Monthly Archives: September 2014

PRESS RELEASE: SA national health data overestimates immunisation coverage rates by up to 6 times


CAPE TOWN – Inaccurate data on South Africa’s national health information system means that the national database shows numbers up to 6 times higher than are recorded in corresponding facility registers, a new study published in the October issue of Strengthening Health Systems reveals.

The study, which involved authors from the Eastern Cape Department of Health and the University of Alberta, Canada, investigated the accuracy of nationally reported immunisation rates for children younger than 1 year in Eastern Cape Province, as reported on South Africa’s national health database – the District Health Information System.

By visiting a selection of facilities and counting numbers of children immunised as listed in facility records, then comparing these numbers with the database figures, the team calculated error rates for the data from each facility and sub-district. They then conducted a series of interviews with staff and district managers to find out why the data was not being managed correctly.

“We knew from an initial review of the national data that there were problems with the figures because five sub-districts reported that they had immunised more than 100% of the children in their catchment area – which is, of course, impossible,” explains lead-author Anne-Marie Jamin, University of Alberta, Canada, who supported the Eastern Cape Department of Health to investigate the issue.

“When we compared the database numbers with records at the facilities, we found surprisingly large differences between the national data and the records at facility level. One facility reported a 358% coverage rate when they had only recorded immunising 1.4% of the local children,” says Jamin.

According to authors, these findings show how the data management system is struggling to provide health managers and policy makers with the crucial information they need to do their jobs properly.

“If you looked at the reported figures alone, without knowing the error rates, you would think that the Province is doing really well on immunisation. What we found was that feasible-sounding district and provincial averages may actually be obscuring a significant problem, not only with data but also with the underlying public health campaign to expand immunisation,” explains Jamin. “Knowing more accurately where the problem areas are would help the Province target its work much more effectively.”

The authors recommend that the better training about data management processes in line with the national policy on health management information, better communication between programmes that deal with child health and improved systems for procuring registers for facilities could address the identified issues.

Notes for editors

  1. The referenced paper is: A-M Jamin, B Kaposhi, D Schopflocher, N Mqoqi. Strengthening health systems through improving the reliability of health information: an evaluation of the expanded programme on immunisation data management in Eastern Cape, South Africa. Strengthen Health Sys 2014 epub ahead of print DOI:10.7196/SHS.10.
  2. This paper is being published to coincide with the Third Global Symposium on Health Systems Research in Cape Town, South Africa, Sept 30-Oct 3.
  3. PDF copies of the paper can be obtained from the journal office:
  4. Strengthening Health Systems is a new international peer-reviewed open access journal that aims to publish articles that support evidence-informed policy changes to improve health system function and health outcomes. It is published by the Health and Medical Publishing Group (, publishers for the South African Medical Association, and is supported by the United States’ President’s Emergency Plan for AIDS Relief through an award to the Foundation for Professional Development, South Africa (


Study lead author: Anne-Marie Jamin –, +254 (0)704 968 870

Strengthening Health Systems: Hannah Kikaya –, +27 791 525 406

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Strengthening Health Systems @ #HSR2014

We have arrived in Cape Town, South Africa, ready to join in the conversation at the Third Global Symposium on Health Systems Research – on how we can best use existing knowledge and focus our collective efforts towards strengthening health systems in ways that reduce barriers to access and inequities in service provision.

In honor of this landmark event – held in the shadow of the accelerating Ebola epidemic in West Africa which has exposed the true fragility of health systems in the face of severe health threats – Strengthening Health Systems is today publishing two articles that speak to the central themes of the conference, and to key issues the health systems community continues to grapple with:

1. MSH President Jonathan Quick and colleagues write in an editorial that the “people-centered” approach, around which the conference is based, is inextricably linked to the movement towards universal health coverage, so that neither goal can be achieved without achievement of the other.

2. In an article that evaluates the accuracy of immunisation data on South Africa’s national health information system, Anne-Marie Jamin (University of Alberta, Canada) and colleagues from the Eastern Cape Department of Health, South Africa, find that database figures are up to 6 times higher than the corresponding figures in facility registers, signalling severe problems with data management in the province. The authors warn that without a data management system that can be relied upon to convey accurate data, policy makers and health managers are unable to make informed decisions about health programmes and priorities.

For the full text of these and other articles published in Strengthening Health Systems, please visit our website and online submission system – now live!

Quick JD, Canavan CR, Jay J. People-centered health systems for UHC. Strengthen Health Sys 2014 epub ahead of print DOI:10.7196/SHS.9

Jamin A-M, Kaposhi B, Schopflocher D, Mqoqi N. Strengthening health systems through improved reliability of health information: An evaluation of the expanded programme on immunization data management in Eastern Cape, South Africa. Strengthen Health Sys 2014 epub ahead of print: DOI:10.7196/SHS.10

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