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Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
Orientation to PRISM Framework
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Orientation to PRISM Framework

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Orientation to PRISM Framework …

Orientation to PRISM Framework
Session 1.5

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  • I have been involved in various RHIS reform efforts and we even published a book in 2000 called “ Design and Implementation of Health Information Systems” It describes many of the experiences in RHIS reform.
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    • 1. 4 th International RHINO Workshop Guanajuato, Mexico March 8, 2010 Measuring and Improving Routine Health Information System Performance Session 1.5: The PRISM Framework: a paradigm shift for RHIS design, strengthening and evaluation
    • 2. So, the main question that we want to answer during this workshop is: How can we measure and improve RHIS performance in support of planning and management of quality district health systems?
    • 3. Examples of RHIS reform efforts in the past twenty years <ul><li>Chad (USAID, 1985-88) </li></ul><ul><li>Eritrea (USAID, 2000-03) </li></ul><ul><li>Ethiopia (UNDP/USAID, 2006-current) </li></ul><ul><li>Haiti (USAID, 2002-2005) </li></ul><ul><li>Ivory Coast (PEPFAR, 2004-current) </li></ul><ul><li>Morocco (USAID, 1998-2002) </li></ul><ul><li>Niger (USAID, 1992-95) </li></ul><ul><li>Pakistan (USAID/UNICEF, 1992-1996) </li></ul><ul><li>Pakistan (JICA, 2004-current) </li></ul><ul><li>South Africa (USAID, 2003) </li></ul><ul><li>Uganda (USAID/WB, 2004-current) </li></ul><ul><li>Uzbekistan (USAID, 2002) </li></ul>
    • 4. Some of the lessons learned <ul><li>Successful RHIS reform linked to strong leadership in the country </li></ul><ul><li>Need for standardized business and data generation architecture </li></ul><ul><li>Need for well defined RHIS performance criteria: </li></ul><ul><ul><li>Production of relevant and quality information </li></ul></ul><ul><ul><li>Continued use of information for DM at all levels </li></ul></ul><ul><li>Information technology is not a silver bullet (don’t put the cart before the horse): adapt to local resource context </li></ul><ul><li>Empirical evidence shows that availability of relevant and quality information does NOT NECESSARILY mean that is it used </li></ul><ul><ul><li>Need for better understanding of factors influencing RHIS performance </li></ul></ul><ul><ul><li>PRISM framework: P erformance of R outine I nformation S ystems M anagement </li></ul></ul>
    • 5. Behavioral Determinants Knowledge/ skills, attitudes , values, motivation PRISM Framework for Understanding Routine Health Information System (RHIS) Performance Improved Health System Performance Improved Health Outcomes Technical Determinants Data generation architecture Information/communication technology Desired Outputs = RHIS performance • good quality information • appropriate use of information Inputs RHIS assessment, RHIS strategies RHIS interventions Organizational Determinants Information culture, health system structure, roles & responsibilities, resources
    • 6. <ul><li>Technical Factors </li></ul><ul><li>Complexity of the reporting form, procedures </li></ul><ul><li>RHIS design </li></ul><ul><li>Computer software </li></ul><ul><li>IT Complexity </li></ul><ul><li>Behavioral Factors </li></ul><ul><li>Level of knowledge of content of RHIS forms </li></ul><ul><li>Data quality checking skill </li></ul><ul><li>Problem-solving for RHIS tasks </li></ul><ul><li>Competence in HIS tasks </li></ul><ul><li>Confidence levels for RHIS tasks </li></ul><ul><li>Motivation </li></ul>RHIS Determinants PRISM Framework <ul><li>RHIS Processes </li></ul><ul><li>Data collection </li></ul><ul><li>Data trans- mission </li></ul><ul><li>Data Processing </li></ul><ul><li>Data Analysis </li></ul><ul><li>Data presentation </li></ul><ul><li>Data check </li></ul><ul><li>Feedback </li></ul>Improved Health System Performance Improved health status <ul><li>Improved RHIS Performance </li></ul><ul><li>Data Quality </li></ul><ul><li>Information Use </li></ul>PROCESSES OUTPUTS OUTCOMES INPUTS IMPACT <ul><li>Promotion of a culture of information </li></ul><ul><li>Organizational Factors </li></ul><ul><li>Critical management functions & information needs </li></ul><ul><li>Governance </li></ul><ul><li>Planning </li></ul><ul><li>Training </li></ul><ul><li>Supervision </li></ul><ul><li>Finances </li></ul><ul><li>Availability of resources </li></ul>
    • 7. How to improve RHIS performance based on the PRISM framework <ul><li>PRISM assessment (baseline) </li></ul><ul><ul><li>PRISM tools </li></ul></ul><ul><ul><li>Assessment methodology </li></ul></ul><ul><ul><li>Analysis of findings </li></ul></ul><ul><li>RHIS performance improvement </li></ul><ul><ul><li>Develop Action Plan </li></ul></ul><ul><ul><li>Implement interventions </li></ul></ul><ul><li>PRISM evaluation (endline) </li></ul>
    • 8. Documents to consult <ul><li>PRISM Tools User Guide, (January 2010) </li></ul><ul><li>Improving RHIS Performance for Better Health System Management: RHIS course, (January 2010) </li></ul><ul><ul><li>Trainer’s Guide </li></ul></ul><ul><ul><li>Participant’s Guide </li></ul></ul>
