Indicators of the Status of a Health Information System

CountriesThese country profiles explore the status of a country’s health information system (HIS) through 30 indicators. To document the status of indicators for each country, we searched for documents online, especially on government websites. Once completed, we contacted professionals working in these countries to populate the remaining indicators. MEASURE Evaluation continues to document additional indicators in the Resource Center as information becomes available. Please contact us to share information related to indicators.

Indicators

The indicators selected represent various areas of the HIS Strengthening Model. Indicators and brief descriptions are presented below:

Indicators

 Description

HISSM component

1. Country has a national health strategy (year)

A national health strategy outlines a country's vision, priorities, budgeting, and planned action to improve and maintain people’s health. Ideally, any activities for strengthening HIS are documented in the national health strategy.

HIS governance and leadership

2. Country has a health sector monitoring and evaluation plan (M&E)

Once a country has a national health strategy, it should have an accompanying M&E plan. An M&E plan provides feedback on the effectiveness of the country’s strategic plan for all major disease programs and health systems. The motivation to improve HIS is often driven by national M&E needs.

HIS governance and leadership

3. Country has Health Information System policy (year)

Policies that govern national HIS are one indicator of its strength. HIS policies outline a deliberate system of principles to guide decisions and achieve better HIS outcomes.

HIS governance and leadership

4. Country has an HIS strategic plan (year)

Strategic plans for HIS are based on HIS assessments, such as those that were developed based on the Health Metrics Network (HMN) Framework (see #8 below). Strategic plans outline approaches to strengthen an HIS and describe costed interventions to achieve results.

HIS governance and leadership

5. Country has set of core health indicators (year updated)

A list of core health indicators helps track progress. Availability of indicators and information on definitions, data sources, and data collection methods are indicative of HIS performance and organization. Data should be comprehensive and cover all categories of health indicators: determinants, inputs, outputs, outcomes, and health status. A core list of indicators can be part of the health sector M&E plan.

HIS governance and leadership

6. National HIS coordinating body/committee

An interagency body or steering committee should oversee implementation of the national HIS strategy. This body should include representatives from the ministry of health, national statistics office, academia, telecommunications, local government, and the private healthcare sector. This committee can provide a technical advisory role for health and social welfare data managers in collaboration with other partners.

HIS management

7. Country has master facility list (year updated)

A master facility list (MFL) is a list of health facilities in a country (both public and private) and includes information that identifies each facility (unique ID). An MFL is important in monitoring health infrastructure and the services provided and assists in calculating the percentage of facilities included in routine health data collection. This list should be updated regularly.

HIS governance and leadership

8. Conducted Health Metrics Network (HMN) assessment (year)

This is  a self-assessment tool to: identify strengths and weaknesses of the national HIS, identify priorities for improvement, establish a baseline to monitor progress, and provide a basis for strategic planning.

HIS management

9. Population census (within the last 10 years)

A population census collects data on the size, distribution, and composition of the population, plus social and economic information. It provides sampling frames for surveys (household and other types). These population projections are used to calculate health indicators.

Data sources

10. Availability of national health surveys

National surveys include data collection on health-related behaviors and bioclinical measurements, e.g., Demographic Health Survey (DHS), Multiple Indicator Cluster Surveys (MICS), and living standards measurement survey.

Data sources

11. Completeness of vital registration (births and deaths)

Vital registration systems record the occurrence and characteristics of vital population events (e.g., births and deaths) and are a main source of population statistics. Countries with complete vital statistics registries (at least 90% coverage) may have more accurate and timely demographic indicators.

Data sources

12. Country has electronic system for aggregating routine facility and/or community service data

Many countries are transitioning from paper-based systems of aggregating routine health data from facilities and community services to electronic systems. Electronic systems assist data collection, data transmission, data quality, and aggregation. This can be DHIS 2 or another system.

Data management

13. Country has national statistics office

This government agency should be a designated and functioning mechanism charged with analysis of health statistics, synthesis of data from different sources, and validation of data from population-based and facility-based sources.

Data management

14. National health statistics report (annual)

This report summarizes the status of health indicators. It is produced annually and should provide information on health statistics nationally and by region and can include service delivery statistics and specific health outcomes. It can be called by various names—such as an annual health management and information system (HMIS) report, annual performance report, health and health-related indicators report, etc.

