The document defines and discusses health information systems and their importance. It provides definitions of key terms like health information system, management information system, and health management information system. It outlines the importance of health information systems in supporting management functions, decision making, and health system strengthening. It describes the typical components and structure of health information systems, including data collection, management, and use. It also discusses issues that can undermine current health information systems and provides steps to develop and improve such systems.

1. Health management information
system
1

2. Definitions: Health information system
– Any system that captures, stores, manages or
transmits information related to the health of individuals
or the activities of organizations that work within
the health sector
– A system that integrates data collection, processing,
reporting, and use of the information necessary for
improving health service effectiveness and efficiency
through better management at all levels of health
services
– A set of components and procedures organized with the
objective of generating information which will improve
health care management decisions at all levels of the
health system 2

3. Definitions (2)
• Management information system
– A formal method of making available accurate and
timely information to management that is necessary to
facilitate the decision making process and enable the
organizations’ planning, control and operational
functions to be carried out effectively
• Health management information system
– Application of the principles of management information
system in health care systems
– Information management system specially designed in
management and planning of health programs as
opposed to delivery of care
3

4. Definitions (3)
• HMIS is a data collection system specifically
designed to support planning, management, and
decision making in health facilities and
organizations
4

5. Importance of health information systems
• Supports each step in the management cycle
• Improved health information system is linked to
good management  critical for increasing
efficiency of health services
• It is required by policy makers, managers, health
care providers, community health workers
5

6. Importance of health information systems (2)
• Data from different sources are used for multiple
purposes at different levels of health care system
– Individual level data about patient's profile, health care
needs, & treatment are used for clinical decision-making
– Health facility level data, both from aggregated facility-level
records and from administrative sources such as drug
procurement records, enable health care managers to
determine resource needs, guide purchasing decisions for
drugs, equipment and supplies, and develop community
outreach
– Population level data are essential for public health decision-
making
– Public health surveillance brings together information from
both facilities and communities
6

7. Importance of health information systems (3)
• One of the six building blocks essential for health
system strengthening
7

8. 8

9. Health information system structure
Information process
Resources
data collection
data transmission management
data processing
organizational
rules
information for use
in management 9

10. Health information system components
• Data/ information/ knowledge component
• Hardware / software / network components
• Process / task / system component
• Integration / interoperability
• User / administration / management component
10

11. Health information system components (2)
• Inputs (Health information system resources)
– Consist of legislative, regulatory, and planning
frameworks required to ensure a fully functioning health
information system
– The resources that are prerequisites for such a system to
be functional.
• Resources involve personnel, financing, logistics support,
information and communications technology (ICT), and
coordinating mechanisms within and among the components
11

12. Health information system components (3)
• Processes
– Indicators
• A core set of indicators and related targets for the components of
health information  Indicators need to encompass determinants
of health; health system inputs, outputs, and outcomes; and health
status.
– Data sources can be divided into two main categories:
• Population-based approaches (censuses, civil registration, and
population surveys) and
• Institution-based data (individual records, service records, and
resource records).
– Data management
• All aspects of data handling: collection, storage, quality-assurance,
flow, processing, compilation, and analysis 12

13. Health information system components (4)
• Outputs
– Information products.
• Data must be transformed into information that will become
the basis for evidence and knowledge to shape health action
– Dissemination and use.
• The value of health information can be enhanced by making it
readily accessible to decision makers (giving due attention to
behavioral and organizational constraints) and by providing
incentives for information use
13

14. Desired characteristics of information in
health services
• Relevance
• Accuracy (provides the information that it is supposed
to provide)
• Completeness (both in geographical coverage and in
terms of range/amount of data it is supposed to
provide)
• Timeliness
• Conciseness
• Reliable (information that it is consistent) 14

15. Determinants of quality of data
Technical
determinants
Organizational
determinants
Behavioral
determinants
HMIS design
Forms
Technology
Organizational
Structure
Functions
Management
Roles &
responsibilities
Knowledge
Skills
Values
motivation
15

16. Areas of assessment for quality
• Information use
• Data quality
• Data burden
• Human resource
• ICT
• Finance, resource 16

17. What is wrong with current HIS?
• Information use
– Mere collection and reporting of data to higher level
– Aggregation of unused data
– No information use for performance and service delivery
improvement at the periphery
– Irrelevance of information gathered
– Management staff rely on gut feeling to make decisions
instead of using available data  lack of interest & capacity
– Resistance to changes
17

18. What is wrong with current HIS? (2)
• Data Quality
– Poor quality data leads to erroneous conclusion and
improper decision
– Additional work of late error detection
– Important data items often missed
– Significant discrepancy between data reported and
recorded in registers in the facilities
18

19. What is wrong with current HIS? (3)
• Data Burden
– Too much data is collected
• Duplication of efforts
– Independent data collection requirements of different
partners
• Non-comparability
– Different definitions of indicators among different
partners and across regions
• Skills in interpreting information & Problem solving
appeared weak at all levels 19

