2. What is health information?
• Health information has been variously
described as the “foundation” for better
health,
• as the “glue” holding the health system
together, and
• as the “oil” keeping the health system
running
3. • HIS is an integral part of the health system,
the operational boundaries of which include:
• … all resources, organizations and actors
that are involved in the regulation, financing,
and provision of actions whose primary intent
is to protect, promote or improve health
5. On the demand side
• there are different users and uses of
information
• people and patients,
• communities,
• service providers,
• programme managers,
• policy-makers,
• providers of funds,
• global agencies and organizations.
6. All need information on a range of health-
measurement areas including
• mortality and morbidity rates;
• disease outbreaks;
• determinants of health (such as nutrition,
environment, and socioeconomic status);
• access, coverage and quality of services;
• costs and expenditures; and
• equity
7. On the supply side
• various tools and methods are available
including
• vital registration and census systems;
• household, facility and district surveys;
• routine clinic-based data;
• disease surveillance systems;
• national health accounts; and
• modeling.
8. • Unfortunately, supply and demand in the
health information field are not currently in
equilibrium, with an oversupply of data
coexisting with large unmet needs for
information.
9. Renewed interest in health
information
• The demand for good-quality health
information is growing – driven by
1. the move towards performance-based
resource allocation and
2. significant increases in the resources for
health
10. Benefits of investing in health
information
• Detect and control emerging and endemic
health problems;
• monitor progress towards health goals; and
promote equity.
• Empower individuals and communities with
timely and understandable health related
information; and drive improvements in
quality of services.
• ·
11. • Strengthen the evidence base for effective
health policies;
• permit evaluation of scale-up efforts; and
enable innovation through research.
• Improve governance; mobilize new
resources; and ensure accountability in their
use.
12. WHAT IS A HEALTH
INFORMATION SYSTEM?
• HIS is a set of components & procedures
organized with the objective of generating
information for the health care management
decisions at all levels of the health system.
• It is universally accepted that health
information is essential for health decision-
making at all levels of the health pyramid.
13. Goal of health information
systems
• The ultimate objective of a health information
system is to produce information for taking
action in the health sector. Performance of
such a system should therefore be measured
not only on the basis of the quality of data
produced, but on evidence of the continued use
of these data for improving health systems
operations and health status.
• Rhino 2003
14. Domains of health information
1. Health determinants
2.Health system inputs
3. Health system outputs
4. Health outcomes
15.
16. Health information subsystems
• Disease surveillance and outbreak notification
• household surveys.
• Registration of vital events and censuses
• Data collection based on patient and service
records and reporting from health workers,
• Programme-specific monitoring and evaluation
• Administration and resource management
17. • “The function of a health information system is
to bring together data from all these different
subsystems, to share and disseminate them to
the many different audiences for health
information, and to ensure that health
information is used rationally,effectively and
efficiently to improve health action.”
Health Matrix network
18. WHO ARE THE MAIN ACTORS IN THE
HEALTH INFORMATION SYSTEM?
• A health information system should generate
information for different uses by different health
system actors.
• Some of these actors operate at macro-decision
level (for example, strategic planning, allocation
of resources, and evaluation) while others
operate at micro-management level (for
example, case management)
20. HIS characteristics
• Given the range of actors involved and the
diversity of potential data items, it is
imperative that the health information system
has the following interlinked characteristics:
21. HIS characteristics …
1. The ability to identify detailed and disaggregated
information items useful for decision- making at
various levels within the health care system that
are also immediately relevant at the level of data
collection.
2.The ability to screen and channel to central level
only what is most essential and detailed enough
for strategic decision- making and policy
analysis.
22. HIS principle
• the different users of health information at
different levels demonstrates three
important principles
23. HIS principle …
• 1. Different types of health-related data are
needed at different levels of the health care
pyramid – not all items of information need
to be reported at every level.
24. HIS principle …
2. Those working at the periphery, closest to
patient management, need more detailed
information on clients seen and services
provided than those working at the central
level.
25. HIS principle …
3. In order to avoid overburdening health care
workers at the peripheral level, managers
and planners should consider carefully what
type of data should be generated at each
level.
