Weeks R M, Svetlana F, Noorgoul S, Valentina G
USAID/BASICS Project, Arlington, Virginia 22209, USA.
Health Policy Plan. 2000 Sep;15(3):279-86. doi: 10.1093/heapol/15.3.279.
Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish both goals, the MOH updated the national immunization policies and established a more effective structure for managing immunization services. To support the MOH, the US Agency for International Development (USAID) Resources for Child Health (REACH) and Basic Support for Institutionalizing Child Survival (BASICS) projects provided technical assistance through a resident coordinator and consultants, and by organizing an international seminar. The improvements extended beyond systems and forms, but, instead, emphasized monitoring by the frontline health worker and supervising the quality of health information. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. This group, representing both national and local levels, was composed of MOH epidemiologists, paediatricians and a management information specialist. To reduce the burden of excessive record-keeping and reporting requirements, the Working Group identified four key indicators for the service delivery level: (1) DPT3 immunization coverage rates for children less than 1 year of age; (2) contraindication rates for DPT; (3) usage of DPT vaccine; and (4) daily refrigerator temperatures. Additional indicators were included at district and provincial levels. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but the new approach provided visible evidence, from facility to national levels, that the MOH was approaching their objective of reducing contraindication rates for DPT immunizations to 5% or less, and that vaccine wastage could be substantially reduced. The project demonstrated that giving health workers the basic epidemiologic skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work.
1991年苏联解体后，吉尔吉斯斯坦政府无力维持此前的卫生服务水平。为振兴卫生服务，卫生部首先着重改善免疫服务，包括健康管理信息系统（HMIS）中的免疫部分。其次，为提高免疫覆盖率，卫生部将消除开具虚假免疫禁忌证作为优先事项。为实现这两个目标，卫生部更新了国家免疫政策，并建立了更有效的免疫服务管理架构。为支持卫生部，美国国际开发署（USAID）的儿童健康资源（REACH）项目和儿童生存制度化基本支持（BASICS）项目通过驻地协调员和顾问，并组织国际研讨会提供技术援助。改进不仅涉及系统和表格，还强调一线卫生工作者的监测以及对卫生信息质量的监督。为实现目标，卫生部任命了一个工作组来确定问题、修订记录保存程序并开发监测工具。这个代表国家和地方层面的小组由卫生部的流行病学家、儿科医生和一名管理信息专家组成。为减轻过多记录保存和报告要求的负担，工作组确定了服务提供层面的四个关键指标：（1）1岁以下儿童的三联疫苗（DPT3）免疫覆盖率；（2）DPT的禁忌证发生率；（3）DPT疫苗的使用情况；（4）每日冰箱温度。地区和省级层面还纳入了其他指标。经过为期一年的成功试点后，卫生部在全国实施了修订后的HMIS。不仅信息系统的质量得到了改善，而且新方法从机构层面到国家层面都提供了明显证据，表明卫生部正在朝着将DPT免疫禁忌证发生率降至5%或更低的目标前进，并且疫苗浪费可以大幅减少。该项目表明，赋予卫生工作者监测自身工作的基本流行病学技能可显著提高数据质量，通过掌握新技能，工作者对自己的工作产生了自豪感。
