District Health Management

Information System (DHMIS)

Standard Operating Procedures:

Facility Level
November 2012

A Long and Healthy Life for All South Africans

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 FOREWORD BY THE DIRECTOR-GENERAL

In July 2011, I approved the District Health Management

Information Systems (DHMIS) Policy for South Africa, which
is aimed at ensuring uniformity in the implementation of
the DHMIS across the country. I also indicated then, that
a need exists for the development of Standard Operating
Procedures (SOPs), to guide the implementation of the
policy.
This document sets out SOPs for the DHMIS policy, for
use by health facilities, which are the first level of interaction between community
members and health services. Health facilities are therefore the first point of
data collection and the level at which data quality must first be improved. Health
facility SOPs have thus been prioritised for publication. These SOPs seek to achieve
standardisation in data collection, capturing, collation, storage, analysis and
transmission to other levels of the health system. Related SOPs have been produced
for other levels of the public health sector namely: Health sub-districts; districts;
provinces and the National DoH.
These SOPs present basic and practical steps to be followed by health care providers
and health information management personnel to ensure that data is appropriately
handled and used to improve service delivery at local level, prior to submission to
the next level of the health system, within the specified time frames. An E-Tool has
also been developed to facilitate daily capturing and collation of data, which avoids
the “month-end rush” for submission of health facility data.
The long-term vision of the National DoH is the creation of a national integrated
patient-based information system, which will require implementation of electronic
systems for data management at all levels of the health system. This will eliminate
most of the challenges that emanate from manual data management systems,
including discrepancies. Notwithstanding this, the need for policies and SOPs will
exist even in an environment of automation and electronic information systems.
All health facility managers in the public health sector should ensure implementation
of these SOPs. They must be assisted in this role by information officers from health
sub-districts; districts; provinces and the National DoH.
I wish to acknowledge the pivotal role of the Health Information Task Team of the
National DoH, which I established in August 2010, in effectively facilitating and co-
ordinating the development of these SOPs. This team consists of officials from the
Health Information Management and Monitoring and Evaluation (HIMME) Cluster
of the National DoH; provincial Departments of Health, our development partners,
as well as non-governmental organisations (NGOs) working in the health sector.
The immense technical support provided by the John Snow Incorporated/Enhancing

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Strategic Information (JSI/ESI) Project; Health Information Systems Programme (HISP)
and the Health Systems Trust (HST) is acknowledged with gratitude.
I anticipate major improvements in the quality of DHIS data as a result of effective
use of these SOPs.

___________________________________
MS. MP MATSOSO
DIRECTOR-GENERAL
NATIONAL DEPARTMENT OF HEALTH
DATE: 19.11.12

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LIST OF ABBREVIATIONS

ART Antiretroviral Therapy

CHC Community Health Centre
DG Director-General
DHER District Health Expenditure Review
DHIS District Health Information System
DHMIS District Health Management Information System
DHP District Health Plan
DoH Department of Health
ETR Electronic Tuberculosis Register
HIS Health Information System
HOD Head of Department
ICT Information and Communication Technology
IT Information Technology
M&E Monitoring and Evaluation
NDoH National Department of Health
NHISSA National Health Information Systems Committee of South Africa
NIDS National Indicator Data Set
OPD Outpatient Department
PHC Primary Health Care
PIDS Provincial Indicator Data Set
PQRS Provincial Quarterly Reporting System
QRS Quarterly Reporting System
SOP Standard Operating Procedure

