Abstract: Background: Between 1987 and 1998 Save the Children conducted a child survival programme in Mali with the goal of reducing maternal and child morbidity and mortality. An integral part of this programme was a computerized demographic surveillance and health information system (HIS) that gathered data on individuals on an on-going basis.
Objective: To assess the overall coverage and quality of the data in the HIS, to identify specific health districts that needed improvements in data collection methods, and to determine particular areas of weakness in data collection.
Methods: Random samples of 20 mothers with children <5 years were selected in each of 14 health districts. Mothers were interviewed about pregnancies, live births, deaths of children <5, and children’s growth monitoring and immunization status. The Lot Quality Assurance Method (LQAS) was used to identify districts in which records and interview results did not meet predetermined levels of acceptability. Data collected in the interviews were combined to estimate overall coverage and quality.
Results: When all variables were analyzed, all 14 lots were rejected, and it was estimated that 52% of all events occurring in the community were registered in ProMIS. Much of this poor performance was due to immunization and growth monitoring data, which were not updated due to printer problems. Coverage of events increased (92%) when immunizations and growth monitoring were excluded, and no lots were rejected. When all variables were analyzed for quality of data recorded, six lots were rejected and the overall estimation was 83%. With immunizations and growth monitoring excluded, overall quality was 86% and no lots were rejected.
Conclusions: The comprehensive computerized HIS did not meet expectations. This may be due, in part, to the ambitious objective of complete and intensive monitoring of a large population without adequate staff and equipment. Future efforts should consider employing a more targeted and streamlined HIS so that data can be more complete and useful.

Abstract: Patient monitoring is the routine collection, compilation and analysis of patient data over time and across service delivery points. Given the life-long nature of antiretroviral therapy and the significant increase in the number of people receiving antiretroviral therapy in low- and middle-income countries, adequate patient monitoring systems are critical to ensure good clinical care, enable sound decision-making at all levels of service delivery and secure the long-term sustainability of antiretroviral therapy programmes.
Based on the wealth of experience accumulated in Ethiopia, Guyana and India, this report provides a compilation of best practices and lessons learned that can guide programme managers implementing patient monitoring systems (focusing on the WHO paper-based system) in resource-limited settings. Among the multiple issues discussed in this report, the following core elements stand out.

Abstract: As national resources for health decline, so dependence on international resources to finance the capital
and recurrent costs is increasing. This dependence, combined with an increasing emphasis on policybased,
as opposed to project-based, lending and grant-making has been accompanied by greater involvement
of international actors in the formation of national health policy. This paper explores the process of
health policy development in Uganda and examines how nnajor donors are influencing and conflicting with
national policy-making bodies. Focusing on two examples of user fees and drugs policies, it argues that
while the content of international prescriptions to strengthen the health system may not be bad in itself,
the process by which they are applied potentially threatens national sovereignty and weakens mechanisms
for ensuring accountability. It concludes by proposing that in order to increase the sustainability of policy
reforms, much greater emphasis should be placed on strengthening national capacity for policy analysis
and research, building up policy networks and enhancing the quality of information available to the public
concerning key policy changes.