    • 9. PRISM Tools A) RHIS Performance Diagnostic Tool B) RHIS Overview Facility/ Office Checklist Quality of data Use of information C) Organizational & Behavioral Questionnaire D) RHIS Management Assessment Tool (MAT)
    • 10. <ul><li>Technical Factors </li></ul><ul><li>Complexity of the reporting form, procedures </li></ul><ul><li>RHIS design </li></ul><ul><li>Computer software </li></ul><ul><li>IT Complexity </li></ul><ul><li>Behavioral Factors </li></ul><ul><li>Level of knowledge of content of RHIS forms </li></ul><ul><li>Data quality checking skill </li></ul><ul><li>Problem-solving for RHIS tasks </li></ul><ul><li>Competence in HIS tasks </li></ul><ul><li>Confidence levels for RHIS tasks </li></ul><ul><li>Motivation </li></ul>RHIS Determinants PRISM Framework <ul><li>RHIS Processes </li></ul><ul><li>Data collection </li></ul><ul><li>Data trans- mission </li></ul><ul><li>Data Processing </li></ul><ul><li>Data Analysis </li></ul><ul><li>Data presentation </li></ul><ul><li>Data check </li></ul><ul><li>Feedback </li></ul>Improved Health System Performance Improved health status <ul><li>Improved RHIS Performance </li></ul><ul><li>Data Quality </li></ul><ul><li>Information Use </li></ul>PROCESSES OUTPUTS OUTCOMES INPUTS IMPACT Diagnostic Tool OBAT MAT Facility/Office Checklist <ul><li>Promotion of a culture of information </li></ul><ul><li>Organizational Factors </li></ul><ul><li>Critical management functions & information needs </li></ul><ul><li>Governance </li></ul><ul><li>Planning </li></ul><ul><li>Training </li></ul><ul><li>Supervision </li></ul><ul><li>Finances </li></ul><ul><li>Availability of resources </li></ul>
    • 11. PRISM Tools Implementation <ul><li>Adapt and adjust tools according to the situation </li></ul>Self-administered questionnaire OBAT Observations MAT Observations and interviews Overview/ Checklist RHIS implementer Supervisor Evaluator Assessment Monitoring Evaluation Facility level District level Intermediate level National level Observations and interviews Diagnostic Who When Where How to use Tool
    • 12. PRISM Tools: Sampling Methodology <ul><li>Purposive sampling or Cluster sampling </li></ul><ul><ul><li>Suggested: Lot Quality Assurance Sampling (LQAS) </li></ul></ul><ul><li>Sample size considerations </li></ul><ul><ul><li>RHIS performance in a region or higher level </li></ul></ul><ul><ul><ul><li>Divide the region into five administrative areas and take a sample of 19 from each area </li></ul></ul></ul><ul><ul><li>Self-assessment at a facility or district for data accuracy </li></ul></ul><ul><ul><ul><li>Take 10 to 19 items randomly from the monthly report and check against the register information. </li></ul></ul></ul><ul><ul><li>RHIS performance of the facilities in a district: </li></ul></ul><ul><ul><ul><li>If less than 30 facilities in a district take 12 facilities </li></ul></ul></ul><ul><ul><ul><li>If more than 30 facilities in a district then take a sample of 12-19 facilities </li></ul></ul></ul>
    • 13. RHIS performance improvement: Taking Action <ul><li>Based on the results of the PRISM assessment the following steps will be required: </li></ul><ul><ul><li>Prioritize causes </li></ul></ul><ul><ul><li>Prepare management objectives </li></ul></ul><ul><ul><li>Identify interventions </li></ul></ul><ul><ul><ul><li>Technical </li></ul></ul></ul><ul><ul><ul><li>Organizational/Behavioral </li></ul></ul></ul><ul><ul><li>Develop action plan </li></ul></ul>
    • 14. Examples of technical interventions <ul><li>Defining set of essential indicators: information needs adapted to management functions of the health system at all levels </li></ul><ul><li>Standardize data generation architecture based on best practices: </li></ul><ul><ul><li>Revising/simplifying data collection instruments </li></ul></ul><ul><ul><li>Developing computerized data entry/data processing applications </li></ul></ul><ul><ul><li>Streamlining data flows within the MOH </li></ul></ul><ul><li>Development of computerized data analysis/presentation application: DSS </li></ul>
    • 15. Examples of organizational and behavioral interventions (let us go a step further...) <ul><li>Participatory decision space analysis in decentralized district managed health systems (Pakistan) </li></ul><ul><li>Provide sufficient and appropriate resources: staffing, equipment/supplies, ICT, financial resources </li></ul><ul><li>Promote HMIS self-assessment (Uganda) </li></ul><ul><li>Performance Improvement Tools focused on problem solving approach (Thailand) </li></ul><ul><li>Provide advocacy skills to district and facility managers (Honduras, Paraguay) </li></ul><ul><li>Creating incentives for use of information (Pakistan, Uganda) </li></ul><ul><li>Integration of district health systems </li></ul>
    • 16. To further the cause of RHIS and their support towards strengthening health services systems… <ul><li>… need for advocacy </li></ul><ul><li>System strengthening interventions take time: usually a minimum of 3-5 years </li></ul><ul><li>Lack of visibility as compared to vertical disease interventions </li></ul><ul><ul><li>Fight against the common mindset: “RHIS do not work” </li></ul></ul><ul><ul><li>Advocacy network: RHINO </li></ul></ul>
    • 17. THANK YOU! RHINO Secretariat 1616 N. Fort Myer Drive 11th Floor Arlington, Virginia 22209-3100 USA Tel.: 703.528.7474 Fax: 703.528.7480

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