Capacity and practical skill of health statistical staff and training needs

JOURNAL OF MEDICAL RESEARCH<br /> <br /> CAPACITY AND PRACTICAL SKILL OF HEALTH<br /> STATISTICAL STAFF AND TRAINING NEEDS<br /> Nguyen Phuong Hoa¹, Pham Ngan Giang¹,<br /> Thanh Ngoc Tien¹, Hoang Thanh Huong²<br /> ¹Department of Family Medicine, Hanoi Medical University; ² Ministry of Health<br /> Objectives of the study were to assess the capacity and practical skills of the health statistical staff along<br /> with their training needs. A cross-sectional study was conducted in health facilities of 3 provinces Ha<br /> Nam, Bac Giang, Bac Ninh divided into three levels: province, district and commune. 104 health statistical<br /> staffs completed questionnaires. The results indicated that human resource for the health management<br /> information system was at low qualification. Only 29% of statistical staffs had graduation or post – graduate education, especially, the rate of personnel trained in statistic was very low (2.9%). The majority of<br /> staffs did the statistical activities as part-time job and the average number of years working in statistical<br /> field was 6. The capacity to use ICT for reporting and storing data was quite low at 12.4% and 7.9%<br /> respectively. The capacity to analyze and use statistical data was poor, only less than 20% of total considered themselves “good” at data accuracy checking and interpreting the result. Only 35.6 % of health<br /> staffs were able to interpret charts and a negligible amount of people could infer the reason of those<br /> findings. In conclusion, it is important to provide new and qualified human resources and there is a large<br /> need for training the existing staff in order to improve the performance of the health statistical information.<br /> <br /> Keywords: health information, health statistical staff, training needs<br /> <br /> I. INTRODUCTION<br /> According to the UN Agencies framework [1], adopted by the Vietnam Ministry of<br /> Health (MOH) [2], information is one important component of the health system and<br /> plays a vital role in the development process of the health system. Complete, timely,<br /> accurate and well-analyzed information not<br /> only meets the needs of management and<br /> Corresponding author: Nguyen Phuong Hoa, Department of Family Medicine, Hanoi Medical University<br /> Email: nguyenphuonghoa@hmu.edu.vn<br /> Received: 05 June 2017<br /> Accepted: 16 November 2017<br /> <br /> JMR 111 E2 (2) - 2018<br /> <br /> administration of the health sector, but also<br /> those of scientific research activities, policy<br /> formulation and communication on healthcare for the population. The health information system consists of six components:<br /> resources, indicators, data sources; management data; information product, dissemination, and use of information [3]. Among<br /> those components, human resource development is the utmost importance [4 - 6].<br /> Until 2012, in Vietnam, although there<br /> were a number of policies from the government related to health statistics and infor95<br /> <br /> JOURNAL OF MEDICAL RESEARCH<br /> mational activities, but so far there was no<br /> official document, that defines the health<br /> statistics professional career, including the<br /> training requirements for statistics staff.<br /> Therefore, competency levels of health statistical personnel were also not assessed.<br /> This was compounded by there not yet<br /> having a plan for human resources development in the health sector in Vietnam. In<br /> order to improve better capacity, it is essential to develop a detailed training program.<br /> Hence, to build capacity for health statistical<br /> staff, there should be specific assessments<br /> of their practical skills, qualification, and<br /> training needs [7; 8].<br /> Based on the above reasons, this study<br /> was conducted with the aim to assess the<br /> capacity and practical skills of health statistical staff, and their training needs at provincial, district and commune levels<br /> <br /> II. SUBJECTS AND METHODS<br /> 1. Subjects<br /> Health statistical staffs who worked in<br /> provincial, district and commune levels<br /> were selected.<br /> 2. Methods<br /> Locations<br /> This study took place in 2012 at health<br /> facilities of three provinces Ha Nam, Bac<br /> Giang and Bac Ninh. Each province was divided into three levels:<br /> - At Provincial level: staffs from the Department of Health, Provincial General<br /> Hospital, Specialized hospitals, Provincial<br /> Preventive Medicine Centers, Reproductive<br /> Health Centre, and the HIV/AIDS Centre of<br /> these provinces.