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Health Information Systems Challenges

Health Information Systems Challenges. But first.. Some Concepts from Yesterday’s Readings/ Lectures . You should be able to explain to a friend what these concepts mean in relation to Health Management Information Systems : 1. Primary Health Care (preventive/curative care)

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Health Information Systems Challenges

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  1. Health Information Systems Challenges

  2. But first.. Some Concepts from Yesterday’s Readings/ Lectures You should be able to explain to a friend what these concepts mean in relation to Health Management Information Systems: 1. Primary Health Care (preventive/curative care) 2. Routine Health Information 3. Individual/patient care / Continuity of Care 4. (Electronic) Medical Record 5. Epidemic disease / disease surveillance 6. Fragmentation 7. Integrated Health Information Architecture 8. Data Warehouse / Data Repository 9. Indicator (covered later in course)

  3. Our goal withtheHealth Information System “is to produce relevant information that health system stakeholders can use for making transparent and evidence-based decisions for health system interventions” (HMN) But the challenges here are many: • You need access to data • You need qualitydata (covered later in the course) • You need toknowwhat to do with it

  4. Accessible data? Picture: HMN

  5. Picture: HMN

  6. The lackofaccess to healthinformation Why?

  7. Multileveled fragmentation Uncoordinated Health programs Different Health informationdomains Public/private Manyelectronicformats (and paper still verycommon)

  8. Some Global Trends and Goals Towards more granularpatientbaseddata Globally, two-thirds (38 million) of 57 million annual deaths are not registered. And every year, almost 40% (48 million) of 128 million global births go unregistered. Towardsintegrated and shared data Manyministiresofhealtharefragmented and have vertical programs withtheirownreporting and data analysis systems (+ donors) From Paper to Digital (integration or more mess?) From ‘data collection’ to evidencebaseddecisionmaking Mobiles and ICT oftenproposed as solutions technicalsolutions to social problems??

  9. Example Routine PHC data (clinic/outreach)

  10. Registers/records Record data that need follow-up over long periods such as ANC, immunisation, FP, TB

  11. some registers in Practice…

  12. Paper Reports monthly, Quarterly but there are many different reports….

  13. Fragmentationofhealth programs One informationstream for Malaria program One informationstream for TB program One informationstream for… etcetcetc Surveys Data not available for comparison. Double counting, low data quality Country X (e.g., Malawi): threenationalfiguresof HIV+ rate or infantmortality rate. All different…

  14. Manyofficialactors: risk offragmentation Ministryof Health is not alone… • Central Statisticsoffice (census) • MinistryofLocalGovernment (run theclinics) • Ministryof Education (schoolhealth programs) • MinistryofDefence (militaryclinics) • Special unitson for example HIV Whatdoesthislook like In Norway?

  15. Why program fragmentation? Health services inherently fragmented due to high level of specialization Donors (both from necessity and ignorance) WHO is highly fragmented itself Interests and ownership Leads to lack of transparency, some people thrive on that (corruption)

  16. WHO’shistoryofsuccesswithfocusedprogrammes Smallpox eradicated in 1977 Eliminating polio in the Americas in 1985 Eliminating measles in Southern Africa Reducing guinea worm disease by 99% in 20 African countries between 1986 and 2005 Relative successful compared to other UN agencies (such as World Bank). Each disease eradication program operated autonomously, with its own administration and budget and very little integration into the larger health system

  17. Buthealth systems continued to be inefficient Short-term successeswere not addressingpoorpopulations overall diseaseburden Health systems were urban based, high-technology, curativeoriented. Little contactwiththepopulation for preventive care Health is socioeconomic: • Health services, economy, security, education, nutrition… More comprehensiveapproachesemerged in a numberofcountries

  18. Primary Health Care Promotive, preventive, and curative Involvesrelatedsectors (education, food, agricultureetc), and wideraims (equity, affordabilityetc) Promotescommunity and individualinvolvement and committment Came as a reaction to older, high-tech, curativeapproaches. Basedonbottom-upexperiences from ”developing world” How to implement it? Comprehensivevsselective? Overarchingquestion ever since

  19. Comprehensive vs. selectivetoday? Bothexists WHO is still veryfragmented in specific programs, whicharereplicated at countrylevel Cross-cuttingunits have beencreated; Health Metrics Network In other areas, newagencies have beencreated to target specific areas: Global Fund, UNAIDS, GAVI Alliance

  20. HMN Framework: An exampleofcomprehensiveappraoch to HIS

  21. National: Fragmented reporting; gaps & overlaps Data sources not linked CRIS Excel Excel Excel Facility Facility Excel Excel Excel surveys surveys ICS SUM (hospitals - poor) Other Other Excel Excel Excel data data sources sources Excel Excel Excel Excel Excel Excel Data capture Excel Excel Excel CRIS District: Fragmented Data management Data capture SUM ICS Excel Excel Excel Excel Excel Excel Data capture Summary reports Compiled Summary report Data capture Summary report monthly reports Facility: ARV patient Hospital Hospital ARV ARV PMTCT PMTCT Other Other Morb Morb Multiple Forms Paper records ICS ICS idity idity . . In & out patients & registers Records / registers A selectiveapproach to HIS

  22. Comprehensive vs. selective: ICTs Comprehensive: integration, comprehensiveinformationneeds, varied outputs Selective: Silos, fragmentation, inefficientdevelopment and utilizationofinfrastructure. Closed-boundary ICT systems. Potential for cross-comparisonofindicators is lower. Both: provisionofhealth services decentralized. IS needs to allowlocallevels to collect, process, and useinformation Scope for varioustechnologies to contribute: Mobile phones, mobile modems to access online services

  23. The MDGs in the PHC tradition(milleniumdevelopment goals) Adopted by UN in 2000, to reach by 2015 goals related to: • Poverty and hunger • Universal primaryeducation • Genderequality • Childmortality • Maternal health • HIV/AIDS, Malaria, and otherdiseases • Environmentalsustainability • Developing global partnership for development

  24. The MDGs in the PHC tradition DespitethecomprehensivenessoftheMDGs, selectiveapproacheswithinhealthcontinues Addressessomecritiqueofselective PHC • Takeintoaccountthebroadercontextofdevelopment • Doesackowledgetheroleofsocial and genderequity Still challengesrelated to: • Donor-driventechnocraticapproach to priorities, ratherthangrassrootapproachof Alma Ata • Verticalobjectives, fighting onedisease at a time • Little coordinationamongvertical programs New actorsfindlegitimacy in theMDGs for focusingonspecific areas, contributing to and sustainingfragmentation

  25. In Conclusion There is a strong trend towardsindividual and encounter-based data (drilling down) • Security, patientconfidentiality, robustness IncreasedfocusonCivilRegistration and Vital Statisticswill lead to newrequirements for selectivesharingof data • Birth data: not all stakeholders shouldget all data • Who has access, whoownsthe data

  26. In Conclusion II ICTsonlyas effective as the system they support International healthcommunitybecomingincreasinglyawareofthelimitationsofICTs: WhatICTscan do? Help in integration, collection, storage, processing, presenting information. Decentralization. Communityempowerment, but not withoutitschallenges

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