This document provides an overview of health information systems. It defines key terms like health information system and routine health information system. It describes the six components of an effective health information system according to the HMN framework: governance and leadership; data sources; data management; information products and dissemination; data quality; and data use. It also discusses data collection instruments, indicators, data quality dimensions, and characteristics of a strong health information system. The document is intended to teach participants about health information systems and their essential role in supporting decision-making across health system levels.

1. Health Information Systems
Said Moalim MBBS, MPH.
October, 2020

2. Learning Objectives
By the end of this module, participants will be able
to:
• Understand the essential link between the health system
and the health information system
• Explain who needs health data, what type of data is needed,
and how data could be used
• Describe the six components of a health information
system, according to the Health Metrics Network (HMN)
framework
• Describe the health data sources and give examples of each
data source and its categories
• Define a routine health information system (RHIS)
• Describe what they will learn in this RHIS course 2

3. Functions and Goals of a Health System
(2000)
FUNCTIONS (6 Building Blocks) GOALS/OUTCOMES OF
THE SYSTEM
Stewardship
Commodities
Infrastructure
Service delivery
Financing
I
N
P
U
T
S
Health
Responsiveness
(the way people are
treated and the
environment)
Fairness in
financial
contribution
Quality
Coverage
Efficiency
Source: WHO, 2000.3
Human resources
Information
Safety

4. Health System and HIS
• What is an information system?
• “ … a system that provides specific information
support to the decision-making process at each
level of an organization” (Hurtubise, 1984)
• What is a HEALTH information system?
• … a system that provides specific information
support to the decision-making process at each
level of the health system
4

5. Why Health Information System?
• Good management is a prerequisite for
increasing the efficiency of health services
• Improved health information system is clearly
linked to good management
• Information is crucial at all management levels
of the health services from periphery to the
centre. It is required by policymakers,
managers, health care providers, community
health workers
5

6. Health Information System Supports Decision Making
at All Levels
1) At patient/client management level
• Management of the care of an individual patient or
client using information on health status, health
services, behavior and practices, and risks
• Management of health of family and household
6

7. The Health Information System Supports Decision
Making at All Levels
2) At health-unit management level
• Monitoring and evaluation (M&E) of health services
coverage and quality
• Management of resources for efficient and equitable
allocation, distribution, and use
• Management of vaccines, drugs, cold chain
• Planning program interventions; annual planning
• Disease surveillance
7

8. The Health Information System Supports Decision
Making at All Levels
3) At system management level
(district/regional/national)
• Policy and strategy decisions
• Health programs planning and management
• Resource management
• Capacity building
• Disease surveillance
• Innovations
• Research and M&E
8

9. Small-Group Exercise on Information Needs
Duration: 15 minutes
• Identify information needs in support of
management functions at all levels
• Use matrix of next slide
9

10. Management Functions and
Information Support
Management
Level
Functions Information Needs
Patient/client
Health unit
Health system
10

11. Management Functions and
Information Support
Management
Level
Functions Information Need
Patient/client Provide quality care
Provide continuity of
care
Diagnostic information
Past history
Family history
Health unit Provide pregnancy care
to all pregnant women
catchment area
Service coverage
Geographic pockets of
underserved women
Commodity supply data
Health system Ensure distribution of
health commodities
in the district
Number of stockouts for
essential drugs or vaccines
Drug cost and efficacy
11

12. Components and Standards of a National Health
Information System (HMN, 2008)
12

13. HIS Resources
 Adequate staffing
 Adequate logistic system for printed
supplies
 Computer hardware/software and
maintenance
 Communications equipment
 HIS line-item in MOH recurrent budget
13

14. Indicators
• “…a measure that helps quantify the
achievement of a goal.”
―Mark Friedman
• a variable (its value changes)…
• that measures (objective calculation of value)…
• key elements of a health intervention (program, service,
or project)
o (inputs/processes, outputs, outcomes, impact)
14

15. Types of Health Indicators
INPUTS AND
PROCESSES
OUTPUTS OUTCOMES IMPACT
• Availability of
drugs per care
level
• Basic
equipment per
activity type
• Number of staff
per category
and per capita
• Number of
drug shortages
• Number of
surgical or
obstetrical acts
done
• Number of
children
immunized
• Number of
new cases in
the facilities
• Hospital bed
occupation
rate
• Full
immunization
rate
interventions
• Incidence and
prevalence of
certain
diseases, such
as HIV, malaria,
TB
• Number of TB
cases detected
• Life expectancy at
birth
• Infant mortality
• Prevalence of
malnourished
children under 5
Source: Adapted from WHO. Global reference list of 100 core health indicators. Retrieved from
http://www.who.int/healthinfo/indicators/2015/en/.

