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NHMIS TRAINING

PATICIPANTS’
NOTE

Facilitator’s Notes – page 1


Module I – Introduction

Module I: Introduction

Slide 1

NIS Trai
· To familiarize the participants with the use of data collected by the Nutrition Information
System.
· What is new in this NIS course is the emphasis on data use: self-assessment and action

• Objective
based on analysis of collected data.
· Participants should know that after attending this course they will start working with the
new system in their stations of work.

participan
System d
 NIS em
Facilitator’s Notes – page 1
Module III – NMIS Principle

Module III: HMIS Principles

Slide 1

Directora
Planning and Policy
and Statis
The Directorate of Planning, Research, and Statistics has responsibility for setting policy and planning for its
implementation. To carry out this responsibility it relies on information collected through the routine
information system, the Health Management Information System (HMIS) and through special purpose
investigations and research.

Health Management Information System (HMIS)

The HMIS collects data that are recorded in registers or other records while delivering services. These data
are aggregated, analyzed, and reported onwards at fixed intervals of time. Because the HMIS collects only
data that are routinely recorded during services and reports them regularly, it is called a routine information
system. It feeds information into planning and policy formulation procedures and can uncover the need for
special studies and surveys.

Research

The Directorate of Planning has a responsibility for conducting research activities and for training peripheral
levels in survey and surveillance techniques so the LGA and facility staff can use these methodologies to
verify and clarify information generated by the routine reporting of the HMIS, as well as produce data for other
scientific purposes such as monitoring drug resistance.

Facilitator’s Notes – page 2


Module III – NMIS Principle

Slide 2

Monitor
Toolbox
The Monitoring and Evaluation Toolbox includes the HMIS, Health Systems Research, and
surveys and sentinel surveillance. As the skills and capacities of health workers in using
HMIS data increase, it can be expected that they will receive increased training in survey
and research methodologies.

NMIS (Nutrition Management Information System)

The NMIS collects information on nutrition status, like disease cases e.g. marasmus,
kwashiorkor, etc and preventive services e.g. EBF, ACF delivered. These Nutrition
statistics are very important, but additional information is required to monitor nutrition sector
performance. Human resources, supplements and supplies, finance, and capital assets
must be in place to support the delivery of nutrition services. Therefore the NMIS collects

Health syst
data on all of these aspects of nutrition system performance. In this course we concentrate
on nutrition statistics. In the future, the techniques learned and practiced with this data will
be expanded to other types of information.

research
Facilitator’s Notes – page 3
Module III – NMIS Principle

Slide 3

Monitor
NMIS an
This slide summarizes the relationship between the different types of information and data
collection methodologies described in the previous slides.

 Monitoring &
 Informatio
policy
 Routine d
 NMIS
 Part of Mo
Facilitator’s Notes – page 4
Module III – NMIS Principle

Slide 4

DART HMI
The NMIS is like a dart: it goes straight to the target.

Decentralized
Analysis & self-as
done at all levels
Action Orient
Data are collected
making Facilitator’s Notes – page 5
Module IV – Indicators

Module IV: Indicators

Slide 1

Indicato

 Data Co

 Assess
Indica
Facilitator’s Notes – page 6


Module IV – Indicators

Slide 2

Indicato

 actual v
 alerts

 results
Facilitator’s Notes – page 7
 achiev
Module IV – Indicators

Slide 3

Types o
Sentinel. A sentinel indicator is a single event which should set off an investigation. For
example, a case of measles or a marasmus / kwashiorkor warrants investigation.

 Sentinel
Tracer. A tracer indicator is one in which the indicator shows performance in relation to
standards, like Vitamin A supplementation coverage, wasting, underweight and stunting.

Proxy. A proxy indicator is one that is used, when it is not possible to use an “ideal”
indicator. For example we can monitor the incidences of Vitamin A deficiency cases by

single ev
number of measles cases presented at health facilities or in the communities.

