Capacity and practical skill of health statistical staff and training needs

Nội dung text: Capacity and practical skill of health statistical staff and training needs

1. 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 3 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 – grad- uate 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. 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 con- sidered 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 frame- administration of the health sector, but also work [1], adopted by the Vietnam Ministry of those of scientific research activities, policy Health (MOH) [2], information is one import- formulation and communication on health- ant component of the health system and care for the population. The health infor- plays a vital role in the development pro- mation system consists of six components: cess of the health system. Complete, timely, resources, indicators, data sources; man- accurate and well-analyzed information not agement data; information product, dissem- only meets the needs of management and ination, and use of information [3]. Among those components, human resource devel- Corresponding author: Nguyen Phuong Hoa, Depart- opment is the utmost importance [4 - 6]. ment of Family Medicine, Hanoi Medical University Until 2012, in Vietnam, although there Email: nguyenphuonghoa@hmu.edu.vn were a number of policies from the govern- Received: 05 June 2017 ment related to health statistics and infor- Accepted: 16 November 2017 JMR 111 E2 (2) - 2018 95
2. JOURNAL OF MEDICAL RESEARCH mational activities, but so far there was no - At District level: staff from the District official document, that defines the health Preventive Medicine Centres and District statistics professional career, including the Hospitals out of 5 districts per each prov- training requirements for statistics staff. ince. 5 districts were selected by the simple Therefore, competency levels of health sta- random method. tistical personnel were also not assessed. - At Commune level: staff from random This was compounded by there not yet 5 CHCs out of each district selected. There- having a plan for human resources devel- fore, the total number of CHCs selected in opment in the health sector in Vietnam. In each province was: 5CHCs x 5 districts = order to improve better capacity, it is essen- 25 CHCs. tial to develop a detailed training program. Size of the sample Hence, to build capacity for health statistical There were a total of 104 respondents staff, there should be specific assessments - At Provincial level: of their practical skills, qualification, and + In each Department of Health (DOH) 3 training needs [7; 8]. officers were selected: 2 statistical officers Based on the above reasons, this study and 1 planning officer. was conducted with the aim to assess the + In the Provincial General Hospital, or capacity and practical skills of health statis- specialized hospitals and other health cen- tical staff, and their training needs at provin- tres at provincial level, 2 officers were se- cial, district and commune levels lected (1 statistical officer, and 1 planning officer). II. SUBJECTS AND METHODS - At District level: 1. Subjects + 3 people were selected at the District Health statistical staffs who worked in Health Centre (one general statistics staff; provincial, district and commune levels one reproductive health statistics staff; and were selected. one planning staff). + At District Hospital: 01 statistical officer 2. Methods and 1 planning officer were selected. Locations - At Commune/ ward level: only one per- This study took place in 2012 at health son of each facility(the CHC/CHS heads) facilities of three provinces Ha Nam, Bac was selected to answer the questionnaire. Giang and Bac Ninh. Each province was di- Study design vided into three levels: Cross-sectional survey using self – ad- - At Provincial level: staffs from the De- ministered mail questionnaire. partment of Health, Provincial General Data collection Hospital, Specialized hospitals, Provincial This survey used a structured question- Preventive Medicine Centers, Reproductive naire. Health Centre, and the HIV/AIDS Centre of Self-administered questionnaire was these provinces. used to collect the information on general 96 JMR 111 E2 (2) - 2018
3. JOURNAL OF MEDICAL RESEARCH demographic characteristics, qualifications; regarding the objectives of this assessment capacity in collecting, aggregating data, and and the detail of collecting information. Re- using information; and self-perceived train- spondents completed autonomy in regard ing needs of staff doing statistical works and to participation, as well as were freedom to planning in health facilities. withdraw at any stage during the interview. Health staffs participating in this survey The collected data were used only for the would complete the questionnaires under purpose of research. the direct supervision of the researchers. III. RESULTS Data processing STATA software was used for process- Human resources ing data. The assessment of the capacity of Table 1 describes the demographic analysing and using data ranged from 0% characteristics and qualifications of statisti- (“Incapable”) to 100% (“most capable”). For cal staffs in our sample. In general, the sta- convenience, we subdivided the percentag- tistical staffs were mostly over 50 years old