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Part I-Achieving Universal Health Coverage: The Role of Routine Health Information


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As countries continue to invest and make strides toward achieving the SDGs and universal health coverage, strong routine health information systems (RHIS) are fundamental to the effort. Well-functioning RHIS provide a wealth of data on a country’s health system, including service delivery, availability of a trained workforce, and reach of interventions, that can be harnessed to identify gaps and support evidence-based decision making. Yet, while many low-to-middle income (LMIC) countries have established a national RHIS structure, there are existing challenges related to the availability, analysis, and use of the data that have yet to be addressed.

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Part I-Achieving Universal Health Coverage: The Role of Routine Health Information

  1. 1. Routine Health Information Network AchievingUniversalHealthCoverage: RoleofRoutineHealthInformationSystems Theo Lippeveld, MD, MPH Senior HIS Adviser John Snow Inc RHINO Forum January 15, 2019
  2. 2. Universal Health Coverage and the Measurement Challenge  Currently major investments in Low and Middle Income Countries (LMIC) to achieve Universal Health Coverage (UHC), as well as the Sustainable Development Goals (SDG)  UHC means “the delivery of high-quality essential health services that are accessible to all without the risk of financial hardship”  Data are critical for monitoring progress, identifying areas of improvement, and implementing practical solutions (JLN and Bloom et all, 2018)  Routine Health Information Systems (RHIS) can provide many of the data required for measuring the delivery and cost of high-quality health services (Lippeveld, 2017)
  3. 3. The role and importance of decentralized Routine Health Information System (RHIS)  Facility-based and ideally also community- based  Main data source for (daily) planning and management of quality health services at district level and below  Coverage and quality of health interventions  Disease surveillance  Commodity security  Human resource management  Financial information systems  Ideal support to integrated management of health interventions
  4. 4. Administrative records systems (NHA, FMIS, LMIS) Services records systems (HMIS, IDSR) Individual Records systems (paper-based – EMR) Pop based surveys Vital registration Census Population-based data sources Health Institution (including community) based data sources (RHIS) Routine Health Information System (RHIS)
  5. 5. RHIS in most LMICs are woefully inadequate to provide the needed information support... But We All Know
  6. 6. What is wrong with existing routine health information systems?  Irrelevance, plethora, and poor quality of the data collected  Fragmentation into “program- oriented” information systems: duplication and waste  Poor and inadequately used HIS and ICT infrastructure and resources MOST OF ALL  Absence of information culture where data are valued and used for decision making
  7. 7. RHIS Reform and strengthening: Achievements and Way Forward  Advocacy: growing demand in the past decade for strong RHIS in the global health community  RHIS performance has improved in many countries thanks to technical interventions such as  Better measurement of RHIS performance: PRISM tools  Data quality assurance systems  Better use of Information and Communication Technology  eHealth Architecture establishment  Improved data visualization  But use of information for DM lagging behind Need for broader “system” thinking : PRISM framework Need for behavioral interventions at individual and organizational level including communities
  8. 8. Behavioral Determinants Knowledge/ skills, attitudes, values, motivation 2008: PRISM Logical 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
  9. 9. This RHINO Forum: Innovative approaches to better use of RHIS data for improving service delivery • Building an information culture • Use of human-centered design (HCD) methodology to help design an information system that accommodates the needs of the users at all system levels • Creating accountability in the community • Providing innovative electronic tools for data management and use at the community level
  10. 10. Need to Establish a “Culture of Information” Operational definition “The capacity and control to promote values and beliefs among members of an organization for collection, analysis and use of information to accomplish its goals and mission.”
  11. 11. What drives Culture of Data Use? (JLN, 2018) Enabling environment with a decentralized organizational structure Robust data feedback loops throughout the health system Clear roles and responsibilities around decision making No-blame environment with respect and promotion of transparency Mutual accountability and shared ownership within the health system, and between the health system and the community Encouragement and incentives to motivate behavioral change
  12. 12. Illustrative Interventions to Promote Data Culture Role modeling by Senior Management for using collected information Dissemination of success stories on use of HIS information  Publication of district level indicators through media (Uganda)  Allocation of resources based on HMIS indicators (Brazil) Institutionalizing use of RHIS information  Use of information as a criteria for annual performance appraisal Health Services Performance Review meetings  with focus on using RHIS data (problem solving methodology) Creating data use incentives  Performance based financing (PBF) Human Centered Design (HCD) methodology
  13. 13. Human-centered Design (HCD) methodology  HIS design process that accommodates the needs of the users at all health system levels by involving users at the RHIS design stage  HCD methods facilitate empathy among various stakeholders, to help create an environment for learning, idea generation, and developing effective solutions (Gobee Group, 2017)  Initially used by private sector, but recently also in social projects (e.g. Data Use Partnership project in
  14. 14. Building Local Innovation Capacity via HCD methodology Establishment of Innovation Labs: groups of end- users (policy level, district level, delivery of care level) • Key to the creation of a culture of data use • Meetings to solve problems using HCD approach:
  15. 15. “Two years ago, we were the least performing woreda in the zone. The training we received on how to use our performance data to make decisions and take action was an eye opener. We knew very little about using our own data to identify our own gaps and propose solutions. Now, we are completely data-driven. Soro Woreda health office has witnessed a growing interest in use of performance data for DM, making it a cliché in the hearts and minds of health workers and managers in the woreda. Abenezer Bekele, Head of Soro Woreda HO. Case Study: Creating an information culture in Soro woreda in SNNPR/Ethiopia (IHFP, Selected Stories from the Field, 2016)
  16. 16. Challenges and the way forward  Creating an information culture is a behavioral intervention: it will take time to see results!  Measure information use for decision making based on PRISM assessments (evidence-based)  RHIS capacity building to improve data analysis, problem solving and advocacy skills of district and facility staff
  17. 17. Routine Health Information Network THANK YOU Theo Lippeveld, MD, MPH Senior HIS Adviser John Snow Inc.
  18. 18. References Bloom, D., Khoury A., and Subbaranam R.: The Promise and Peril of Universal Health Care. Science, 361, 766, 2018 Bjorkman M, and Svensson, J.: Power to the people: evidence from a randomized field experiment on community-based monitoring in Uganda. Q.J. Economics, 2009. Nutley T. and Reynolds H.: Improving the use of health data for health system strengthening. Global Health Action, 2013 Lippeveld, T.: Routine Health Facility and Community Information Systems: Creating and Information Use Culture. Editorial in GHSP, Vol 5 Nr 3, 2017 Measuring the Performance of Primary Health Care: A Toolkit for Translating Data into Improvement. JL Network for UHC, 2018. Ethiopia Data Use Partnership: Concept Note on Human Centered Methodology (HCD)