Global Context for Strengthening Health Information Systems.

1. Global Context for Strengthening Health Information Systems. Good Citizenship in a Complex Global Health Environment Michael St. Louis, M.D. Science Officer, COGH, CDC, USG mes2@cdc.gov PEPFAR Strategies for Longitudinal Patient Monitoring Lusaka, October 2-5, 2007

2. USG Policy & Plans regarding Electronic Health Records and Systems • "We will make wider use of electronic records and other health information technology to help control costs and reduce dangerous medical errors."-- President Bush, January 31, 2006"..to link all health records through an interoperable system that protects privacy as it connects patients, providers and payers, resulting in fewer medical mistakes, less hassle, lower costs and better health."-- HHS Secretary Mike Leavitt

3. Key Questions for this Initiative on longitudinal health records: • Are we adherent to global best practices? (i.e., well-aligned externally) • Are we maximally using information systems investments within PEPFAR in the most efficient manner possible? (i.e., well-aligned and well–coordinated internally) • Are we measuring and being driven by any indicators of assistance effectiveness? (What are those outcomes/indicators for our domain?)

4. Brief History of Concern regarding Effectiveness of Flows of Assistance • 1980s – proliferation of donor projects, recognition of impacts • 1990s – budget assistance, SWAPs, Program-Based Approaches  Poverty Reduction Strategies (PRS) • 2003 – Rome High Level Forum (HLF) on Aid Effectiveness: defined the “aid effectiveness” agenda and committed to it • 2005 – Paris HLF: added indicators and targets to the Rome commitments; broadened support among countries, assistance providers

5. What is the Paris Declaration on Aid Effectiveness (2005)? • Principles, strategies, and monitoring framework for efficient and effective assistance programs signed by: • 35 donor countries (including USG) • 26 multilateral donor agencies. • 56 countries that receive aid. • Encourages partners and donors to work together to streamline aid delivery, build sustainable systems, and harness resources to priorities aimed at results. • It tracks mutual commitments, indicators & targets which should encourage change. • It strengthens the mechanisms for mutual accountability; especially at local level.

6. Tiered Elements of More Effective Assistance to low-income Partners Assistance Results

7. PEPFAR Country Teams and the Opportunity to Provide Leadership Assistance Results Within-PEPFAR Harmonization of EPM Transparency & sharing Simplifying transactions Willingness to learn, adopt, converge

8. Problems that have arisen in past from Global Health Partnerships (GHPs) • Poor coordination and duplication among GHPs • High transaction costs to government and donors • Variable degrees of country ownership* • Lack of alignment with country systems* * Key factors in sustainability of programs

9. Best Practice Principles for Global Health Partnerships, Paris Declaration • Ownership • Alignment: global health partnerships (GHPs) base their support on partner countries’ national development strategies, institutions, systems, and procedures; • Harmonization (among GHPs) • Managing for Results • Mutual accountability and transparency

10. Paris Declaration - Mutual Commitment to: • Concerted action at the country level, translating Paris Declaration into local action plans. • Less burden on recipients (coordinated missions, reports, etc; reliance on strengthened country systems). • Simplified rules of the game • Shared Results: • Use of common results frameworks and reporting to measure impact of plans and programs.

11. Major Initiatives and Organizations Relating to Health Information Systems • International Standards Organization (ISO) • Partnership in Statistics for Development in the 21st Century (PARIS21) • Health Metrics Network (HMN) • Institute for Health Metrics and Evaluation (IHME) • Global Health Workforce Alliance (GHWA) • International Association for Medical Informatics, other professional societies

12. What is Health Metrics Network? • A global health initiative with the goal of improving the quality and use of health information, ultimately to improve health • A public-private partnership, with a Secretariat housed with the Health Information unit at WHO Geneva • A network of organizations with shared interests in improved and standardized health information, including HHS/CDC and USAID

13. HMN Framework Health information system components & standards Roadmap for implementation Principles HIS resources Indicators Process Data sources Tools Data management Information products HMN GoalIncrease availability, accessibility, quality and use of health information that are critical for decision making at country and global levels. Dissemination and use

14. HMN Situation Analysis Tool • Spreadsheet based tool with over 200 items • Broad based application within country with participation of large number of stakeholders • Objectives: • Establish a baseline and monitor progress in country • Identify strengths and weaknesses; priority areas • Rates aspects of the health information system • Country scores are converted to quintiles for the overall report • Lowest quintile (<20th percentile) >> Not adequate or not functional • Second quintile >>> Present but not adequate • Third quintile >>> Partial adequate • Forth quintile >>> Adequate • Fifth quintiles >>> Highly adequate

15. Not adequateat all Present but not adequate Adequate Highly Adequate Partial adequate Key: HMN Rating Context & Resources for HIS; Thailand & Ghana 2005 Note: Results of assessment based on early version of tool.

16. Opportunities for Global Best Practice through to Work with HMN • Become familiar with HMN Framework, and use the Framework and HMN tools to reflect commitment to and alignment with global best practice • Learn about and align your efforts to your country’s high level health information strategy • Participate in the HMN Task Force in your country • Utilize and Adapt health systems metrics specifically for work on health info systems, longitudinal health records • Build out a Best Practice Model(s) and guidance for electronic patient monitoring in low-income settings

17. CDC Workgroups related to Global Best Practices re Health Information • CDC Global Health Information Systems Workgroup (GHISW) - umbrella • Global Surveillance Workgroup (GSW) • Household & Facility Survey Workgroup • Workgroup on Mortality and Causes of Death • Mobile Computing Devices and Public Health Data Collection (aka “PDA”) Workgroup • Surveillance Science Advisory Group (SurvSAG) • Other? – e.g. a new Workgroup for: Patient-level health monitoring in low-income settings??

18. Hypothetical concepts for Best Practices for Electronic Patient Monitoring in PEPFAR • Systems and tools follow global standards per ISO TC 215, WHO, HMN, IAMI, etc. • Tools follow best software design practice (eg, object-oriented design, platform independence, etc.) • EPM systems are technically designed to easily be extended to other health conditions • Fewer tools is better: ultimate Best Practice is willingness of each individual project to adopt consensus best tools, i.e. converge over time

19. Key Questions for this Initiative on longitudinal health records: • Are we adherent to global best practices? (i.e., well-aligned externally) • Are we maximally using information systems investments within PEPFAR in the most efficient manner possible? (i.e., well-aligned and well–coordinated internally) • Are we measuring and being driven by any indicators of assistance effectiveness? (What are those outcomes/indicators for our domain?)

20. Challenge to Lusaka Participants: • Could PEPFAR’s work on longitudinal health records raise the bar and become the standard-setter for global health good citizenship / highly effective assistance provider? • Could we blaze any trails for the U.S.?