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DEFINITIONS

TERMINOLOGY OPERATIONAL DEFINITION

Accuracy Also known as validity. Data is measured against a referenced source
and found to be correct. Accurate data minimize error (e.g. transcrip-
tion error) to a point of being negligible
Completeness Data are present and usable and represent the complete list of eli-
gible sources and not just a fraction of it
Confidentiality Assurance that data will not be disclosed inappropriately and treated
with appropriate levels of security
Data Raw, unprocessed numbers
Data collation The process where data for a data element from various service
points are added together. It is very important to ensure that during
this process the responsible person add the data correctly together
and avoid arithmetic errors
Data input This refers to the final form which will be used to enter the data into
forms the relevant database
Data sign off Data sign off refers to the process where the person with the re-
quired authority agree to the correctness and validity of the data and
commits him or herself to submit data in accordance with data flow
guidelines
Indicator A quantitative or qualitative variable that provides a simple and reli-
able measurement of one aspect of performance, achievement or
change in a program or project
Information Processed or analysed data that adds context through relationships
between data to allow for interpretation and use
Integrity System used to generate data is protected from deliberate bias or
manipulation or loss of
Precision Data has sufficient detail and is free as far as possible of error in
terms of under and/or over reporting
Reliability Data generated by an information system is based on protocols and
procedures that do not change according to who is using them or
how often they are used. Data is measured and collected consistently
Service point Reporting units within a facility e.g. consultation rooms, services
within facility (OrgU6)
Source point Facility level e.g. hospital, PHC clinic, delivery facility (OrgU5 levels)

Timeliness Data and information is available on time for meeting budgeting,

monitoring, decision making and reporting requirements
Users of data Stakeholders who are authorised to access and use data in DHIS for
monitoring, evaluation, research and reporting purposes

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CONTENTS
FOREWORD........................................................................................................................1
LIST OF ABBREVIATIONS......................................................................................................3
DEFINITIONS.......................................................................................................................4
1. Introduction...................................................................................................................6
1.1 Purpose.........................................................................................................................6
1.2 Scope............................................................................................................................6
1.3 Training.........................................................................................................................6
1.4 Background...................................................................................................................6
1.5 Principles.......................................................................................................................6
2. DATA/INFORMATION MANAGEMENT..............................................................................8
2.1 Responsibility.................................................................................................................9
2.1.1 Health Facility Receptionist/Patient Registration Staff Responsibilities..........................9
2.1.1.1 Procedure: Health Facility Receptionist/Patient Registration Staff..............................9
2.1.2 Health Care Provider Responsibilities............................................................................10
2.1.2.1 Procedure: Health Care Provider................................................................................10
2.1.3 Data Capturers Responsibilities...................................................................................11
2.1.3.1 Procedure: Data Capturer........................................................................................12
2.1.4 Health information officer responsibilities ................................................................13
2.1.4.1 Procedure: Health Information Officer......................................................................16
2.1.5 Facility Manager’s responsibilities...............................................................................14
2.1.5.1 Procedure: Facility Manager.....................................................................................18
3.REFERENCE DOCUMENTS..............................................................................................20
4. ANNEXURES...................................................................................................................21
4.1 Facility Headcount Tick Register......................................................................................22
4.2 Reception Headcount Tick Register Summary Form.....................................................23
4.3 Data Summary Form (Daily, Weekly or Monthly)................................................................24
4.4 Monthly Data Input Form............................................................................................25
4.5 Facility Data Sign-off form...........................................................................................26

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1. INTRODUCTION
1.1 Purpose
This document provides Standard Operating Procedures (SOPs) to ensure appropriate data
and information management at health facilities.
1.2 Scope

These Standard Operating Procedures are mandatory and shall be implemented by all
employees and contractors when engaging in health information related activities for
Department of Health facilities. These SOPs must be used in conjunction with the following:
• DHMIS Policy 2011
• National Indicator Dataset (NIDS)
• Reference Documents listed in page 20

1.3 Training
The Facility Manager must ensure that team members who follow these procedures
understand these Standard Operating Procedures’ objectives and other inter-related activities.

Facility Manager must ensure that team members sign that they have read and understand
these SOPs.
1.4 Background
In terms of the National Health Act (Act 61 of 2003) the National Department of Health
(NDoH) is required to facilitate and coordinate the establishment, implementation and
maintenance of health information systems at all levels. The District Health Management
Information System (DHMIS) Policy 2011 defines the requirements and expectations to provide
comprehensive, timely, reliable and good quality routine evidence for tracking and improving
health service delivery. The strategic objectives of the policy are to strengthen monitoring
and evaluation (M&E) through standardization of data management activities and to
clarify the main roles and responsibilities at each level for each category of staff to
optimize completeness, quality, use, ownership, security and integrity of data.
In 2000 the District Health Information System (DHIS) was adopted as the official South
African routine health information system for managing aggregated routine health service
based information. These Standard Operating Procedures aim to clarify the responsibilities
and procedures for effective management of aggregated routine health service data.
In October 2012 the DHIS eTool for daily data capturing at health facility level was implemented
to reduce professional time spent on manual calculations and human error. Facilities where
daily health service data is captured, continue to capture data for some aspects such as
supervisor visits, drug stock-outs and clinical work load monthly.

