1. Introduction to the Routine Health Information System
Performance of Routine Information System Management (PRISM)
Assessment Training
Session 3:
Introduction to the Routine Health Information System
MEASURE Evaluation
Date:

2. Session objectives
Explain the roles of the routine health information system (RHIS) in health system management
Describe the data management processes
Describe the importance of good RHIS data-management practices

3. Basic concepts Data element and data Information Knowledge
When information is analyzed, communicated, and acted upon, it becomes knowledge.
Information
Data organized with reference to a context, which gives the data meaning.
Data element and data
Data element is a recorded event. Data are an aggregation of data elements, in the form of numbers, characters, and images.
Raw data are available at the first stage of information gathering and are not directly useable by all players. For data to be useable, they must be transformed into information that can answer questions of interest for the users.
For example, the outpatient register captures a list of patients with their symptoms, their diagnoses, and the treatments they have received. This information is useful to the care provider, but if the health facility in-charge wants to know the volume of work done in the outpatient department (OPD), she or he needs to transform the data into a meaningful summarized measurement (e.g., the number of patients seen in the OPD for a given period).

4. The role and importance of the RHIS
TYPE
USE
Aggregated service statistics
Aggregated management data
Aggregated surveillance data
Financial data
Vital registration systems
Policymaking
Strategic planning
Program tracking
Disease surveillance
Technical & logistical support
National
level
Aggregated service statistics
Aggregated management data
Sentinel sites
Observation checklist
Self-evaluation
District
level
Planning (access)
Management (quality/efficiency)
Supervision (performance)
Disease surveillance
The types of data that are collected and how they are used for planning, monitoring, and managing vary from one geographic level of the HIS to the next.
At the national level, decision makers are often interested in routine aggregated statistics, whether they be management, surveillance, or financial data, or vital registration systems. These data are often used for policymaking, strategic planning, program tracking, disease surveillance, and technical support.
At the district level, decision makers are interested in aggregated service statistics and aggregated management data. They also have access to additional data from sentinel sites, observation checklists, and self-evaluation. At the district level, routine data are often used for planning; for improving access to services, the quality and efficiency of management systems, and supervisory system performance; and for disease surveillance.
At the facility level, the RHIS consists of client records, financial records, supply records, facility logbooks, and aggregated community data. These data are valuable for client management and follow-up, health management, work planning, and priority setting.
At the community level, the following data may be routinely available: birth and death records, school records, logbooks used by community-based distributors, and drug revolving-fund records.
Client records
Financial records
Supply records
Facility logbooks/data records
Aggregated community data
Facility/
client
Client management & follow-up
Health unit management
Work planning/priority setting
Birth and death records
School records
Community-based distribution logbooks
Drug revolving fund records
Client management & follow-up
Supplies management
Community awareness
Community

5. Examples of RHIS subsystems
Individual records systems (facility and community-based)
Paper-based records
Electronic medical records (EMRs)
Services records systems
Health management information system (HMIS)
Community health information system (CHIS)
Integrated disease surveillance and response (IDSR) systems
Administrative records systems
Financial management information system
(FMIS, such as national health accounts [NHAs])
Human resource information system (HRIS, such as iHRIS)
Logistics management information system (LMIS)

6. Information needs/indicators Information use for decision making
RHIS data management processes
Information needs/indicators
Resources
Data collection
Components of a routine and nonroutine information system:
It is a SYSTEM made up of a number of components that are put together in a structured manner.
It has a process with input (data) and output (information). Also, as with any other system, to make it work, you need to manage it. You need resources and a set of organizational rules. The ultimate goal is not to gain information, but to improve evidence-based action.
So the main output is USE OF INFORMATION.
Management
Data transmission
Data processing
Organizational
rules
Data analysis
Information use for decision making

7. Data collection Data collection instruments Patient/client records:
Facility-based versus patient-retained
Household records (e.g., family folder)
Record system for integration and continuity of care (e.g., tickler file system)
Electronic data systems
Facility-based records:
Registers
Tally sheets
Electronic data systems (e.g., DHIS 2)

8. Data transmission
Within the individual healthcare system (referral mechanisms):
Between healthcare services and the referral level, to promote integration and continuity of care
From health units to the health system management level (aggregate data)
Periodic reporting within existing channels
(facility → district → region → national)
Electronic data transmission (monthly or real-time) using communications technologies (Internet, , personal digital assistants, etc.)
Discussion: What is the reality of data transmission in your country?

