Developing HMIS

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DEVELOPINGHEALTH MANAGEMENT

INFORMATION SYSTEMSA PRACTICAL GUIDE FORDEVELOPING COUNTRIES

WORLD HEALTH ORGANIZATIONREGIONAL OFFICE FOR THE WESTERN PACIFIC

WORLD HEALTH ORGANIZATIONREGIONAL OFFICE FOR THE WESTERN PACIFIC


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WORLD HEALTH ORGANIZATIONREG IO NA L OFFICE FO R THE WESTERN PAC IFIC

DevelopingHealth M anagement

Inform at ion System sA PRACTICAL GUIDE FORDEVELOPING COUNTRIES


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WHO Library Cataloguing in Publication Data

Developing health m anagem ent inform ation systems: a practical guide for

developing countries

1. Management information systems 2. Guidelines 3. Developing countries

ISBN 92 9061 1650 (NLM C lassification: WA 26.5)

World Health O rganization 2004

All rights reserved.

The designations employed and the presentation of the material in this publication do not imply the

expression of any opinion whatsoever on the part of the World Health O rganization concerning the legal

status of any country, territory, city or area or of its authori ties, or concerning the delimitation of its

frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may

not yet be full agreement.

The mention of specif ic companies or of certain manufacturers products does not imply that they are

endorsed or recommended by the World Health O rganization in preference to others of a similar nature

that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished

by initial capital letters.

The World Health Organization does not warrant that the information contained in this publication is

complete and correct and shall not be liable for any damages incurred as a result of its use.

Publications of the World Health O rganization can be obtained from M arketing and D issemination,

World Health O rganization, 20 Avenue A ppia, 1211 G eneva 27, Switzerland (tel: +41 22 791 2476; fax:

+41 22 791 4857; email: bookorders@ who.int) . Requests for permission to reproduce WHO publications,

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addressed to Publications, at the above address (fax: +41 22 791 4806; email: permissions@ who. int).

For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed

to Publications O ffice, World Health Organization, Regional Office for the Western Pacific, P.O . Box 2932,

1000, M anila, Philippines, Fax. No. (632 521-1036, email: publications@ wpro.who.int).

The named author/s alone is/are responsible for the views expressed in this publication.

Acknowledgements

The WHO Regional O ffice for the Western Pacific acknowledges the contributions made

by Dr O phelia M endoza, WHO Consultant, and Dr Y.C . Chong, Regional Adviser in

Health Information.


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Acknow ledgem ents . . . . . . . . . . . ii

Abbreviat ions . . . . . . . . . . . . v

1 Int roduct ion . . . . . . . . . . . . 1

2 The basic concepts . . . . . . . . . . 3

3 Review ing the exist ing system . . . . . . . . 5

4 Def in ing data needs . . . . . . . . . . 9

5 Determ in ing the data f low . . . . . . . . . 13

6 Design ing the data co llect ion and report ing too ls . . . . 17

7 Develop ing procedures for data processing . . . . . 21

8 Develop ing the t rain ing program m e . . . . . . . 25

9 Pre-test ing the system . . . . . . . . . . 29

10 M onitoring and evaluat ing the system . . . . . . 33

11 Develop ing data d issem inat ion and feedback mechanism s . . 37

12 Enhancing the HM IS . . . . . . . . . . 41

Exam ples . . . . . . . . . . . . . 45

References . . . . . . . . . . . . . 53

Contents


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Abbreviations

ARICP A cute Respiratory Infection Control Programme

BC G Bacille-C almette G urin

CDSS Communicable Disease Surveillance System

CHC C ommune Health Centre

DHC D istrict Health C entre

DHS Department of Hospital Services

DO F Department of Finance

DM CH Department of M aternal and Child Health

DP Department of Planning

DPT Diphteria-Pertussis-Tetanus

DSS Disease Surveillance System

EH Environmental Health

EPI Expanded Programme of Immunization

FPSF Family Planning Service Facilities

H Hospital

HACP H IV /A IDS Control Programme

HM IS Health M anagement Information Systems

M C H M aternal and C hild Health

M O E M inistry of Education

M O H M inistry of Health

N IN National Institute of NutritionNM CP National M alaria Control Programme

NSO National Statistics O f fice

NTCP National Tuberculosis Control Programme

O PV O ral Polio Vaccine

O RS O ral Rehydration Salts

PHC Primary Health C entre

PHO Provincial Health O ffice

PM C Preventive M edical C entre

TT Tetanus Toxoid


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1

Purpose of t he M anual

This M anual is designed to be a quick-and-easy, user-friendly reference for the

development of health management information systems (HM IS), with the focus

on applications. It serves as a primer on HM IS development and provides a general

overview of the basic principles, as well as the fundamental steps and issues

involved in the different activities to be undertaken. The information is presented

in a concise, direct-to-the point, easy-reading, and outline format. It aims simply

to provide the basic elements on HM IS development for people who do not

have the time or the need to read deeply on the subject. For those who wish to

develop a more in-depth knowledge, the M anual can also serve as the springboard

for further reading and research.