<br /> 96<br /> <br /> - At District level: staff from the District<br /> Preventive Medicine Centres and District<br /> Hospitals out of 5 districts per each province. 5 districts were selected by the simple<br /> random method.<br /> - At Commune level: staff from random<br /> 5 CHCs out of each district selected. Therefore, the total number of CHCs selected in<br /> each province was: 5CHCs x 5 districts =<br /> 25 CHCs.<br /> Size of the sample<br /> There were a total of 104 respondents<br /> - At Provincial level:<br /> + In each Department of Health (DOH) 3<br /> officers were selected: 2 statistical officers<br /> and 1 planning officer.<br /> + In the Provincial General Hospital, or<br /> specialized hospitals and other health centres at provincial level, 2 officers were selected (1 statistical officer, and 1 planning<br /> officer).<br /> - At District level:<br /> + 3 people were selected at the District<br /> Health Centre (one general statistics staff;<br /> one reproductive health statistics staff; and<br /> one planning staff).<br /> + At District Hospital: 01 statistical officer<br /> and 1 planning officer were selected.<br /> - At Commune/ ward level: only one person of each facility(the CHC/CHS heads)<br /> was selected to answer the questionnaire.<br /> Study design<br /> Cross-sectional survey using self – administered mail questionnaire.<br /> Data collection<br /> This survey used a structured questionnaire.<br /> Self-administered questionnaire was<br /> used to collect the information on general<br /> JMR 111 E2 (2) - 2018<br /> <br /> JOURNAL OF MEDICAL RESEARCH<br /> demographic characteristics, qualifications;<br /> capacity in collecting, aggregating data, and<br /> using information; and self-perceived training needs of staff doing statistical works and<br /> planning in health facilities.<br /> Health staffs participating in this survey<br /> would complete the questionnaires under<br /> the direct supervision of the researchers.<br /> Data processing<br /> STATA software was used for processing data. The assessment of the capacity of<br /> analysing and using data ranged from 0%<br /> (“Incapable”) to 100% (“most capable”). For<br /> convenience, we subdivided the percentages into four different groups: a group of people with “weak” capacity (ranging from 0%<br /> to 30%); a group “average” capacity (40%<br /> - 60%); a group with “pretty good” (70% 80%) capacity, and a group with “good”<br /> (90% - 100%) capacity.<br /> Regarding the assessment of statistical<br /> capacities related to health information, the<br /> respondents were observed and scored<br /> using some basic queries related to data<br /> analysis. To analyze capacities related to<br /> specific statistical methods, scores were<br /> given to each respondent based on correct<br /> responses to statistical problems.<br /> 3. Ethics<br /> <br /> regarding the objectives of this assessment<br /> and the detail of collecting information. Respondents completed autonomy in regard<br /> to participation, as well as were freedom to<br /> withdraw at any stage during the interview.<br /> The collected data were used only for the<br /> purpose of research.<br /> <br /> III. RESULTS<br /> Human resources<br /> Table 1 describes the demographic<br /> characteristics and qualifications of statistical staffs in our sample. In general, the statistical staffs were mostly over 50 years old<br /> (44.2%). The higher the level of the facility,<br /> the older personnels were. For example,<br /> the province level had the highest number<br /> of aged staffs, accounting for 67.5%. There<br /> was a reversed age model at commune level with the officers over 50 years old only<br /> accounting for 9.5% of the total, while the<br /> highest pecentage belonged to the group<br /> of staffs from 30 to 50 years old (47.6%). In<br /> term of gender, although the distribution of<br /> male and female in provincial facilities were<br /> quite balanced, the overall pattern leaned<br /> toward female of (72.1%), mostly due to<br /> the big gap at the level of commune where<br /> 97.6% of workforce were female.