16. EXAMPLE: Indicators for Reproductive,
Maternal, and Child Health Monitoring
Source: Adapted from Monitoring, evaluation and review of national health strategies: a country-led platform for information and accountability. Geneva,
World Health Organization, 2011.
INPUTS AND
PROCESSES
•Health financing
•expenditure per
target population
(children, women,
etc.)
•General government
•expenditure on health
as a percentage of
general government
expenditure
•Health workforce
•midwives, per 10 000
population
•Governance
•presence of key
policies to promote
maternal and child
health
•Information
•births registered
•deaths registered
(with cause)
OUTPUTS
•Service access
and readiness
•facilities that offer
and meet tracer
criteria for basic
and
comprehensive
obstetric care, per
10 000 pregnant
women
•caesarean section
rate in rural
populations
•facilities that offer
and meet tracer
criteria for child
health services, per
1000 children
OUTCOMES
•Coverage of interventions
•antenatal care
•births attended by skilled health personnel
•immunization coverage
•family planning needs satisfied
•children with diarrhea receiving oral
rehydration therapy
•children with fever receiving antimalarials
•insecticide-treated bednet use
•antiretroviral prophylaxis among HIV-positive
pregnant women
•vitamin A supplementation among children
•postnatal care
•Risk factors and behaviours
•contraceptive prevalence
•access to safe water
•access to improved sanitation
•low birth weight among newborns
•early initiation of breastfeeding
•children who are stunted or underweight
IMPACT
•Health status
•under-5 mortality
•maternal mortality
ratio
•child mortality by
major cause of
death, by sex and
age
•Financial risk
protection
•out-of-pocket
payments as a
percentage of total
health expenditure

17. What Is the Rationale for Health Indicators?
Indicators are vital in health interventions
because, when collected and used regularly, they
can:
•Provide a reference point for health intervention
planning, management, and reporting
•Allow managers of health interventions to assess trends
and identify problems
•Act as early warning signals for corrective action

18. What Makes an Indicator “SMART” ?
(Characteristics of Good Indicators)
• Specific: Indicator is concrete, detailed, focused, and well
defined
• Measurable: Indicator tells how many or how much and
can be measured with identified measurement sources
• Agreed upon: Stakeholders vested in a specific M&E
question should agree that the indicator is relevant
• Relevant: Indicator generates data that can answer the
question of interest
• Timebound: Indicator specifies time frame of what it is
measuring

19. Small-Group Exercise on indicator development
Duration: 15 minutes
• Develop indicators(inputs, process, output,
outcome and impact) on EPI
• Use matrix of next slide
19

20. EPI indicators
INPUTS AND
PROCESSES
OUTPUTS OUTCOMES IMPACT

21. Data & the Information Cycle
Collect
Process
Analyze
Present
Use
Interpret

22. Sources of Health Information
Population-based data sources
• Census
• Surveys
• Civil registration
22

23. Sources of Health Information
Institution-based sources
Hospitals, health centers, community-based
institutions/service delivery mechanisms
Generate data as a result of administrative and
operational activities from:
• Individual records
• Service records
• Resource records
• Health facility surveys
23

24. Definition of a Routine Health Information System
• A routine health information system produces
information through routine data collection (periods
of less than a year)
• Data are collected by care providers in communities,
in primary care facilities, in hospitals, and by routine
health-facility assessment (through supervision of
surveys)
• Ongoing data collection of health status, health
interventions, and health resources
• Examples: facility-based service statistics, health
administration statistics and community-based
information systems
24

25. The Universe of Routine Health Information Systems (Also
Known as Institution-based Information Systems)
• Individual record systems (facility- and
community-based)
• Paper-based records
• Electronic medical records (EMR)
• Service record systems
• Health management information systems (HMIS)
• Facility- and community-based
• Public, private, and parastatal
• Laboratory and imaging information systems (LIIS)
• Disease surveillance information systems
25

