Strengthening Health Information Systems:Creating an Information Culture

Manila, June 14, 2011Theo Lippeveld, MD, MPH, tlippeveld@jsi.com

Delegates will explore leadership roles in managing health information systems as a national asset …

… for improving evidence based decision making in the health system at all levels

Objective of this session: let us be more specific

Introduction on the need for HIS strengthening worldwide

Brainstorming on how to improve use of information

PRISM framework for HIS strengthening

Where does information culture fit in this

Questions and answers

Overview of this session

Recently spectacular increases in money flows (Gates, PEPFAR, the Global Fund, etc.) to address priority infectious diseases (HIV/AIDS, TB, Malaria, etc.)

The Millennium Development Goals by 2015: excellent drive for better health outcomes

Growing interest in health systems strengthening by the major global health donors

But major constraints (old and new) continue to exist

Global Health: new opportunities and old constraints

• Lack of leadership and country ownership• Fragmentation of the health system

– Disease oriented stove pipe systems• Lack of good models for scaling up evidence

based interventions– How to move from pilot to scale?

• Health workforce crisis• Weak logistic systems for commodity security• Weak health information systems (HIS)

What is going wrong?

Plethora, irrelevance and poor quality of the data collected

Centralization of information management without feedback to district and service delivery levels

Fragmentation into “program- oriented” information systems: duplication and waste

Poor health information system infrastructure and resources

What is wrong with existing HIS?

Poor demand and use of information by users at all levels: policy makers, health managers, as well care providers

So, what can be done to improve use of information for decision making?

Take 3 minutes to write down possible interventions

As a result…

8

Is this the HIS final outcome?

• Need for standardized data generation architecture

• Need for well defined HIS performance criteria:– Production of relevant and quality information– Continued use of information for DM at all levels

• Empirical evidence shows that availability of relevant and quality information does NOT NECESSARILY mean that is it used for decision making

Need for better understanding of factors influencing HIS performance

PRISM framework: Performance of Routine Information Systems Management

Some of the lessons learned from HIS reform in recent years

10

Behavioral Determinants

Knowledge/ skills, attitudes,

values, motivation

PRISM Framework for Understanding

Health Information System (HIS) Performance

Improved Health System

Performance

Improved Health

Outcomes

TechnicalDeterminants

Data generation architectureInformation/communication technology

Desired Outputs

= HIS performance•good quality information•appropriate use of information

Inputs

HIS assessment, HIS strategies

HIS interventions

OrganizationalDeterminants

Information culture, health system structure, roles & responsibilities, resources

Prism Tools: Measuring HIS performance and its determinants

A) HIS Performance Diagnostic Tool

B) HIS OverviewFacility/ Office Checklist

Quality of data Use of information

C) Organizational & Behavioral Questionnaire

D) HIS Process Assessment Tool

PRISM tools allow quantitative HIS performance measurement over time:

Example of Pakistan

Improvements in Data Accuracy and Use of Information Before and After Pilot test in Pakistan,

2006

01020304050607080

Before After

Per

cen

t

Accuracy

Use of info

Technical interventions

Organizational interventions

Behavioral interventions

Based on PRISM assessment: HIS performance improvement interventions

Matching information offer with health system demand

Defining a set of essential indicators Improving data generation processes

Developing user-friendly data collection formats

Introducing appropriate ICT for data management

Improving integration of data sources Building of a national data warehouse

Example of technical HIS interventions

(the classic approach)

• Improve confidence level by asking people to do simple tasks and then add complexity in tasks

• Capacity building to improve data analysis, problem solving and advocacy skills of district and facility staff– Organization of in-service training courses – On-the-job training through supportive

supervision– Include module in pre-service training programs

Examples of behavioral interventions

• Institutionalize interventions focused on improving use of information

Self-assessment

Problem solving approach

Advocacy

Promotion Of Culture Of Information

Examples of organizational interventions

Operational definition (from social sectors):“The capacity of an organization (the health system) to

promote among its members the values and beliefs for generation of quality data, and for use of information to accomplish its goals and mission.”

• This implies an important role for senior management (policy makers and managers) in the health system

• This implies behavioral change (individual and institutional) = long term process

What is a “culture of information”

• Communication by senior management to health staff that information is considered a key organizational value

• Clarify expectations regarding desired behaviors and performance levels for use of information

• Improve transparency and accountability within the health system and the health information system

• Creating ownership and demand for information, leading to improved use of information for DM

• Ultimately in the presence of a culture of information less supervision and less external control is required leading to less costs

Rationale for promoting culture of information

• Role modeling by senior managers on using the information generated for DM

• Emphasis on HIS performance during review meetings

• Dissemination of success stories of use of info for service improvement and advocacy

• Institutionalizing and creating incentives for use of HIS information – Dissemination of HIS district level indicators through

media (Uganda): creating competition…– Allocation of resources based on HIS indicators (Brazil)– Use of HIS info as criteria of the annual performance

appraisal

How to promote culture of information

• A successful HIS not only produces quality information but also makes sure that the information is used to improve health system management functions at all levels and down to the service delivery levels

• Senior management needs to promote culture of information for improving performance, accountability, transparency in the health system and to role model use of information

CONCLUSIONS

MEASURE Evaluation is a MEASURE project funded by theU.S. Agency for International Development and implemented bythe Carolina Population Center at the University of North Carolinaat Chapel Hill in partnership with Futures Group International,ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. Views expressed in this presentation do notnecessarily reflect the views of USAID or the U.S. Government.MEASURE Evaluation is the USAID Global Health Bureau'sprimary vehicle for supporting improvements in monitoring andevaluation in population, health and nutrition worldwide.

Thank YouFor info on the PRISM framework and tools: see www.rhinonet.org