Prospective Users of t he M anua l

This M anual was designed with the following persons in mind:

Heads and staff of Statistics Units at the national, provincial, or even the

district health service level who are actively involved in the development of

their HM IS

People who do not have the in-depth background on HM IS but need to have

a general overview of its components because they are members of M ulti-

disciplinary Committees tasked with overseeing the development of the HM IS

in their country

M anagers and staff of vertical programmes whose responsibi lities include

any component of the information system of their respective programmes

Scope and Style of t he M anual

Each chapter in this M anual has four parts:

(a) Principles

(b) Steps

(c) Issues

(d) Worksheets

1 Introduction


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The worksheets give the reader an idea of how to go through the different steps,

or how to process the different issues in an organized and systematic manner.

Sample entries for the worksheets are provided to demonstrate how they are

filled out.

The last part of the M anual gives an example of a list of basic indicators that

might be used in M inistry of Health programmes, together with the corresponding

data sources, modes and frequency of data collection, as well as the lowest

administrative level where the indicator is computed. While the reader can adopt

some of these indicators for their use, the main objective of the example is to

show how the set of indicators used by a country can be presented so that it will

be easy for the staff of the Statistics Unit to monitor their status. A lso provided

at the end of the M anual is an example of a flow chart of the HM IS of hypothetical

country X. As in the first example, the aim is to show not what , but how ;not to prescribe a model flowchart for the HM IS as such, but rather to demonstrate

how the HM IS can be presented by means of a flow chart.


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Some Definitions

System A collection of components that work together to achieve a common

objective1

Info rmation System A system that provides information support to the

decision-making process at each level of an organization2

Health Information System A system that integrates data collection,

processing, reporting, and use of the information necessary for improving health

service effectiveness and efficiency through better management at all levels of

health services3

Health Management Information System A n information system

specially designed to assist in the management and planning of health

programmes, as opposed to delivery of care4

Steps in Developing a Health M anagement Informat ion System

(1) Review the existing system

(2) Define the data needs of relevant units within the health system

(3) Determine the most appropriate and effective data flow

(4) Design the data collection and reporting tools

(5) Develop the procedures and mechanisms for data processing

(6) Develop and implement a training programme for data providers and data

users(7) Pre-test, and if necessary, redesign the system for data collection, data flow,

data processing and data utilization

(8) M onitor and evaluate the system

(9) Develop effective data dissemination and feedback mechanisms

(10) Enhance the HM IS

1 World Health O rganization (2000)2 Hurtubise (1984)

3 World Health O rganization (2000)4 World Health O rganization (1993)

2 The basic concept s


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S T E P S

P R I N C I P L E

(1) M ake an inventory of the forms, log books and other tools used to record and

summarize data at different levels.

(2) A ssess the quality of the data being collected using the existing forms at different

levels. Among the aspects to be included in the assessment are:

A ccuracy

Completeness

A dequacy

Timeliness

(3) Determine the problems encountered with the current system of data collection at

different levels, including the timing and flow of information.

(4) Determine the current status of the other components of the HM IS like:

Data processing

Data analysis

Data dissemination

Supply and logistics

Staff development

Coordination, cooperation and communication within and between different

units in the M inistry of Health, as well as with related agencies outside of the

ministry

Do not destroy existing systems; build on the strengths and learn

from the weaknesses of what already exists.

3 Review ing theexist ing syst em


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I S S U E S

(1) Who has the authority to make the assessment?

(2) Availability of technical expertise and resources to do the assessment.

(3) Cooperation among the different units in the assessment process; involvement of

end-users at all levels.

(4) Formation of a body (ideally an inter-departmental committee) tasked with planning,

monitoring and managing all phases of the development of the HM IS, from the

baseline assessment to the evaluation phase.

(5) Identify the aspects of the system that need to be:

Retained

M odified

Abolished

(6) Summarize the results of the assessment in a formal report.