 Tracer
Facilitator’s Notes – page 8

 performa
Module IV – Indicators

Slide 4

Charact
Two characteristics of indicators are very important - the sensitivity and the specificity. We
say that an indicator is “sensitive” if the indicator changes as the situation itself changes
e.g. wasting, underweight, stunting.
We say that an indicator is “specific” if it changes when factors that we can influence
change e.g. increase in EBF rate.

 Sensitivit
For example, a child’s “weight for age” may change as the child’s nutritional status
changes. A decrease in the percentage of children below the lower line may reflect a
change in nutritional status. But it may not be specific, since a child’s growth may be
affected by a number of factors.

[Read the slide]  change in


 Specificit
 change in
Facilitator’s Notes – page 9
Module IV – Indicators

Slide 5

Functio
in Analy
 Trends ov

 Comparis

Facilitator’s Notes – page 10


Module IV – Indicators

Slide 6

SMART
Specific: Re

Measurable

Appropriate
Facilitator’s Notes – page 11
Module IV – Indicators

Slide 7

Indicato
[Read the slide]

This slide illustrates the use of proxy indicators which come closer and closer to measuring
what we really want to know.

 Inputs: av
Inputs, such as supplies, are easy to measure. However, just being available does not
mean that they are being used well, so measuring inputs does not tell us a lot about health
status.

Outputs - such as the utilisation of curative and preventive services, is also easy to

drugs/sup
measure, but not as easy to measure as inputs are. Changes in outputs reflect changes in
health status more accurately.

Changes in outcomes (or the impact of a program on illness and death) are more difficult

easy to m
and expensive to measure. Often special surveys are used. However, measuring outcome
and impact is the only way to be certain that an action plan is having a positive effect on
health status. 
health sta
Facilitator’s Notes – page 12
Module IV – Indicators

Slide 8

Steps in

1. Define
2. Name t
3. Why wo
 What i
4. How w
Facilitator’s Notes – page 13
Module IV – Indicators

Slide 9

Improvi
interme el of performance

Facilitator’s Notes – page 14


Module IV – Indicators

Slide 10

How to
When defining a new indicator, we need to ask ourselves these questions.

[Read the slide]

 Whatwill
 Who will b

 How much

 How will y
Facilitator’s Notes – page 15
Module VI – Catchment Areas

Module VI: Catchment Areas

Slide 1

Objective
[Read the slide]
Catchment areas are important to assure that everyone has access to health services.
Catchment areas show the health facilities which communities they are responsible for.

 1. Impor
Clear catchment areas let people know where they should go to obtain health services.

Catchment areas allow facilities to make a good estimate of the staff and material
resources to provide services. Using maps, facilities can choose the most effective
outreach points.

 ensure a
Health facilities should estimate the population that lives within the catchment area. Using
this population estimate, they can estimate the amount of drugs, supplements and supplies
needed to provide service to the area.

estimate
Health facilities should determine their catchment areas - in the past there have been some


areas that were not covered, and there have been some health facilities with overlapping
catchment areas. Now, all health facilities should know their own areas.

 2.Facilitator’s Notes – page 16

Popul
Module VI – Catchment Areas

Slide 2

Importan

 Define p
 forplan
 epidem
Facilitator’s Notes – page 17
Module VI – Catchment Areas

Slide 3

Populati
Census and population growth census d
The most recent census in Nigeria was done in 2006. To estimate the current population
using 2006 data, population shifts since 2006 must be estimated.

 Census a
Changes in population size come about because of births, deaths, and migrations.

Natural rate of increase


Changes in population size that can be attributed to births and deaths alone are called the
natural rate of increase. If the area has a stable population, and people rarely move into or
away from the area, changes in population size can be estimated from births and deaths.

 2006cen
Often, however, there may be substantial migration, either into or away from the area. In
these cases, the natural rate of increase alone will not give a reliable estimate of population
size.

Actual growth rate


 natural in
Changes in population size that include births, deaths, and estimates of migration are called
the actual growth rate. These estimates are based on the change in population size

migration
between two censuses. This change is also called the intercensal growth rate.


