Value of information for planning and management of healthcare in India

1. Value of information for planning and management of healthcare in India Theme 2012: "Women and Girls in ICT" Dr BijuSoman MBBS, MD, DPH, MSc CID, DLSHTM Associate Professor, AMCHSS SreeChitraTirunal Institute for Medical Sciences & Technology. Thiruvananthapuram-11

2. overview • Value of information in health sector • Types of information needed • Need for trans-sectoral synthesis • Public health in Indian context • Sources of our health data • Reasons for not using information • Future directions NHSRC - bs

3. Need for timely information • Individual/Community level • Effective clinical management • Access, utility, etc • District/Functional adm. unit level • Effective functioning • System management • State/National Level • Strategic policy making • Resource allocation NHSRC - bs

4. Health system needs information on • Health determinants • Social, behavioral, environmental, etc • Health system inputs • Infrastructure, human resources, policy/legal, etc • Health system outputs • Performance, availability, utilization, quality, etc • Health outcome • Mortality, morbidity, disability, well-being, outbreaks • Health inequities • Coverage & access by sex, SES, ethnic, locality, etc Macfarlane, SB 2005, Bulletin of the World Health Organization NHSRC - bs

5. Information for health • Not exclusively from health sector • Inter-sectoral requirements • Cross-sectoral action for health • Interdependence between information needs of other sectors • Epidemics & climatic change • Trauma & transport system • Chronic diseases & risk factor surveillance • Education, welfare, agriculture, industry, tourism, trade, governance , etc NHSRC - bs

6. WHO framework for HIS function Macfarlane, SB 2005, Bulletin of the World Health Organization NHSRC - bs

7. Public Health • Collective action for sustained population-wide health improvement • Should have the ability to measure and monitor the health of populations • Epidemiology, demography and biostatistics are key components NHSRC - bs

8. Public health in India • Ayurvedic teachings • Holistic • Intuition rather than empiricism • Sanitation drive (West) • Bills of mortality • Colonial time • Indian Medical Services • Sanitary Commissioners • Post independence period • Bhore committee • Lost its charm to clinical medicine • MDG • Helps to highlight our lacunae NHSRC - bs

9. Sources of Health Data in India • Census • Birth & Death registration • Surveillance & response systems • Household surveys • Health Research • Service generated data • Mapping of health facilities • Behavioral surveillance • National health accounts • Financial and management information • Modeling, estimations and projections Raban MZ et al BMC Public Health, 2009 NHSRC - bs

10. issues • Lack of standardization • Lack of synthesis with data from other sectors • Only estimated/projected figures at national level • Insufficient data at lower levels • Don’t have the data we need! • Data overload at the central! NHSRC - bs

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12. Health information in the public domain in India • Health information and statistics are important for planning , monitoring, and improvement of health of populations • District level data are very limited • Almost no data from private sector • Relatively limited data on epidemiological transition NHSRC - bs

13. Other reasons for not using data • Financial constraints; a myth? • Cuba, Iran, Malaysia, Sri Lanka • Overlaps • Statistical capacity building • Demand ? • Decentralized planning • Honoring responsibility • Legitimacy issues • risk and protective factors are often outside health sector • Private facilities • Weakness Decision making • Political opportunism, adhoc systems • Not accepting community as a stakeholder NHSRC - bs

14. Research data is not based upon our requirements • Dandona, L. et al. Public Health 2004 NHSRC - bs

15. Online resources for health data in India Raban MZ et al BMC Public Health, 2009 NHSRC - bs

16. Online resources for health data in India-2 Raban MZ et al BMC Public Health, 2009 NHSRC - bs

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18. biju soman

19. Uses Open Source Softwares Cost ~ Rs 5000 Pilot testing of its use for JPHNs is planned biju soman

20. Recent/Future efforts • IDSP • ? • HMIS • DHIS2 • Capacity/Team building • Institutionalization • Systemic changes • Federal system • Use GIS as an integration tool • Timely release of health data for public NHSRC - bs

21. challenges • Quality • Capture of routine data • Use of information by stakeholders • Capturing data from private establishments • Open MRS lite version? • Standardisation • Intersectoral synthesis of data NHSRC - bs

22. Important references used • Macfarlane, SB 2005, ‘Harmonizing health information systems with information systems in other social and economic sectors’, Bulletin of the World Health Organization, vol. 83, no. 8, pp. 590–596. • Dandona, Lalit, Yegnanarayana S Sivan, Mukkamala N Jyothi, V S UdayaBhaskar, and RakhiDandona. “The Lack of Public Health Research Output from India.” BMC Public Health 4 (November 25, 2004): 55. • Das Gupta, Monica. Public Health in India : an Overview. Policy Research Working Paper Series. The World Bank, 2005. http://ideas.repec.org/p/wbk/wbrwps/3787.html. • Dandona, Lalit, Yegnanarayana S Sivan, Mukkamala N Jyothi, V S UdayaBhaskar, and RakhiDandona. “The Lack of Public Health Research Output from India.” BMC Public Health 4 (November 25, 2004): 55. • Raban, Magdalena Z, RakhiDandona, and LalitDandona. “Essential Health Information Available for India in the Public Domain on the Internet.” BMC Public Health 9, no. 1 (2009): 208. NHSRC - bs

23. Thank you Questions / Suggestions / Opinions ? NHSRC - bs