es into four different groups: a group of peo- (44.2%). The higher the level of the facility, ple with “weak” capacity (ranging from 0% the older personnels were. For example, to 30%); a group “average” capacity (40% the province level had the highest number - 60%); a group with “pretty good” (70% - of aged staffs, accounting for 67.5%. There 80%) capacity, and a group with “good” was a reversed age model at commune lev- (90% - 100%) capacity. el with the officers over 50 years old only Regarding the assessment of statistical accounting for 9.5% of the total, while the capacities related to health information, the highest pecentage belonged to the group respondents were observed and scored of staffs from 30 to 50 years old (47.6%). In using some basic queries related to data term of gender, although the distribution of analysis. To analyze capacities related to male and female in provincial facilities were specific statistical methods, scores were quite balanced, the overall pattern leaned given to each respondent based on correct toward female of (72.1%), mostly due to responses to statistical problems. the big gap at the level of commune where 97.6% of workforce were female. 3. Ethics Respondents of this study all information JMR 111 E2 (2) - 2018 97
4. JOURNAL OF MEDICAL RESEARCH Table1. General information of the statistic personnel Province District Commune All locations Characteristic (n=43) (n=19) (n=42) (n=104) (%) (%) (%) (%) Age group < 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 Sex Male 46.1 40.8 2.4 27.9 Female 53.9 59.2 97.6 72.1 Education Statistics 4.7 5.3 0 2.9 IT-ICT 7.0 5.3 0 3.9 Med/Pharm 32.6 26.2 0 18.3 Pub.Health 7.0 5.3 0 3.9 Middle or Secondary School 48.7 57.9 100 71.0 Working time Full time 46.5 36.8 0 26.0 Part time 53.5 63.2 100 74.0 In provincial facilities, there was 51.3% proportion of staff having middle-level ed- of staff having graduate and post-graduate ucation was high, about 71.0%, while the education. However, out of the 43 people, amount of staff specializing in statistics was only 4.7% of them had graduated in statis- critically low (2.9%). Another aspect of hu- tics and only 7.0 % in ICT disciplines. Fur- man resources is working time. There was thermore, all other locations had more than no level of health facility having over 50% 50% of their statistical officers with middle or of the statistical staffs working full-time. The secondary level qualifications. For instance, most optimistic circumstance came from the district health facilities had 57.9%; at the provincial facilities, where 46.5% of their commune level, this rate was 100%. There- statistical officers did statistical activities as fore, the officers specifically competent in their main daily work. The overall survey re- managing the statistics and information sults showed that 74.0% of 104 statistical workload were very, very few. Overall, the officers responding to the questionnaires 98 JMR 111 E2 (2) - 2018
5. JOURNAL OF MEDICAL RESEARCH were part-time mainly due to the absolute Figure 1 illustrates influencing factors on rate of part-time staff at the commune level. the quality of statistical reports, in the pri- In terms of experience in health sta- mary health care system. Statistics showed tistics calculated by years, the average personnel had compromising their work number was 6. For more detail, the rate of awareness of several critical factors which three dimensions of experience, including were ranked as followings: insufficient and ≤ 4 years, 5 - 10 years, over 10 years of unstable workforce with 64.5% of respon- experience were 54.2%, 30.1%, 15.7%, re- dent agreeing that high percentages came spectively. This showed high staff turnover from lack of supervision, untrained staff in health statistics. and too many forms accounting for 56.5%, Staff performance features 50.2% and 46.3% respectively. 70 64.5 60 56.5 50.2 50 46.3 40 30 22.5 19.5 20 13.5 7.8 10 5.1 0 Figure 1. Influencing factors on the quality of reports Capacity of using ICT Figure 2 shows the situation and use of MS Access-based software and 60.7% of ICT in health information system concerning staff used software for statistical reports. data processing and software applications. Pertaining to the way of reporting data, There was a very high proportion (94.3%) most of respondents said they sent their of officers who used a computer to process reports by post, only 7.3% sent reports via data, while only 5.7% recorded data man- emails, and only 5.1% used web-based re- ually. With respect to data processing soft- porting. Further investigation suggest the ware, 70.3% of statistics personnel used situation of report submission and data ar- JMR 111 E2 (2) - 2018 99
6. JOURNAL OF MEDICAL RESEARCH chive of CHC: reports were mainly in hard ing 80%. About 70% of the total staff stored copies, (74.3%) followed by reporting via data on personal computers. Server-based official government email system account- archive only accounted for 7.9%. There ed at 5.89%; while via personal emails were 96.18% of CHCs storing data on pa- was 22.87%. Furthermore, data archive per, and of those, 22.8% also stored data on of statistical and planning personnel was their personal computers. predominantly paper based, approximat- Figure 2. 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 ca- pacity to conduct several type of data analysis. The findings are presented in Table 2. Table 2. Self assessment of capacity of analysing and using data 70 - 80% 0 - 30% 40 - 60% 90 - 100% Statement (fairly Mean SD (Weak) (average) (good) good) 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 im- 11.8 37.3 32.4 18.6 61.2 24.1 plications 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
