What is H(M)IS?

Purpose of HIS “is to produce relevant information that health system stakeholders can use for making transparent and evidence-based decisions for health system interventions” - Health Metrics Network 2

HIS are socio-technical People 3 Norms Traditions Routines Procedures Activities HIS ICT Software Networks Data

HIS for decision support HIS Includes the what, how, who, when, and where to collect, process, analyze, present, interpret, and use information related to health. Includes data on events and resources, the organizational routines, staff, infrastructure, channels of communication, organizational outputs 4

Is X part of HIS? X = Reporting forms? = Computers used for processing the data? = The nurses at a clinic? =Internet? =Roads? =National policies on patient data security? =District review meetings? =Data collection procedures? 5

WHO Health System building blocks 6

7 Benefits of good HIS  providing care to patients (medical staff)  assist decision makers in detecting and controlling emerging and endemic health problems  monitor progress towards health goals/targets (MDGs)  promote equity (if everyone is counted!!)  strengthening the evidence base for effective health policies  permitting evaluation of health system interventions over time  ensuring accountability in the way resources are used

8 Domains of measurement for HIS

Health determinants indicators:  Prevalence and level of poverty  Education levels  Water and sanitation coverage Health status indicators:  Infant mortality rate  1-4 year old mortality rate  maternal mortality  life expectancy at birth  prevalence/incidence of infectious diseases Measurement of Health determinants & Health status 9

Main determinants of (district) Health Status Health status Environment : Health service delivery system Community 10 physical environment, political context, health care policies, development policies, socio-economic status coverage, affordability, responsiveness to equity culture, Gender, Beliefs, health seeking behaviour

1)to understand and influence how the health care service delivery operates: access, coverage, continuity, risk assessment 2)efficient and effective health care service delivery Health care resource allocation indicators (per capita):  distribution of qualified health personnel  distribution and type of health services, by hierarchical level  distribution of health expenditure on personnel, supplies and facilities Health care utilization indicators:  immunization coverage  antenatal coverage  proportion of births attended by a skilled attendant  use of modern contraceptives Measures for Health System 11

12 Types of (health) information systems Strategic information systems Tactical information systems Operational information systems Decision support, financial forecasting, performance assessment (Health) Management information systems Electronic patient records, payroll, HR, invoicing, patient administration, purchasing/inventory, office automation Artificial Intelligence

13 Typical organization structure of a HIS 13

HMIS around the world Huge differences between national systems, however generally a move from paper to digital and hence convergence/integration of systems Common challenges: – Little use of health information – Too much collected data – Low quality of information – Fragmentation of information streams 14

15 Health information subsystems A National health information system can be considered to consist of several subsystems  Routine data collection based on patient and service records and regular reporting from community health workers & health facilities  Disease surveillance and outbreak notification  Programme-specific monitoring and evaluation (ex: EPI, Malaria, TB, HIV/AIDS)  Administration and resource management (budget, personnel, supplies)  Data generated through household surveys (KPC, DHS)  Registration of vital events and censuses (births, deaths and causes of death) Individual /program tracking Aggregate data

Global HIS Health Metrics Network (since 2005) – Build consensus around integrated data warehouses Many donors are changing their ways: – Paris declaration to build on local systems – Shift funding towards evidence-based interventions: dependent on quality information 16

Paris declaration (2005) Ownership - Developing countries set their own strategies for poverty reduction, improve their institutions and tackle corruption Alignment - Donor countries align behind these objectives and use local systems. Harmonisation - Donor countries coordinate, simplify procedures and share information to avoid duplication Results - Developing countries and donors shift focus to development results and results get measured. Mutual Accountability - Donors and partners are accountable for development results. 17

18 HIS subsystems rarely interact

Global consensus: HMN framework 19

Key points  HIS is both part of, and supporting, the health system  Involves many types of information related to provision of health care  Increasingly the agenda for both national governments and international organizations is to improve weak HIS through integrated data warehouse 20