Activities specific to daily health service data capturing are displayed in green text
where relevant in the document

1.5 Principles
The following principles should be kept in mind when these SOPS are implemented:

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1. Health service data to be captured into the DHIS are collected by means of bound Tick
Registers. The cover page of each Tick Register should have space for the following:
• Facility name (as in DHIS), year and register number (Tick Register number starts
on 1 April and ends on 31 March of the following year )
• Start date of register
• End date of register
• Register pages must be numbered
2. Facilities using Reception Headcount Tick Registers should use these headcount figures
to verify headcount figures collated from the Health Care Provider Tick Registers.
3. Data collection tools and processes for mobile and satellite clinics as well as health posts
and outreach teams must be managed in the same manner as those for fixed facilities.
Summary forms must be submitted to the manager of the ‘parent’ fixed facility to be
captured into the DHIS as level 6 organisational units where applicable.
4. Some facilities employ data capturers to enter data into electronic patient based
monitoring tools as those for ART and TB. Specific SOPS have been developed to
guide data capturing into each of these systems and are therefore not covered in this
document. Facilities capturing data into these systems must have copies of these SOPS
and adhere to them.
5. The following are crucial for monitoring and optimising data quality:
• Standardised activation of relevant data elements of each health care facility
• Standardised use of 0 (zero) reporting irrespective of the DHIS capturing level
(facility or sub-district) or frequency (daily or monthly)
• Audit readiness
6. All patient clinical records, data collection and collation tools must be stored in a secure
facility on a daily basis

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2. DATA/INFORMATION MANAGEMENT
This data flow diagram provides the timelines to ensure that the 45 day deadlines for routine
data submission to NDoH is met.

MONTHLY ROUTINE DATA REPORTING FLOW DIAGRAM

FACILITY LEVEL
DAILY WEEKLY MONTHLY
1. Collect data during each • Interim aggregation and • 1st: Validate clinician/service
patient/client contact validation point summary to facility
2. Validate data manager
3. Caculate sub-totals • 5th: Validate facility
4. Capture data (selected summary submitted for
facilities capturing
• 10th: Facility level cap-
turing, validation and
export to sub-district level
completed

SUB-DISTRICT LEVEL
MONTHLY 20 Sub-district level captur-
th:
Feedback in five days down to
ing, import, validation and facility level
export completed

DISTRICT LEVEL
MONTHLY 30th: District level import, vali- Feedback in five days down to
dation and export completed sub-district level

PROVINCIAL LEVEL
MONTHLY 45 days after Provincial import, Feedback in five
reporting period validation and export days to district level
completed

NATIONAL LEVEL
MONTHLY 50 days after National import, vali- Feedback 60 days
reporting period dation and saving on after reporting pe-
server completed riod to provinces

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2.1 Responsibility
2.1.1 Health Facility Receptionist/Patient Registration Staff Responsibilities
Some large facilities have dedicated reception staff, but all staff providing a service to patients
is responsible for the procedures relevant to patient clinical records and facility headcounts.
2.1.1.1 Procedure: Health Facility Receptionist/Patient Registration Staff

Step Action

ON A DAILY BASIS THE HEALTH FACILITY RECEPTIONIST/PATIENT REGISTRATION STAFF IS ACCOUNT-

ABLE FOR THE FOLLOWING:

Each facility should have an identified area where patients are received and patient
clinical records are filed and issued
1
Draw patient clinical records from the filing facility or issue new patient clinical
record

Double check whether a clinical patient record is available before a patient is regis-
2
tered as a new patient to prevent duplicate patient records from being issued

