What is H(M)IS?

Purpose of HIS

“is to produce relevant information that health system stakeholders can use for making transparent and evidence-based decisions for health system interventions”

- Health Metrics Network

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HIS are socio-technical

PeoplePeople

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NormsNorms

TraditionsTraditions

RoutinesRoutines

ProceduresProcedures

ActivitiesActivities HISHIS

ICTICT

SoftwareSoftware

NetworksNetworks

DataData

HIS for decision support

HIS Includes the what, how, who, when, and where to collect, process, analyze, present, interpret, and use information related to health.

Includes data on events and resources, the organizational routines, staff, infrastructure, channels of communication, organizational outputs

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Is X part of HIS?

X = Reporting forms?

= Computers used for processing the data?= The nurses at a clinic?= Internet?= Roads?= National policies on patient data security?= District review meetings?= Data collection procedures?

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WHO Health System building blocks

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Benefits of good HIS

providing care to patients (medical staff) assist decision makers in detecting and controlling emerging

and endemic health problems monitor progress towards health goals/targets (MDGs) promote equity (if everyone is counted!!) strengthening the evidence base for effective health policies permitting evaluation of health system interventions over

time ensuring accountability in the way resources are used

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Domains of measurement for HIS

Health determinants indicators: Prevalence and level of poverty Education levels Water and sanitation coverage

Health status indicators: Infant mortality rate 1-4 year old mortality rate maternal mortality life expectancy at birth prevalence/incidence of infectious diseases

Measurement of Health determinants & Health status

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Main determinants of (district) Health Status

Health status

Environment :

Health service delivery system

Community

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physical environment,political context,health care policies,development policies,socio-economic status

coverage,affordability,responsiveness to equity

culture,Gender,Beliefs,health seeking behaviour

1) to understand and influence how the health care service delivery operates: access, coverage, continuity, risk assessment

2) efficient and effective health care service delivery

Health care resource allocation indicators (per capita): distribution of qualified health personnel

distribution and type of health services, by hierarchical level distribution of health expenditure on personnel, supplies and facilities

Health care utilization indicators: immunization coverage antenatal coverage proportion of births attended by a skilled attendant use of modern contraceptives

Measures for Health System

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Types of (health) information systems

Strategic information

systems

Tactical information systems

Operational information systems

Decision support, financial forecasting, performance assessment

(Health) Management information systems

Electronic patient records, payroll, HR, invoicing, patient administration, purchasing/inventory, office automation

Artificial Intelligence

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Typical organization structure of a HIS

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HMIS around the world

Huge differences between national systems, however generally a move from paper to digital and hence convergence/integration of systems

Common challenges:– Little use of health information– Too much collected data– Low quality of information– Fragmentation of information streams

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Health information subsystemsA National health information system can be considered to consist

of several subsystems

Routine data collection based on patient and service records and regular reporting from community health workers & health facilities

Disease surveillance and outbreak notification Programme-specific monitoring and evaluation

(ex: EPI, Malaria, TB, HIV/AIDS) Administration and resource management

(budget, personnel, supplies) Data generated through household surveys (KPC, DHS) Registration of vital events and censuses

(births, deaths and causes of death)

Individual /program tracking

Individual /program tracking

Aggregate dataAggregate data

Global HIS

Health Metrics Network (since 2005)– Build consensus around integrated data

warehouses

Many donors are changing their ways:– Paris declaration to build on local systems– Shift funding towards evidence-based

interventions: dependent on quality information

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Paris declaration (2005)

Ownership - Developing countries set their own strategies for poverty reduction, improve their institutions and tackle corruption

Alignment - Donor countries align behind these objectives and use local systems.

Harmonisation - Donor countries coordinate, simplify procedures and share information to avoid duplication

Results - Developing countries and donors shift focus to development results and results get measured.

Mutual Accountability - Donors and partners are accountable for development results.

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Administrative data

Routine service

data

Householdsurveys

Census Behaviouralrisk

surveys

Sexual behavioursurveys

EPI surveys

Vital registration

TBHIV

MCH/FPEPI

MCH/FPHIV

malariaWater/san

Disease surveillance

HIVSTI

HIVEbolacancer

smokingexercisenutrition

MCHcause

ofdeath

costsresources

HIS subsystems rarely interact

Global consensus: HMN framework

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Key points

HIS is both part of, and supporting, the health system

Involves many types of information related to provision of health care

Increasingly the agenda for both national governments and international organizations is to improve weak HIS through integrated data warehouse

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