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Relationship Between RHIS and HSS

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Session 1.3

Session 1.3

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  • The ultimate goal of the health system, as we all agree, is to improve the health status of individuals in a population. Health status is classically known to be determined by at least four main groups of factors: (1) biological assets; (2) personal lifestyle; (3) the environment; and (4) the health care system. The exact potential impact in various settings, of interventions related to each of these groups, can be debated, but this slide shows the potential impact on mortality in the USA. As you can see, the contribution of the health care system alone is only marginal compared to the potential impact of interventions on personal lifestyle and on the environment. While health care interventions are mostly the result of interactions between care providers and individual patients and clients, life style and the environment need public health or community interventions. Therefore, individual health interventions and public health interventions are complementary and interdependent.
  • Historical time for definition of health system (see article Murray and Evans)
  • What is HMN? A global partnership Origin: Measuring the MDGs… The Health Metrics Network (HMN) is a global partnership that will facilitate better health information at country and global levels. Partners include developing countries, multilateral and bilateral agencies, foundations, global health initiatives, and technical experts. Most importantly, HMN seeks to bring together health and statistical constituencies in order to build capacity and expertise and enhance the availability, quality, dissemination and use of data for decision-making.
  • Let us come back to the National Health Information System (HIS) and its different data sources. Particular attention is needed for the health services based data sources…
  • Here are some examples of management functions. In order to fulfill these functions, managers eventually need information to make the right decisions Information is often presented in a form that permits to measure changes. That’s the definition of an INDICATOR. The information for these indicators is produced by the health information system.
  • Transcript