No patient should be seen by a health care provider without a clinical record except
3 in emergencies
The clinical record must be issued as soon as possible in these exceptional cases
Record the visit as a headcount each time a patient presents to the facility for any
4 service in the Reception Headcount Tick sheet (reflected in Annexure 4.1) before
the patient clinical record is handed to health care provider

Count each patient as a headcount once each day, regardless of the number of
5
services provided to the individual at the facility
Start each day with a new page of the Reception Headcount Tick Register
In small facilities where not many patients are seen, one line in the Reception Head-
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count Tick Register can be left open after totalling that day’s headcount
The new date can be written in the middle of the next row
Ensure that no patient clinical record leave the facility
If a patient is transferred to another facility a letter of transfer and copies of rel-
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evant records should accompany the patient to the referred facility
The original patient clinical record remains in the referral facility

8 Make follow up appointments for patients and provide appointment cards or dates

Adding and double checking sub-totals at the bottom of each Reception Head-
count Tick Register

9 Storing the Tick Register in a locked facility

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 Step Action

ON A WEEKLY BASIS THE HEALTH FACILITY RECEPTIONIST/PATIENT REGISTRATION STAFF IS AC-

COUNTABLE FOR THE FOLLOWING:

Completing and double checking the weekly Reception Headcount summary sheet
10
(reflected in Annexure 4.2)
Entering the daily totals of the Reception Headcount Tick Sheet into the weekly Re-
11 ception Headcount summary sheet. Add and double check the weekly Reception
Headcount summary sheet

ON A MONTHLY BASIS THE HEALTH FACILITY RECEPTIONIST/PATIENT REGISTRATION STAFF IS AC-

COUNTABLE FOR THE FOLLOWING:

Entering the weekly totals of the weekly Reception Headcount summary Sheet
into the monthly Reception Headcount summary sheet. Add and double check the
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monthly Reception Headcount summary sheet and submit to the facility manager
on the 1st day of each month
Filing and storing the daily Reception Headcount Tick Register, weekly and monthly
summary sheets and a copy of the Data Input Form completed by facility manager,
in a locked facility for monitoring and auditing purposes
13 Filing should be done on the same day as when Tick Register and input forms have
been completed to prevent loss of records, data collection tools and information
The day, month and year must be clearly written on each Tick Register and filed in
order from the latest date on top

2.1.2 Health Care Provider Responsibilities

Health care providers (nurses, doctors and other health professionals) are responsible and
accountable for ensuring high quality data in individual patient clinical records and on their
own routine data collection and collation tools. These data collection tools are mainly DHIS-
generated Tick Register and standardised registers.

It is essential that all health care providers write clearly and legibly on all
data collection tools

2.1.2.1 Procedure: Health Care Provider

Step Action
1 RECORDING OF DATA ON DATA COLLECTION TOOLS:

ON A DAILY BASIS THE HEALTH CARE PROVIDER IS ACCOUNTABLE FOR THE FOLLOWING:

1.1 Record individual patient data in the facility retained clinical records and if relevant, in the
patient retained records (e.g. Antenatal cards and Road to Health charts) during or directly
after each patient contact. A copy of patient retained records must be retained in the
health facility
Use only standardised abbreviations in clinical patient records

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 Step Action
1.2 Record required data in line with NIDS definitions in the standardised Tick Register during
or directly after each patient contact

1.3 Indicate the patient file number clearly on the standardised Tick Register for patient fol-
low- up and auditing purposes
1.4 Double check that all the correct data elements and the correct columns were ticked for
health care interventions provided to patients
1.5 In the absence of dedicated data capturers, patient data from clinical record must be
transferred into program –specific longitudinal registers such as the ART and TB registers
at least by the end of each day

2 COLLATION OF DATA ON TICK REGISTER

2.1 Calculate, capture and sign daily sub-totals clearly

DAILY CAPTURING: Submit for daily DHIS capturing in relevant facilities
File and store Tick Register in a locked facility ( if there is no data capturer who can collect
it)
ON A WEEKLY BASIS THE HEALTH CARE PROVIDER IS ACCOUNTABLE FOR THE FOLLOWING:

2.2 Complete and sign the weekly Tick Register summary form
File and store weekly Tick Register summary in a locked facility

ON A MONTHLY BASIS THE HEALTH CARE PROVIDER IS ACCOUNTABLE FOR THE FOLLOWING:

3 COLLATION OF DATA IN THE STANDARD REGISTERS

3.1 The manager of the service point or a designated person must add the totals for each data
element in the standard registers on the first day of each month to get a monthly total for
the previous month
DAILY CAPTURING: Verify and sign monthly service point summary extracted from the
DHIS and submit to the facility manager
3.2 A line must be drawn after the totals for the month to indicate clearly when it was totalled

3.3 Copy the totals in the registers onto the Tick Register summary form (reflected in Annex-
ure 4.3) to be submitted to the facility manager on the 1st day of each month

2.1.3 Data Capturers Responsibilities

Data capturers, also referred to as data officers, are responsible for capturing data and then
forwarding the data to the next level.
Data capturers must spend 100% of their work time on the data-related
responsibilities stipulated below.

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2.1.3.1 Procedure: Data Capturer

Step Action

ON A DAILY BASIS THE DATA CAPTURER IS ACCOUNTABLE FOR THE FOLLOWING:

1 COLLATION OF DATA

1.1 DAILY DATA CAPTURING: Collect Tick Register completed by health care providers per
service point and capture into the DHIS
Conduct rapid data quality assessment on Tick Register before capturing – indicate captur-
ing date and sign
Run absolute validation per service point and verify data with health care provider
Follow up any discrepancies with relevant service point / health care provider
Please note:If daily capturing on DHIS is implemented it is not required to collate data on
weekly basis

1.2 If data cannot be captured into DHIS at the facility the Tick Register must be collected and
summarised
Follow up any discrepancies with service point
Store Tick Register in locked facility

ON A WEEKLY BASIS THE DATA CAPTURER IS ACCOUNTABLE FOR THE FOLLOWING:

1.3 Complete and sign the weekly Tick Register summary form (reflected in Annexure 4.3)
Store weekly Tick Register summary form in a locked facility

ON A MONTHLY BASIS THE DATA CAPTURER IS ACCOUNTABLE FOR THE FOLLOWING:

1.4 Complete and sign monthly Tick Register collation form and submit to facility manager on
the 1st day of each month

DAILY DATA CAPTURING: Extract monthly summary from DHIS and submit to facility
manager for sign off

1.5 File the daily, weekly, monthly Tick Register summary forms together with a copy of the
Data Input form (reflected in Annexure 4.4) completed by the facility manager in a locked
facility

2 CAPTURING OF DATA INTO DHIS

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 Step Action

Obtain validated Data Input forms from the facility manager on all data sets on the 7th of
each month if data is provided on hard copies (paper based):
• Monthly data capturing: Conduct a rapid data quality assessment of data on data
input forms – must be 100% complete and should contain no gaps or outliers without
comments
• Capture monthly data into the DHIS
• Indicate date of capturing on each monthly data input form and sign
• Run Min/Max range violations, Absolute validation and Statistical Validation reports
on data
• Run Standard Reports on data for outstanding input forms, routine raw data reports
and ad hoc reports
• Follow up any discrepancies found in data with facility manager and keep record of
follow up date and person
• Verify that facility manager made the appropriate corrections on the data input form.
A line should be drawn through the incorrect value and the new value should be writ-
ten. Changes are to be initialled and dated. No correction fluid is to be used. The entire
data trail back to the initial service point must be corrected
• On receiving feedback from the facility manager, correct the values in DHIS and send
2.1
updated reports and pivot tables to the facility manager to sign off the data
• Export data to Data Mart and refresh pivot tables – compare data in pivot tables with
that on summary forms. The following is crucial in this process:
o Save existing standard pivot tables with a different name(for example add date)
before exporting to Data Mart
o Empty the Data Mart, do a full export to Data Mart and then refresh the standard
pivot tables
• Obtain sign-off from the Facility Manager of the data
• Attach following DHIS reports to sign-off form as proof of data quality:
o Data entry validation report
o Min/Max violations
o Outstanding input forms
o Pivot table of raw data
• Export data on all NIDS data elements and send export file to sub-district or district
level (as relevant) before the 10th of each month
• Ensure that back-ups are made every time data is changed
• File records needed to meet monitoring and audit requirements and store safely in a
locked facility

2.1.4 Health information officer responsibilities

Health Information officers should be progressively appointed at fixed facilities (clinics,

community health centres and hospitals). They are responsible for data quality assurance and
encouraging local use of information.

