The Department of Maternal, Newborn, Child, Adolescent Health and Ageing of the World Health Organization (WHO) convened a global consultation on the standardisation of health facility data recording and reporting forms for maternal, newborn and child health and linkages to home-based records from 17 to 19 September 2024. Representatives from ministries of health, academia, non-governmental organizations, United Nation Agencies, as well as donors attended in the meeting.
During the discussion, it was emphasized that the home-based record is one tool in the broader health information system, and it should not be viewed in isolation. Any decisions made related to the content in the facility register needs to generate a discussion about whether the information has already been included in the country’s home-based records or other reporting tools and whether the overlap is necessary.
It was proposed that WHO could develop global templates with core minimum data elements to record in home-based records for maternal, newborn and child health, which countries can adapt based on their context, objectives and epidemiology. Format and functionality considerations for digital and paper-based home-based records were also discussed, including size, privacy and accessibility issues.
As a next step, WHO proposes to standardize maternal, newborn and child health registers. Home-based record experts will remain engaged in the discussions to ensure home-based records are considered in the process.
This is a truly fantastic initiative, very much needed and very difficult, as well. While it is important to standardise registers and to acknowledge the value of Home Based Records, we need to emphasise that data is meant to inform decisions. If we agree with this, then we have to accept that collecting data that do not inform decisions is an unacceptable waste of resources.
Let’s not forget that the first and most important decisions in health care take place at the interface between health workers and users, where decisions (e.g. refer or treat a protracted labor?) can mean the difference between life and death. Hence, any information tool that does not support these decisions will likely end up obstructing them, compromising quality of care.
Anecdotal evidence suggests that large register books in tabular forms are not fit for health workers decisions: health workers do not make decisions following an endless row of data in hardly readable cells (likewise with digital tools that follow the same rationale). Other evidence suggests that the amount of time that health workers spend in collecting data could divert up to one third of their working time away from health care tasks.
We have to stop doing wrong, even if we have been wrong for decades. We need to grant power to professional designers and design ‘new’ information tools supported by a decision-making framework that puts users and health workers at the centre of it. This is possible, WHO has the capacity to lead this revolution (and some have also the vision to do it).
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