Session 2.1: Geography and time across the HIS MODULE 2: GEO-ENABLING THE HEALTH INFORMATION SYSTEM (HIS) Session 2.1: Geography and time across the HIS

Key terms used in this session Data: Facts and statistics collected for reference or analysis Geographic Information System (GIS): An integrated collection of computer software and data used to view and manage information about geographic places, analyze spatial relationships, and model spatial processes. A GIS provides a framework for gathering and organizing spatial data and related information so that it can be displayed and analyzed. Geography: The study of the natural features of the Earth, such as mountains and rivers Information: Facts provided or learned about something or someone Here are the key terms that will be used in this session.

Key terms used in this session Information System: Organized system for the collection, organization, storage and communication of information Health Information System (HIS): A system that integrates data collection, processing, reporting, and use of the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services. HIS is a much broader term than Health Management Information System (HMIS) and includes HMIS, Patient Management Registration System (PMRS), Logistics Management Information System (LMIS), Human Resources Information System (HRIS), Financial Management System (FMS), etc. Here are the key terms that will be used in this session.

Key terms used in this session Health Information Management System: HMIS is a data collection system specifically designed to support planning, management, and decision making in health facilities and organizations. Public health: All organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole Here are the key terms that will be used in this session.

Health Information System (HIS) Why is HIS important? The HIS is the backbone providing the necessary information needed to make decisions regarding public health problems. Why do we need the HIS? We need information to be able to make decisions and we need to be able to know what is happening in the country to be able to solve public health problems. The HIS is the collection of all the information systems under the health sector and as such, is important as it provides the information needed to make decisions regarding public health issues. MEASURE Evaluation’s curriculum on Routine Health Information System (RHIS) includes a discussion on Health Information System: https://www.measureevaluation.org/our-work/routine-health-information-systems/rhis-curriculum What are the decisions that need to be made? Let’s look at public health. MEASURE Evaluation’s curriculum on Routine Health Information System (RHIS) includes a discussion on Health Information System: https://www.measureevaluation.org/our-work/routine-health-information-systems/rhis-curriculum

Geographic dimension of public health The three main public health functions are: Risk assessment - The places most at risk are those where the hazard and vulnerability are the highest and capacity the lowest. Policy formulation - The formulation of public health policies is supported by maps that help visualize and analyse spatial distribution of public health related issues Ensuring access to health care - Physical accessibility to health care is influenced by the location of the health services, the spatial distribution of the population, and the environment between the two. According to the Institute of Medicine’s report, The Future of Public Health (1988) the three core functions of public health are: Risk assessment: assessing and monitoring the health of communities and populations at risk This involves analyzing the hazards, vulnerability, and capacity of places to determine which places are most at risk. Risk assessment is actually at the origin of modern Epidemiology: The study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems. Has a strong geographic dimension Policy development: formulating public health policies designed to solve identified health problems and priorities This function is best completed through the support of maps and other object-based data products such as graph and tables. Assurance: assuring that all populations have access to quality, timely, and cost-effective care This functions determines the best possible location for health services to ensure physical access to health care by the population All of the three functions have strong geographic dimension! This further emphasizes the need to have geography, and time, properly captured in the HIS to be able to fulfill the functions of public health.   All three functions have strong a geographic dimension! Geography, and actually time, should be properly captured in the HIS!

Geography and time in the HIS Can you think about one piece of data or information within an HIS that has neither a geographic nor a time dimension? "everything happens somewhere at a given time" “Everything happens somewhere at a given time” Every piece of data or information within the HIS has a geographic and time dimension. Examples: malaria transmission, vaccination schedule, capacity of a hospital, etc. This again emphasizes the need to have geography, and time, properly captured in the HIS. Unfortunately, despite the foundational importance of the above, these two dimensions are generally among the most poorly captured elements in the HIS, leading to health programs not being able to fully benefit from what geography as the science, geospatial data as the content, and geospatial technologies as the tools have to offer to address public health priorities such as Universal Health Coverage (UHC) under the umbrella of the Sustainable Development Goal of healthy lives and well-being for all (SDG 3). What then are the benefits of properly integrating geography and time in the HIS? Importance of properly capturing geography and time in the HIS Generally among the most poorly captured dimensions in the HIS

Geography and time in the HIS Once properly integrated, geography and time allows to: Properly integrating geography and time in the HIS allows to: 1. Contextualize data from different sources in both space and time. One will be able to piece together and make sense of information from different sources by using geography and time as the common factor. Extracted from https://www.adb.org/publications/building-capacity-geo-enabling-health-information-systems

Geography and time in the HIS Malaria surveillance For example, in Malaria surveillance, data are coming from different sources but by using geography and time to contextualize the information, it is possible to understand how each data relates to each other to successfully conduct malaria surveillance. An ideal dataset will be able to tell you that a cluster of cases occur close to each other at relatively the same time. When it comes to malaria, there are different time stamps: time of the event (actual infection), time when the information was captured/observed, time when it entered into the system. All these can be captured in the system which will help further contextualize the information.