If there are no data capturers at the facility the health information officer is responsible for
the same procedures as relevant for data capturers.
Information officers/managers must spend 100% of their time on the data/information-
related activities stipulated below.

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2.1.4.1 Procedure: Health Information Officer

Step Action

1 Develop a health information plan specifying:

• Information needs of all stakeholders at service points
• Reporting processes
• Areas for improvement
2 Provide DHIS generated data collection tools (Tick Register) and collation/monthly sum-
mary forms for different service points to optimise data quality and minimise data errors

3 Monitor standardised use of 0 (zero) reporting

STANDARDISED USE OF ZERO (0)
• Only NIDS (and standardised province or district-specific) data elements, for which
services/interventions are provided routinely at a specific facility, should be activated
for capturing into the DHIS. DHIS auto-generated Tick Registers and Monthly Sum-
mary forms will then contain only the relevant data elements for collection, collation
and capturing. For example, the data element delivery in a PHC facility should not be
activated for mobile and satellite clinics and should therefore not appear on the data
collection and collation forms for these types of facilities.
-- Allocation of elements to facilities should be standardised as far as possible
-- Only information officers/managers with administrative rights should be al-
lowed to activate/change activation of elements for capturing
-- Allocation/activation of data elements should be exported to sub-district or
district levels as relevant to the facility
• A 0 (zero) should be captured for all activated elements if no activities/interventions for
the specific element took place during the reporting month.
• If a specific routine activity did not take place due to a specific reason (for example
children were not weighed because the scale was broken) capture a 0 (zero) with a
comment.
• If a PHC facility has not functioned at all during a specific month, capture a 0 (zero)
for PHC headcount and add a comment explaining the reason why no services were
provided (for example mobile broken, the only Professional nurse was sick etc.)
• If a delivery facility has not functioned at all during a specific month, capture a 0 (zero)
for delivery in facility and add a comment explaining the reason why no services were
provided (for example renovation etc.)
• NO BLANKS should be left on the monthly summary form or data capturing screen
without a tick and a comment.
• Information officers must monitor data elements to be de-activated to minimise the
capturing of 0 (zero)
• Inappropriate 0 (zero) must be corrected at data capturing level like all other data
value changes.
• Hospitals that do not provide caesarean sections every month should be reclassified
in the DHIS (for data management and monitoring purposes) as CHCs and the data
element caesarean section in facility should be de-activated for capturing. If a hospital
is not doing caesarean sections temporary (for example if there was no doctors for a
specific month or the theatre is renovated) a 0 should be captured with a comment
indicating the reasons.

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 Step Action

3 Data elements that should not be activated for capturing

The following data elements should not be activated for capturing because services are
not routinely provided and/or specific incidences (such as deaths) do not occur in these
facilities regularly.
• Mobiles, Satellite clinics and health posts
o Delivery-related
o Mortality/death-related
o Inpatient and OPD-related
o ART treatment-related EXCEPT if the facility is an approved ART site
o Doctor clinical work days EXCEPT if the facility is routinely visited by a doctor at
least once a month
• Clinics
o Delivery-related EXCEPT if the clinic provides daily delivery services
o Mortality/death-related
o Inpatient and OPD-related
o ART treatment-related EXCEPT if the facility is an approved ART site
o Doctor clinical work days EXCEPT if the facility is routinely visited by a doctor at
least once a month
• Community Health Centres
o Mortality/death-related EXCEPT:
 Still births, early and late neonatal deaths, deaths under 1 and deaths under 5
 Maternal deaths, if they do more than 100 deliveries a month. Because small
delivery facilities do not often have maternal deaths, the element should only
be
activated when a maternal death occurred
o ART treatment-related EXCEPT if the facility is an approved ART site
• Hospitals
It should be kept in mind that most OPDs provide ambulatory services similar to PHC facili-
ties and must report on most PHC/ambulatory NIDS elements.

