1) Strengthening health information systems has been difficult due to issues like replacing routine data collection with surveys, a lack of accountability, and parallel data collection between agencies. 2) Assessments of health information systems have increased understanding of problems, but not provided solutions. More work is needed to establish how to strengthen systems. 3) The Brazilian experience shows that empowering civil society and decentralizing systems can improve accountability and make local governments responsible for health information and indicators.

1. Strengthening Information Systems for Social Development Indicators and Targets for a Post-Millennium Development Goal Fatima Marinho [email_address] Coordinator of Information and Health Analysis Pan America Health Organization – PAHO/WHO Global Health Metrics & Evaluation Seattle, Mar 14-16 2011

2. Information is one of the main MDG weaknesses. For two and a half days we have discussed methods, metrics, discrepancies, models, strategies, accountability etc In all of those discussions the problem of the information has been pointed. If we look at the situation of the information in the world we could say: Although efforts have been made to strengthening the Health Information Systems (HIS). Introduction

3. WHY HAS IT BEEN SO HARD STRENGTHENING THE HEALTH INFORMATION SYSTEM? Problems 1- Replace routine systems by surveys and estimates. The easy option for surveys and estimations as a primary way of understanding and measuring progress occurred in detriment of the strengthening of the HIS in most countries. 2- Accountability issues: both governments and international organizations need to be responsible for improving health information. 3- Parallel information . In the Americas there are many international agencies with projects to prevent children and maternal mortality or disease prevention and control (like Global Fund), but those projects collect parallel information without strengthening national HIS. 4. The use of the statistical models for estimates instead of strengthening the local capacity for analysis. 5- Non-ownership or non-usage of results . Production of external knowledge that is given to national governments causes non-ownership or non-usage of results by many countries.

8. Proportion of Ill-defined causes of death by municipalities - Brazil (darker areas have higher proportion of ill-defined causes) 2003 2005 * 2008 RESULT *project started

11. The Post-Millennium has started Lets move it!