(7) Discuss results of the assessment with proper authorities.


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W

O

R

K

S

H

E

E

T

S

Wo

rksheet3.1:Checklistof

ProblemsEncounteredW

iththeExistingHMIS,atDifferentAdministrat

iveLevels

Typ

eofProblemsEncountered

Village

District

Province

National

Du

plicationofforms

Too

manyrecordbooks/formsbeingfilled

outatthislevel

Lac

kofconstantsupplyofforms

Reportsnotsubmittedontime

Ina

dequatetrainingofhealthworkerson

howtofilloutforms

Hig

hdegreeofinaccuraciesindatacollec

ted

Lac

koftechnicalexpertiseofstafftoproperlyanalyzethedatacollected

Lac

kofutilizationofdatabeingcollected

Low

level/nodisseminationofandfeedba

ckaboutdatacollected


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Wo

rksheet3.2:ChecklistofProblemsEncounteredW

iththeExistingForms

Typ

eofProblemsEncountered

MCHForm

Form2

-----------

Form(n)

Ent

riesinthisform

duplicatethoseofotherforms

Too

manydataelementsrequiredtocomp

letethisform

Structureoftheform

istoocomplicated,makingitdifficulttofillout

Difficulttocollectthedatarequiredtofill

outtheform

Writteninstructionsonhowtofilloutthe

form

arenotavailable

Lac

kofconstantsupplyofthisform

Completedform

notsubmittedontime

Inadequatetrainingofhealthworkerson

how

tofillouttheform

Hig

hdegreeofinaccuraciesindatacollected

Notallitemsintheform

arefilledoutorcompleted

The

rearedifficultiesincollecting

dataforthisform

from

allgeographicorserviceareascovered

Lac

koftechnicalexpertiseofstafftoprop

erlyanalyzethedatacollectedfromth

isform

Lac

kofutilizationofdatabeingcollected

from

thisform

Low

level/nodisseminationofdatacollectedfrom

thisform


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(1) Define the different roles/functions of each level, for each of the major programmes.

A common set-up is as follows:

Different administrative levels in the health system have

different roles, and therefore have different data needs.

Not all data needs should be generated through the

routine system of data collection. Data that are not

frequently needed or are required only for certain subsets

of the population can be generated through special studies

and sample surveys.

(2) Identify the indicators needed by each level to perform its functions. Note that

some levels, especially at higher administrative levels, need data coming from other

ministries or departments related to the health sector.

(3) Determine the formula and identify the variables or data elements needed in order

to compute the indicators.

P R I N C I P L E S

S T E P S

4 Def ining dat a needs

Administrative Level Function

Village Case finding; service delivery

District M onitoring and supervision

Province Programme planning; evaluation

National Policy formulation


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(1) Roles and functions of different units with respect to data generation and utilization

are not well defined.

(2) Defining minimum basic data needs.

(3) Differentiating data that should be included in the routine data collection system,

from data that are best generated through the conduct of special studies and

sample surveys.

(4) Inability of staff at different levels to identify their data needs; understanding of

indicators often lacking.

(4) Determine the source of the different data elements needed for both the numerator

and denominator of each indicator. The major sources can be:

Routine data generated from the health management information system of

the M inistry of H ealth

Special studies and surveys conducted by the M inistry of Health, as the needarises

O ther health-related information systems under the responsibili ty of other

agencies or institutions (Examples of these are the vital registration system

usually under the Department of Justice or the National Statistics O ffice and

the nutrition data collected by the M inistry or Department of A griculture)

I S S U E S

Group discussion o n selecting relevant health indicators.


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W

O

R

K

S

H

E

E

T

S

Wo

rksheet4.1:IdentificationofIndicatorsCorrespo

ndingtoEachProgramm

eObjectiveandStrateg

y

Pro

grammeObjectives

To

increasethecoverageof

immunizationby20%a

t

the

endoftheyear

To

increasetheutilization

ofhospitalservicesby20%

To

decreasetheincidence

ofnosocomialinfectionsby

30%

Inp

ut

Numberofhe

altheducation

classesonimm

unization

conducted

Numberofthefollowing

information,e

ducationand

communicatio

n(IEC)materials

developedanddistributed:

posters

leaflets

Numberofseminarsconducted

Numberofhosp

italstafftrained

Indicat

ors

Effect/Impact

Changeintheknowledgeand

attitudesofmotherson

immunization

Changeinthepercentageof

fullyimmunizedchildren(FIC)

Documents

Developing HMIS