1. 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

2. 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.

3. 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

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

5. Indicators needed in each domain

6. 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)

7. 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

8. 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

9. 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

10. 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

11. Fragmentation of demand

12. 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)

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

14. 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

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

16. 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%

17. Corrected distribution of causes of death, Thailand 2005
MR certified (urban) COD
COPD %
IHD %
Oth.heart dis %
Stroke %
HIV/AIDS %
Diabetes % …
Ill-defined %
VA-assigned(rural) COD
IHD %
COPD %
Stroke %
Diabetes %
Oth.heart dis 6.2%
Lung cancer % ….
Ill-defined %
MR: Medical records review
VA: Verbal Autopsy

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

19. 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;

20. 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.

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