RHIS Performance Improvement: Examples of Interventions


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  • Geographical comparisons between health centers in the same “province” (=district) in Morocco
  • Comparison between an input indicator (ORS packets) and severe dehydration rates in a Moroccan health region.
  • RHIS Performance Improvement: Examples of Interventions

    1. 1. 4 th International RHINO Workshop Guanajuato, Mexico March 8, 2010 Measuring and Improving Routine Health Information System Performance Session 4.3: RHIS Performance Improvement: Examples of Interventions
    2. 2. Examples of technical interventions <ul><li>Defining set of essential indicators: information needs adapted to management functions of the health system at all levels </li></ul><ul><li>Standardize data generation architecture based on best practices: </li></ul><ul><ul><li>Revising/simplifying data collection instruments </li></ul></ul><ul><ul><li>Developing computerized data entry/data processing applications </li></ul></ul><ul><ul><li>Streamlining data flows within the MOH </li></ul></ul><ul><li>Development of computerized data analysis/presentation application: DSS </li></ul>
    3. 3. Computerized data analysis/presentation What is a Decision Support System (DSS)? <ul><ul><li>A computerized application allowing health managers to visualize health indicators and data elements collected by the RHIS in graphical and geographical presentations </li></ul></ul><ul><ul><li>Based on the principle that COMPARISON is one the most powerful analytical methods: </li></ul></ul><ul><ul><ul><li>spatial : by health facility, district, province etc. </li></ul></ul></ul><ul><ul><ul><li>time : trends by week, month, year, etc. </li></ul></ul></ul><ul><ul><ul><li>indicators : between inputs and outputs </li></ul></ul></ul><ul><ul><ul><li>benchmark : expected versus achieved </li></ul></ul></ul>
    4. 4.
    5. 5.
    6. 6. Examples of organizational and behavioral interventions (let us go a step further...) <ul><li>Participatory decision space analysis in decentralized district managed health systems (Pakistan) </li></ul><ul><li>Provide sufficient and appropriate resources: staffing, equipment/supplies, ICT, financial resources </li></ul><ul><li>Promote HMIS self-assessment (Uganda) </li></ul><ul><li>Performance Improvement Tools focused on problem solving approach (Thailand) </li></ul><ul><li>Provide advocacy skills to district and facility managers (Honduras, Paraguay) </li></ul><ul><li>Creating incentives for use of information (Pakistan, Uganda) </li></ul><ul><li>Integration of district health systems </li></ul>
    7. 7. How can RHIS help building integrated district health systems? <ul><li>Horizontal and vertical integration of program interventions </li></ul><ul><li>Develop functional database at district level incorporating information from routine and other sources of information </li></ul><ul><li>Integration of public and private HIS </li></ul>
    8. 8. Integration of program interventions <ul><li>Between individual care interventions within the health services system </li></ul><ul><ul><li>Horizontal integration: at each level but mostly at health facility and district levels (e.g. HIV/AIDS – neonatal health) </li></ul></ul><ul><ul><li>Vertical integration: between levels (e.g. continuum of care in maternal health) </li></ul></ul><ul><li>Between individual and community health interventions (e.g. EOC – community transport solution) </li></ul><ul><ul><li>Including inter-sectoral integration </li></ul></ul>
    9. 9. <ul><li>Integration of the individual patient record system for continuity of care </li></ul><ul><li>Paper-based record and register design </li></ul><ul><li>Paper-based system filing systems </li></ul><ul><li>Electronic medical records in hospitals </li></ul>
    10. 10. Integration of Individual-Community Health through integrated district data-warehouse (South Africa)
    11. 11. Integration of public-private HIS <ul><li>Needs further exploration and research </li></ul><ul><li>Examples of sticks and carrots </li></ul><ul><ul><li>Improved regulation (link reporting to licensing) </li></ul></ul><ul><ul><li>Accreditation of facilities </li></ul></ul><ul><ul><li>Health insurance - database </li></ul></ul><ul><ul><li>Make diseases notifiable by law (and in case of MNH: maternal/neonatal deaths) </li></ul></ul><ul><ul><li>FP/ STI / Immunisation supplies provided free if reporting </li></ul></ul>