Data elements that may cause confusion

• Supervisor visit this month – capture only a 1 if one or more documented supervisor
visits took place during the reporting month (which means yes) or a 0 (zero) in case of
no documented visits (which means no)
4 Provide staff who collect data with training on data elements to be collected and tools to
be used to collect data as well on how to analyse their own data
5 Check quality of data captured by data capturers

6 Discuss discrepancies in captured service point data with manager

7 Provide feedback on data quality and performance to all service points

8 Presentation of analysed facility information to management team meetings

9 Identify data quality problems and develop data quality improvement plan to address
identified problems

10 Recalculate min/max values after the last month of the financial year’s data is in the DHIS
system to establish the values relevant for the next financial year in consultation with facil-
ity manager and service point managers

15
 Step Action

11 Import DHIS files from service points on relevant d-date according to data flow diagram if
data is captured on DHIS at that level
• Check whether all DHIS datasets have been received and follow up outstanding export
files
• Import data from electronic patient-based registers/systems such as ETR.net and TIER.
net
• Conduct import validations
• Ensure that detail is correct when updating existing records, accepting new records
and matching records
• Ensure that back-ups of the data are made every time it is changed
• File records needed to meet monitoring and audit requirements and store safely in a
locked facility
12 Make pivot tables available to relevant service point managers at facility by means of
hard copies, emails or intranet.

13 Prepare Data Quality Pivot tables and reports on quarterly basis and make available to
relevant service point managers at facility level

14 Keep submission logs for monitoring adherence to reporting timeframes and identification
of bottlenecks for remedial action

15 Analyze DHIS data and provide feedback:

• monthly feedback within 5 days after the export date to facility manager and
service points by means of updated graphs on selected indicators and display it in the
facility
• quarterly input to facility review meetings on data quality (emphasising timeliness
and completeness) and program performance with recommendations to optimise
data quality
16 Update antivirus software daily or at least weekly (crucial for data security purposes)

2.1.5 Facility Manager’s responsibilities

The provider-patient interaction at the health facility is the foundation for effective and
efficient routine health information management. If health facility data submitted for
capturing into the DHIS is of poor quality, evidence-based management decisions are
compromised at all levels.
The health information management, monitoring and reporting responsibilities of health
facility managers are similar at all types of facilities and these focus on the management of
high quality information that must be used to:
• optimise patient care
• optimise public health and the health status of the population
• optimise performance of health programs and the healthcare system
• improve data quality
• monitor, evaluate and report on performance against all legislated plans in the health
sector

16
2.1.5.1 Procedure: Facility Manager

Step Action

Provide sufficient resources for routine health information management:

• Stationery such pens, rulers, carbon paper, calculators and staplers
• Filing cabinets, files and an effective filing system
• Telephones and fax machines
• Up-to-date pivot tables, graphs and reports on data quality and program perfor-
mance
1 • Definitions of data elements and indicators
• Data collection tools (Tick Register, standardised registers, summary forms and
Data Input forms
Mobilise for further resources (staff, hardware and software, email and internet connec-
tions) according to national guidelines as outlined in Generic Standardised Operating
Procedures

Include data management, monitoring and reporting in performance contracts and job
2
descriptions of all managers

Ensure training on data elements, data quality assessment and data use for all staff
responsible for data collection and collation and managing service points
3
Ensure that all new staff are orientated on health information management system in
the facility

Compile a patient and data flow plan for the facility indicating where patients are
4
received and headcounts are done and where service points are

Oversee, lead and support effective and efficient data collection, management and use
on:
5 • Patient visits and care/interventions provided
• Clinical work days and supervision visits
• Stock and equipment

17
Step Action

Optimise DHIS data quality and use by means of:

• Spot checks weekly on:
o Patient clinical record reviews (10 records per month)
o Verification that data in registers and on summary forms correlate
o Filing practices for clinical records and data collection tools as required for data
verification and audits
• Keep dated and signed records on spot checks done
• Hard copies of data collection tools kept for a minimum of three (3) years
• Establish an information committee/team for the facility to discuss data before it is
send to the next level, assess data quality and promote an information culture in
the facility
• Complete monthly facility Data Input form (refer Annexure 4.4) in duplicate by the
7th of the month for data to be captured into DHIS
• Validate data on monthly Data Input form before submitting it for capturing
6 • Ensure that data quality report and pivot table of raw data is received from health
information officer or data capturer
• Follow up on feedback from the health information officer/data capturer and make
corrections. If changes to the data are required it should be made on all the sheets
to indicate that the totals have changed. Draw a line through the incorrect value,
write in the new value. These changes are to be initialled and dated. No correction
fluid is to be used. Ensure the entire data trail back to the initial collection point is
corrected
• Ensure that the validation rules that were violated are corrected or commented on
and that feedback on violations are given to the sub-district/sub-structure/district
office
• Ensure that outliers are commented on
• Ensure that updated data quality reports and pivot table of raw data is received from
the health information officer/data capturer after corrections were made in the DHIS
• Submit corrected signed-off Data Input form to health information officer/data cap-
turer and ensure that a duplicate is filed in the facility
Provide monthly feedback to facility staff with regard to:

7 • Data quality – timeliness, completeness and accuracy of data

• Program-related indicators highlighting good performance and service delivery
shortcomings
Analyze, interpret and use information for remedial interventions to optimise pa-
tient care and facility performance
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Develop action plans in collaboration with facility staff for indicators that reflect poor
performance

Sign off on additional indicators and data elements collected for purely local use using
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Facility Data Sign-off form (reflected in Annexure 4.5)

10 Ensure that facility is ready for an audit at all times

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A facility is ready for an audit when:
• All internal policies and procedures documents are available and are implemented
• Each patient has only one patient folder/clinical record and file is available in the
facility at all times (proper filing system)
• Information recorded on data collection tool (Tick Register, standard register or
patient based software application) are consistent with patient folder and supporting
documentation
• Where applicable all patient records are captured on electronic databases, e.g.ETR.
net, TIER.net,
• Information recorded in DHIS is consistent with data input forms
• All data input forms applicable to the facility have data collected for and are captured
in the DHIS
• All data collection tools used for collection of data by institution have been reviewed
for quality and have been signed off by the health care provider who collected the
data
• All registers must be reviewed for quality and have been signed off by the facility
manager
• All validation errors are corrected or explained
• All outliers are explained
• Processing of data updates is done correctly
• All sign off forms are properly completed and signed off by the facility manager

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3. REFERENCE DOCUMENTS

Individuals using these procedures should become familiar with the following documents:

3.1 DHMIS Policy, National Department of Health, 2011.

3.2 National Health Act (Act 61 of 2003): Commencement Section 53 of the National
Health Act, 2003.
3.3 PHC Supervisory Manual, National Department of Health, October 2009
3.4 Promotion of Access to Information Act (Act 2 of 2000): GN 585, Government
Gazette 26332, 14 May 2004.
3.5 Public Audit Act of 2004 (Act 25 of 2004): Government Gazette Vol 474, Cape
Town, 20 December 2004 No. 27121.
3.6 Public Finance Management Act (Act 1 of 1999): Public Finance Management
Amendment Act (Act No. 29 of 1999).
3.7 Statistics Act (Act 6 of 1999): Government Gazette Vol. 406, Cape Town 21 April
1999. No. 19957.
3.8 Treasury Regulations: Government Gazette, Vol. 500, Pretoria, 20 February 2008,
No. 29644.

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4. ANNEXURES

4.1 Facility Headcount Tick Register

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4.2 Reception Headcount Tick Register Summary Form

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4.3 Data Summary Form (Daily, Weekly Or Monthly)

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4.4 Monthly Data Input Form

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4.5 Facility Data Sign-off form

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Department of Health
Private Bag x 828
Pretoria
0001
Tel: 012 395 8000
website: www.doh.gov.za

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