The document summarizes interventions in China and Pakistan to strengthen routine health information systems and improve health system outputs. It describes using the PRISM framework to conduct training, develop monitoring tools, and provide feedback reports. Monitoring tools were used to assess improvements in counties over time. Significant improvements were observed after interventions, such as increased follow-up and testing rates for HIV/AIDS patients. The conclusions state that continuous improvement requires teamwork, systems thinking, ownership, accountability, and learning from mistakes.

1. Strengthening Routine Health Information System for Better Health Systems Outputs: China and Pakistan Experiences Anwer Aqil , MD, MCPS, MPH, DrPH Senior HIS Advisor, MEASURE/JSI June 17, 2010

4. Cycle of RHIS Performance Improvement Develop Interventions Monitor Progress Base line and Final Assessment

6. Monitoring Tool 1 1 Observe that county has a newsletter or other means to share success stories of use of information? C5 1 Did feedback report make comparison by facilities? C4 1 Observe that County has a feedback mechanism in place based on training C3 1 Observe that county has denominator for each facility catchment area? C2 1 Observe that county office has the HIV/AIDS targets broken down by months for facilities C1 18 24 20 16 19 23 22 23 22 22 24 22 1 1 0 0 0 1 1 0 0 0 1 1 Observe Newsletter or other means of communicating describing success stories of use of information available 24 1 1 1 0 0 1 1 0 0 1 1 Observe county feedback report from last months available 23 1 1 1 0 0 1 1 1 1 1 1 1 Record showed that data was used for community education 22 0 1 1 0 0 1 1 1 1 1 1 1 Observe record showing that identified problem referred to county for solutions 21 1 1 1 0 0 1 1 1 1 1 1 1 Observe records showing follow-up actions on previous decisions reviewed 20 1 1 1 0 1 1 1 1 1 1 1 1 Observe records showing that decisions were taken to correct gap in the performance indicator(s) 19 1 1 1 0 1 1 1 1 1 1 1 1 Observe records showing that HIV/AIDS performance indicators which were below target performance were noted 18 1 1 1 0 1 1 1 1 1 1 1 1 Observe monthly meeting records showing discussion on the HIV/AIDS data 17 1 1 1 1 1 1 1 1 1 1 1 1 Observe display of control chart of any service performance indicator (HIV/AIDS, Immunization, ANC etc) by target and time 16 1 1 1 1 1 1 1 1 1 1 1 1 Observe display of control chart of data quality over time 15 1 1 0 1 1 1 1 1 1 1 1 1 Observe that HIV/AIDS services filled monthly report for last month is available 14 1 1 0 1 1 1 1 1 1 1 1 1 Observe display of catchment area population chart with calculation of target population 13 1 1 0 1 1 1 1 1 1 1 1 1 Can you show me you story board/book? 12 0 1 1 1 1 1 1 1 1 1 1 1 Describe at least four things included in story board or book 11 0 1 1 1 1 1 0 1 1 1 1 1 Show me your advocacy chartl 10 0 1 1 1 1 1 0 1 1 1 1 1 Describe at least two benefits of advocacy 9 0 1 1 1 1 1 1 1 1 1 1 1 Can you show me priority matrix for causes 8 0 1 1 1 1 1 1 1 1 1 1 1 Describe at least two benefits of prioritizing causes 7 1 1 1 1 1 1 1 1 1 1 1 1 Can you show me cause and effect diagram of your identified problem? 6 1 1 1 1 1 1 1 1 1 1 1 0 Describe at least two benefits of cause and effect diagram 5 1 1 1 1 1 1 1 1 1 1 1 1 Describe at least three criteria for interpreting information? 4 1 1 1 1 1 1 1 1 1 1 1 1 Describe at least three components of cycle of use of information? 3 1 1 1 1 1 1 1 1 1 1 1 0 Describe at least three methods of checking data accuracy? 2 1 1 1 1 1 1 1 1 1 1 1 1 Did you share methods of use of information learned during training with your facility team members, especially facility incharges? 1 12 11 10 9 8 7 6 5 4 3 2 1 Observe MONTH 2 1 Observe that county has a newsletter or other means to share success stories of use of information? C5 1 Did feedback report make comparison by facilities? C4 1 Observe that County has a feedback mechanism in place based on training C3 1 Observe that county has denominator for each facility catchment area? C2 1 Observe that county office has the HIV/AIDS targets broken down by months for facilities C1 9 9 10 14 15 14 15 15 13 16 24 14 1 1 1 1 1 1 1 0 0 0 1 1 Observe Newsletter or other means of communicating describing success stories of use of information available 24 0 0 0 1 1 1 0 0 0 1 1 0 Observe county feedback report from last months available 23 0 1 0 0 0 1 1 0 0 1 1 1 Record showed that data was used for community education 22 1 0 0 1 1 1 0 0 0 1 1 1 Observe record showing that identified problem referred to county for solutions 21 0 0 1 1 1 1 0 1 1 0 1 0 Observe records showing follow-up actions on previous decisions reviewed 20 0 0 1 1 0 0 0 1 1 1 1 1 Observe records showing that decisions were taken to correct gap in the performance indicator(s) 19 1 0 1 0 1 0 1 0 1 1 1 0 Observe records showing that HIV/AIDS performance indicators which were below target performance were noted 18 0 1 0 1 0 1 1 1 0 0 1 1 Observe monthly meeting records showing discussion on the HIV/AIDS data 17 1 1 1 1 1 1 1 1 1 1 1 1 Observe that HIV/AIDS services filled monthly report for last month is available 16 0 0 0 0 0 0 1 0 1 0 1 0 Observe display of control chart of any service performance indicator (HIV/AIDS, Immunization, ANC etc) by target and time 15 1 0 1 0 1 0 1 0 1 0 1 1 Observe display of control chart of data quality over time 14 1 1 1 1 1 1 1 1 1 1 1 1 Observe display of catchment area population chart with calculation of target population 13 0 1 1 0 0 1 0 1 0 1 1 0 Can you show me you story board/book? 12 0 0 0 1 1 1 0 0 0 1 1 1 Describe at least five things included in story board or book 11 1 0 0 0 0 0 1 1 0 0 1 0 Show me your advocacy chart 10 0 0 0 0 1 1 1 1 1 1 1 1 Describe at least four steps of advocacy process 9 0 0 0 0 0 1 1 1 1 0 1 0 Can you show me priority matrix for causes 8 1 0 0 1 1 0 0 1 1 0 1 1 Describe at least four benefits of prioritizing causes 7 1 1 1 0 0 0 0 1 0 1 1 0 Can you show me cause and effect diagram of your identified problem? 6 0 0 0 1 1 1 1 1 1 1 1 1 Describe at least three benefits of cause and effect diagram 5 0 0 0 1 1 0 1 1 0 1 1 0 Describe at least three criteria for interpreting information? 4 0 0 0 0 0 0 1 1 1 1 1 1 Describe at least five components of cycle of use of information? 3 0 1 1 1 1 1 1 1 1 1 1 0 Describe at least four methods of checking data accuracy? 2 0 1 0 1 1 0 0 0 0 1 1 1 Did you share methods of use of information learned during training with your facility team members, especially facility incharges? 1 12 11 10 9 8 7 6 5 4 3 2 1 Observe MONTH 1

8. Significant Improvements