Facilitator’s Notes – page 18
Module VI – Catchment Areas

Slide 4

Estimatin
Natural rate of increase an examp
For the natural rate of increase equation, we subtract the number of deaths from the
number of births. In this example there were 440 births and180 deaths, creating 260

 Natural rat
additional persons per 10,000 per year, for a natural rate of increase of 2.6%.

This calculation is the same for the natural and actual rates. But the natural rate stops
here, while the actual rate calculation continues with the migrations.

( births - d
Actual growth rate


For the first part of the actual growth rate equation, we subtract the number of deaths from
the number of births. In this example there were 440 births and 250 deaths, creating 190

( 440 -
additional persons per 10,000 per year, for a natural rate of increase of 1.9%.


Next we compare the number of people who migrated IN to the area to the number who
migrated OUT. In this case 350 moved in, and 100 left, resulting in an increase of 250.

 natural rate
Next we add 190 to 250 and divide by 10,000. The result is an actual growth rate of 4.4%.

Facilitator’s Notes – page 19


Module VI – Catchment Areas

Slide 5

Calculate
Method A
growth ra
This is the basic formula for estimating population growth based on the annual growth rate
and a population estimate.

Method B
Method A: p
(annua
Method B is based on Method A; it is faster than Method A. It requires only one
multiplication, by a constant factor, which can be stored in the calculator’s memory.

 exampl
2006
 2006 po
10,000
Facilitator’s Notes – page 20
Module VI – Catchment Areas

Slide 6

Target G
Interven
In Nigeria, we can use the percentages shown on this transparency to estimate the number
of people who are in the target groups for health interventions.

[Read the transparency]

Targe
children unde
children unde
women of rep
Facilitator’s Notes – page 21
Module VII – Data Processing, Analysis, and Interpretation - Introduction

Module VII: Data Processing, Analysis, and Interpretation - Introduction

Slide 1

Objecti

Proces

Facilitator’s Notes – page 22


Module VII – Data Processing, Analysis, and Interpretation - Introduction

Slide 2

Data Pro
Transmis
 Collect

 Send re
Facilitator’s Notes – page 23
Module VII – Data Processing, Analysis, and Interpretation - Introduction

Slide 3

Reportin
Schedul

Facility to L

LGA to state
Facilitator’s Notes – page 24
Module VII – Data Processing, Analysis, and Interpretation - Introduction

Slide 4

Analysis

 Calcula

 Compar
standar
Facilitator’s Notes – page 25
Module VII – Data Processing, Analysis, and Interpretation - Introduction

Slide 5

Focal Se

 Diseas
 Malar

 Unde
Facilitator’s Notes – page 26
Module VII – Data Processing, Analysis, and Interpretation - Introduction

Slide 6

Characteristics of Indicators

 Sensitivity
This slide was  change in indicator reflects changes in situation
discussed  Specificity
 change in indicator reflects effects of a specific action
earlier, during
 Validity
the module on  indicator should use current data to be valid
indicators.  Feasibility
 reasonable cost to measure the indicator

The indicators Module VII: Data Processing, Analysis, and Interpretation - Introduction 6

selected for
monitoring are both sensitive and specific to basic health interventions for disease
reduction, facility utilization, and maternal and child health preventive care.

The procedures call for these indicators to be monitored monthly, so that the data are valid
for taking action.

All of the indicators are currently recorded and the cost is reasonable.

Facilitator’s Notes – page 27


Module VII – Data Processing, Analysis, and Interpretation - Introduction

Module VIII, part 1: Data Processing, Analysis, and Interpretation –


Diseases: Malaria
Slide 1

Objectiv
Data quality assurance

A high standard of data quality is essential to support good decisions. Action taken, and
resources spent, based on poor quality data, may waste resources, and produce
undesirable results.

 Data qu
Graphic analysis

Graphs present a more easily understood picture of the situation than a table of
numbers. A picture is worth a thousand words, and a graph is worth a thousand
numbers. We will follow malaria trends through a graph. World-wide, it is standard
practice to monitor disease trends through a graph.

Interpretation

Facilitator’s Notes – page 28