Introduction to the Health Information System Performance of Routine Information System Management (PRISM) Assessment Training Session 2: Introduction to the Health Information System MEASURE Evaluation Date:

Session objectives Define the health system and its generic functions Describe the relationship between the health system and the health information system (HIS) Describe the relationship between the health system and the routine HIS (RHIS) 2

What is a health system and what are its components? It is all the organizations, institutions, resources, and activities whose primary purpose is to promote, restore, or maintain health. It needs staff, funds, information, supplies, transport, communications, and overall guidance and direction. It needs to provide services that are responsive and financially fair. The definition is taken from World Health Organization (WHO). (2007). Everybody’s business: Strengthening health systems to improve health outcomes: WHO’s framework for action. It includes, for example: A mother caring for a sick child at home Publicly owned facilities that deliver personal health services Private providers Behavior change programs Vector-control campaigns Health insurance organizations Occupational health and safety legislation Intersectoral action, like encouraging the ministry of education to promote female education

Functions and goals of a health system Service delivery Human resources Commodities infrastructure Leadership and governance I N P U T S Responsiveness Improved health Improved efficiency Quality Coverage Safety Goals/outcomes Source: World Health Organization (WHO), 2000 Functions (6 building blocks) Information Financing Access Social and financial risk protection Health systems have four fundamental objectives Improving the health of the population they serve Responding to people’s needs (the way people are treated and the environment) Protecting people from the burden of the financial cost of illness Improving efficiency The health system has six components, or building blocks: service delivery, health workforce, health information system, medical products, vaccines and technology, health financing, and leadership and governance. The four functions of the health system that relate to the building blocks are (World Health Report 2000): Stewardship (oversight) Creating resources (investment and training) Financing (collecting, pooling, purchasing) Delivering services (ensuring access, quality, coverage and safety)

What is an HIS? An HIS is a system that provides specific information support to the decision-making process at each level of the health system The Health Information System (HIS) is an integral part of the health system and refers to any system that captures, stores, manages, or transmits information related to the health of individuals or the activities of organizations, which will improve health care management decisions at all levels of the health system. A well-functioning HIS is an integrated effort to collect, process, report, and use health information and knowledge to influence policy and decision making, program action, individual and public health outcomes, and research (WHO, 2010).

Health information system Responsive & efficient health system Good decisions A well-functioning HIS supports the delivery of health services, by ensuring the production, analysis, dissemination, and use of reliable and timely information on health determinants, health system performance, and health status. Reliable information is the foundation of evidence-based decision making across all health system building blocks. It is essential for health system policy development and implementation, governance and regulation, health research, human resource development, service delivery, and financing. “Health systems need reliable information to be responsive as well as efficient.” ― Margaret Chan, former Director-General, World Health Organization Use Good data Data quality assurance Data management Well-functioning information systems

Health information system Nonroutine data Routine data Administrative records systems Census Vital registration Services records systems Health Information System (HIS) can be categorized according to the data sources. These data sources are broadly classified into Population-based and Health Institution-based data sources (even though there can be some overlap) Another way to categorize HIS subsystems is based on the frequency of data collection. Routine data collection refers to data that are collected continuously (daily, patient by patient, monthly, etc.). While processing and reporting are periodic, they are conducted more frequently than annually. Examples of HIS subsystems using continuous data collection are health facility-based subsystems that collect information on patients when they use services. Service statistics are usually aggregated monthly and reported quarterly. Vital registration occurs when a person registers, which may happen at any time. Nonroutine data collection refers to data that are collected at certain periods or over a specific period. Examples of nonroutine data are household surveys, special studies, surveys carried out for specific purposes, or a national census. Individual records systems Population- based surveys Population-based data sources Health institution (including community-based data sources)

How does the HIS help to address health challenges? Management of an individual patient/client using information on health status, health services, behavior and practices, and risks Management of the health of the family and household Management of vaccines, drugs, and the cold chain At the patient/client (health service delivery) level Management of resources for efficient and equitable allocation, distribution, and use Planning program interventions; annual planning Monitoring and evaluation (M&E) of heath services coverage and performance Disease surveillance At the health unit level Health systems research Policy and strategy decisions Formulating specific programs Resource management At the health system level Facilitator’s Note Brainstorm: What are the different data/information needed at various levels of the health system, i.e., patient level; health service delivery unit level; health system level? For what purposes are those data/information utilized? Note the responses on flip chart and then show the slide and reconfirm what the participants have said. Clarify misconceptions. Capacity building Disease surveillance Innovations Research, monitoring, and evaluation

Core components of a well-functioning HIS Data quality, analysis, dissemination, & use Data quality assessment Monitoring quality of care Analytical methods Data sharing Governance Policies, plans, and accountability Data standards and data architecture Human resources Data collection and management Individual client data Aggregated facility data Facility data on causes of death Health facility assessment Community-based services data As a system, the core components of HIS are: Governance of HIS Standards and mechanisms for data collection and management Mechanisms and practices of: Assuring data quality Data analysis Dissemination Use

Brainstorm What are enablers and barriers of: Assuring data quality? Using HIS information? Facilitator’s Note In the plenary session, ask the participants to list the enablers of and barriers to HIS data quality and information use. Note the responses on flip charts. Facilitate to group the responses as: Those related to the design of the information system, or data burden, difficulty in using electronic data system, etc. Those that relate to support from within the organization, such as supply of HIS instruments; lack of computers; no training mechanism; lack of SOPs for data quality assurance or information use; no systematic mechanism to present and disseminate data; no structure to discuss performance based on HIS data; no incentive for data use; no positions for HIS experts Those that relate to the motivation and skills of the staff Inform them that we will further use this chart in a later discussion.

How to access the PRISM Series This slide deck is one of nine in the PRISM Series Training Kit, which also includes a Participant’s Manual and a Facilitator’s Manual. Also in the PRISM Series is a Toolkit (the centerpiece of the series) and a User’s Kit. The PRISM Series is available in its entirety on MEASURE Evaluation’s website, here: https://www.measureevaluation.org/prism

MEASURE Evaluation is funded by the United States Agency for International Development (USAID) under the terms of Cooperative Agreement AID-OAA-L-14-00004. It is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill, in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government. www.measureevaluation.org