7. JOURNAL OF MEDICAL RESEARCH 56.3% of staffs claimed that their capac- Capacity of analyzing and using ity of checking data accuracy was “fairly health statistical data good” or “good”; more than 65% considered The results were not encouraging. Many themselves able to calculate percentages respondents were not able to indicate the for interpreting data and its implications; reasons for data collection, not able to de- and rates well or fairly well but less able to scribe ways of assessing the data quality plot data by months and years. More than not able to list activities for removing the 50% considered themselves able to calcu- causes of the poor data quality. In fact, the late trends and interpret bar charts and the mean of the respondents was below one same percentages; more than 70% consid- point in four out of six queries. Moreover, ered themselves “fairly good” or “good” in the remaining two questions also received the use of the data for cost estimation; and similarly, low scores: the first question ob- 67% of the staffs “fairly good” at using data tained a mean of 1.21 points, while the last for planning. These were maybe too opti- one had a mean of 1.20. mistic results. Table 3. Assessment on statistical capacities related to health information ≤ 1 score Questions on Mean SD Max (%) Why collect data on diseases 1.21 0.74 3 62.4 Why collect data on immunization 0.91 0.74 3 78.9 Why collect population data by age groups 0.83 0.49 3 95.2 Listing at least 3 methods to check data quality 0.97 0.80 3 60.2 Defining not accurate data and their causes 0.10 0.33 1 99.0 Listing tentative activities to be implemented 1.20 0.89 10 69.2 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 4. Assessment on capacity related to specific statistical examples and calculations 0 score ≥ 1 score Statement Mean SD Max (%) (%) Capacity of calculation 0.69 0.5 1 27.5 72.5 Plot data in a bar chart 0.71 0.46 1 28.9 71.1 Interpret findings from this bar chart 0.61 0.89 6 64.4 35.6 JMR 111 E2 (2) - 2018 101
8. JOURNAL OF MEDICAL RESEARCH Infer the possible reasons for the results 0.09 0.28 1 91.4 8.6 of the example chart Training needs tively high rate of request (> 40%) were sta- Most of the staff, 84.2 %, working on sta- tistics on morbidity and mortality by ICD10, tistical information had not been trained. Out population statistics or using software for of this total, the health workers at commune data management and reporting. level accounted for the highest percentages Noticeably, there were considerable dif- of not trained, more than 90%. At the lev- ferences between levels in some training el of the province and district, the rates of needs. In regard to population statistics untrained staffs are lower, but still account and health related statistics on socio-eco- for relatively high percentages, 80% and nomic problems, commune health workers 77.8% respectively. requested to be trained at high rates (71.1% Table 5 lists 11 training topics offered by and 65.9%, respectively), while officers at statistical personnel working on three levels higher levels (25%) didn’t pay as much at- of health facilities. Among these numerous tention to these issues. Reversedly, in three demands of training, the basic statistics sub- areas as using data for evaluation, using ject was the most needed, about 77%, and management software and evidence based also the highest proportions of demand at planning, statistical personnels in provincial all three levels. Next requested topics were and district health facilities demanded re- synthesizing report and data interpretation, markably more than their colleagues at the (60.4%) and using data for evaluation and commune level. analysis (48%). Several topics with a rela- Table 5. Training needs recommended by staff Province District Commune All location No Training topics (n = 43) (n = 19) (n = 42) (n=104) 1 Basic statistics 77.2 65.3 81.5 76.8 Population statistics related to 2 24.1 26.4 71.1 43.5 health Statistics on morbidity and mor- 3 44.6 35.9 50.8 45.5 tality by ICD10 Statistics and nutrition and life- 4 14.1 13.7 42.1 25.3 styles Synthesizing report and data 5 58.5 49.9 67.1 60.4 interpretation Statistics on workforce and health 6 37.9 24.4 59.1 44.0 services 102 JMR 111 E2 (2) - 2018
