TOPIC 1: Introduction to Health Information Systems

1. Elective on District Health Information Systems, University of Oslo, 2007 TOPIC 1:Introduction to Health Information Systems Humberto Muquingue

2. Learning objectives • At the end of this session you will be able to: • Define what is: system, health information system (HIS), monitoring and evaluation • List and describe the properties of a system • Present the advantages and benefits brought by HIS • List the distinct domains of health data and give examples of indicators • Describe systems and structures within a HIS • Present the types of HIS and the typical organization of HIS

3. What is a system? A system is a set of objects and the relationships between the objects and their attributes. A.D.Hall and R.E. Fagen, in:Modern System Research for the Behavioral Scientist. Aldine Publishing, 1968

4. What is a HIS? • Definitions of HIS abound  Occram’s rule! • “an integrated effort to collect, process, report and use health information and knowledge to influence policy-making, programme action and research” WHO (2000)Guidance on Needs Assessment for National Health Information Systems Development. • “a set of interrelated components working together to gather, retrieve, process, store and disseminate information to support the activities of health system planning, control, coordination and decision-making, both in management and service delivery” Jack Smith, in:Health Management Information Systems – a handbook for decision makers. OUP, 2000.

5. Properties of systems • Unity/integrity: a system is an entity in its own right, with describable boundaries • Complexity: a system is more than the sum of its parts; there are no simple cause-effect relationships between the individual components of the system • Hierarchical structure: large systems can be divided into smaller subsystems • Stability/equilibrium: a system must function in face of changing requirements and changes in the external environment  accommodation and self-adaptation through control mechanisms

6. A health information system is... a SYSTEM interactions • People • Procedures • Culture (values, norms, traditions) • Processes • Activities • Hardware • Software • Networks • Data Technological subsystem Behavioural subsystem

7. Why HIS? Any health organization/entity requires data in order to: • Assess the impact of program interventions • Prioritize policies and strategies • Prioritize interventions vis-a-vis resource constraints (examples?) • Adapt to reforms • Obtain information pertinent to new styles, participants, and locations of (health) services management and decision-making

8. Why countries need HIS? • To apply performance-based resource allocation • To understand and influence how the health care service delivery operates: access, coverage, quality • To fulfill donor requirements • To access development money • To monitor progress towards major international goals • To build and maintain efficient health care services • To respond to public calls for transparency/accountability

9. Benefits of HIS Investment in HIS may result in many benefits (WHO): • helping decision makers to detect and control emerging and endemic health problems, monitor progress towards health goals, and promote equity; • empowering individuals and communities with timely and understandable health-related information, and drive improvements in quality of services; • strengthening the evidence base for effective health policies, permitting evaluation of scale-up efforts, and enabling innovation through research; • improving governance, mobilising new resources, and ensuring accountability in the way they are used.

10. HIS in health services planning How will we know when we get there? Monitoring and evaluation  Choice of appropriate indicators Where are we now? Identification of needs and problems Pervasive role of information How will we get there? Development of interventions Identification of resources Where do we want to go? Setting priorities and targets

11. What kinds of data flow in a HIS? • birth, morbidity and mortality data • type and location of health personnel • type and quality of clinical services provided at national and sub-national level • population indicators demographics and socio-economic status This data can be organized in 5 domains.

12. Domains of health data • health determinants • health system inputs • health system outputs • health system outcomes • health status.

13. Typology of measurement domains in health care

14. Types of data commonly collected under each domain Health determinants indicators: Prevalence and level of poverty Education levels Water and sanitation coverage Health status indicators: Infant mortality rate 1-4 year old mortality rate maternal mortality life expectancy at birth prevalence/incidence of infectious diseases

15. Types of data commonly collected under each domain Health care resource allocation indicators (per capita):distribution of qualified health personnel distribution of health services, by level distribution of health expenditure on personnel, supplies and facilities Health care utilization indicators: immunization coverage antenatal coverage proportion of births attended by a skilled attendant use of modern contraceptives

16. Main determinants of district health status Environment Health status Health service delivery system Community

17. Main determinants of district health status ENVIRONMENT:the context in which the health care delivery system works: physical environment; political system; health care policies; development policies; socio-economic status HEALTH SERVICE DELIVERY SYSTEM:how health facilities and personnel are distributed; coverage; affordability; responsiveness to equity. COMMUNITY: characteristics of the society – culture, gender, beliefs, health seeking behaviour

18. Types of (health) information systems Artificial Intelligence Strategic information systems Decision support systems, simulation systems, financial forecasting, performance assessment Management information systems Tactical information systems Electronic patient records, payroll, invoicing systems, patient administration systems, purchasing/inventory, office automation Operational information systems

19. Typical organization structure of a HIS

20. Health information subsystems A health information system can be considered to consist of several separate subsystems: • Data collection based on patient and service records and reporting from community health workers, health workers and health facilities • Programme-specific monitoring and evaluation(ex: EPI, Malaria, TB, HIV/AIDS) • Administration and resource management(budget, personnel, supplies) • Disease surveillance and outbreak notification • Data generated through household surveys (KPC, DHS) • Registration of vital events and censuses (births, deaths and causes of death)

21. HIS subsystems rarely interact

22. Fragmentation in HIS: Mozambique

24. Relationship between HIS and M&E Mission Vision Priority Actions STRATEGIC PLAN ACTION PLAN External accountability RESULTS ACTIVITIES M&E mechanisms INDICATORS INDICATORS Information subsystems RAW DATA Internal accountability Forms, registers, etc