26. The Universe of Routine Health Information Systems
(Also Known as Institution-based Information Systems)
• Resource record systems
• Financial management information systems (FMIS)
• Human resource information systems (HRIS)
• Logistics management information systems (LMIS)
• Infrastructure and equipment management information
systems (IEMIS)
• Health facility surveys
• Service availability and readiness
• Quality of care
• Supervisory records
26

27. Data Collection Instruments
Data collection instruments in RHIS:
Curative
• Medical records
• Laboratory forms
• Referral forms
Preventive
• Growth cards
• MCH cards
• School health card
• Family registration
records
27

28. Data Collection Instruments for Health Unit
Management
• Service delivery records
• Registers
• Tally sheets
• Population charts
• Resource Management records
28

29. Issues with Routine Data Collection Instruments
 Content (comprehensive)
 Record filing (patient-retained vs. health
unit-retained)
 Layout (self-explanatory)
 Production form
 Electronic patient record
29

30. Guiding Principles of RHIS
• Data for decision making
• Collection of only essential health data used for decision
making
• Data collection for local analysis and use by the health worker
• Data collected by all health workers as they perform their day
to day duties
• Data processing and analysis are done starting from the point of
collection
• Integration of all routine information systems
• Simple to operate and maintain
30

31. What is Wrong with Current RHIS?
• Irrelevance of the information gathered
• Poor quality of data
• Duplication and waste among parallel health
information system
• Lack of timely reporting and feedback
• Poor use of information
• The difference in culture between data people and
decision makers: Planning and management staff rely
primarily on “gut feeling” to formulate ad hoc
decisions rather seek pertinent data
31

32. The Role and Importance of Decentralized
Routine Health Information Systems
• Main source of information for (daily) planning and
management of quality health services at district level and
below
• Coverage and quality of health interventions
• Disease surveillance
• Commodity security
• Financial information systems
• Also feeding real-time information to national and global
levels
• Ideal information system in support of integrated
management of health interventions
32

33. Performance Criteria of a Well-Functioning
Routine Health Information System
Governance and management
• Policies, legislation, plans,
accountability, and operational
procedures
• Data standards and
accountability
• Human resources
• ICT infrastructure
Data quality
• Individual client data
• Aggregate facility data
• Aggregate community
data
• Assessment of data
quality
• Assurance of data
quality
Information Use
• Relevant Indicators
• Data analysis
• Data visualization
• Data interoperability
• Problem solving
33

34. Six Essential Functions of a High-Performing Health
Information System
1.Monitor trends in health outcomes and
services
2.Ensure that data are trustworthy
3.Make decisions quickly and efficiently
4.Identify what works
5.Ensure the coordination and equity of
health services
6.Manage resources for the greatest benefit

35. Characteristics of a Strong Health Information System
• Well-defined: Has a strategy with standards and
principles; defined health indicators and data sources
used consistently; a user-friendly structure; and standard
operating procedures for data collection, analysis, and
use.
• Comprehensive: Captures and monitors all health
services and functions (e.g., medicines, human
resources, technology); includes all levels of the health
system; encompasses all data sources (e.g., routine
records, population surveys, civil registration and vital
statistics).
• Functional: Uses appropriate technology (including
paper records) for the context; has a plan for data quality
checks and strategies for using and sharing data; has
appropriate training for health workers.

36. Characteristics of a Strong Health Information System
• Adaptable and scalable: Has the in-country capacity to
redesign, reform, expand, or roll out the HIS through
procedures and standards which govern the regular
review of evolving health sector information needs,
measures to support sustainability, ongoing human
capacity building, and methods to evaluate new
interventions.
• Resilient: Is able to withstand social, political, and
biological crises through mechanisms for resilience,
coordination with other health system functions, and
regular assessments to determine system capacities and
weaknesses.

