TOPIC 1:Introduction

to Health Information Systems

Humberto Muquingue

Elective on District Health Information Systems, University of Oslo, 2007

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At the end of this session you will be able to:

• Define what is: system, health information system (HIS), monitoring and evaluation

• List and describe the properties of a system• Present the advantages and benefits brought by HIS• List the distinct domains of health data and give examples

of indicators• Describe systems and structures within a HIS• Present the types of HIS and the typical organization of HIS

Learning objectives

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A system is a set of objects and the relationships between the objects and their attributes.A.D.Hall and R.E. Fagen, in:Modern System Research for the Behavioral Scientist. Aldine Publishing, 1968

What is a system?

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What is a HIS?

• Definitions of HIS abound Occram’s rule!

• “an integrated effort to collect, process, report and use health information and knowledge to influence policy-making, programme action and research” WHO (2000) Guidance on Needs Assessment for National Health Information Systems Development.

• “a set of interrelated components working together to gather, retrieve, process, store and disseminate information to support the activities of health system planning, control, coordination and decision-making, both in management and service delivery” Jack Smith, in:Health Management Information Systems – a handbook for decision makers. OUP, 2000.

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Properties of systems

• Unity/integrity: a system is an entity in its own right, with describable boundaries

• Complexity: a system is more than the sum of its parts; there are no simple cause-effect relationships between the individual components of the system

• Hierarchical structure: large systems can be divided into smaller subsystems

• Stability/equilibrium: a system must function in face of changing requirements and changes in the external environment accommodation and self-adaptation through control mechanisms

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A health information system is... a SYSTEM

•People

•Procedures

•Culture (values, norms, traditions)

•Processes

•Activities

Behavioural subsystem

•Hardware

•Software

•Networks

•Data

Technological subsystem

interactions

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Why HIS?

• Assess the impact of program interventions

• Prioritize policies and strategies

• Prioritize interventions vis-a-vis resource constraints (examples?)

• Adapt to reforms

• Obtain information pertinent to new styles, participants, and locations of (health) services management and decision-making

Any health organization/entity requires data in order to:

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Why countries need HIS?

• To apply performance-based resource allocation

• To understand and influence how the health care service delivery operates: access, coverage, quality

• To fulfill donor requirements

• To access development money

• To monitor progress towards major international goals

• To build and maintain efficient health care services

• To respond to public calls for transparency/accountability

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Benefits of HIS

Investment in HIS may result in many benefits (WHO):

• helping decision makers to detect and control emerging and endemic health problems, monitor progress towards health goals, and promote equity;

• empowering individuals and communities with timely and understandable health-related information, and drive improvements in quality of services;

• strengthening the evidence base for effective health policies, permitting evaluation of scale-up efforts, and enabling innovation through research;

• improving governance, mobilising new resources, and ensuring accountability in the way they are used.

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HIS in health services planning

How will we know when we get there? Monitoring and evaluation Choice of appropriate indicators

Where are we now? Identification of needs and problems

How will we get there? Development of interventions Identification of resources

Where do we want to go? Setting priorities and targets

Pervasive roleof information

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What kinds of data flow in a HIS?

• birth, morbidity and mortality data

• type and location of health personnel

• type and quality of clinical services provided at national and sub-national level

• population indicators demographics and socio-economic status

This data can be organized in 5 domains.

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Domains of health data

• health determinants

• health system inputs

• health system outputs

• health system outcomes

• health status.

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Health determinants

Risk factorsBehavioursGeneticsEnvironment

Socio-economic &demographic

Health system inputs

PolicyFinancingHuman resourcesOrganization

Health system outputs

InformationService availability and quality

Health system outcomes

Service utilization

Health status

Mortality

Morbidity / disability

Well-being

Figure 2 Typology of measurement domains

Typology of measurement domains in health care

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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

Types of data commonly collected under each domain

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

Types of data commonly collected under each domain

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Main determinants of district health status

Health status

Environment

Health service delivery system

Community

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ENVIRONMENT:the context in which the health care delivery system works: physical environment; political system; health care policies; development policies; socio-economic status

HEALTH SERVICE DELIVERY SYSTEM:how health facilities and personnel are distributed; coverage; affordability; responsiveness to equity.

COMMUNITY: characteristics of the society – culture, gender, beliefs, health seeking behaviour

Main determinants of district health status

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Types of (health) information systems

Strategic information

systems

Tactical information systems

Operational information systems

Decision support systems, simulation systems, financial forecasting, performance assessment

Management information systems

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

Artificial Intelligence

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Typical organization structure of a HIS

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

several separate subsystems:

• Data collection based on patient and service records and reporting from community health workers, health workers and health facilities

• Programme-specific monitoring and evaluation(ex: EPI, Malaria, TB, HIV/AIDS)

• Administration and resource management(budget, personnel, supplies)

• Disease surveillance and outbreak notification

• Data generated through household surveys (KPC, DHS)

• Registration of vital events and censuses (births, deaths and causes of death)

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Administrative data

Routine service

data

Figure 3 - Health information sub-systems rarely interact

Householdsurveys

Census Behaviouralrisk

surveys

Sexual behavioursurveys

EPI surveys

Vital registration

TBHIVMCH/FPEPI

MCH/FPHIVmalariaWater/san

Disease surveillance

HIVSTI

HIVEbolacancer

smokingexercisenutrition

MCHcauseofdeath

costsresources

HIS subsystems rarely interact

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Fragmentation in HIS: Mozambique

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Behavioral

determinantsKnowledge/ skills, attitudes,

values, motivation

PRISM Framework for Understanding

Health Information System (HIS) Performance

Organizational/ Environmental

DeterminantsInformation culture, structure, roles &

responsibilities, resources

Improved Health System

Performance

Improved Health

Outcomes

Technical

DeterminantsData quality,

system design, IT

Desired Outputs

= HIS performance

•good quality information

•appropriate use of information

InputsHIS assessment,

HIS strategies

HIS interventions

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Relationship between HIS and M&E

STRATEGIC PLAN

RESULTS ACTIVITIES

RAW DATA

Info

rma

tion

su

bsy

stem

s

Forms, registers, etc

M&E mechanisms INDICATORSINDICATORS

Internal accountability

VisionMission Priority Actions

External accountability

ACTION PLAN