Strengthening routine health information
systems (RHIS) in LMICs:
Towards a sustainable data source for
measuring evidence...
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 wel...
The role and importance of decentralized
Routine Health Information System (RHIS)
 Facility-based and ideally also commun...
Unfortunately...
Routine health information systems in most
developing countries are woefully
inadequate to provide the ne...
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
colle...
As a result…
• Poor use of information by users at all
levels: care providers as well as managers
• Reliance on more expen...
So, the question is not ….
Where can we find other data sources (since
RHIS cannot provide the information)?
but rather…
H...
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 inform...
Behavioral
Determinants
Knowledge/ skills, attitudes,
values, motivation
PRISM framework for understanding
Routine Health ...
PRISM tools
A) RHIS Performance Diagnostic Tool
B) RHIS Overview
Facility/ Office Checklist
Quality of data Use of informa...
Application of PRISM tools
Measuring RHIS Performance:
Findings of PRISM assessment in different
countries at different health system levels
Availabi...
Measuring RHIS Performance:
Competency in problem solving
Inter-
ventions
What can we do to improve RHIS
performance?
 Technical interventions (classic)
 Organizational and behavioral
interventi...
1. Technical interventions
 Defining set of essential indicators
 Standardize data generation architecture based on best...
2. Organizational interventions
 Self-assessment
 Problem solving approach
 Advocacy
 Promotion Of Culture Of Informat...
How does self-assessment
work?
 Facility staff along with district staff set their own
service coverage targets and monit...
Problem solving approach towards
performance improvement
Track and create institutional memoryTrack and create institution...
How does advocacy work?
 Ensure that all relevant information for supporting
the position is based on objective assessmen...
How to promote culture of information?
 Role modeling by senior management on
using collected information
 Emphasis on H...
3. Behavioral Interventions
 Improve confidence level by asking people to do
simple HMIS tasks and then add complexity in...
PRISM assessment results in Ivory
Coast
RHIS
Performance
Health Facilities Districts
2008 2012 Status 2008 2012 Status
Dat...
Examples of RHIS strengthening
interventions in Ivory Coast
 Integration of HIS/AIDS indicators into the
overall RHIS (T)...
Conclusions
 The unique role of HMIS is to produce quality
information that is used to improve health system
management f...
MEASURE Evaluation is a MEASURE project funded by the
U.S. Agency for International Development and implemented by
the Car...
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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.

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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

  1. 1. 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
  2. 2. Presenter Disclosures Presenter: Theo Lippeveld I have no relationships to disclose
  3. 3. 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
  4. 4. 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
  5. 5. Unfortunately... Routine health information systems in most developing countries are woefully inadequate to provide the needed information support ...
  6. 6. The burden of data
  7. 7. Where HMIS data often end their journey…
  8. 8. 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
  9. 9. 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
  10. 10. 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?
  11. 11. Examples of RHIS reform efforts in the past twenty years
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. Application of PRISM tools
  16. 16. 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
  17. 17. Measuring RHIS Performance: Competency in problem solving Inter- ventions
  18. 18. What can we do to improve RHIS performance?  Technical interventions (classic)  Organizational and behavioral interventions (new approach)
  19. 19. 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
  20. 20. 2. Organizational interventions  Self-assessment  Problem solving approach  Advocacy  Promotion Of Culture Of Information
  21. 21. 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
  22. 22. Problem solving approach towards performance improvement Track and create institutional memoryTrack and create institutional memory
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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%
  27. 27. 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)
  28. 28. 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
  29. 29. 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.

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