Information System on Live Births: influence of the municipal health organizational context on the implantation, 2012-2013

Abstract Background The information system on live births (Sinasc, in Portuguese) is essential for the calculation of health indicators and should provide quality information. Objective Evaluate the influence of the organizational context on the implementation of Sinasc. Method Evaluative study of multiple cases in nine municipalities through implementation analysis based on the logical model and indicator matrix. In order to appreciate the context, we adopted the categories government project, governance capacity and governance (Matus Triangle); and to measure the degree of: implementation; structure and process indicators related to management; distribution and control; emission and filling; collection; processing; and analysis and disclosure. The results were intertwined accord to theoretical references. Results Of the nine municipalities, the organizational context was favorable in six and unfavorable in three. Regarding the degree, one was classified as implanted (82.8%); five partially implemented (ranging from 79.3 to 62.6%); and three incipients (57.0% to 46.1%). Conclusion Organizational political contexts favored the better implementation of Sinasc, influencing and interacting among themselves. A few challenges were identified and need to be addressed; including a government project that prioritizes the system and investments in the technical capacity and autonomy, all essential to obtain adequate and timely information.摘要：活产信息系统（葡萄牙语缩写为Sinasc）是健康指标计算的核心支撑系统，需保障信息质量。本研究旨在评估组织情境对Sinasc系统实施落地的影响。方法：采用基于逻辑模型与指标矩阵的实施分析框架，对9个市镇开展多案例评价研究。为全面刻画实施情境，本研究采用政府项目、治理能力与治理维度（马特斯三角，Matus Triangle）作为分析范畴；并从实施程度、管理相关结构与过程指标、分配与管控、生成与填报、信息收集、数据处理以及分析与公开七个维度衡量系统实施水平。研究结果结合理论依据进行综合分析。结果：在所调研的9个市镇中，6个的组织情境表现为有利，3个为不利。按实施程度划分，1个市镇被归类为完全实施（实施率82.8%），5个为部分实施（实施率区间为62.6%~79.3%），剩余3个为初步实施（实施率区间为46.1%~57.0%）。结论：组织情境对Sinasc系统的高质量实施具有正向推动作用，且各影响要素间存在相互影响与交互关联。本研究识别出若干亟待解决的挑战，包括需构建优先支持该系统的政府项目，加大对技术能力与自主权的投入——上述要素均为获取及时、充足信息的核心必要条件。