37. Dimensions of Quality
Accuracy - they measure what they are intended to
measure
Completeness - collected comprehensively
Reliability - repeated measurements using the same
procedures get the same results
Timeliness - up-to-date & available on time
Confidentiality - clients’ data are not disseminated
Precision - have sufficient detail to use for decision-
making
Integrity - protected from bias or manipulation

38. Dimensions of Quality
 Validity
• considered accurate -- they measure what they are
intended to measure
 Timeless
• means that data are sufficiently current and frequent to
inform management’s decision-making
• They are received by the established deadline
 Completeness
• Comprehensive data collection
• percent of all fields on data collection form filled in
• percent of all expected reports actually received

39. Key Factors in Ensuring Data
Quality
 Standard data collection tools and reporting forms
 Steps addressing quality challenges
 Specific reporting timelines
 Description of roles and responsibilities
 Storage policy that allows to retrieve data
 Functioning information systems
 Clear definitions of indicators
 Document data review procedures
These8factorsaffectdataquality
atalllevelsofinformationsystem

40. HIS Strengthening Model Overview
• Articulates the project’s
current understanding of
health information system
(HIS) strengthening
• Guides ongoing learning on
how HIS in low- and middle-
income countries (LMICs) are
designed, developed, and
implemented to support
health systems and to
improve health outcomes
• Focus is on HIS strengthening
at the country level
• The model can guide
countries in assessment,
planning, and improving HIS

42. Key Uses of HIS Strengthening
Model (HISSM)
1. Conceptualizing causal frameworks in terms of
expected outcomes for HIS interventions
2. Communicating project and activity-specific
results
3. Identifying additional questions
4. Organizing the findings of multiple activities
5. Framing project and non-project research,
evidence, and resources to share on the project’s
website

44. HISGovernanceandLeadership
• Partnerships and technical working groups
• Health sector plans
• Health sector M&E plans
• HIS policy and strategy
• Identification of information needs and
indicators
• Digital health standards
• Information and communication technology
standards
• Data stewardship
• HIS champions at all levels
HISManagement
• Financial resources management
• Infrastructure development, supply, and
maintenance
• In-service and continuous education
• Human resources training development,
training, and incentives
• Information and communication technology
• Roads; vehicles

45. DataSources
• Population: census, population/facility surveys;
registration and vital statistics (CRVS)
• Institution: patient records
• Human resource: infrastructure including
technology, human resources, and
and laboratory supplies and logistics
DataManagement
• Standard operating procedures
• Guidance for data managers
• Data quality assurance practices
• Development and production of data collection
tools
• Supportive supervision procedures
• Data quality assessments, data ethics procedures
Information
Productsand
Dissemination
• Routine reports
• Bulletins, data briefs
• Stakeholder dissemination meetings
• Feedback mechanisms (dashboards and
scorecards)
• Websites, social media
• Non-routine reports and other publications

46. DataQuality
An area of HIS performance
measured by the quality of the
data collected to
support the HIS.
DataUse
An area of HIS performance
measured by the use of HIS
data to generate health
indicators, statistics, trends,
and coverage—and for data-
informed decision making
based on the health sector’s
decision-making needs.

47. HIS provide data to
inform:
• National health
sector needs
• Global health
initiatives and
agendas

48. Contextual Factors
and the Human Element
The Human Element:
• Data producers
• Data users
• His managers
• Healthcare providers
• Clients
• Decision makers
• Contextual Factors:
o Health Equity (including
gender)
o Donors
o Global Initiative
o Availability of Public Utilities
o Civil/Political Unrest
o Devolution
o Privatization
o Disease Outbreaks
o Socioeconomic Status
o Natural Disasters

49. HISSM— Illustrative Interventions
Enabling Environment Information Generation
Governance &
leadership
HIS
management
Data sources Information
products &
dissemination
Data
management
Create HIS
technical working
group
Develop
financial
management
plan
Design electronic
system for RHIS
Create and
disseminate quarterly
health bulletins
Establish a
schedule and
budget for data
quality assessment
Convene
policymakers to
review data for
planning and
decision making
Create central
data
warehouse
Revise and
redesign specified
data source
systems
Implement feedback
mechanisms (data
visualization
dashboards and
scorecards)
Create and
distribute supportive
supervision tools
and procedures
Creation of
SOPs to
address
privacy and
security
standards
Develop and
distribute
standardized data
collection tools to all
districts

50. Thank you

51. This presentation was produced with the support of the United States Agency for International
Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-
OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center,
University of North Carolina at Chapel Hill in partnership with ICF International; John Snow,
Inc.; Management Sciences for Health; Palladium; and Tulane University. The views
expressed in this presentation do not necessarily reflect the views of USAID or the United
States government.