNU are incorporating training on death certification to their medical studentsSource: I Wainiqolo, R Rampitage, S Walker, A Aumua. 2012. Improving cause- of-death certification practices in the Pacific. Health Information Systems Knowledge Hub | 2012
    13. 13. Cause of death certification in Tonga Mr Sione Hufanga, MoH• Review of death certificates in 2011• Analysis of Annual Report • High number of ‘ill-defined’ or ‘garbage’ codes• Analysis of cause-of-death data • NCD-related deaths are three-times higher than previously estimated• Training provided to doctors• Agreement to modify death certificate to match international standards• Agreement to promote online ICD-10 training to medical interns and refresher coursesSource: K Carter, S Hufanga, C Rao, S Akauola, A Lopez, R Rampitage, R Taylor. 2012. Causes of death in Tonga, quality of certification and implications for statistics Health Information Systems Knowledge Hub | 2012
    14. 14. Thank you Health Information Systems Knowledge Hub | 2012