Strengthening national health information systems for better reporting of regional

core indicators and the Sustainable Development Goals (SDGs)

Dr Arash Rashidian Director of Information, Evidence and Research

Eastern Mediterranean Region

World Health Organization

14 December 2016, Islamabad

Outline

• Health information systems framework

• Progress on the regional core indicators program

• Outcomes and recommendations of the rapid assessment of country capacity on reporting on core indicators

• The way forward

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Intelligence, including research

Role of CRVS in health and health care improvement and policy debates

Health systems

HIS CRVS

SDGs

Communicable diseases

NCDs and mental health

Emergencies

RMCH, Health promotion

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Health Data Collaborative Initiative

“It was necessary to determine how data

were generated, analysed, reported

and disseminated for each core indicator. “ EM/RC/61 (2014)

Dr. Ala Alwan, WHO

Regional Director

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SDG3 with 13 targets 24+ indicators (May 2016)

Other SDGs health related indicators

Further need for working CRVS systems

Increasing reliance on “estimation” processes Need for

collaboration with non-health sectors – within countries and across UN agencies

Problems with certain proposed indicators: UHC indicators, others

More comprehensive coverage of important health issues (compared with MDGs)

Focus on national, regional and global targets

Opportunities and threats of the SDG ‘agenda’ for health information system strengthening

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Only ~20% of death in the region are

medically certified

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Effective health information systems

• Needed for sound policy development

– Rational use of resources

– Monitoring and evaluation of implementation and outcomes.

• There is increasing demand in light of SDGs and due to equity concerns

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The regional core indicators program

• Strong political mandate through the Regional Committee

• A limited number of “core” indicators

– 68 indicators

– Other global or regional frameworks require a far larger number of indicators

• It has been followed with a coherent plan of action between the WHO and Member States

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Endorsed in the 61th Session of the Regional Committee

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68 indicators

In 3 categories

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Main observations from EMR core-indicators program

• Improvements observed throughout the region 2014-2016 – In all but one country

• Countries with better HIS infrastructures have more reporting capacity – regardless of national income-levels

• Countries are concerned, in occasions, about – Quality of data

– Estimated indicators

– Reporting mechanisms, within countries and to WHO

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National health information system

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Data management and standards

Effective National Health

Information System

Quality assurance

Governance framework

Infrastructure and support

Dissemination and data use

For: Routine sources of data (patient and

management records), population surveys and

other (non-health sector) sources of data

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Adapted model for use in EMR

Rapid assessment of countries capacity in reporting on

the 68 Core Indicators in EMR

For each core indicator, the following key questions were asked

1. Is it currently collected?

2. Responsible agency for reporting

3. Data sources

4. Frequency of reporting

5. Level of reporting (national, subnational)

6. Use standardized WHO indicator definition

7. Indicator measurement methods

8. Electronic or paper reporting/data collection

9. If not reported, feasibility of reporting in future

10. Main barriers to reporting

19 countries participated in the assessment – August 2016

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Selected assessment outcomes

• None of the countries are able to produce all 68 core

indicators in a timely basis

• Most HIS systems lack adequate connectivity with

relevant stakeholders

• Population surveys do not follow a long term plan

– Most group 2 and 3 countries rely on donor support for surveys

• Data quality assessments are inadequate

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Selected assessment outcomes

• 8 countries know about the global estimation

processes and methodologies

• 15 countries publish annual statistical reports

• 12 countries use ICD 10 coding system for cause

specific mortality

• Half of core indicators are reported for all countries

– Many based on estimates

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Actions that are following the assessment

• Developing a recommended list of population surveys for different groups of countries

• Conducting comprehensive health information system assessments for interested countries

– The first country in October 2016

• Expanding capacity building activities

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Proposed changes and additions to the

core-indicators list

• Indicators requiring updates – changes in the definition or measurement approach

for 2 indicators

– Change in the proposed age ranges of adolecence related indicators

– replacing one indicator

• 9 new SDG indicators to be added

• As a result the core indicators list may be expanded in light of SDG requirements

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EMR Framework for heath information system and core indicators

SDG indicators

Indicator Name

Proposed new core indicators for better reporting on SDGs A) Health determinants and risks 3.5.2 Harmful use of alcohol

B) Health Status 3.4.2 Suicide mortality rate

3.9.1 Mortality rate attributed to household and ambient air pollution

3.9.2 Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene

3.3.4 Hepatitis B incidence per 100,000 population (children U5 years)

3.3.5 Number of people requiring interventions against neglected tropical diseases

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EMR: Framework for heath information system and core indicators SDG indicators

Indicator Name

Proposed new core indicators for better reporting on SDGs

C) Service coverage

3.5.1 Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders

3.8.1 Coverage of essential health services

D) Country capacity

3.d.1 International Health Regulations (IHR) capacity and health emergency preparedness

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The way forward

• 19 countries completed the assessments

– Follow up with the remaining three countries to complete by the end of October 2016

• As gaps in the plans and indicators are identified:

• We will discuss further with countries about how we can help in

– improving health information systems, and

– capacity to develop and use the key indicators

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Thank you