    • 1. 4 th International RHINO Workshop Guanajuato, Mexico March 8, 2010 Measuring and Improving Routine Health Information System Performance Session 1.3: Health Systems and Health Information Systems
    • 2. Objectives
      • By the end of the session, participants will have a common understanding about:
        • The health system, its generic functions, and its actors
        • Describe the relation between the health system and the health information system
        • The relation between the health services system and the routine health information system
        • The health services system, its three management levels, and its implementers
    • 3. There are evidence based interventions available for most of life threatening health problems in developing countries…
        • Antenatal care
        • Tetanus Toxoid vaccine
        • Delivery with skilled attendance
        • BCG vaccine
        • Emergency newborn care
        • Hygienic cord/skin care
        • DTP vaccine
        • Measles vaccine
        • Vit. A supplementation
        • Safe Water Supply
        • etc.
    • 4. … but the health system is not able to deliver them
      • Co-coverage study* of 8 essential interventions in 8 countries (DHS data)
        • DTP, BCG, Measles, TT, Vit A, ANC, Delivery with Skilled Attendance, Safe Water Supply
      • Showed that in low-income countries less than 1% of households have access to all these interventions at the same time
      • Example Cambodia
        • Half of the children receive less than 3 interventions
        • Half of the poorest children receive less than 2 interventions
      *Cesar Victora et al (Lancet, 2005)
    • 5. What is going wrong?
      • Fragmentation of the health system
        • Disease oriented stove pipe systems
      • Models for scaling up
        • How to move from pilot to scale
      • Weak logistic systems for commodity security
      • Health workforce crisis
      • Weak health information systems
    • 6. What is the Health System then?
      • It is a “system”: has interrelated inputs, processes and outputs that aim at promoting or maintaining health
      • Narrow view of a Health System:
        • Interventions by the “health care system”
      • Broader view of a Health System:
        • All interventions whose primary intent is improving health
    • 7. Main Determinants of Health
      • Access to and use of appropriate health care
      • Biologic factors
        • Genetic makeup
      • Environmental factors
        • Air, water, food, soil, socio-economic environment
      • Lifestyle
        • Nutrition, smoking, sexual behavior, literacy
    • 8. MAIN DETERMINANTS OF HEALTH Potential contribution of interventions on reducing mortality in the USA (in %) Adapted from Devers G.E.A. An Epidemiological Model for Health Policy Analysis Soc.Ind. Res., 1976 Vol.2 P 465
    • 9. QUESTION
      • What are the broad goals and functions of the health system to address these health determinants?
    • 10. Functions and Goals of Health System (WHO, 2000) FUNCTIONS THE SYSTEM PERFORMS GOALS / OUTCOMES OF THE SYSTEM Stewardship (oversight) Resource development Service delivery (provision) Financing (collecting, pooling and purchasing) I N P U T S Health Responsiveness (the way people are treated and the environment) Fairness in financial contribution Quality Coverage Efficiency
    • 11. QUESTION
      • Who are the main actors in your country’s health system?
    • 12. Health system actors
      • Government as steward of the health system, as financing body, as health service provider
      • Parastatal health services, such as those operated by corporations solely for the benefit of their employees
      • Private sector health services
      • NGOs and CBOs, which can be responsible for providing health care and/or for carrying out other activities such as health promotion, health education programs within the community
      • Traditional, “non-Western” health services, such as those provided by traditional healers and traditional birth attendants
    • 13. Health system and health information system
      • What is an information system ?
        • “ … a system that provides specific information support to the decision-making process at each level of an organization” (Hurtubise, 1984)
      • What is a HEALTH information system
        • … a system that provides specific information support to the decision-making process at each level of the health system
    • 14. Building a National HIS
      • How can the national health information system (HIS) monitor and manage the goals and functions of the broader health system?
      • What are the different data sources to generate this information?
      • How can the national HIS be standardized and integrated?
    • 15. The Health Metrics Network
      • Global health partnership reflecting a range of country and global health and information constituencies
      • Underlying premises:
        • Improved health through data for evidence-based decision-making
        • Better measurement , through strengthened health information and statistical systems
        • Networking to galvanize partners and resources for improved health information
      • Funding first phase 2005-2012
        • USD 70 millions from Gates Foundation
        • Also Danida, DFID, Thailand, USAID & WHO
      • Website: www.healthmetricsnetwork.org
      Better data - better decisions - better health
    • 16.  
    • 17. National HIS: Measurement Domains
    • 18.
      • Country leadership and ownership
      • Responding to country needs and demands
      • Building upon existing initiatives and systems
      • Building broad-based consensus and stakeholder involvement
      • Gradual and incremental process with a long-term vision
      Guiding Principles for Country HIS Development
    • 19.  
    • 20. HMN: Next Steps
      • Expanding networks for technical support to HIS strengthening:
        • Partnerships with other GHIs
        • Reaching out to regional and local partners
      • Deepening the framework and its standards
        • Enterprise Architecture development
    • 21. What is an “Enterprise Architecture” (TOGAF 2007) Four Layers Representative Questions Addressed Business Architecture
      • Who are the key decision makers, what are their roles and behaviors insofar as decision making is concerned?
      • What are the essential questions & requirements of users?
      • What are the business domains and processes (functions)
      • Who will be responsible for the managing the HIS?
      Data Architecture
      • What are the essential core and common data necessary to support the organization’s business architecture?
      • How will the sources of these data be extracted linked and transformed for use from existing operational systems?
      Applications Architecture
      • What are the priority applications that a core HIS must deliver?
      • What applications are best included within a single platform design versus those applications that are best maintained as separate operational systems?
      • How should the user interface work?
      Technical Architecture
      • What are the requirements for information to be captured, data entered, tagged, communicated and managed?
      • What is the minimum information and communication technology capacity needed across the country to support access to the applications and dissemination of information?
    • 22.
      • How do we translate the concepts of enterprise architecture in developing a “health system architecture” and a “HIS architecture”?
        • See concurrent session on Enterprise Architecture
    • 23. National HIS: What is the contribution of various sources of information? Health Metrics Network, 2005 Administrative records systems Services records systems Individual Records systems Pop based surveys Vital registration Census Population-based data sources Health services based data sources (RHIS)
    • 24. RHINO (and this workshop): Focus on health services based data sources
      • Routine Health Information System (RHIS)
        • aka: Health Management Information System (HMIS)
      • Address mainly the “health services system” (both facility and community based)
        • Service statistics
        • Disease surveillance
        • Resource management (human, physical)
        • Community participation
      • Generate information for evidence-based decision making mainly at district level and below (including the community)
    • 25. The Health Services System and Role of RHIS GEO-GRAPHICAL LEVEL OTHER SECTORS: -Environment -Civil Administr. -Transport -Education SECONDARY HEALTH SYSTEM Community Level PRIMARY TERTIARY Patient/Client contact Referred patients First level care unit District Hospital Referred patients Regional Hospital Regional Health Mgmt Team Referred patients National Hospital University Hospital Ministry of Health Universities Other Health Institutions INDIVIDUAL CARE MANANAGEMENT HEALTH UNIT MANAGEMEET SYSTEM MANAGEMENT DISTRICT LEVEL REGIONAL LEVEL NATIONAL LEVEL HEALTH CARE SERVICES ►► HEALTH SERVICES SYSTEM Routine Health Information System NON-ROUTINE DATA COLLECTION METHODS CATCHMENT AREA POPULATION District Health Mgmt Team
    • 26. How to design a RHIS in support of the health services system?
      • Developing a match between functions of the health services at all levels (business architecture) and the information needs in support of those functions (data architecture)
    • 27. The three management levels of the health services system
      • Patient/client management level
      • Health unit management level
      • System management level
    • 28. Examples of Patient/Client management functions
        • Make curative/preventive case management decisions based on evidence based standardized guidelines (quality of care)
        • Follow up patients with chronic disease or risk episodes (continuity of care)
        • Reduce missed opportunities by checking immunization and nutritional status (integrated care)
    • 29. Examples of health unit management functions
        • Provide a standard package of services to various target and risk groups of the population in the catchment area of the health unit
        • Ensure quality of care of the services provided
        • Assure sufficient supplies of essential drugs
        • Ensure financial management of the health unit (adapted to financing mechanisms of the health services)
        • Improve client satisfaction (e.g. reduce waiting times)
    • 30. Examples of System management functions: National – Regional – District
      • Policy making and advocacy
      • Resource allocation decisions
      • Emergency response to disease outbreaks
      • Improving access (coverage), quality, and utilization of health services
      • Provide supportive supervision of the health units
      • Manage the health information system
    • 31. Management functions & information support (Phuket, 1999) N of registered pregnancies/N of expected pregnancies Provide prenatal care to all pregnant women in catchment area Health Unit Number of stock-outs for essential drugs or vaccines Ensure distribution of health commodities throughout district System Treatment according to standard N of DPT3/N of DTP1 Provide quality care Provide continuity of care Patient/Client Indicators Functions Mgmt Level

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