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Interventions to Improve RHIS Performance
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Interventions to Improve RHIS Performance


Technical, Organizational and Behavioral RHIS interventions …

Technical, Organizational and Behavioral RHIS interventions
Session 4.3

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  • Geographical comparisons between health centers in the same “province” (=district) in Morocco
  • Comparison between an input indicator (ORS packets) and severe dehydration rates in a Moroccan health region.


  • 1. 4 th International RHINO Workshop Guanajuato, Mexico March 8, 2010 Measuring and Improving Routine Health Information System Performance Session 4.3: RHIS Performance Improvement: Examples of Interventions
  • 2. Examples of technical interventions
    • Defining set of essential indicators: information needs adapted to management functions of the health system at all levels
    • Standardize data generation architecture based on best practices:
      • Revising/simplifying data collection instruments
      • Developing computerized data entry/data processing applications
      • Streamlining data flows within the MOH
    • Development of computerized data analysis/presentation application: DSS
  • 3. Computerized data analysis/presentation What is a Decision Support System (DSS)?
      • A computerized application allowing health managers to visualize health indicators and data elements collected by the RHIS in graphical and geographical presentations
      • Based on the principle that COMPARISON is one the most powerful analytical methods:
        • spatial : by health facility, district, province etc.
        • time : trends by week, month, year, etc.
        • indicators : between inputs and outputs
        • benchmark : expected versus achieved
  • 4.  
  • 5.  
  • 6. Examples of organizational and behavioral interventions (let us go a step further...)
    • Participatory decision space analysis in decentralized district managed health systems (Pakistan)
    • Provide sufficient and appropriate resources: staffing, equipment/supplies, ICT, financial resources
    • Promote HMIS self-assessment (Uganda)
    • Performance Improvement Tools focused on problem solving approach (Thailand)
    • Provide advocacy skills to district and facility managers (Honduras, Paraguay)
    • Creating incentives for use of information (Pakistan, Uganda)
    • Integration of district health systems
  • 7. How can RHIS help building integrated district health systems?
    • Horizontal and vertical integration of program interventions
    • Develop functional database at district level incorporating information from routine and other sources of information
    • Integration of public and private HIS
  • 8. Integration of program interventions
    • Between individual care interventions within the health services system
      • Horizontal integration: at each level but mostly at health facility and district levels (e.g. HIV/AIDS – neonatal health)
      • Vertical integration: between levels (e.g. continuum of care in maternal health)
    • Between individual and community health interventions (e.g. EOC – community transport solution)
      • Including inter-sectoral integration
  • 9.
    • Integration of the individual patient record system for continuity of care
    • Paper-based record and register design
    • Paper-based system filing systems
    • Electronic medical records in hospitals
  • 10. Integration of Individual-Community Health through integrated district data-warehouse (South Africa)
  • 11. Integration of public-private HIS
    • Needs further exploration and research
    • Examples of sticks and carrots
      • Improved regulation (link reporting to licensing)
      • Accreditation of facilities
      • Health insurance - database
      • Make diseases notifiable by law (and in case of MNH: maternal/neonatal deaths)
      • FP/ STI / Immunisation supplies provided free if reporting