Health information systems
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The importance of health information systems
Sound and reliable information is the foundation of decision-making across the health system.
The importance of health information systems
The UN Sustainable Development Goals set an ambitious agenda for a healthier world. It is clear that achieving the goals will require reliable data, in order to understand the scale of the work to be done, and to make good decisions on health priorities and how to allocate resources for the most efficient and effective results.
A well-functioning health information system is essential for the collection and generation of quality data to inform on time all relevant stakeholders for planning, review, programme monitoring, and overall quality assurance and improvement of all aspects of the health system.
Attaining these goals will require investments in robust health information systems.
In many countries, the quality of data gathered at health facilities and the capacity to analyse and use this data remain inadequate to support decision-making that will accelerate Universal Health Coverage.
WHO health system strengthening stresses the need to support countries to strengthen their health information systems (HIS), which provide reliable information on which to base programme decisions, to support the development of solid national health policies, strategies and plans and contribute to reliable procurement and supply of health products through accurate data on needs and usage.
UNDP has amassed a wealth of experience in providing technical assistance to national entities supporting the roll-out of integrated Health Management Information Systems in different countries where UNDP is an interim Principal Recipient (PR). UNDP staff across country offices and at the global level play an important role in the international District Health Information System 2 (DHIS2) community, including facilitating DHIS2 i academies and sharing best practices and experiences across countries about strategic approaches to strengthening HIS systems in both fragile and relatively stable contexts.
- In Sudan, for example, UNDP has assisted the country to achieve considerable progress since 2015 in launching a web-based DHIS2 database to implement one national routine health information system. To facilitate the sustainable uptake of the system, UNDP supported training of 900 staff at national and sub-national levels on the use of the HIS. This was complemented by support to revise, print, and distribute Health Management Information Systems (HMIS) and reporting tools for use at health facilities
- In Angola, in 2017, UNDP provided implementation support for the deployment of DHIS2 in 17 out of the 18 provinces in the country. UNDP has supported the development of new HIV data collection tools to facilitate their integration into DHIS2. With these new tools, information is now collected on HIV/TB co-infection and key populations
- In Mali, UNDP provided training sessions on the use of DHIS2 for key actors within health districts. It also provided 90 IT kits for pharmacists in 90 treatment sites, which helped to improve the quality of DHIS2
UNDP worked with the Ministry of Health and Child Care (MoHCC) to implement a District Health Information System (DHIS) to replace the mainly paper-based, multiple reporting systems previously in use at health facilities.
The DHIS2 package, implemented in partnership with President's Emergency Plan for AIDS Relief (PEPFAR), i and RTI i, provided a dramatic improvement in data management and analysis for health programme monitoring and evaluation, leading to more informed and integrated decision-making.
DHIS2 can be used in many ways—ranging from processing facility registers and service availability mapping to logistics management and mobile tracking of pregnant mothers in rural communities. Efforts are underway, with technical support from the University of Oslo, to provide a platform for the integration of electronic Patient Management Systems (ePMS) and other programme electronic systems into DHIS2.
In addition, a Weekly Disease Surveillance System (WDSS), incorporating innovative inbuilt Frontline SMS messaging into mobile-phone based reporting of weekly data, has been supported, ensuring timely transmission of surveillance data.
- Significant and ongoing investments in the DHIS2 and the WDSS have strengthened the national HIS
- The result is more timely and reliable health information enabling improved analysis, more informed decision-making and higher quality national forecasting and planning
- Improved responsiveness of the services for patients.
- The completeness of the monthly reports has increased from around 50% to over 98% and the weekly reports from about 45% to 90%
- The reporting burden for health workers has been significantly lessened through the integration of different reporting systems into the DHIS2, enabling them to spend more time with patients
Definition of health information system
Why is a well-functioning HIS important?
Good governance of a health system requires reliable, timely information. Decision makers need to know, for example, whether or not people are getting the services they need and where resources are going.
Information is used in a wide range of situations: when developing national strategies and plans; when monitoring progress against national priorities; or when ensuring accountability for results.
Information is essential for health system policy development and implementation, governance and regulation, health research, human resources development, health education and training, service delivery and financing.
The role of a HIS is to ensure the production, analysis, dissemination and use of reliable and timely data by decision-makers at all levels of the health system.
Developing resilient and sustainable health systems
The strength of the HIS ensures that when an emergency health situation arises, such as Ebola, health leaders are aware of it early and can divert the necessary resources to prevent epidemics. It also ensures that in countries with areas that are difficult to reach, for example in rainy seasons, sufficient data are collected and shared to ensure their needs are known on time.
Data to support key populations
Data on age and gender and non-discriminatory accessibility and quality of services can be particularly critical in HIV prevention and care, since the population groups most vulnerable to infection continue to face legal and cultural barriers in accessing health care. In many countries it can be challenging collecting data on most-at-risk populations due to the profound stigma and discrimination directed towards them. It may be important to carry out qualitative behavioural studies and operations research to complement data collection, analysis and synthesis.
health information systems & monitoring and evaluation
In addition to being essential for monitoring and evaluation (M&E), the information system also serves broader objectives, such as providing an alert and early warning capability, supporting patient and health facility management, enabling planning, stimulating research, permitting health situation and trends analyses, and reinforcing communication of health challenges to different groups.
Information is of little value if it is not available in formats that meet the needs of different groups, i.e. policymakers, planners, managers, health-care providers, communities and individuals. The way information is collated and presented, and its dissemination and communication, are therefore essential attributes of the system.
The HIS supports strategic and management decisions for the entire health sector and so is the responsibility of multiple stakeholders (e.g.: ministries of health as well as national statistics offices).
The national M&E system needs to contribute to and draw on existing data from the HIS. As such, the performance of the M&E system is directly linked to the capacity of the HIS. For example, health workers who report and manage HIV-specific data are often also responsible for collecting and managing data about other health services.
The Global Fund has developed guidelines on what activities countries should prioritize for strengthening data systems when applying for funding.
Applicants should include investments to scale up capacities and establish sustainable systems at country level in their funding requests. The Global Fund recommends that grants allocate 5-10% of the total budget to M&E. Examples of activities that can be included in applications to the Global Fund to strengthen country HIS include the following:
- Routine information systems: the establishment, maintenance and strengthening of national HMIS, district health information systems, mobile platforms for community level data collection and reporting, and support for human resources for data systems
- Programme and data quality: activities related to assessments of programme and/or data quality, as well as monitoring of quality improvement activities
- Evaluations, reviews, data analysis and use
- Surveys and studies
- Administration and financing of data systems
- Civil registration and vital statistics (CRVS) systems