Initial experience of using a knowledge based system for monitoring immunization services in Papua New Guinea.

A knowledge based system (KBS) which helps health service managers to interpret immunization coverage rates was installed in two provinces of Papua New Guinea. It was assessed over a period of 4 months to determine whether it was a potentially useful management tool. One province used the system but did not adjust its activities significantly because it was meeting its targets for immunization. In the other province the KBS helped provincial managers to detect problems and respond to them. Consequently, improvements in performance indicators were detected. It is difficult to attribute the improvements entirely to the KBS but several actions were taken to strengthen immunization services and the KBS appeared to support these. It appears that interventions which make routinely collected data more understandable and readily usable by health service managers can lead to improvements in the delivery of health services.

PIP: Since 1986 the Department of Health in Papua New Guinea has undertaken a nationwide program to computerize its health information systems at the provincial level. The computerized information system, based on IBM-compatible PCs, generates monthly reports on various health programs. A knowledge based system (KBS) for analyzing immunization coverage rates in the provincial health information system has been developed using the expert system shell CRYSTAL. The KBS is a menu driven program that reads data in the existing system and attempts to make interpretations for health service managers. It points out problems in delivering immunization services, suggests why they might occur and what could be done about them. To ensure that the KBS would be relevant to its potential users, the KBS was installed in two provinces, Manus and New Ireland, so that comments on the system could be obtained and a preliminary assessment made. The two provinces were visited in July 1992 and the software installed on provincial microcomputers. A follow-up visit was made early in November 1992 to see what use was made of the system. The KBS helped staff to recognize several problems and successes: 1) immunization results in the second quarter were generally poor; 2) some immunization reports had not been submitted by certain health centers; 3) ranking of health centers showed that some health centers were performing well and others poorly; 4) particular problems were being experienced at individual health centers, e.g., high drop-out rates from first to third doses of triple antigen; and 5) problems occurring with supplies could be followed up. During the four months that the KBS was installed the average number of attenders for final doses rose from 306 to 453 per month (p = 0.037). The KBS appeared to be of potential benefit in helping health service managers make use of routinely collected data for the monitoring and evaluation of health services.

An overview of quality issues in health services.

This paper establishes a common framework for understanding some of the quality issues in health services. It presents definitions and examples of the most frequently used and the most frequently confused terms related to quality. The meanings of quality, quality of health care, quality assessment, quality assurance, quality control and total quality management are described with illustrative examples. The major approaches to quality assessment and its uses are discussed. A model of the quality assurance process is explained as well as the issues surrounding quality assurance in the settings of primary and secondary health services.

Health systems research--a key to progress.

Papua New Guinea has made significant strides towards establishing a capacity in health systems research. This can be expected to strengthen the country's overall health development programme.

Better management for better health services.

Poor management has been a significant limiting factor in the development of Papua New Guinea's health services, particularly since their decentralization increased the responsibilities of provincial staff. A programme designed to strengthen management at this level has been proceeding since 1986.

AIDS in Asia and the Pacific.

PIP: Acquired immune deficiency syndrome (AIDS) has been an African and Western concern due to its epidemic nature. Although nearly 99% of all reported cases occurred in these regions, Asia has reported cases, and the potential for devastation of Asia's already strained health care reserves are undeniable. This review compiled by analysis of 1986-88 articles on AIDS research, demographics, official statements from government and health organizations, news reports, and public statements describe how AIDS has spread in well documented regions like America, Europe, and Africa, and how the Asian regions have attempted to handle the AIDS epidemic before it becomes as serious as in the West. The topics covered include a clinical overview of how human immunodeficiency virus (HIV) causes AIDS, how it is transmitted, and what are the primary forms of transmission in well documented regions. The report briefly documents what policies China, Hong Kong, Japan, Republic of Korea, Taiwan, Philippines, Thailand, Singapore, Malaysia, Indonesia, India, Sri Lanka, Bangladesh, Nepal, Pakistan, Australia, and New Zealand have individually instituted to stem the flow of AIDS into their country, and/or stop the spread of AIDS already found there. The efforts to combat AIDS globally by the World Health Organization/United Nations Development Program alliance (WHO-UNDP) along with the US Agency for International Development (USAID), and UNICEF are highlighted. The available research and aid programs are contrasted with how the Asian nations are preparing to deal with the AIDS epidemic. 1) AIDS has an incubation time wherein an infected individual is not AIDS symptomatic, but is capable of infecting others, and this hidden infected population makes it essential that containment policies are also enforced in countries with few reported cases. 2) A committee should be established in all Asian countries to coordinate education on safe sexual behaviors with specific programs for prostitutes, intravenous drug users, and prison inmates. 3) HIV testing of foreigners and students returning from abroad was discouraged due to its logistic impracticality and consumption of health resources. 4) AIDS education in the schools and sterile needle distribution to drug addicts was encouraged.^ieng