1. Overview of the PRISM Tools
Performance of Routine Information System Management (PRISM)
Assessment Training
Session 7:
Overview of the PRISM Tools
MEASURE Evaluation
Date:

2. Session objectives Describe how the PRISM Tools are organized
Explain how each PRISM tool relates to the PRISM Conceptual Model
Explain the purpose of each tool

3. The PRISM Tools Six tools, used for the following purposes:
Establish a baseline for RHIS performance and monitor progress
Identify technical, behavioral, and organizational factors that affect RHIS performance
Aid in designing and prioritizing interventions to improve RHIS performance
Advocate technical and financial support to improve RHIS performance

4. Electronic RHIS Assessment Tool RHIS Performance Diagnostic Tool
The PRISM Tools
Electronic RHIS Assessment Tool
FUNCTIONALITY
USABILITY
RHIS Performance Diagnostic Tool
DATA QUALITY
USE OF INFORMATION
The tools can be used in combination or alone.
RHIS
Overview
Tool
Facility/
Office
Checklist
RHIS Management
Assessment Tool (MAT)
Organizational & Behavioral Assessment Tool (OBAT)

5. Linking the PRISM Tools to the PRISM Conceptual Model
INPUTS
PROCESSES
OUTPUTS
OUTCOMES
IMPACT
RHIS determinants
Technical factors:
Complexity of reporting forms, procedures
HIS design
Computer software
Information technology complexity
Performance Diagnostic and Electronic RHIS Assessment Tools
RHIS Performance Diagnostic Tool
Behavioral factors:
Level of knowledge of content of HIS forms
Data quality checking skills
Problem-solving for HIS tasks
Competence in HIS tasks
Confidence levels for HIS tasks
Motivation
RHIS processes:
Data collection
Data transmission
Data processing
Data analysis
Data quality check
Feedback
Improved RHIS performance
Data quality
Information use
Improved health system performance
Improved health status
Facilitator’s Note:
Remind participants that the PRISM Conceptual Model was presented in Session 4 and now we are showing how the PRISM Tools are related to it.
Click 6 times to show the linking of PRISM tools with the model.
Organizational factors:
Critical management functions & information needs
Governance
Planning
Training
Supervision
Quality
Finance
MAT
Overview Tool
Promotion of a culture of information
OBAT
Availability of resources
Facility/Office Checklist

6. Application of the PRISM Tools
Levels of application 1
RHIS Overview Tool
Mainly at national level, but can be used
at subnational levels 2
RHIS Performance Diagnostic Tool
(Data Quality & Use of Information)
Health facility and district or higher levels 3
Electronic RHIS Assessment Tool
(Functionality and Usability)
Functionality at national level
Usability at each level using the electronic RHIS 4
Management Assessment Tool (MAT)
District or higher levels 5
Facility/Office Checklist 6
Organizational and Behavioral Assessment Tool (OBAT)
Part 1 at all levels
Part 2 at district and higher levels
Parts 3 and 4 at health facility
Participants should open “Performance of Routine Information System Management (PRISM) Toolkit: Tools,” to go through each tool one by one.
Facilitator’s Note:
Carefully go through each tool, explaining all the sections in each tool
Encourage participants to ask clarifying questions, and address those questions

7. 1. RHIS Overview Tool Use this tool to understand the structure of:
Existing information systems, type of information collected, and duplication of information
Information flows among different levels of the organization
Interactions among the different HIS
The tool consists of:
Data collection and transmission sheet
Information system mapping sheet
Information flow sheet
Facilitator’s Note:
Go through the RHIS Overview Tool, explain, with examples, what data is collected using:
Data collection and transmission sheet
Information system mapping sheet
Information flow sheet
Encourage participants to ask clarifying questions. Respond accordingly.
Also elaborate that:
This tool is mostly used at the national level or in group exercises jointly with national- and subnational-level managers.
Identify existing information systems, types of information collected under each system, and duplication of information among systems and links (or lack of links) among the systems.
Describe details of the data collection registers/forms and reporting forms used.
Illustrate how and when information flows among different levels of the organization, their overlap, and the burden of information.
RHIS Overview Tool provides opportunities to help integrate systems, reduce duplication, and streamline data collection.

8. 2. RHIS Performance Diagnostic Tool
Use this tool to:
Determine the current level of RHIS performance at health facility and district or higher levels
Regularly monitor RHIS performance
The tool measures the status of:
RHIS performance
(data quality and information use)
RHIS data management
Go through the RHIS Performance Diagnostic Tool; explain, with examples, what data is collected.
Encourage participants to ask clarifying questions. Respond accordingly.

9. Measuring RHIS performance
2. RHIS Performance Diagnostic Tool
Measuring RHIS performance
Data Quality
Accuracy
Do data reflect what is actually happening at the facility?
Completeness
Are all facilities reporting?
Are all required data elements reported?
Timeliness
Are facilities reporting by or before deadline?
Information Use
Analytic report production
Health service performance review and supportive supervision
Revising strategies, developing plans, and setting targets
Mobilizing and shifting resources
Advocacy for more resources
Dissemination of information

10. 2. RHIS Performance Diagnostic Tool
Measuring RHIS data management
Data collection and transmission
Data collection and reporting guidelines
Designated staff for data compilation and reporting
Clear reporting timeframe
Data quality check
Presence of data quality assurance mechanisms
Data processing and analysis
Data processing procedures
Comparisons of data
Data presentation
Feedback mechanism(s)

