strengthening health information systems: creating an information culture manila, june 14, 2011 theo...
TRANSCRIPT
Strengthening Health Information Systems:Creating an Information Culture
Manila, June 14, 2011Theo Lippeveld, MD, MPH, [email protected]
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…
• 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