WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in ambulatory care in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in ambulatory care in the future.

No abstract

Background: An efficient health management information system (HMIS) improves health care delivery and outcomes. However, in most rural settings in Uganda, paper-based HMIS are widely used to monitor public health care services. Moreover, there are limited capabilities and capacity for quality HMIS in remote settings such as Kayunga district.Objectives: The quality assurance practices of HMIS in health centres (HCs) in Kayunga district were evaluated.Method: A cross-sectional descriptive study design was used to assess the quality of HMIS at 21 HCs in Kayunga district. Data were collected through in-depth interviews of HMIS focal persons as well as document analysis of HMIS records and guidelines between 15 June 2010 and 15 July 2010. The main outcomes were quality assurance practices, the HMIS programmatic challenges and opportunities. The practice of HMIS was assessed against a scale for good quality assurance practices. Qualitative data were coded and thematically analysed, whereas quantitative data were analysed by descriptive statistics using SPSS v22 software.Results: All the 21 HCs had manual paper-based HMIS. Less than 25% of HCs practised quality assurance measures during collection, compilation, analysis and dissemination of HMIS data. More than 50% of HCs were not practising any type of quality assurance during analysis and dissemination of data. The main challenges of the HMIS were the laborious and tedious manual system, the difficulty to archive and retrieve records, insufficient HMIS forms and difficulty in delivering hard copies of reports to relevant stakeholders influenced quality of data. Human resource challenges included understaffing where 43% of participating HCs did not have a designated HMIS staff.Conclusion: The HMIS quality assurance practices in Kayunga were suboptimal. Training and support supervision of HMIS focal persons is required to strengthen quality assurance of HMIS. Implementation of electronic HMIS dashboards with data quality checks should be integrated alongside the manual system.

No abstract

Background Standard treatment guidelines (STGs) are a critical public health tool for promoting rational use of medicines. No studies have evaluated alignment of STGs with medicine use indicators especially in low and-middle-income countries (LMICs) with disproportionate burden of disease and irrational medicine use. Objective To determine the level of alignment of Namibia's STGs with WHO medicine use indicators. Methods A descriptive policy analysis of alignment of Namibia's STGs and WHO medicine use indicators. Thirty-two conditions/diseases prevalent and managed at primary healthcare level were included in the study of alignment of the STGs with two WHO medicine use indicators in terms of average number of medicines/condition (polypharmacy, WHO target <2) and antibiotic prescribing (WHO target <30%) after adjusting for estimated encounters per condition. Data were analyzed using (SPSSv24 software, IBM Corporation, NY) to determine frequencies, percentages and means. Key findings Of the 32 conditions/diseases studied, 41% had three or more medicines per condition indicated in the STGs. The weighted minimum and maximum average number of medicines/condition/encounter in the STGs were 2.62 and 2.78 respectively. Antibiotics were indicated for 72% (weighted per encounter = 75%) of the 32 conditions. Conditions/diseases of the urogenital system had the highest antibiotics indicated in the STGs (100%); respiratory (80%); ENT (80%); gastrointestinal (33%) before weighting conditions for estimated patient encounters, while ENT conditions had the highest antibiotics (32%) after weighting. Conclusions Alignment of Namibia STGs and medicine use targets is sub-optimal. The STGs have a high indication of antibiotics and polypharmacy. Misalignment is the main contributor to sub-optimal medicine use indicators with respect to average number of medicines and antibiotics. Countries should review their STGs and align with medicine use indicators to enhance rational medicine use and fight antimicrobial resistance. This article provides guidance for aligning STGs with medicine use indicators.