11. 3. Electronic RHIS Assessment Tool
Use this tool to assess how well:
The electronic RHIS is designed with functions that the system is expected to perform at the national level (functionality)
Staff are able to use the system to carry out their functions at any level of the system (usability)
The tool measures functions as part of the RHIS process and technical factors, such as:
Unique identifiers for the health facility (master facility list)
Aggregate report generation
Coverage calculation using population estimates
Data integration (interoperability)
Data disaggregation by sex and age
Data analysis and visualization

12. 4. Management Assessment Tool (MAT)
Use this tool to measure the effectiveness of key RHIS management functions at the district or higher levels, such as:
RHIS governance
RHIS planning
Training
Supervision
Finance
The MAT is mainly applied through a desk review or observation of relevant documents, such as an office organogram, HIS/RHIS or health sector plans and reports, SOPs, training plan and manuals, supervision tools, etc.
RHIS governance is assessed by examining organizational arrangements, vision, role, and functions with regard to the HIS/RHIS; the presence of SOPs that form part of the organizational culture of the health sector; and a description of who is doing what, how, and with what resources to manage and maintain the RHIS.
RHIS planning is assessed by collecting data on the availability of a copy of a multiyear national or subnational plan, and targets for improving data quality and the regular use of information. Please note that some countries may not have a separate HIS/RHIS strategy but describe the HIS/RHIS vision, plan, and targets in the broader health sector plan or strategic document.
The MAT also captures evidence of ongoing RHIS-related trainings through the review of relevant documents, such as, RHIS training needs assessment report, training plan/schedule, and training manual.
For assessing RHIS related supervision, data on RHIS supervision guidelines/checklists, a supervision plan, and feedback report is collected using MAT.
MAT also helps to examine government and donors’ investment in the process of the production of health information (e.g., to cover RHIS supply, training, and supervision costs).

13. 5. Facility/Office Checklist
Use this tool to:
Understand the availability of resources and their condition at health facilities, district offices, and at higher levels
Identify systemic resource issues at any level of the system
The checklist measures the availability of:
Equipment (computers, printers, backup units, etc.)
Utilities (electricity, backup power, Internet, etc.)
Registers and forms (RHIS supplies)
Human resources (adequately trained personnel and the type of RHIS training received)

14. 6. Organizational and Behavioral Assessment Tool (OBAT)
Use this self-assessment tool to:
Assess whether organizational mechanisms are in place to produce desired results in RHIS performance
Identify the support of upper management for enhancing the RHIS
Quantify staff performance in the RHIS
The tool measures:
Promotion of a culture of information
Individual behaviors
The culture of information is defined as “the capacity and control to promote values and beliefs among members of an organization for collection, analysis, and use of information to accomplish its goals and mission.”
As part of understanding behavioral factors, the OBAT quantifies staff motivation, knowledge, and skill to perform RHIS tasks.

15. 6. Organizational and Behavioral Assessment Tool (OBAT)
Who should fill out the tool?
OBAT
Who?
What? (sections)
Part 1
Staff and management at all levels
Respondent background
Promotion of a culture of information
RHIS knowledge
Perception of competence to perform RHIS tasks
Part 2
Staff and management at district and higher levels
Competence to perform RHIS tasks
Part 3
Health facility in-charge
Part 4
Data management staff in the health facility
The OBAT assesses someone’s perception of the organization through a rating scale, while the behavioral factors are estimated by responses to problems given in a written test.

16. 6. Organizational and Behavioral Assessment Tool (OBAT)
Promotion of a culture of information
Does the organization promote a culture of information by:
Emphasizing data quality
Valuing the use of information
Promoting evidence-informed decision making
Encouraging problem-solving
Promoting feedback
Encouraging a sense of responsibility
Promoting empowerment and accountability
Facilitator’s Note:
Ask: Can you describe what comes to your mind when you think of a culture of information in your organization?
The organizational processes that are considered to be part of a culture of information (as perceived by the respondents) are:
Emphasizes data quality (SE3): The extent to which a health department places importance on data quality
Values the use of information (S10, P9, P11, P15, P25): The extent to which a health department emphasizes and uses data from the RHIS
Promotes evidence-informed decision making (D1, D2, D4, D5, D6): The extent to which a health department uses evidence from various resources and other objective criteria for decision making
Encourages problem-solving (P16, P17, P18, P19): The extent to which a health department’s staff have the capacity for problem-solving.
Promotes feedback (S2, S8, S9): The extent to which a health department promotes various types of feedback.
Encourages a sense of responsibility (P1, P2, P3, P4, P5, P6, P21, P23, P24): The extent to which people feel responsible for their work and its impact by being honest, punctual, and ethical, and by making a difference in their clients’ lives.
Promotes empowerment and accountability (P20, P22, P7): The extent to which a health department gives the authority to make decisions, and people feel accountable for their decision making.

17. 6. Organizational and Behavioral Assessment Tool (OBAT)
Individual behavior
Behavioral assessment:
Confidence level for carrying out RHIS tasks
Knowledge of the rationale for the RHIS and methods for data quality checks
Skills in data quality assurance, data analysis, interpretation, problem-solving, and use
Motivation to perform RHIS tasks
Facilitator’s Note:
The OBAT is a self-assessment tool that looks at behavioral and organizational factors that affect RHIS performance such as:
Do staff have the necessary knowledge, skills, problem-solving ability, confidence, and motivation?
Does the organization promote a culture that values information quality and use? Does comparing these factors with RHIS performance identify gaps and opportunities for improvements?

18. 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:

19. MEASURE Evaluation is funded by the United States Agency for International Development (USAID) under the terms of Cooperative Agreement AID-OAA-L 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.