Financial information at district level: experiences from five countries

Management information systems are intended to help managersmake decisions. But few management information systems in primaryhealth care include information on costs, even though resourceallocation and budgeting are key functions of primary healthcare managers. Drawing on five papers presented to a WHO conferenceon strengthening district health systems, this article illustratesthe potential usefulness of financial data to district managers.The examples come from individual districts in Ethiopia, Indonesia,Kenya, Sri Lanka and Tanzania.No original data were collectedfor the studies - much can be learned from budgets and expenditureledgers. Some problems were encountered with the reliabilityof the data - a particular confusion was between allocated andrealized budgets. Allocated budgets area stated intention tospend money; realized budgets show that the expenditure actuallyoccurred. For planning purposes, realized amounts are of moreinterest.Managers can use financial information to questionthe allocation of resources in various ways. Providing informationon how much is being spent on what activities enables an explicitconsideration of the desirability of the existing use of resources,relative to priorities. Comparing unit costs can raise questionsabout the relative efficiency of different units, be they healthcentres, vaccination points or wards. Looking at the distributionof resources according to geographical areas, or other waysof grouping people, provides background data for the considerationof equity. Finally, the paper discusses how financial informationmight be used to identify areas of wastage.The paper concludesthat health systems already produce a good deal of financialinformation. At present, however, this information is oftenonly used by accountants or finance officers. Financial informationshould be incorporated into the larger management informationsystem.     

Anaemia in the Elderly

A study has been made of the haemoglobin levels of 475 peopleover the age of 65 living at home. Anaemia (Hb less than 12g/100 ml) was commoner in women than men and increased in frequencywith age. Haemoglobin concentrations below 10 g/100 ml werefound in only 2·4 per cent. Iron deficiency was the cause of anaemia in 45 per cent, and10 per cent of non-anaemic subjects also had evidence of irondeficiency. Gastrointestinal lesions and regular salicylateingestion were common causes of iron deficiency, but evidenceof dietary iron deficiency was indefinite. Vitamin B₁₂ deficiency was found in 9 per cent of anaemic and5 per cent of non-anaemic subjects. Folate deficiency was rare(1 per cent of subjects), and there was no evidence that dietaryfolate deficiency contributed to anaemia. No cause for anaemia was found in 30 per cent of anaemic subjects.In the majority of these the haemoglobin concentration was justbelow 12 g/100 ml, and was probably normal for them. These findings are discussed with regard to population screeningprocedures in old age. ¹Present address: Dept. of Geriatrio Medicine, University ofSouthampton.     

Disseminating research results-the challenge of bridging the gap between health research and health action

Dissemination is now acknowledged as an important componentof the research process. A Scottish-based project has researchedtheoretical and practical aspects of dissemination for healthpromotion research. This project included: a literature review,annotated bibliography, guideline document and a series of workshopsin Scotland. Dissemination is about the communication of innovation,this being either a planned and systematic process or a passive,unplanned diffusion process. The utilization of research findingsin policy or practice is in many instances a subtle and indirectprocess. Effective communication is an important aspect of dissemination.However, because the audience for health promotion researchis heterogeneous, dissemination has to meet the various requirementsof different users. There are many barriers to effective communicationbetween researchers and users. These include: career structures,institutional barriers, ownership issues, barriers relatingto the protracted process of publishing in academic journals,technical barriers and problems related to secrecy and lackof trust. Enhancing dialogue between researchers and users,developing new contacts and networks, the creation of ResearchLiaison Officers and developing effective dissemination strategiescan bridge the communication gap. The current contract culturein which health promotion research is commissioned could resultin a more controlled and limited dissemination stage. It isargued that researchers have a duty to share new knowledge witha wider audience including the general public. Effective disseminationrequires an active and systematic approach which is adequatelyresourced throughout.