1. www.healthmetricsnetwork.org Leveraging HIV Scale Up for HIS Strengthening Interdisciplinary Partnerships for HIS and Health System Strengthening John Cutler, Chief of Country Programmes HMN Secretariat, WHO, Geneva, Switzerland

2. Overview of Presentation Health Metrics Network HIV/AIDS Scale Up and HIS Negative and positive effects of HIV/AIDS programmes on HIS strengthening The Case of Sierra Leone The Case of Botswana Summary

3. Drawing on Conference Themes Targeted programmes v. systems approaches –Including reporting demands and indicator proliferation Right to information framing the social contract ART leading the way to the transition to chronic disease management Using information for public health impact: –Planning and policy development –Producing efficiencies and saving money –Improving health services, achieving better health outcomes and saving lives

4. What is the Health Metrics Network? Network of partners to respond to country demand to strengthen HIS Goal is for countries to use information for decision making to improve health outcomes Standards-based approaches and tools –Modern, business-like approach to information –HMN Framework provides principles a conceptual approach to HIS strengthening –Not a prescription, a product or system

5. Origins of HMN Millennium Development Goals (MDGs) Paris Declaration Hosted by WHO since 2003 HMN launched at the World Health Assembly in May 2005 HMN Framework endorsed by resolution at the World Health Assembly in May 2007 But, why was HMN needed?

6. Growing and Increasingly Fragmented Demand for Information

7. Confusing System Complexities

8. Growing Pressures to Deliver Information - MDGs reporting - Performance-based funding - SWAps and resource allocation

9. The HMN Framework Data Sources Integrated Health Information System Policies, Resources and Processes Census Civil Registration Population Surveys Individual Records Service Records Resource Records HIS Actors Using Evidence for Decision Making Senior Country Official National Public Health Official International M&E Officer District Health Manager Senior Country Official Facility Health Officer Civil Society Integrated Data Repository Extract and Integrate Data Dashboard, Reports, Queries, Events & Alerts Routine and Non-Routine Data Collection Activities

10. Implementing the HMN Framework Assessment and visioning Strategic planning Mobilise financing for implementation Implement HIS/CRVS strengthening activities Using the information for analysis and decision making at all levels Evidence-driven decision making

11. Countries Using the HNM Framework & Tools

12. The HMN Assessment Process Brings stakeholders together to develop a shared vision of an integrated HIS Establishes a baseline to monitor progress in HIS strengthening Provides the starting point for strategic planning Builds consensus and support for implementing a strategic plan Assesses the six domains of HIS as defined by the HMN Framework

13. The Assessment Tool 197 questions on 6 domains: –Resources –Indicators –Data sources –Data management –Information products –Dissemination and use Main goal is to convene stakeholders, develop a shared vision leading to the development of the HIS strategic plan

14. Limitations Assessment tool was not intended for country comparison –Subjective and qualitative –Different methodologies used –Variations in the number and qualifications of the participants –Knowledge about the topic will influence the answer provided

15. 54 countries included in the study

16. Overall score, 54 countries

17. Summary of HIS Assessment Findings Need to strengthen HIS policies and data management Findings in line with other HIS informal assessments Over 50 assessments are available online Assessment process convenes stakeholders and develops a shared vision for HIS reform Nearly 30 country strategic plans for HIS strengthening Progress tracking tool to monitor implementation

18. HIV Scale Up and HIS Strengthening Fragmentation and Synergies Fragmentation of HIS –Redundant data generation and analysis and reporting functions –Poor data quality and limited access to informaton –Less information-driven decision making Fragmentation has many sources - legacy systems, categorical systems, reporting and M&E focus etc. – linked by lack of awareness Synergies: HIV/AIDS programmes bring resources, operate at scale and can drive the HIS reform process in country

19. HIV Programmes and HIS Systems Two main challenges: fragmentation and a focus on reporting information, not its use Categorical M&E systems not linkable to country health information systems Focus on reporting discourages local ownership of information and its use Undermines data quality and value of data and information

20. Vicious Cycle Leading to Fragmentation limited capacity to manage or analyse data Using evidence not perceived as a winning strategy Data not trusted Weak demand Weak HIS Poor data quality Limited investment in HIS Decisions not evidence-based Donors get their own Fragmentation

21. Positive Influence of HIV Programmes on HIS Adds resources and value to the information systems –Money, resources, power => political and social importance and influence Builds infrastructure and human capacity –Systems and equipment for data and information management –More and better trained human resources Helps to develop major HIS components of prevention, patient management, logistics, programme management etc. Stimulates the development of important policies and procedures for the whole sector: individual medical records, unique identifiers, data confidentiality etc.

22. Sierra Leone Initial situation 2005: fragmented and dysfunctional HIS; HIV/AIDS Information System relatively well functioning Redundant data collection, incompatible data formats, no discussions among M&E systems HIS reform began at the Health Information Unit of the MOH Data collection forms were revised and harmonized HIV/AIDS Information System decided not to join so duplicate data collection and processing continued

23. Sierra Leone ART tracking software was introduced that made HIV data interoperable with wider HIS Current situation: Interoperable systems, HIV/AIDS Information System officer seconded part-time to the MOH HIS unit HIV/AIDS programme is now a core actor in HIS strengthening in Sierra Leone

24. Botswana District Analysis of AIDS Information Botswana HIV/AIDS Information System based on UNAIDS CRIS Provides information for analysis and decision making at district level for the first time Data system is compatible with the national District Health Information System Policy and implementation effects at district level: STI and teen pregnancy trends, food rations etc.

25. Summary and Conclusion Individuals and societies have the right to access and make use of quality information Use of quality information drives improvements in health status HIV/AIDS programmes are a powerful force in HIS development in general Shared responsibility to improve the availability and use of quality information to improve health status

26. Thank You

27. Some Example Questions

28. Resources unpacked

29. Data Management unpacked