Strengthening the Health Information Systems: FROM WHERE DO WE START? Mohamed M Ali, PhD

1. Capacity Building Workshop on Health System Development for National Policymakers and WHO Staff June 8-12, 2008Alexandria, Egypt Strengthening the Health Information Systems: FROM WHERE DO WE START? Mohamed M Ali, PhD Evidence-based, Health Situation and Trend Assessment, EMRO

2. HIS -Strengthening Definition Rationale Components Principles, Processes and Tools The first step or Phase

3. The WHO Health System Conceptual Framework Source: WHO Health System Strengthening Strategy 2007

4. What is the Health Information System A “System” is defined as any collection of components that work together to achieve a common objective. The objective in the case of the HIS is to improve the health services management through optimal information support. Information can be define as a meaningful collection facts or data Therefore, Health Information System (HIS) can be define as a set of components and procedures organized with the objective of generating information which will improve the health care management

5. Rationale for strengthening HIS • Improving health – the reason for better health information • The challenge of measuring health • Poor performance of the current HISs • Drivers for change • Global standards and harmonization of health information • A unifying approach to HIS development

6. Entering information from death certificatesinto a database. She records 100 forms daily

7. 1- Improving health – the reason for better health information • Decision-makers can not identify problems and needs, track progress, evaluate the impact of intervention and make Evidence-based decision on health policy, programme design and resource allocation, because reliable and timely information is often un-available due to under-investment

8. 2-The challenge of measuring health • Measuring health is conceptually and technically complex. • Accurate measurement depends upon the availability of disease-specific biometric test, clinical diagnosis and feasibility of measuring population behaviors and coverage of health services • As a result health statistics may vary in terms of scientific soundness, usability and timeliness

9. 3-Poor performance • HIS have evolved in a fragmented way, due to administrative, economic, legal or donor pressure, responsibilities often divided among different players • Multiple and often parallel demands stretch available resources beyond their limits. • Data often presented in crude format without any attempt at the synthesis or analysis require for day-to-day management or long term plans • Increase in demand, cutting cost and increase efficiency- vicious cycle of under-investment and further decline in use

10. 3-Poor performance (cont’d) • Decision-makers at all levels need information that is relevant, reliable and timely. Unfortunately, even when high-quality information are available, this doesn’t guarantee its appropriate use in the decision-making process Much of the data remains unprocessed, or, if processed, unanalysed, or, if analysed, not read, or, if read, not used or acted upon

11. 4-Drivers for change • There is a broad consensus that improving health outcomes can not be achieved without strengthening health systems (including HIS) as whole. • Monitoring MDGs • Improve accountability • Ensure evidence-based decision making • The need to make better use of limited resources • Performance-based disbursement: GAVI, GFATM • HSR and decentralization, HS are managed as closely as to the level of service delivery.

12. 5-Global standards and harmonization • Country institutions and management structures must be strengthened by adopting and adapting global health information standard that are aligned to broader efforts to improve the availability and quality of data • Development partners including WHO must harmonize their efforts and align themselves around a sound NHIS

13. 6- A unifying approach to HIS development • HIS involve complex processes and relationships that go beyond the responsibility of any single government agency. Multiple institutions produce and use health data. • Therefore, a comprehensive and collaborative plan is needed to reform the HIS

14. HIS Components • Input • Resources • Process • Indicators • Data Sources • Data management • Outputs • Information products • Dissemination and use

15. Resources • Coordination and leadership • Information policy • Financial and human resources • infrastructure

16. Indicators • Domain • Determinants of health • Health systems • Health status • Core indicators • Valid, reliable, specific, sensitive and feasible/affordable to measure • Relevant and useful to decision making • Should reflects changes over time • Choosing minimum set of indicators is challenging

17. Indicators: domain and core Determinant of health Socio-economic & demographic factors Environmental and behavioral risk factors Heath Status Mortality Morbidity/ disability Well-being Health Systems Inputs Outputs Outcomes Policy Information Service Financing Service coverage HR availability Organization & and quality Utilization management

18. Data Sources Resource Records Census Service Records Civil Registration Population Surveys Individual Records

19. Linking Indicators and data source

20. Data management • Data storage • Coding • Restricting access • Procedure for distribution and re-filing • Minimum period for dispatch • Backups • Ensuring data quality • Timeliness • Periodicity • Consistency • Representativeness • Disaggregation • Confidentiality • Data processing • Cleaning, documentation, manipulation and extraction

21. Information products • Data is the raw material of the HIS, therefore they have little intrinsic value in themselves, only when compiled, managed and analysis to produce information • More variable when integrated with other information • some HIS is data-rich but information poor • The key is to integrate, synthesis, analysis, and interpretation of information from multiple sources.

22. Dissemination and use • Use of information for decision making at various levels of HS for health service, system management, planning, advocacy and policy development • linking information to actual resource allocation and develop indicator-driven planning (short and medium)

23. Guiding principles for HIS development • Country leadership and ownership • Responding to country needs and demands • Building upon exiting initiatives and systems • Building broad-based consensus and stakeholders involvement • Gradual and incremental process with a long-term vision

24. Implementation processes • Identify a lead sponsor and a country champion • Establish consultation and coordination mechanisms • Establish a SC to provide ongoing oversight • Create 1 /2 country action team(s) • Assess the current situation

25. Assessment NHIS • What are the objectives of assessment? • Who should assess? • How can assessment be organized and facilitated? • How can final consensus be reached and findings disseminated? • How can the assessment findings be built upon?

26. Scoring and interpretation of results Assessment and Monitoring Tool has been developed which can be used to score the status of each of the SIX HIS components