9. Data processing
Monitoring of data quality: reporting completeness, inconsistencies, and data entry errors
Aggregating data for reporting to higher levels
Integrating data from various sources
Data storing and warehousing
Resource for desk review of data quality: World Health Organization (WHO). (2015). A toolkit for facility data quality assessment.
The data reported by health facilities cannot be interpreted without first knowing how complete they are and examining them for inconsistencies and likely errors. In some cases the data need to be adjusted before they can be meaningfully analyzed.

10. Data analysis Comparisons
Between groups of people (e.g., new cases per age group)
Over time (trends)
Geographic (e.g., between health facilities, districts)
With goals and targets (e.g., coverage of distribution of insecticide-treated bed nets)
Between interrelated services (e.g., antenatal care with prevention of mother-to-child transmission of HIV)
Data analysis and presentation tools
Tabular
Spatial
Electronic analysis (e.g., DHIS 2)
Decision support system
Data analysis and presentation tools
Tabular presentation (e.g., in summary tables and listing reports)
Spatial presentation (e.g., in charts, graphs, and maps created using a geographic information system)
Electronic analysis tools (e.g., with pivot tables)
Decision support tools (e.g., automated graphing and charting of indicator data based on parameters, such as period of analysis, geographic area, age group, etc., supplied by the user)
Decision Support System (DSS)
A computerized application primarily used to consolidate, summarize, or transform data to support analytical reporting and trend analysis. Usually such applications have user-friendly graphic and geographic interfaces, with a connection to a data warehouse. However, the DSS differs from the data warehouse.

11. Use of information for decision making at all levels
TYPE
USE
Aggregated service statistics
Aggregated management data
Aggregated surveillance data
Financial data
Vital registration systems
Policymaking
Strategic planning
Program tracking
Disease surveillance
Technical & logistical support
National
level
Aggregated service statistics
Aggregated management data
Sentinel sites
Observation checklist
Self-evaluation
District
level
Planning (access)
Management (quality/efficiency)
Supervision (performance)
Disease surveillance
We have reviewed this slide at the beginning of the session. To reiterate,
At the national level, decision makers are often interested in routine aggregated statistics, whether they be management, surveillance, or financial data, or vital registration systems. These data are often used for policymaking, strategic planning, program tracking, disease surveillance, and technical support.
At the district level, decision makers are interested in aggregated service statistics and aggregated management data. They also have access to additional data from sentinel sites, observation checklists, and self-evaluation. At the district level, routine data are often used for planning; for improving access to services, the quality and efficiency of management systems, and supervisory system performance; and for disease surveillance.
At the facility level, the RHIS consists of client records, financial records, supply records, facility logbooks, and aggregated community data. These data are valuable for client management and follow-up, health management, work planning, and priority setting.
At the community level, the following data may be routinely available: birth and death records, school records, logbooks used by community-based distributors, and drug revolving-fund records.
Client records
Financial records
Supply records
Facility logbooks/data records
Aggregated community data
Facility/
client
Client management & follow-up
Health unit management
Work planning/priority setting
Birth and death records
School records
Community-based distribution logbooks
Drug revolving fund records
Client management & follow- up
Supplies management
Community awareness
Community

12. RHIS management Governance Infrastructure Resources Procedures
Mission statements, organogram, reporting structures, master facility list, planning structures, financial plans
Infrastructure
Electricity, phones, Internet, data record room, etc.
Resources
Human: multipurpose versus specialized
Physical: printed supplies, hardware, transport, calculators
Financial: separate budget line item
Procedures
Policies
Operational guidelines
Capacity building

13. 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:

14. 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.