Value of information for planning and management

of healthcare in India

Dr Biju SomanMBBS, MD, DPH, MSc CID, DLSHTM

Associate Professor, AMCHSSSree Chitra Tirunal Institute for Medical Sciences & Technology.

Thiruvananthapuram-11

Theme 2012: "Women and Girls in ICT"

overview• Value of information in health sector• Types of information needed• Need for trans-sectoral synthesis• Public health in Indian context• Sources of our health data• Reasons for not using information• Future directions

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Need for timely information• Individual/Community level

– Effective clinical management– Access, utility, etc

• District/Functional adm. unit level– Effective functioning– System management

• State/National Level– Strategic policy making– Resource allocation

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Health system needs information on

1. Health determinants – Social, behavioral, environmental, etc

2. Health system inputs– Infrastructure, human resources, policy/legal, etc

3. Health system outputs– Performance, availability, utilization, quality, etc

4. Health outcome– Mortality, morbidity, disability, well-being, outbreaks

5. Health inequities– Coverage & access by sex, SES, ethnic, locality, etc

Macfarlane, SB 2005, Bulletin of the World Health Organization21 April 2023 4NHSRC - bs

Information for health

• Not exclusively from health sector• Inter-sectoral requirements

– Cross-sectoral action for health

• Interdependence between information needs of other sectors– Epidemics & climatic change– Trauma & transport system– Chronic diseases & risk factor surveillance

• Education, welfare, agriculture, industry, tourism, trade, governance , etc

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WHO framework for HIS function

21 April 2023 6NHSRC - bsMacfarlane, SB 2005, Bulletin of the World Health Organization

Public Health

• Collective action for sustained population-wide health improvement

• Should have the ability to measure and monitor the health of populations

• Epidemiology, demography and biostatistics are key components

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Public health in India• Ayurvedic teachings

– Holistic– Intuition rather than empiricism

• Sanitation drive (West)– Bills of mortality

• Colonial time– Indian Medical Services– Sanitary Commissioners

• Post independence period– Bhore committee – Lost its charm to clinical medicine

• MDG– Helps to highlight our lacunae

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Sources of Health Data in India1. Census2. Birth & Death registration3. Surveillance & response systems4. Household surveys5. Health Research6. Service generated data7. Mapping of health facilities8. Behavioral surveillance9. National health accounts10. Financial and management information11. Modeling, estimations and projections

Raban MZ et al BMC Public Health, 200921 April 2023 9NHSRC - bs

issues

• Lack of standardization

• Lack of synthesis with data from other sectors

• Only estimated/projected figures at national level

• Insufficient data at lower levels

• Don’t have the data we need!

• Data overload at the central!

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Health information in the public domain in India

• Health information and statistics are important for planning , monitoring, and improvement of health of populations

• District level data are very limited

• Almost no data from private sector

• Relatively limited data on epidemiological transition

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Other reasons for not using data• Financial constraints; a myth?

• Cuba, Iran, Malaysia, Sri Lanka• Overlaps

• Statistical capacity building• Demand ?• Decentralized planning

• Honoring responsibility• Legitimacy issues• risk and protective factors are often outside health

sector• Private facilities

• Weakness Decision making• Political opportunism, adhoc systems• Not accepting community as a stakeholder

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Research data is not based upon our requirements

• Dandona, L. et al. Public Health 200421 April 2023 14NHSRC - bs

Online resources for health data in India

21 April 2023 NHSRC - bs 15Raban MZ et al BMC Public Health, 2009

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Online resources for health data in India-2

Raban MZ et al BMC Public Health, 2009

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Friday, April 21, 2023 18biju soman

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Uses Open Source SoftwaresCost ~ Rs 5000

Pilot testing of its use for JPHNs is planned

Recent/Future efforts

• IDSP– ?

• HMIS– DHIS2

• Capacity/Team building• Institutionalization• Systemic changes

– Federal system– Use GIS as an integration tool– Timely release of health data for public

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challenges

• Quality• Capture of routine data• Use of information by stakeholders• Capturing data from private establishments

– Open MRS lite version?

• Standardisation• Intersectoral synthesis of data

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Important references used• Macfarlane, SB 2005, ‘Harmonizing health information systems with

information systems in other social and economic sectors’, Bulletin of the World Health Organization, vol. 83, no. 8, pp. 590–596.

• Dandona, Lalit, Yegnanarayana S Sivan, Mukkamala N Jyothi, V S Udaya Bhaskar, and Rakhi Dandona. “The Lack of Public Health Research Output from India.” BMC Public Health 4 (November 25, 2004): 55.

• Das Gupta, Monica. Public Health in India : an Overview. Policy Research Working Paper Series. The World Bank, 2005. http://ideas.repec.org/p/wbk/wbrwps/3787.html.

• Dandona, Lalit, Yegnanarayana S Sivan, Mukkamala N Jyothi, V S Udaya Bhaskar, and Rakhi Dandona. “The Lack of Public Health Research Output from India.” BMC Public Health 4 (November 25, 2004): 55.

• Raban, Magdalena Z, Rakhi Dandona, and Lalit Dandona. “Essential Health Information Available for India in the Public Domain on the Internet.” BMC Public Health 9, no. 1 (2009): 208.

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Thank you

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Questions / Suggestions / Opinions ?