Global Health Information: strengthening health systems through better evidence Prof. Alan Lopez Health Information Systems Knowledge Hub School of Population Health University of Queensland Health Information Systems Knowledge Hub 2009

What do we mean by HIS? HIS is an integrated effort to collect, process, report and use health information and knowledge to guide and influence public health policy-making, program action and research. Without a functioning HIS, the ability to decide public health priorities and to determine the efficacy of health interventions is severely compromised.

WHO Framework for Health System Strengthening System Building Blocks Overall goals Service Delivery Health Workforce Information Medical Products, Vaccines and Technology Financing Leadership and Governance Improved Health Outcomes Responsiveness Social and Financial Risk Protection Improved efficiency A well functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely health information by decision-makers at different levels of the health system, both on a regular basis and in emergencies. It involves three domains of health information: on health determinants; on health systems performance; and on health status. World Health Organisation (WHO) Everybody’s Business: Framework for Action Strengthening Health Systems to Improve Health Outcomes http://www.who.int/healthsystems/round9_2.pdf

Health information system components & standards HMN Framework Health information system components & standards HIS resources Indicators Data sources Data management Information products Dissemination and use

Indicators needed in each domain

Sources of Health Information Census Continuous monitoring of births and deaths, with certification of cause of death Surveillance and response systems Household surveys Service-generated data (facilities and patient-provider interactions)

Sources of Health Information – cont’d Behavioral surveillance (focus on risk factors) National health accounts, financial and management information Modeling, estimates and projections Health research

4/16/2017 Drivers for change MDG and other global health goals have increased demand for data to monitor progress Donors demand better accountability and many have introduced performance-based disbursements Health sector reforms and decentralization have generated new information needs and challenges for standardization and quality of data HIV, SARS, avian influenza, etc have further created awareness of the need for a functioning HIS

Common grievances about health information Incomplete Inaccurate Irrelevant Redundant Unanalyzed Unused Obsolete Untimely Biased Parallel systems Neglects equity concerns Underestimates the poor Too aggregated Not integrated Unexploited synergies Not population-based High but unknown costs Ignored in sector reforms

Weak systems Complex, crowded field; many donors; project and program focused M&E; fragmentation; epidemic of indicators Lack of comparability, need for certification and application of common standards Weak analytical capacities; health poorly connected to statistics; Translation of health data into information for policy action; evidence-based decision making Much frustration at all levels, producers and users Paris Declaration on Aid Effectiveness; ownership, harmonization and alignment

Fragmentation of demand

Key Challenges Lack of comprehensive vital registration systems (record of births and deaths) Competing donor and national program requirements (disease specific vertical programs) Integrating public and private sector information (incorporating non-state actors)

Operational Constraints Measurement and classification – standardisation needed Human resource capacity Data storage and use – health technology investments

What do we need vital statistics for? Develop key health indicators nationally and for small areas (fertility, mortality, disease specific rates) Generate reliable and timely information for policy-making nationally and sub-nationally Help guide efficient resource allocation in health sector To identify health inequalities and develop programs and policies to reduce them Provide information on patterns of leading diseases and trends Identify emerging health problems Monitor and evaluate the effectiveness of health programs and policies

Registered causes of death, Sri Lanka (2001) & Australia (2006), selected causes Percentage of deaths

Leading causes of deaths registered in Thailand, 2005 Cause of death Ill-defined causes Septicemia Other external causes Other cancers Stroke Dis of GU system Cancer of liver Pneumonia Ischaemic heart dis Road Traffic Acc % of all deaths 38.2 5.8 4.8 4.0 3.2 3.1 2.9 2.8 52.8%

Corrected distribution of causes of death, Thailand 2005 MR certified (urban) COD COPD 13.4% IHD 12.7% Oth.heart dis 8.2% Stroke 5.2% HIV/AIDS 4.5% Diabetes 4.5% … Ill-defined 0.7% VA-assigned(rural) COD IHD 11.6% COPD 11.4% Stroke 8.9% Diabetes 6.8% Oth.heart dis 6.2% Lung cancer 5.5% …. Ill-defined 2.9% MR: Medical records review VA: Verbal Autopsy

Broad causes of death patterns (%) before and after correction, Thailand, 2005, males

The Potential of HIS Benefits include: helping decision makers to detect and control emerging and endemic health issues, monitor progress towards goals and promote equity; empowering individuals and communities with timely and relevant health information and supporting improvements in health service quality;

The Potential of HIS – cont’d strengthening of evidence base for assessing effectiveness of health policies; improving governance, mobilising new resources, ensuring accountability in way resources are used.

Good health information is essential for evidence-based decision making at all levels of the health system