www.healthmetricsnetwork.org leveraging hiv scale up for his strengthening interdisciplinary...
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www.healthmetricsnetwork.org
Leveraging HIV Scale Up for HIS Strengthening
Interdisciplinary Partnerships for HIS and Health System Strengthening
John Cutler, Chief of Country ProgrammesHMN Secretariat, WHO, Geneva, Switzerland
Overview of Presentation
• Health Metrics Network• HIV/AIDS Scale Up and HIS• Negative and positive effects of HIV/AIDS programmes on HIS
strengthening• The Case of Sierra Leone• The Case of Botswana• Summary
Drawing on Conference Themes
• Targeted programmes v. systems approaches– Including reporting demands and indicator proliferation
• Right to information framing the social contract • ART leading the way to the transition to chronic disease management• Using information for public health impact:
– Planning and policy development– Producing efficiencies and saving money– Improving health services, achieving better health outcomes and saving lives
What is the Health Metrics Network?
• Network of partners to respond to country demand to strengthen HIS• Goal is for countries to use information for decision making to improve
health outcomes• Standards-based approaches and tools
– Modern, business-like approach to information – HMN Framework provides principles a conceptual approach to HIS
strengthening – Not a prescription, a product or system
Origins of HMN
• Millennium Development Goals (MDGs)• Paris Declaration• Hosted by WHO since 2003• HMN launched at the World Health Assembly
in May 2005• HMN Framework endorsed by resolution at
the World Health Assembly in May 2007• But, why was HMN needed?
Growing and Increasingly Fragmented Demand for Information
Confusing System Complexities
Growing Pressures to Deliver InformationGrowing Pressures to Deliver Information
- MDGs reporting
- Performance-based funding
- SWAps and resource allocation
The HMN Framework
Data SourcesData Sources Integrated Health Information SystemIntegrated Health Information System
Policies, Resources and ProcessesPolicies, Resources and Processes
CensusCensus
CivilRegistration
CivilRegistration
PopulationSurveys
PopulationSurveys
IndividualRecordsIndividualRecords
Service RecordsService Records
ResourceRecords
ResourceRecords
HIS Actors Using Evidence for Decision Making
Senior Country Official
National Public Health Official
International M&E Officer
District Health Manager
Senior Country Official
Facility Health Officer
Civil Society
IntegratedData
Repository
IntegratedData
Repository
Extractand
IntegrateData
Extractand
IntegrateData
Allocated Length-Of-Stay Utilization
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100
200
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700
Pat
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Status 143 221 412 574 325 172 68 145
25% 50% 75% 100% 125% 150% 175% 200%
Allocated Length-Of-Stay Utilization
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100
200
300
400
500
600
700
Pat
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Status 143 221 412 574 325 172 68 145
25% 50% 75% 100% 125% 150% 175% 200%
Dashboard,Reports, Queries,
Events & Alerts
Routine and Non-RoutineData Collection ActivitiesRoutine and Non-RoutineData Collection Activities
Implementing the HMN Framework
• Assessment and visioning• Strategic planning• Mobilise financing for implementation• Implement HIS/CRVS strengthening activities• Using the information for analysis and
decision making at all levels• Evidence-driven decision making
Countries Using the HNM Framework & Tools
The HMN Assessment Process
• Brings stakeholders together to develop a shared vision of an integrated HIS
• Establishes a baseline to monitor progress in HIS strengthening
• Provides the starting point for strategic planning• Builds consensus and support for implementing a
strategic plan• Assesses the six domains of HIS as defined by the
HMN Framework
The Assessment Tool
197 questions on 6 domains:– Resources– Indicators– Data sources– Data management– Information products– Dissemination and use
Main goal is to convene stakeholders, develop a shared vision leading to the development of the HIS strategic plan
Limitations
Assessment tool was not intended for country comparison– Subjective and qualitative– Different methodologies used– Variations in the number and qualifications of the
participants– Knowledge about the topic will influence the
answer provided
54 countries included in the study
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AFRO EMRO EURO PAHO SEARO WPRO
Upper Middle Income
Lower Middle Income
Low Income
Overall score, 54 countries
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30.0
40.0
50.0
60.0
70.0
Resources Indicators Data Sources DataManagement
InformationProducts
Disseminationand use
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Summary of HIS Assessment Findings
• Need to strengthen HIS policies and data management
• Findings in line with other HIS informal assessments• Over 50 assessments are available online• Assessment process convenes stakeholders and
develops a shared vision for HIS reform• Nearly 30 country strategic plans for HIS
strengthening• Progress tracking tool to monitor implementation
HIV Scale Up and HIS StrengtheningFragmentation and Synergies
• Fragmentation of HIS– Redundant data generation and analysis and reporting
functions– Poor data quality and limited access to informaton– Less information-driven decision making
• Fragmentation has many sources - legacy systems, categorical systems, reporting and M&E focus etc. – linked by lack of awareness
• Synergies: HIV/AIDS programmes bring resources, operate at scale and can drive the HIS reform process in country
HIV Programmes and HIS Systems
• Two main challenges: fragmentation and a focus on reporting information, not its use
• Categorical M&E systems not linkable to country health information systems
• Focus on reporting discourages local ownership of information and its use
• Undermines data quality and value of data and information
Vicious Cycle Leading to Fragmentation
limited capacity to manage or analyse data
Using evidence not perceived as a winning strategy
Data not trusted
Weak demand
Weak HIS
Poor data quality
Limited investment in HIS
Decisions not evidence-basedDonors get their own
Fragmentation
Positive Influence of HIV Programmes on HIS
• Adds resources and value to the information systems– Money, resources, power => political and social importance and
influence• Builds infrastructure and human capacity
– Systems and equipment for data and information management– More and better trained human resources
• Helps to develop major HIS components of prevention, patient management, logistics, programme management etc.
• Stimulates the development of important policies and procedures for the whole sector: individual medical records, unique identifiers, data confidentiality etc.
Sierra Leone
• Initial situation 2005: fragmented and dysfunctional HIS; HIV/AIDS Information System relatively well functioning
• Redundant data collection, incompatible data formats, no discussions among M&E systems
• HIS reform began at the Health Information Unit of the MOH
• Data collection forms were revised and harmonized• HIV/AIDS Information System decided not to join so
duplicate data collection and processing continued
Sierra Leone
• ART tracking software was introduced that made HIV data interoperable with wider HIS
• Current situation: Interoperable systems, HIV/AIDS Information System officer seconded part-time to the MOH HIS unit
• HIV/AIDS programme is now a core actor in HIS strengthening in Sierra Leone
Botswana District Analysis of AIDS Information
• Botswana HIV/AIDS Information System based on UNAIDS CRIS
• Provides information for analysis and decision making at district level for the first time
• Data system is compatible with the national District Health Information System
• Policy and implementation effects at district level: STI and teen pregnancy trends, food rations etc.
Summary and Conclusion
• Individuals and societies have the right to access and make use of quality information
• Use of quality information drives improvements in health status
• HIV/AIDS programmes are a powerful force in HIS development in general
• Shared responsibility to improve the availability and use of quality information to improve health status
Thank You
Some Example Questions
Resources unpacked
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HIS Infrastructure HIS Institutions, humanresources and financing
Policy and planning
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Data Management unpacked
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Metadatadictionary
National datawarehouse
Sub-national datawarehouse
Unique identifyercodes
Written set ofprocedures
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