Geography and time in the HIS 2. Use geographic objects as the common link between data collected by different sources. Having an object-oriented approach allows linking statistics or information from different sources using a common object like health facilities, administrative divisions, patients, etc. This would then make it possible to analyze the different information about the particular object to make important decisions. Extracted from https://www.adb.org/publications/building-capacity-geo-enabling-health-information-systems

Geography and time in the HIS Emergency management Map Source 1 Number of pregnant women in affected area Source 2 Capacity of the health facility Table/graph Source 3 In an ideal system where all programmatic data uses the same geography, it is possible to readily collect data for a particular health facility, for example, that could help in emergency management. In having this, you can readily know how may pregnant women go to this particular health facility at the moment, what is the capacity of that health facility, what magnitude/intesity of earthquake can this health facility can withstand, what is the nearest and safest hospital that you can refer these patients to. This is because everyone agrees that a particular health facility is the same health facility throughout all the programmatic systems and it has the same unique identifier. And their systems will be able to collate all the data of that health facility by entering its unique identifier in the system. By having all these data in relation to a geographic object, you will be able to create data products such as maps, tables, and graphs that can help you plan accordingly for an emergency. Magnitude/intensity of earthquake the HF can withstand Health facility Source 4 Nearest facilities outside affected area All object based!

Geography and time in the HIS 3. Facilitate trend analysis by taking into account how geography has changed through time. By properly integrating geography and time into the HIS, one would be able to keep track of when and how the geography of an object has changed and incorporate this information when doing trend analysis. Extracted from https://www.adb.org/publications/building-capacity-geo-enabling-health-information-systems

Geography and time in the HIS Changes in a district in Uganda Source 1 Source 2 Source 1 Source 3 For example, by clearly recording how and when the geography of the district of Tororo has changed, it was possible to do a correct trend analysis by taking into account that the geograhy of Tororo district has changed a number of times througout the years and therefore, the information for those years should be attributed to the correct geography. If you would like to do a population trend analysis and knowing that the geography of Tororo has changed in the past, you cannot do a direct comparison between the population of Tororo of July 2005-June 2007 to the population in the years before that. You must take into account the changes in geography that happened. Time

Geography and time in the HIS 4. Use a Geographic information System (GIS) to create thematic maps, conduct spatial analyses, or apply spatially distributed models. By properly integrating geography and time into the HIS, one would be able to use GIS and benefit from the various solutions it could provide. Extracted from https://www.adb.org/publications/building-capacity-geo-enabling-health-information-systems

Geography and time in the HIS Thematic mapping One can do thematic maps like the ones shown here wherein it is made possible to visualize the distribution of health facilities and municiapl population in the provinces of Albay and Catanduanes in the Philippines.

Geography and time in the HIS Spatial modelling One can do spatial modelling such as the one conducted in Cambodia to analyze the geographic accessibility for Emergency Obstetric Care (EmOC) services. https://www.healthgeolab.net/KNOW_REP/WHO-HIS-HGF-GIS-2016.2-eng.pdf It is important to note that the first three benefits are purely data management and the last one is the use of GIS. It means that there is an emphasis on the content of the HIS and not just about the technology. https://www.healthgeolab.net/KNOW_REP/WHO-HIS-HGF-GIS-2016.2-eng.pdf

Geography and time in the HIS Properly integrating geography and time in the HIS actually improves geographically-based decision making and therefore provides a more systemic approach to solving public health problems. How do you properly integrate geography and time in the HIS? The previous slides have emphasized why it is important to properly integrate geography and time in the HIS. How then do you properly integrate geography and time in the HIS? The next two sessions discuss about the HIS geo-enabling framework – it’s description and implementation. Session 2: The HIS geo-enabling framework: Description Session 3: The HIS geo-enabling framework: Implementation