Strengthening paper health register systems: strategies from case studies in Ethiopia, Ghana, South Africa and Uganda

Abstract

H ealth information systems (HIS) include a spectrum of data collection tools that support clinical decision-making; facilitate tracking of patients, drug stock, and disease trends; and inform policymaking [1]. As intermediaries between individual patient records and population-level data, health registers occupy a unique space in HIS. Health registers are "a collection of records containing data about aspects of the health of individual persons" [2].Paper health registers can be books, folders, or forms that include individual-level data for a population. Paper registers are primarily used at the facility level, though they can serve as inputs to higher level reporting. Because they serve health providers, program administrators, and health management decision-makers, registers can sometimes fail to meet all stakeholder identified needs. Studies of paper registers frequently document data quality challenges which compromise efforts to deliver effective care.Despite the global shift toward digital data collection, there remain low-resource settings that are unable to support the infrastructure required for electronic register systems. For these settings, strengthening paper health register systems can bolster evidence-based decision-making in patient encounters, program planning and policy, and serve as a first step toward improving quality data in HIS as they shift toward electronic systems. STRATEGIES FOR IMPROVING PAPER REGISTER SYSTEMSWe developed case studies on innovations in paper health register systems in low-resource settings in Sub-Saharan Africa. The resulting studies were informed by 14 expert interviews (2-4 per study) and 101 documents, including peer-reviewed and non-peer-reviewed literature. Case studies are described in Table 1.This commentary synthesizes lessons learned from these case studies, illuminating four successful strategies for optimizing paper health register systems: support local solutions, align with global standards; collect only essential data elements; foster data use and data quality improvement; and invest in strengthening human resources. Within these strategies we identify specific, actionable recommendations that could be applied by policymakers, facility managers, health workers, or others who are interested in strengthening paper health register systems. While these recommendations may be obvious to those who work in HIS, they are not yet well-documented in the literature. SUPPORT LOCAL SOLUTIONS, ALIGN WITH GLOBAL STANDARDSMany of the challenges with registers occur when these systems are designed and implemented by outside stakeholders

Modelling hospital operations: insight from using data from paper registries in the obstetrics ward at a hospital in Addis Ababa, Ethiopia

“…Our analysis illustrates the limitations of paper-based records. Still, strategies to improve paper-based record systems have been developed by other researchers 28. In their review of paper registries in four countries, including Ethiopia, Westley et al 28 recommend that only essential data be collected and that registries be designed to fit local needs.…”

“…Still, strategies to improve paper-based record systems have been developed by other researchers 28. In their review of paper registries in four countries, including Ethiopia, Westley et al 28 recommend that only essential data be collected and that registries be designed to fit local needs. Additionally, internal systems could audit data quality and incorporate feedback from front-line users into registry design, for example 28.…”

“…In their review of paper registries in four countries, including Ethiopia, Westley et al 28 recommend that only essential data be collected and that registries be designed to fit local needs. Additionally, internal systems could audit data quality and incorporate feedback from front-line users into registry design, for example 28. Efforts to improve information systems in Mozambique and Rwanda have pursued both of these strategies 29.…”

Assessing the performance of the family folder system for collecting community-based health information in Tigray Region, North Ethiopia: a capture–recapture study

“…The FFs are stored at the local health posts, according to the identifier number for quick retrieval. In general, when taken as a unit, the FF provides a quick yet comprehensive overview of the health services a family is receiving, alongside the household’s characteristics 14 15…”

“…In general, when taken as a unit, the FF provides a quick yet comprehensive overview of the health services a family is receiving, alongside the household’s characteristics. 14 15 …”