Information products and dissemination

15. Country’s ministry of health has an updated website

A health ministry website should have the most recent health data and make available various reports covering different health and health program areas. It may link to other national and subnational departments and websites.

Information products and dissemination

16. Data quality assessment (DQA) conducted on prioritized indicators aligned with most recent health sector strategy (year of most recent)

Data quality assessments (DQAs) are important to gauge the overall quality of routine health data. DQAs are conducted at the facility level where essential data are gathered for monitoring interventions to address specific health areas such as HIV, tuberculosis, and malaria. DQAs should be conducted within the current health sector strategy cycle.

Data management

17. PRISM assessment conducted in any regions/districts

This is an assessment of the performance of a routine health information system (RHIS) or HMIS. The framework consists of tools to assess RHIS performance; identify technical, behavioral, and organizational factors that affect RHIS; aid in designing priority interventions to improve performance; and improve quality and use of routine health data.

HIS management

18. Percentage of facilities represented in HMIS information

Countries should define core data that all facilities report at prescribed times throughout the year (monthly, quarterly, biannual, or annual). The percentage of facilities that report should be recorded in HMIS reports (the number of facilities reporting [numerator] divided by the total number of health facilities [denominator]).

Data quality

19. Proportion (facility, district, national) offices using data for setting targets and monitoring

Use of routine and nonroutine data helps in setting annual targets and monitoring key indicators. It is critical for evidence-informed decision making. This information may be available from country reports, meeting minutes, or through special studies.

Data use

20. Measles coverage reported to World Health Organization (WHO)/UNICEF

The ability to report the proportion/percentage of children aged one who received one dose of measles vaccine is a measure of HIS performance. The WHO site that is the data source for this indicator presents information from both the United Nations/WHO estimates and official government figures, which allows comparison of the two.

HIS performance

21. Number of institutional deliveries (births) available by district and published within 12 months of preceding year

Births that occur in institutions (e.g., hospitals and health clinics) and that are attended by skilled and trained staff can provide necessary supervision, care, and advice to women during pregnancy, labor, and the postpartum period. The number of institutional deliveries is the numerator in determining coverage and is an indicator of HIS performance.

HIS performance

22. Existence of policies, laws, and regulations mandating public and private health facilities/ providers to report indicators determined by the national HIS

Countries should have a regulatory framework for the generation and use of health information, which helps to ensure data availability from public and private providers. This may include specific laws but, in some cases, it may be contained in other policies or regulations.

HIS governance and leadership

23. Availability of standards/guidelines for RHIS data collection, reporting, and analysis

To ensure uniformity and standardization in the collection of RHIS data, countries need standards or guidelines describing how data should be collected, reported, and analyzed. This information is used for training and should be available as reference documents.

HIS management

24. Presence of procedures to verify the quality of data (accuracy, completeness, timeliness) reported.

As part of an effort to assure data generated by the HIS is of high quality, countries need procedures to assess data quality. This can include data accuracy checklists prior to report acceptance, internal data quality audits, and written feedback forms.

Data management

25. RHIS data collection forms allow for disaggregation by gender

To ensure gender equity in health, countries need to collect and analyze data by gender. Data collection forms should allow for gender disaggregation in RHIS.

HIS governance and leadership

26. At least one national health account completed in last five years

This is a process through which countries monitor the flow of money in their health sector. The information is needed to determine the level of financing provided to the HIS.

Data sources

27. National database with health workers by district and main cadres updated within the last two years

This database gathers data from multiple sources, including census, labor force surveys, professional registers, training institutions, and facility assessments. The information is needed to estimate the current workforce and plan for future staffing needs.

Data sources

28. Annual data on availability of tracer medicines and commodities in public and private health facilities

This indicator assesses the availability of data to measure the use of medicines and health commodities, both to measure service provision and to monitor availability of medicines and commodities to ensure there are no stock outs and that necessary commodities are available in facilities.

Data sources

29. eHealth strategy

With the introduction of information communication technologies (ICT) into healthcare, countries should set a strategy of how eHealth will be organized and used. This strategy should be current with the national health planning cycle.

HIS governance and leadership

30. Completeness of disease surveillance reporting

Percentage of disease surveillance reports received from districts to the national level compared to the number of reports expected. This percentage will indicate whether such data are available and note the most recent compilations (by year or month).

Data quality

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