Master Facility Lists and other needed health information registries

One problem of MFLs that needs to be emphasized (and I believe was touched upon in the opening presentation) is the need for clear ownership and management of the MFL. In one country I recently visited there was at least four versions of the MLF circulating, and all different. Which one to use for selecting health facilities for an assessment? These, of course, were not “Master” facility lists, but rather just “facility lists”. The ownership is what makes the list “Master”, that is, one authority to update and maintain the official country facility list. And standard mechanisms for updating them (e.g. an NGO does a facility survey and finds status changes in existing facilities, or new facilities have come online, or old ones have disappeared) and submits the new information to the MOH. Then the MOH validates the information by reaching out to the facilities or the DHMT in the respective districts. Only when the information is validated is the MFL updated. The updates should happen on a regular, predictable schedule.

Dave

Identifying a single authority to maintain the Master Facility list is occasionally a challenge in big countries like Nigeria. While Nigeria previously compiled a MFL, this was developed as a snapshot without processes to continuously keep the list updated. The governance structure in Nigeria is three tiered with 36 states and a Federal Capital Territory. Each state is independent and registers facilities within it according to its unique guidelines. Thus, the data that may be available for one state may differ from the other. While the role of the Federal Government will be to coordinate all these state level registries, this is a challenge in the absence of a uniform dataset and absence of an information system that manages the data across the 37 registries.

MEASURE Evaluation is currently working with the government to establish a minimum national dataset which will be passed on to the states. We are also helping to develop a governance structure to oversee management of the lists.

MFL that in some countries is a document (a pdf or Ms Excel file or Ms Word document) developed and maintained by a department in the ministry of health. Not many entities are involved in this endeavor. The problem with that is, the stakeholders who are not involved are not aware of this registry. Even when they are aware, they have no input in the process of its development or its update. The result is, they maintain their own ‘mini MFL’ that they trust and serves their needs. This process undermines a truly master and authoritative national registry of health facilities where everyone can draw from.

The other important registry is the patient registry. Many countries are either setting up or scaling up EMRs. For these to work efficiently and in support of health facility workflows, each patient must be uniquely identified in the system through a non-volatile method. That is where patient registry comes in. Unfortunately, there are a few success stories in developing countries where this has worked well. Im aware of a country that uses that national ID as the same patient ID. In other countries, national ID cannot be used for obvious reasons. Bottom line is, country players need to come together and agree on a method to uniquely identify the patients.

We been able to maintain MFL for public sectors and we are working to manage a MFL for private sector too. Same as other countries in Afghanistan we have problems of donor driven system development and you know this kind of process generates fragmentation but in spit of the donors influences we could manage to have a MFL at least for public sectors.
The processes for HFs registration we maintain here in our country are as follow:
1. We developed standard registration form
2. Registration forms are being filled by implementer.
3. Registration forms are being approved by Provincial Health Office.
4. Approved registration forms then sends to HMIS department.
5. HMIS department recorded in MFL databases and give it a unique id.
6. Then implementer can access all information on a HF from MFL database.

We kept Unique ids for staff in health facilities for recording in HRMIS system too.

Maintaining unique ids for patients to be recorded in EMR requires governmental approach like Social Security Card ID and it goes beyond ministry of health . well, there can be some vertical approaches like

1.Giving unique ids for patients plus health registration card , but here is the problem we found in our country like patients don’t keep the IDs so one patient is being recorded many times overtime.

2. Search patients in EMR with FirstName, LastName or phone number, its works to some extent but still not a solid record keeping.
The main reason we have not been able to maintain a good EMR is we don’t have the required infrastructure in our country.

Dr.Lutfullah Shifaa
MIS Manager
HMIS department
Afghanistan

Thanks for the good discussion around the benefits and challenges of a MFL. The title of this thread also mentions other health information registries, and I’m curious what the experience has been in establishing:
–master client registry, linked with EMRs, civil registries, etc. for unique identifier
–master provider registry (linked to an HR MIS) that includes both public and private providers and based on provider type and licensing status
–master commodity registry linked to the EML, the national medicines regulatory authority, and pharmaceutical distributors (private and public).

A second question is related to program registries, especially vertical programs like family planning, immunization, malaria elimination, HIV and TB. Many of these programs are converting their paper registries into digital systems, essentially replicating paper registries in digital form without thinking through continuity of care or a client-centered approach. Do we need a central programs registry, or can well-design EMRs and a data warehouse replace them and, through interoperability, achieve the continuity of care and higher level data visibility across programs that we would like to achieve?