26. Where are we coming from?
Tons of data . . . little or no information . . . limited sharing
27. Where do we want to go?
Research based solutions for sustainable Health Information Systems
systems – models – strategies - mechanisms
28. Exercise - Information types
Consider which category of information (operational, tactical or
Strategic) each of the following belong to and to whom the
information would be most appropriate?
1. Present pulse rate of a patient
2. Occupancy on a daily basis for a single hospital ward over the past month
3. Total number of admissions to the pediatric department at the hospital for diarrhoea
and vomiting by month for the past year
4. Total number of infant deaths in each of the Regions in the past year
5. Daily urine output for a ward based renal patient
6. Total reported number of new HIV infected individuals in Ethiopia in the past year
29. HMIS: Definition
• A HMIS is a system of record-keeping, reporting,
processing, analysis, interpretation, use, and
feedback of information.
• A system designed to produce information to be
presented to the management to assist in
decision-making and to enable it to ascertain the
progress made by the organization in the
achievement of its major objectives (WHO 1971)
30. HMIS
• MIS focuses on routine activities &
provides operational information
31. HMIS provides information on:
– Health status
(through surveillance, surveys)
– Health-related interventions and services
(activities, progress, quality)
(through surveillance, program monitoring and
evaluation)
32. Management cycle
Where are we now?
Situation Analysis
Where do we want
to go?
Objectives
Where did we
reach?
Evaluation
Which route shall
we take?
Strategy
Is everything
going according to
plan?
Monitoring
Identifying constraints
Taking action
How shall we
travel there?
Plan of Activities
HMIS
33. Problems in HMIS 1: Design
1. Top-down control, leaving out lower level
2. Unclear objectives and targets
3. Too much working time spent on HMIS
4. No guidelines
5. Not enough skills
6. Not enough staff
7. Fragmentation in services
34. Problems in HMIS 2: Collection
• Too many records
• Too late
• Poor quality
• Poor lay-out, confusing terminology
• Incomplete
• Potential exclusion of private and hospitalized
patients
• Inflexible data collection
• Resistance to change
35. Problems in HMIS 3: (Self-) Assessment
• Data not analysed to produce information, but just
forwarded upward
• No indicators to assess progress
• Presentation not clear, out of date
• Management culture does not value information
(decision-making on intuitive or political basis
only)
36. Problems in HMIS 4: Use
• Inadequate training for managers
• Data not available for the right
persons at the right time
• No feedback to lower levels, no
pressure to use data
• Data not used for supervision
• Rigid criteria
37. A good HMIS system:
• Provides all information required
• Is easy to implement
• Requires minimal staff time
• Is consistent with other management and
recording systems in place
• Is useful for all stakeholders and is used
39. Old HMIS problems
• Weak institutionalization
• Uninterested un-standardized recording and
reporting
• Lack of information use
• Poor linkage between data sources
• Lack of appropriate ICT support
40. Old HMIS problems cont’d
• Data collection;
– Too much data items;
• 400 at HCs,
• 500 at WorHO
– Irrelevant
• Reporting;
– Incomplete, Untimely
– Redundancy, parallel administrative burden
• Data analysis;
– Not done at the point of collection
41. Old HMIS continued…
• Different reporting
formats/data definition
• Duplication
• Uncoordinated initiatives
42. Basic principles of the new design
• Standardize
– Indicators & definitions
– Disease list for reporting & case definitions
– Client / patient flow & data elements
– Recording & Reporting forms
– Procedure manual
– Information use guidelines
• Integrate
– Data channel
– Client / patient information at facility
• Simplify
– Reduce data burden
– Streamline data management procedures
43. BASIC COMPARISION OF
‘As-Is’ AND ‘To-Be cont’d
Service level As is To be
HP 130-825 data
elements
Average: 353
50 data elements
HC 101-649 data
elements
Average: 401
108 data elements
Hospital 184-858 data
elements
Average: 457
150 data elements
44. BASIC COMPARISION OF
‘As-Is’ AND ‘To-Be cont’d
Indicators As is To be
Family health 50 21
Disease prevention
and control
130 47
Resource 35 28
Health system 30 12
Total 245 108