9. JOURNAL OF MEDICAL RESEARCH Health related statistics on eco- 7 25.1 18.2 65.9 40.3 nomics, society, and environment Using data for evaluation and 8 67.3 45.1 28.4 47.5 analysis 9 Evidence based planning 57.8 41.5 25.6 41.8 10 Basic IT knowledge 39.6 39.9 31.2 36.3 Using management and reporting 11 58.0 47.3 23.7 42.2 software IV. DISCUSSION This study provides useful statistics to Many staffs of higher age working in statis- assess thoroughly the current situation of tics are not willing to improve their capacity Vietnam's health information system, pa- and are often committed to the outmoded ticularly the practical capacity of statistical ways of collecting, analysing and reporting staff at primary health facilities. information [11]. With increasing challenges Situation of human resources in the healthcare area, information relating There was a reverse pattern in the age to health is increasingly complicated, and of staff between commune level and the if the statistical officers are not trained to higher level health facilities. While at prov- meet these demands, there will be a messy ince and district level, about two third of meaningless pile of data. statistic personnels were over 50 years old, In terms of sex, there was no significant those at commune level were mostly young. disparity between male and female at prov- This finding was similar to some previous ince and district level, but at the commune reports [9; 10]. This could be explained level, very few males did statistical work. differences in the main daily tasks of the This phenomenon may come from the mo- workforce. While at the commune level, due bilization of CHC/CHS staffs mentioned to lack of human resource, statictical staff above, where many are female officers. had to do other missions. It created the In recent years,the qualification of staff demand of young people who were better working on statistical information has im- poised to accomplish all activities. On the proved but this process has been slow other hand, officers working in provincial or [2]. Until now, the majority of the statistical district facilities professionally practiced sta- workforce (71%) only had middle or sec- tistical activities as their main task, so expe- ondary school qualification, very few have rienced staff were needed. This trend was attended statistical training courses. Drasti- also similar to some previous studies [1; cally, at commune level, there was not any 11]. To some extent, the high rate of aging statistical personnel having graduate train- statistical personnels may affect negative- ing and this influenced directly the quality ly the quality of health information reports. of the report due to insufficient professional JMR 111 E2 (2) - 2018 103
10. JOURNAL OF MEDICAL RESEARCH capacity. Moreover, the number of statistical may mark higher may be due to their fear of experience years of our sample was quite being judged as not capable, a risk to their low, below 4 years. This is another negative promotion, more alarming was when approx impact on the quality of their work. In order 60% of respondents scored below 1 point in to well perform, not only are education qual- queries on health statistical data. Moreover, ifications necessary, but also necessary when the practical skills of respondents are the experience and skills in collecting were tested by concrete problem, in spite of and processing data. Normally, staff having favorable self-assessments more than 60% many years of experience can acquire the of participants weren’t able to explain the expertise to collect, process, analyse data. findings and few people could interpret the Capacity of statistical workforce chart they had just drawn. As seen, the sta- Pertaining to the ability of using ICT, tistical staff were still weak at data interpre- similar to findings from some other authors, tation [11; 13]. It is supposed that the health this study found that despite the high rate statistical information had not been applied of computer and software usage for pro- effectively and comprehensively, therefore, cessing data, few individuals processed in- the meanings of these documents were not formation through internet and web-based paid much attention to. As a result, statistical reporting and data storing service [7; 11 - staff only imitate others’ experience to finish 13]. This limitation can be clarified by some the required reports without any willingness following reasons. According to the existing to explore the data or improve themselves regulations, leaders of health facilities must in applying the findings effectively. duly sign and stamp all reports to guarantee Training needs the legality of the document, consequent- A small proportion of staff working on ly, reports sent by emails were not legally statistical field had been trained. This sit- accepted. In addition, only health facilities uation is similar findings in some previous signing up to Government Gateway Sys- surveys [1; 4; 11]. From above discussed tem have Electronic mail boxes, the rate shortcomings, it is really urgent to focus on of those still now only accounts for 10.6%, training of health statistical staff. To make resulting in the low use of internet for report- this step effective, training should begin at ing statistic data [3]. Moreover, the majority the most practical demands. A lot of topics of aged staffs as discussed above struggled were listed. However, training basic statis- to learn how to use the internet, especially tics was the most wanted, then followings the online applications. were topics on data interpretation, synthe- With regards to the capacity of analys- sizing report and skill to use ICT. Similar ing and using data, about two third of re- recommendation were also stated in sev- spondents self-assessed to be fairly good eral other studies [7; 14]. On further anal- or good at almost all types of data analysis ysis each level, there was a discrepancy in and use. This was an overestimation. Why priority need between commune level and staff filling in the questionnaires themselves higher level facilities. As discussed above, 104 JMR 111 E2 (2) - 2018