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.
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
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
What are the broad goals and functions of the health system to address these health determinants?
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
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
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)
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)
Resource management (human, physical)
Generate information for evidence-based decision making mainly at district level and below (including the community)
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
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)
The three management levels of the health services system
Patient/client management level
Health unit management level
System management level
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)
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
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