20. What is wrong with current HIS?
• Lack of timely reporting & feedback
• Limited funding
• Deficiency in information infrastructure
• Network vulnerability to break-down / failure to
function due to viruses, difficult system codes,
repair delays
• Inadequate human resource to work on HIS 20

21. Components of HMIS
• Epidemiological surveillance (notifiable infectious
diseases, environmental conditions, and risk factors)
• Routine reporting
• Specific program reporting (Malaria, TB, HIV etc)
• Administrative systems (health care financing systems,
health personnel systems, logistic systems)
• Vital registration 22

22. Steps in developing HMIS
• Review existing system
• Define data needs of relevant units within health
system
• Determine most appropriate data flow
• Design data collection and reporting tools
• Develop procedures for data processing 23

23. Steps in developing HMIS (2)
• Develop & implement training program for data
providers and data users
• Pre-test and if necessary redesign system for data
collection, flow, processing and utilization
• Monitor and evaluate system
• Develop data dissemination and feedback
mechanisms
24

24. Key issues to address & monitor in HMIS
• Movement of data through out the system
– Impose strict timetable of flow of data at each level
– Ensure two way flow
– Ensure regular cycle of analysis and feedback
• Accessibility and analyzability of data
• Transmission of finding to potential users
25

25. Data collection instruments
• Data collection instruments for patient / client
management
– Curative e.g. medical records, laboratory forms, referral
forms
– Preventive e.g. growth cards, MCH cards, school health
cards
• Data collection instruments for health unit
management
– Service delivery records e.g. tally sheets, registers, etc
– Resource management records
26

26. Sources of data for HIS
• Health institutions (inpatient, outpatient and other
activities)
• Vital registration systems (births, deaths, and
migratory movements)
• Laboratories and pharmaceuticals
• Community
27

27. Sources of data for HIS (2)
• Census
• Special programmes reporting e.g. TB, MCH
• Administrative systems e.g. financing system,
personnel systems, logistics systems
• Investigation of outbreaks
– Surveys and surveillances
– Disease notifications
– Routine reports 28

28. Frameworks for assessment of HIS
performance
• Health Metrics Network (HMN) Framework
• General Data Dissemination Strategy
• World Bank Statistical Capacity-Building Score
• HIS performance index (HISPIX)
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29

29. Indicators for assessment of HIS
performance
• Indicators related to data generation using core
sources and methods (health surveys, civil
registration, census, facility reporting, health system
resource tracking)
• Indicators related to country capacities for
synthesis, analysis and validation of data.
30

30. Health surveys
• Country has a 10 year costed survey plan that
covers all priority health topics and takes into
account other relevant data source
• Two or more data points available for child
mortality in the past 5 years
• Two or more population-based data points for
maternal mortality in the last 10 years
• Two or more data points for coverage of key health
interventions in the last 5 years
• One or more data point on smoking and adult
nutritional status in the last 5 years
31

31. Birth and death registration
• Percentage of births registered
• Percentage of deaths registered
• ICD10 used in district hospitals and causes of
death reported to national level
32

32. Census
• Census completed within past 10 years
• Population projections for districts and smaller
administrative areas available in print and
electronically, well documented
33

33. Health facility reporting
• Number of institutional deliveries available, by district, and
published within 12 months of preceding year
• HIV prevalence for relevant surveillance populations
published within 12 months of preceding year
• Country web site for health statistics with latest report and
data available to the general public
• Reporting of notifiable diseases makes use of modern
communication technology and reporting of statistics from
district to national levels is web-based
• Percentage of districts that submit timely, complete, accurate
reports to national level
• Data quality assessments carried out and published within
last 3 years
• International Health Regulations implemented according to
international standards
34

34. Health system resource tracking
• At least one national health accounts completed in
last 5 years
• National database with public and private sector
health facilities, and geocoding, available and
updated within last 3 years
• National database with health workers by district
and main cadres updated within last 2 years
• Annual data on availability of tracer medicines and
commodities in public and private health facilities
35

35. Capacity for analysis, synthesis and validation
of health data
• Have designated and functioning institutional
mechanisms charged with analysis of health statistics,
synthesis of data from different sources and validation
of data from population and facility sources
• Have national set of indicators with targets and annual
reporting to inform annual health sector reviews and
other planning cycles
• There is a national microdata archive for health surveys
and census that is operational
• Survey data are used to assess and adjust routine
reports from health facility on vaccinations with the
results published within 12 months of the preceding
year 36

36. Capacity for analysis, synthesis and
validation of health data (2)
• A burden of disease study has been conducted
within the last 5 years by national stakeholders
• A study of health systems performance has been
carried out within the last 5 years by national
stakeholders
• There is national commitment to transparency in
data dissemination and acknowledgement of
uncertainty
• The official annual health statistics report has been
published within 12 months of the preceding
(calendar or fiscal) year 37

37. Criteria for selecting indicators
• Validity
• Cost
• Importance of subject matter to be addressed
• Does indicator actually capture change in
phenomenon under study? (specificity)
38