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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.

Orientation to PRISM Framework Orientation to PRISM Framework Presentation Transcript

  • 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
  • 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?
  • Examples of RHIS reform efforts in the past twenty years
    • Chad (USAID, 1985-88)
    • Eritrea (USAID, 2000-03)
    • Ethiopia (UNDP/USAID, 2006-current)
    • Haiti (USAID, 2002-2005)
    • Ivory Coast (PEPFAR, 2004-current)
    • Morocco (USAID, 1998-2002)
    • Niger (USAID, 1992-95)
    • Pakistan (USAID/UNICEF, 1992-1996)
    • Pakistan (JICA, 2004-current)
    • South Africa (USAID, 2003)
    • Uganda (USAID/WB, 2004-current)
    • Uzbekistan (USAID, 2002)
  • Some of the lessons learned
    • Successful RHIS reform linked to strong leadership in the country
    • Need for standardized business and data generation architecture
    • Need for well defined RHIS performance criteria:
      • Production of relevant and quality information
      • Continued use of information for DM at all levels
    • Information technology is not a silver bullet (don’t put the cart before the horse): adapt to local resource context
    • Empirical evidence shows that availability of relevant and quality information does NOT NECESSARILY mean that is it used
      • Need for better understanding of factors influencing RHIS performance
      • PRISM framework: P erformance of R outine I nformation S ystems M anagement
  • 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
    • Technical Factors
    • Complexity of the reporting form, procedures
    • RHIS design
    • Computer software
    • IT Complexity
    • Behavioral Factors
    • Level of knowledge of content of RHIS forms
    • Data quality checking skill
    • Problem-solving for RHIS tasks
    • Competence in HIS tasks
    • Confidence levels for RHIS tasks
    • Motivation
    RHIS Determinants PRISM Framework
    • RHIS Processes
    • Data collection
    • Data trans- mission
    • Data Processing
    • Data Analysis
    • Data presentation
    • Data check
    • Feedback
    Improved Health System Performance Improved health status
    • Improved RHIS Performance
    • Data Quality
    • Information Use
    PROCESSES OUTPUTS OUTCOMES INPUTS IMPACT
    • Promotion of a culture of information
    • Organizational Factors
    • Critical management functions & information needs
    • Governance
    • Planning
    • Training
    • Supervision
    • Finances
    • Availability of resources
  • How to improve RHIS performance based on the PRISM framework
    • PRISM assessment (baseline)
      • PRISM tools
      • Assessment methodology
      • Analysis of findings
    • RHIS performance improvement
      • Develop Action Plan
      • Implement interventions
    • PRISM evaluation (endline)
  • Documents to consult
    • PRISM Tools User Guide, (January 2010)
    • Improving RHIS Performance for Better Health System Management: RHIS course, (January 2010)
      • Trainer’s Guide
      • Participant’s Guide
  • 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)
    • Technical Factors
    • Complexity of the reporting form, procedures
    • RHIS design
    • Computer software
    • IT Complexity
    • Behavioral Factors
    • Level of knowledge of content of RHIS forms
    • Data quality checking skill
    • Problem-solving for RHIS tasks
    • Competence in HIS tasks
    • Confidence levels for RHIS tasks
    • Motivation
    RHIS Determinants PRISM Framework
    • RHIS Processes
    • Data collection
    • Data trans- mission
    • Data Processing
    • Data Analysis
    • Data presentation
    • Data check
    • Feedback
    Improved Health System Performance Improved health status
    • Improved RHIS Performance
    • Data Quality
    • Information Use
    PROCESSES OUTPUTS OUTCOMES INPUTS IMPACT Diagnostic Tool OBAT MAT Facility/Office Checklist
    • Promotion of a culture of information
    • Organizational Factors
    • Critical management functions & information needs
    • Governance
    • Planning
    • Training
    • Supervision
    • Finances
    • Availability of resources
  • PRISM Tools Implementation
    • Adapt and adjust tools according to the situation
    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
  • PRISM Tools: Sampling Methodology
    • Purposive sampling or Cluster sampling
      • Suggested: Lot Quality Assurance Sampling (LQAS)
    • Sample size considerations
      • RHIS performance in a region or higher level
        • Divide the region into five administrative areas and take a sample of 19 from each area
      • Self-assessment at a facility or district for data accuracy
        • Take 10 to 19 items randomly from the monthly report and check against the register information.
      • RHIS performance of the facilities in a district:
        • If less than 30 facilities in a district take 12 facilities
        • If more than 30 facilities in a district then take a sample of 12-19 facilities
  • RHIS performance improvement: Taking Action
    • Based on the results of the PRISM assessment the following steps will be required:
      • Prioritize causes
      • Prepare management objectives
      • Identify interventions
        • Technical
        • Organizational/Behavioral
      • Develop action plan
  • 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
  • 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
  • To further the cause of RHIS and their support towards strengthening health services systems…
    • … need for advocacy
    • System strengthening interventions take time: usually a minimum of 3-5 years
    • Lack of visibility as compared to vertical disease interventions
      • Fight against the common mindset: “RHIS do not work”
      • Advocacy network: RHINO
  • THANK YOU! RHINO Secretariat 1616 N. Fort Myer Drive 11th Floor Arlington, Virginia 22209-3100 USA Tel.: 703.528.7474 Fax: 703.528.7480