A comparison of different approaches towards a computerised information system for primary health care in the Free State

English: This study is undertaken in the light of the current importance of the Reconstruction and Development Programme (RDP) and the SA government's commitment to better primary health care (PHC) for everybody. Primary health care services in South Africa should be rendered as effective and complete as possible with the manpower available. The government should therefore have exact knowledge about the current health situation in the country in order to make pro-active provision for better health services in the areas that need it most. Nursing management should thus have access to periodical reports regarding the incidence of epidemics, certain notifiable diseases, the death rate, general housing conditions and much more. It is therefore of the utmost importance that the service providers should capture and process statistical data accurately. This study firstly analyses the current situation with regard to data capturing, processmg, presentation and utilisation. The analysis refers to the manual system of patient carried records, tally sheets as well as the available infrastructure. Nursing management in the Free State has a long term vision to implement a database system to service all fixed and mobile clinics. A complete patient record will be kept by the system and the complete clinical history of a patient will be available at each consultation. With such a system all the regular and ad hoc reports can be processed easily and accurately. This study firstly analyses the current situation with regard to data capturing, processmg, presentation and utilisation. The analysis refers to the manual system of patient carried records, tally sheets as well as the available infrastructure. Nursing management in the Free State has a long term vision to implement a database system to service all fixed and mobile clinics. A complete patient record will be kept by the system and the complete clinical history of a patient will be available at each consultation. With such a system all the regular and ad hoc reports can be processed easily and accurately. This study focuses on the process of computerising pnmary health care services. Some theoretical background on systems analysis and development are provided and thereafter three alternative approaches towards computerisation are proposed and investigated. For each of these proposals a prototype system was developed. The first prototype is based on a patient record approach and includes a complete set of health indicators as well as other demographic and clinical data. The second prototype is based on a minimum data set that leads to more user-friendly system. Thirdly a prototype system that is not based on a patient record but on head-count-approach was developed. This system· resembles the current manual system of tally sheets. The three alternatives are compared with regard to the issues of practicality, flexibility, ease of use, accuracy and completeness of statistical reports and efficiency of time utilisation. It is concluded that the flexibility of a patient-record approach, a_lthough more time-consuming, is preferred to a head-count approach. Furthermore, the ease of use of the s~cond alternative in a developing country with mostly computer illiterate nurses makes it a much more feasible approach than a more comprehensive system. Ways in which a computerised system can be implemented in an environment with limited hardware resources are also investigated. The study concludes with a proposed model for the computerisation of primary health care in the Free State.