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Strengthening Routine Facility-based Health Information Systems in Developing Countries: Towards a sustainable data source for measuring the delivery of evidence-based interventions
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Strengthening Routine Facility-based Health Information Systems in Developing Countries: Towards a sustainable data source for measuring the delivery of evidence-based interventions

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Presented by Theo Lippeveld at the November 2013 American Public Health Association Annual Meeting.

Presented by Theo Lippeveld at the November 2013 American Public Health Association Annual Meeting.

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Strengthening Routine Facility-based Health Information Systems in Developing Countries: Towards a sustainable data source for measuring the delivery of evidence-based interventions Strengthening Routine Facility-based Health Information Systems in Developing Countries: Towards a sustainable data source for measuring the delivery of evidence-based interventions Presentation Transcript

  • Strengthening routine health information systems (RHIS) in LMICs: Towards a sustainable data source for measuring evidence based service delivery Presentation by Theo Lippeveld, MD, MPH tlippeveld@jsi.com APHA 143nd Annual Conference Boston, November 5, 2013
  • Presenter Disclosures Presenter: Theo Lippeveld I have no relationships to disclose
  • Presentation Outline  Routine Health Information Systems:  Why are they so important?  Why are they not functioning well?  PRISM framework and tools  PRISM interventions  Use of PRISM in various countries  Conclusion and next steps
  • The role and importance of decentralized Routine Health Information System (RHIS)  Facility-based and ideally also community-based  AKA = Health Management Information System (HMIS)  Main source of information for (daily) planning and management of health services at district level and below  Coverage and quality of health interventions  Disease surveillance  Commodity security  Financial information systems  Commission for Information and Accountability on Women’s and Child Health: essential role of RHIS in accelerating progress on MDGs
  • Unfortunately... Routine health information systems in most developing countries are woefully inadequate to provide the needed information support ...
  • The burden of data
  • Where HMIS data often end their journey…
  • What is wrong with existing routine health information systems? • Plethora, irrelevance and poor quality of the data collected • Centralization of information management without feedback to district and service delivery levels • Fragmentation into “program- oriented” information systems: duplication and waste • Poor and inadequately used health information system infrastructure and resources
  • As a result… • Poor use of information by users at all levels: care providers as well as managers • Reliance on more expensive survey data collection methods but the findings are relevant only to national and global levels
  • So, the question is not …. Where can we find other data sources (since RHIS cannot provide the information)? but rather… How can we improve the RHIS performance in support of planning and management of quality district health systems?
  • Examples of RHIS reform efforts in the past twenty years
  • Some of the lessons learned  Need for well defined RHIS performance criteria:  Production of relevant and quality information  Continued use of information for DM at all levels  Empirical evidence shows that availability of quality information does NOT NECESSARILY mean that is it used for decision making Need for broader “system” thinking Need for better understanding of factors influencing RHIS performance PRISM framework: Performance of Routine Information System Management
  • 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
  • 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 Process Assessment Tool
  • Application of PRISM tools
  • Measuring RHIS Performance: Findings of PRISM assessment in different countries at different health system levels Availability of quality data does not necessarily mean that information is used for making decisions
  • Measuring RHIS Performance: Competency in problem solving Inter- ventions
  • What can we do to improve RHIS performance?  Technical interventions (classic)  Organizational and behavioral interventions (new approach)
  • 1. Technical interventions  Defining set of essential indicators  Standardize data generation architecture based on best practices (data recording – reporting – processing)  Improving integration of data sources: establishment of data warehouse  Development of computerized data analysis/ presentation application: DSS
  • 2. Organizational interventions  Self-assessment  Problem solving approach  Advocacy  Promotion Of Culture Of Information
  • How does self-assessment work?  Facility staff along with district staff set their own service coverage targets and monitor them periodically.  Example (Pakistan): increasing facility utilization rate from 30% to 50% in one year (1.6% increase/month)  Facility staff develop action plan to motivate the community to visit their facility  Facility staff monitors progress through line or control chart and measures whether target is achieved  Self-assessment assumes knowledge and skills of using problem solving approach – next topic
  • Problem solving approach towards performance improvement Track and create institutional memoryTrack and create institutional memory
  • How does advocacy work?  Ensure that all relevant information for supporting the position is based on objective assessment  Establish credibility based on previous good work  Network within the organization (other health centers, other counties)  Create alliances with outside forces to get support:  community, NGOs, private sector, local politicians
  • How to promote culture of information?  Role modeling by senior management on using collected information  Emphasis on HMIS performance during meetings  Dissemination of success stories of use of info for service improvement and advocacy  Institutionalizing use of HMIS information
  • 3. Behavioral Interventions  Improve confidence level by asking people to do simple HMIS tasks and then add complexity in tasks  Capacity building to improve data analysis, problem solving and advocacy skills of district and facility staff  Organization of in-service training courses (Pakistan, Uganda, South Africa, Mexico)  On-the-job training through supportive supervision  Include module in pre-service training programs
  • PRISM assessment results in Ivory Coast RHIS Performance Health Facilities Districts 2008 2012 Status 2008 2012 Status Data quality 43% 60% 40% 81% Data use 38% 38% 44% 70%
  • Examples of RHIS strengthening interventions in Ivory Coast  Integration of HIS/AIDS indicators into the overall RHIS (T)  Organized training in use of information including problem solving techniques at district and health facility levels (B)  Developed feedback bulletins for health offices at all levels (O)
  • Conclusions  The unique role of HMIS is to produce quality information that is used to improve health system management functions at all levels  PRISM tools allow countries (for the first time) to measure RHIS performance  RHIS performance improvement interventions should focus on district level and below and include a mix of technical, organizational, and behavioral interventions  Senior management needs to role model use of information and promote information culture for improving service delivery performance
  • MEASURE Evaluation is a MEASURE project funded by the U.S. Agency for International Development and implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group International, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. Views expressed in this presentation do not necessarily reflect the views of USAID or the U.S. Government. MEASURE Evaluation is the USAID Global Health Bureau's primary vehicle for supporting improvements in monitoring and evaluation in population, health and nutrition worldwide.