Presented at the 2016 Consortium of Universities for Global Health conference.

1. Sector Coordination Committee (HSCC), a high-level decision making body led by the Minister
of Health.
With technical assistance by the USAID-funded MEASURE Evaluation project, the HIS strategic
planning process was implemented in four stages, through broad-based consensus building
among key HIS stakeholders inside and outside the MOH. First, all HIS stakeholders reached
consensus on the HIS strategic plan development process. Secondly, the core team developed
the HIS assessment tools, based mainly on the Health Metrics Network (HMN) framework and
the MEASURE Evaluation Monitoring and Evaluation Capacity Assessment (MECAT) tool. The
HIS assessment tool was administered by the HIS stakeholders during a three-day national
workshop. The information and communication technology (ICT) infrastructure was assessed
with a separate tool. The third stage consisted of an HIS strategic planning process, again with
all stakeholders, where—based on the assessment results—HIS strategic and operational plans
were developed, using the HMN HIS strategic planning guidelines published in 2008. HIS
strategic objectives and interventions were identified, prioritized, and costed. Finally, these
HIS strategic and operational plans were validated by the HSCC.
Outcome and going forward
The HIS strategic plan covers the period of 2016–2021 to coincide with the dates of the
National Health Plan and Resilience Investment Plan. The HIS costed operational plan covers
the fiscal years 2016 and 2017 and designates which internal and external partners are
responsible for implementation of the proposed interventions. It is expected that both the
strategic and operational HIS plans will lead to a more integrated and interoperable HIS and
to better coordination among all HIS stakeholders, leading in turn to a more resilient and
country-owned health system in Liberia.
Challenges, lessons learned, and best practices
The process of HIS strategic and operational planning—including an
HIS assessment—is a complex undertaking and needs a time frame of
minimum six months, as confirmed by the HMN guidelines. The MOH was
lucky to have a champion to lead this effort: Luke Bawo. The core team of
the MOH, led by Luke Bawo mostly followed the HIS strategic planning
process proposed by HMN. The proposed coordination mechanisms are
extremely useful, as they ensure the involvement of all HIS stakeholders,
as well as steady progress through the technical preparations by the core
team. The detailed instructions in the HMN guidelines are overly complex
and will need to be simplified.
The greatest benefit to the MOH of the HIS strategic
planning process as it was implemented was the intense
communication that took place between various MOH
units and with the multiple external stakeholders; this
made explicit the widespread fragmentation both within
the MOH and within the donor and implementing
partner community.
MEASURE Evaluation will use the lessons learned from
the Liberia HIS strategic planning process, from other
Ebola countries, as well as past country experiences, to
revise the HMN strategic planning guidelines and make them more user-friendly.
References
Margaret E. Kruk, Michael Myers, S. Tornorlah Varpilah, Bernice T. Dahn. 2015. What is a
resilient health system? Lessons from Ebola. Lancet 2015:385: 1910-12.
Health Metrics Network. 2008. Assessing the National Health Information System: An Assessment
Tool. Version 4.00. Health Metrics Network.
HMN Guidance for the Health Information Systems (HIS) Strategic Planning Process. 2009.
Health Metrics Network.
Ministry of Health of Liberia. 2015. Assessment of the Liberia Health Information System.
Ministry of Health of Liberia. 2015. Health Information System (HIS) ICT Infrastructure Assessment
Report.
Ministry of Health of Liberia. 2016. Health Information System (HIS) Strategic Plan 2016–2021.
Ministry of Health of Liberia. 2016. Health Information System (HIS) Operational Plan 2016–
2017.
Theodore Svoronos, Rose J. Macauley, and Margaret E. Kruk. 2015. Can the health system
deliver? Determinants of rural Liberians’ confidence in health care. Health Policy and Planning
2015;30:823-829
The HMN Framework Ministry of Liberia:
HIS Organizational Set-Up
Background
During the Ebola Virus Disease (EVD) epidemic 2014–2015, the fragile Liberian health
system, although significantly rebuilding after a 14 year civil war, completely collapsed.
The epidemic had a devastating impact on the health system, the population at large,
and the Liberian economy. The health system was ill-equipped to effectively respond to
the epidemic with the necessary occupational health and infection prevention and control
(IPC) measures for safe and effective health services. As a result, many health workers got
infected and died. Pre-existing structural vulnerabilities included inadequate and poorly
motivated health workers, insufficient and unsuitable infrastructure and equipment, weak
supply chains, and poor quality of care. This led to disruptions in the delivery of routine
health services, with health facility closures. Coverage of life-saving maternal and child
health interventions, in particular, declined dramatically.
As the outbreak waned, the Government of Liberia developed an Investment Plan for
Building a Resilient Health System (2015–2021), with the purpose of rebuilding the
health system in such a way as to ensure that it never again would fail to respond
effectively to similar threats.
Purpose
Strengthening the national health information system (HIS) has been recognized by the
Ministry of Health (MOH) of Liberia as one of the key interventions in building a resilient
health system. Indeed, during the Ebola epidemic it became clear that the fragmentation
of the current HIS made it impossible to have the “right information at the right time in the
right place.” Many HIS subsystems—such as the Health Management Information System
(HMIS) and the Disease Surveillance Information System (DSIS)—were not interconnected.
External HIS partners did not coordinate efforts and by setting up separate reporting
systems contributed even further to fragmentation. The MOH therefore decided to conduct
a comprehensive HIS strategic and operational planning exercise with a particular focus
on leadership and coordination.
Process design and implementation
An HIS strategic planning process took place between July 2015 and February 2016
and used three coordination mechanisms: (1) a core team comprising around 10 HIS
professionals from the MOH and technical agencies; (2) the HIS Stakeholders Working
Group, representing all HIS government and external stakeholders; and (3) the Health
Building a Resilient Health System in Liberia:
Health Information System (HIS) Strategic PlanningL. Bawo, Ministry of Health, Liberia and T. Lippeveld, MEASURE Evaluation, Chapel Hill, NC, USA
HIS Strategic Planning Workshop September 2015
HIS Strategic Planning Workshop September 2015
Chaired by Dr. Bernice Dahn, Minister of Health
MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) under terms of Cooperative Agreement AID-OAA-L-14-00004 and implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF
International, John Snow, Inc., Management Sciences for Health, Palladium, and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government.
HIS Strategic Planning and Design Process
in Twelve Steps (HMN 2009)
7. HIS Objectives
and Interventions
4. Priority HIS
Components and
Problems
8. Intervention
Implementation
Phasing
6. Ongoing &
Planned HIS
Strengthening
Efforts
10. Strategy
Costing
11. HIS M&E Plan
12. HIS Strategic
Plan Document
9. Detailed
Strategy Design
and Activity Plan
Commence
Implementation
Commence
monitoring and
evaluation
Reprogramming
as necessary
Planning Module I
Preparing for Strategic
Planning
Planning Module II
Conducting HIS Strategic
Planning
ImplementationPlanning Module III
Detailed HIS Planning
and Costing
1. Review HIS
Assessment Results
3. Inventory On-going HIS
strengthening Efforts
Steering Committee, Core Team, Stakeholder Working Group & Roadmap
Organize the
HIS Planning
Groups and
Process
2. Review Health System
Development Priorities
and define HIS Problems
HIS
Assessment
Phase 2 – Priority-setting and Planning Phase 3
5. The HIS Vision
Green steps are carried out by the SWG, blue steps by the CT or small working groups
Luke Bawo, the HIS Champion of
Liberia