PARIS 21 Meeting Ghana July 2005

Challenges in health information Health Metrics Network HMN Framework and profiling tool

An Information Paradox: Reporting of Mortality in the World

Data, Data, Everywhere ….

GHS report Maternal health survey SPA CWIQ Data Collection in Ghana (non-routine only) CWIQ DHS 2DHS 3 Living Standards Survey 3 Living Standards Survey 4 Living Standards Survey 5 DHS 4DHS 5 MICS 3 Census WHS

The Vicious Cycle Health Weak Information System Limited capacity to generate or analyse data. Decision Making Sectional interests, donor demand, inertia etc. Donors focus on theirs own data needs Little investment in health information systems. Weak Demand Data not trusted or used for policy-making at country level.

HMN Goal, Principles, Objectives Goal: Goal: Increase the availability and use of timely and reliable health information in countries and globally through shared agreement on goals and coordinated investments in health information systems Principles: Principles: Country ownership; Stakeholder involvementObjectives: – Develop framework and standards for health information systems – Support countries to implement plans adherent to the HMN framework – Develop incentives for enhanced dissemination and use of sound health information

HMN Framework Description and standards for core data elements, data collection methods, data management, resources, data analysis and use. Diagnostic tool; standardized self- assessment and learning tool DQAF for health Principles and processes for strengthening country health information systems

Health Information System Comprehensive Approach Facility-based data disease surveillance patient & facility records facility surveys health system data (infrastructure, supplies, human, financial resources) Population-based data census vital statistics household surveys demographic surveillance Ministry of HealthNational Statistics Office HMN

Health Information System Profile 1.Context, processes & resources 2. Data platforms 4.Data synthesis, analysis and use 3.Outputs/results for selected indicators Country Health Information System Profile

Rating Context, Resources and Processes; Thailand & Ghana 2005 Legal framework, coordination and planning Human resources availability and skills Infrastructure, equipment, information technology Data flow and management, feedback % rating Inadequate Satisfactory

Rating Context, Resources and Processes; Thailand & Ghana 2005 % rating Inadequate Satisfactory Legal framework, coordination and planning Human resources availability and skills Infrastructure, equipment, information technology Data flow and management, feedback

Assessment of Data Sources & Data Collection Methods Criteria for assessment Contents Capacity Practices Dissemination Integration Data collection methods Census Vital statistics Population surveys Surveillance (acute & chronic) Services data (health facilities) System (administrative, financial)

Rating Data Collection Platforms: Thailand & Ghana, 2005 Inadequate Satisfactory

Rating Data Collection Methods: Thailand & Ghana, 2005 Inadequate Satisfactory

Assessment of Outputs % Indicators Criteria for assessment Data collection method Timeliness Periodicity Consistency Representativeness Disaggregration Estimation method Core indicators Child mortality Maternal & adult mortality HIV/AIDS, TB, malaria Smoking, hypertension Immunization Service utilization Water & sanitation

Reconciling Data Sources

Rating Outputs/Indicators: Selected Countries, 2005 Inadequate Satisfactory

Rating Outputs/Indicators: Selected Countries, 2005 Inadequate Satisfactory

Data synthesis, analysis and use Indicators in national data set linked to planning Data available and compared across public, voluntary and private sectors Summary reports covering key indicators produced at all levels Summary reports targeted to different audiences, including policy-makers, parliamentarians, media, civil society Evaluation of data and indicators documented Ghana score: InadequateSatisfactory

From Diagnosis to Action Establish national coordinating mechanism - MOH, Bureau of Statistics, research & academic bodies, disease-specific programmes Select essential indicators and develop integrated database – Data warehouse Develop national health information system plan; better planning and coordination of household surveys Develop health information system components; sample registration that includes causes of death; avoid less cost- effective methods such as maternal mortality surveys Enhance synthesis and use of data for decision-making (linking inputs and outcomes) by combining data from all sources and linking to budgets and expenditure. Support Health Statistics Resource Centre (software library, PDF electronic library).

Value Added of HMN Health system focus, beyond disease Address both facility and population data Bring health and statistics constituencies together Interactive relationship between country and global levels Donor alignment around shared framework Not a fund, more a catalyst Network

HMN Support to Countries Low and lower-middle income countries: technical and financial support up to $500,000 in a given year. Highest priority for HMN action. All countries except high income countries: technical assistance plus limited financial support up to $100,000 in a given year All countries except high income countries: technical assistance if they generate their own in-country financial resources. These countries can serve as regional centres of excellence and facilitate sharing of experiences.