<br /> <br /> Respondents of this study all information<br /> <br /> JMR 111 E2 (2) - 2018<br /> <br /> 97<br /> <br /> JOURNAL OF MEDICAL RESEARCH<br /> Table1. General information of the statistic personnel<br /> Province<br /> (n=43)<br /> (%)<br /> <br /> District<br /> (n=19)<br /> (%)<br /> <br /> Commune<br /> (n=42)<br /> (%)<br /> <br /> All locations<br /> (n=104)<br /> (%)<br /> <br /> < 30<br /> <br /> 9.2<br /> <br /> 10.5<br /> <br /> 42.9<br /> <br /> 23.1<br /> <br /> 30 - 50<br /> <br /> 23.3<br /> <br /> 21.1<br /> <br /> 47.6<br /> <br /> 32.7<br /> <br /> 50+<br /> <br /> 67.5<br /> <br /> 68.4<br /> <br /> 9.5<br /> <br /> 44.2<br /> <br /> Male<br /> <br /> 46.1<br /> <br /> 40.8<br /> <br /> 2.4<br /> <br /> 27.9<br /> <br /> Female<br /> <br /> 53.9<br /> <br /> 59.2<br /> <br /> 97.6<br /> <br /> 72.1<br /> <br /> Statistics<br /> <br /> 4.7<br /> <br /> 5.3<br /> <br /> 0<br /> <br /> 2.9<br /> <br /> IT-ICT<br /> <br /> 7.0<br /> <br /> 5.3<br /> <br /> 0<br /> <br /> 3.9<br /> <br /> Med/Pharm<br /> <br /> 32.6<br /> <br /> 26.2<br /> <br /> 0<br /> <br /> 18.3<br /> <br /> Pub.Health<br /> <br /> 7.0<br /> <br /> 5.3<br /> <br /> 0<br /> <br /> 3.9<br /> <br /> Middle or Secondary School<br /> <br /> 48.7<br /> <br /> 57.9<br /> <br /> 100<br /> <br /> 71.0<br /> <br /> Full time<br /> <br /> 46.5<br /> <br /> 36.8<br /> <br /> 0<br /> <br /> 26.0<br /> <br /> Part time<br /> <br /> 53.5<br /> <br /> 63.2<br /> <br /> 100<br /> <br /> 74.0<br /> <br /> Characteristic<br /> Age group<br /> <br /> Sex<br /> <br /> Education<br /> <br /> Working time<br /> <br /> In provincial facilities, there was 51.3%<br /> of staff having graduate and post-graduate<br /> education. However, out of the 43 people,<br /> only 4.7% of them had graduated in statistics and only 7.0 % in ICT disciplines. Furthermore, all other locations had more than<br /> 50% of their statistical officers with middle or<br /> secondary level qualifications. For instance,<br /> the district health facilities had 57.9%; at<br /> commune level, this rate was 100%. Therefore, the officers specifically competent in<br /> managing the statistics and information<br /> workload were very, very few. Overall, the<br /> 98<br /> <br /> proportion of staff having middle-level education was high, about 71.0%, while the<br /> amount of staff specializing in statistics was<br /> critically low (2.9%). Another aspect of human resources is working time. There was<br /> no level of health facility having over 50%<br /> of the statistical staffs working full-time. The<br /> most optimistic circumstance came from<br /> the provincial facilities, where 46.5% of their<br /> statistical officers did statistical activities as<br /> their main daily work. The overall survey results showed that 74.0% of 104 statistical<br /> officers responding to the questionnaires<br /> JMR 111 E2 (2) - 2018<br /> <br /> JOURNAL OF MEDICAL RESEARCH<br /> were part-time mainly due to the absolute<br /> rate of part-time staff at the commune level.<br /> In terms of experience in health statistics calculated by years, the average<br /> number was 6. For more detail, the rate of<br /> three dimensions of experience, including<br /> ≤ 4 years, 5 - 10 years, over 10 years of<br /> experience were 54.2%, 30.1%, 15.7%, respectively. This showed high staff turnover<br /> in health statistics.<br /> Staff performance features<br /> <br /> Figure 1 illustrates influencing factors on<br /> the quality of statistical reports, in the primary health care system. Statistics showed<br /> personnel had compromising their work<br /> awareness of several critical factors which<br /> were ranked as followings: insufficient and<br /> unstable workforce with 64.5% of respondent agreeing that high percentages came<br /> from lack of supervision, untrained staff<br /> and too many forms accounting for 56.5%,<br /> 50.2% and 46.3% respectively.<br /> <br /> 64.5<br /> <br /> 70<br /> 60<br /> <br /> 56.5<br /> <br /> 50.2<br /> <br /> 50<br /> <br /> 46.3<br /> <br /> 40<br /> 30<br /> <br /> 22.5<br /> <br /> 20<br /> <br /> 19.5<br /> 7.8<br /> <br /> 10<br /> <br /> 13.5<br /> 5.1<br /> <br /> 0<br /> <br /> Figure 1. Influencing factors on the quality of reports<br /> Capacity of using ICT<br /> Figure 2 shows the situation and use of<br /> ICT in health information system concerning<br /> data processing and software applications.<br /> There was a very high proportion (94.3%)<br /> of officers who used a computer to process<br /> data, while only 5.7% recorded data manually. With respect to data processing software, 70.3% of statistics personnel used<br /> JMR 111 E2 (2) - 2018<br /> <br /> MS Access-based software and 60.7% of<br /> staff used software for statistical reports.<br /> Pertaining to the way of reporting data,<br /> most of respondents said they sent their<br /> reports by post, only 7.3% sent reports via<br /> emails, and only 5.1% used web-based reporting. Further investigation suggest the<br /> situation of report submission and data ar99<br /> <br />