This document discusses interventions to improve routine health information systems (RHIS) performance at multiple levels. It describes examples of technical interventions such as defining essential indicators, standardizing data collection, and developing computerized data analysis applications. Organizational and behavioral interventions discussed include participatory decision-making, providing appropriate resources, and creating incentives for information use. The document also discusses how RHIS can help integrate district health systems through functional databases, integrating public and private health information, and integrating individual and community health interventions.

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. Examples of technical interventions Defining set of essential indicators: information needs adapted to management functions of the health system at all levels Standardize data generation architecture based on best practices: Revising/simplifying data collection instruments Developing computerized data entry/data processing applications Streamlining data flows within the MOH Development of computerized data analysis/presentation application: DSS

3. Computerized data analysis/presentation What is a Decision Support System (DSS)? A computerized application allowing health managers to visualize health indicators and data elements collected by the RHIS in graphical and geographical presentations Based on the principle that COMPARISON is one the most powerful analytical methods: spatial : by health facility, district, province etc. time : trends by week, month, year, etc. indicators : between inputs and outputs benchmark : expected versus achieved

6. Examples of organizational and behavioral interventions (let us go a step further...) Participatory decision space analysis in decentralized district managed health systems (Pakistan) Provide sufficient and appropriate resources: staffing, equipment/supplies, ICT, financial resources Promote HMIS self-assessment (Uganda) Performance Improvement Tools focused on problem solving approach (Thailand) Provide advocacy skills to district and facility managers (Honduras, Paraguay) Creating incentives for use of information (Pakistan, Uganda) Integration of district health systems

7. How can RHIS help building integrated district health systems? Horizontal and vertical integration of program interventions Develop functional database at district level incorporating information from routine and other sources of information Integration of public and private HIS

8. Integration of program interventions Between individual care interventions within the health services system Horizontal integration: at each level but mostly at health facility and district levels (e.g. HIV/AIDS – neonatal health) Vertical integration: between levels (e.g. continuum of care in maternal health) Between individual and community health interventions (e.g. EOC – community transport solution) Including inter-sectoral integration

9. Integration of the individual patient record system for continuity of care Paper-based record and register design Paper-based system filing systems Electronic medical records in hospitals

10. Integration of Individual-Community Health through integrated district data-warehouse (South Africa)

11. Integration of public-private HIS Needs further exploration and research Examples of sticks and carrots Improved regulation (link reporting to licensing) Accreditation of facilities Health insurance - database Make diseases notifiable by law (and in case of MNH: maternal/neonatal deaths) FP/ STI / Immunisation supplies provided free if reporting