MODULE 1 · LESSON 1.4
Estimated time: 20 minutes
WRITTEN ON THE BOARD
Lesson 1.4 asks where a health
A number in a report started somewhere. Before you analyse it, you should know the source, the service it describes, and whether the figure is a primary record or a later summary.
Routine health information is collected as services happen. In a Nigerian primary healthcare centre, the usual primary sources include the outpatient register, the antenatal register, the immunisation register, the delivery register, and the tally sheets used on a busy clinic day.
At the end of the month, those registers are compiled onto the National Health Management Information System monthly summary form. Some training materials refer to that compiling form as MSF 001. The summary is a total of the registers. It is not a new set of patients.
The summary is then entered into DHIS2, usually through the local government, and can be reviewed at state and national level. Daily registers, monthly summary, DHIS2, and resource decisions are one pipeline. A mistake in the register can still be visible on a national dashboard.
WHERE THE NUMBER STARTS
Where a facility uses an EMR, the consultation, laboratory request, or pharmacy record may be captured on a screen instead of only in a paper register. The EMR is still a primary clinical record. It does not remove the need to know which report was generated from it.
A malaria result, a haemoglobin result, or a HIV test has its own worksheet or register. A clinical count of “suspected malaria” and a laboratory count of “confirmed malaria” are different sources. Do not treat them as the same indicator.
The Nigeria Demographic and Health Survey and the Multiple Indicator Cluster Survey estimate population indicators, such as care-seeking or immunisation coverage in a community. They are not the same as last month's facility register. A survey describes a sample of people. A register describes services recorded at a facility.
A partner may keep its own attendance sheet, commodity tracker, or supervision checklist for the activities it funds. Those records can be useful, but they must be reconciled with the facility register before anyone treats them as the official service count.
A primary source is the first record of the service or event: the register line, the laboratory worksheet, or the EMR entry. A secondary source is a later compilation: the monthly summary, a DHIS2 value, a supervision report, or a slide in a meeting.
When a secondary figure is questioned, go back to the primary source. Do not “correct” the register so that it matches a dashboard.
Choose an answer for each question, then check. The suggested answers stay hidden until you do.
1. Which document is a primary source for children vaccinated at the clinic?
2. What is the monthly summary form for?
3. A survey says 70% of children in the state are vaccinated, while the clinic register shows 40 doses given this month. What is the sound reading?