“All I want is a system that works” : evaluation of the health information system in Cape Town, South Africa – using an information audit to capture views from the grass root level

This thesis presents a study of the health information system as seen from facility level in the area of Cape Town, South Africa. During our fieldwork, we have tested, adapted and evaluated an information audit within primary health care clinics. This audit is meant to be a basis for future annual evaluation of the status of the health information system. It covers areas such as training and support of staff, use of information, feedback from higher levels, data collection process and staff’s perceptions of the information system. The thesis describes in detail the audit development process, and our recommendations to the equipment situation in health care facilities in Cape Town. In addition to the work on the audits, we conducted a thorough investigation of the status of computers and other important equipment for dealing with data and information. This work resulted in a report on the status of computers and IT-equipment in district hospitals, 24-hour units and community health centres in Cape Town. This report was requested by the provincial administration of Western Cape because of their need to budget for new equipment in the curative facilities. As we saw the benefits of this computer specification part for managers when planning and equipping their facilities in the best way, it was included as a separate part of the information audit. This thesis also includes an analysis and discussion of the results from the paper-based information audits we conducted, and this is presented as a general evaluation of the health information system at the facility level. To give a small taste of what we discovered, we found that the majority of workers at facility level, 60 % have a positive attitude towards the information system, even if the majority states that there is still room for improvements in many areas. 50 % of the facilities have no working computer. 40 % of the facility workers told us that they have not been able to make any use of the training they have received on information and computers. Only 22 % can provide examples of information usage in the facilities. As for the evaluation process, we saw the importance of keeping the questionnaires short and simple. We also found that the personnel at facility level are important pieces in the evaluation, with their closeness to the collection of data. In our opinion, the facilities should not be left out of the process, because of their important role in the health information system, even if it takes time and effort to get the views from the personnel at the grass root level