A Smarter Way to Build Health Information Systems?
By Jim Thomas, PhD
The 25 health indicators in the United Nations’ Sustainable Development Goals (SDGs) were created with the hope that the global health advances of the last few decades will continue. For example, the mortality rate of children under five years of age in developing countries fell from 22 percent in 1960 to less than 5 percent in 2013. Ensuring that we mark and retain those gains, and monitor new ones along with all of the SDG indicators, depends on a system that traffics in data rather than vaccines and medicines—it depends on a country’s health information system (HIS).
An HIS consists of data on deaths, illnesses, patient visits, services delivered, facilities, personnel, and medical supplies in stock. That’s a tall order for many low- and middle-income countries. And, there is no road map to get there—countries have only pictures of fully formed health information systems to guide them, not staged development steps toward a strong HIS. A lot is riding on how they move forward, who helps them do what, and the resources available to do it at all. In our article, published in the November 2016 issue of Health Policy and Planning— “What systems are essential to achieving the sustainable development goals and what will it take to marshal them?”—we encourage countries to stay the course with their ongoing HIS strengthening efforts. But some countries may need help in knowing where to start with HIS strengthening, or what to do next.
All health actors are stakeholders when it comes to HIS. Because HIS have the potential to show where progress is being made and, therefore, how resources should be allocated, many want to tap its power. Local care providers want the HIS to help ensure patient continuity of care; national policy makers need the HIS data to determine which communities need more resources; donor countries want HIS data to show the impact of their investments; and the international community wants HIS data to track progress on the SDGs.
Of course, countries vary in the ability to meet these demands; and HIS systems range from the nascent to the near-robust. Countries also vary in the challenges they confront. Some, for example, have populations living in vast rural areas that lack connection to the Internet and other information technologies. Some are more frequently set back by wars and natural disasters. Some have more opportunities and resources to build and improve their health information system.
These facts bring up the question, what, exactly, should countries aim for? And how can others facilitate their journey, through what investment strategies?
To begin with the “what,” there are several descriptions of a fully functional HIS. They include the Health Metrics Network Framework and Standards for County Health Information Systems, the UNAIDS 12 Components Monitoring and Evaluation System Assessment, the MEASURE Evaluation Performance of Routine Information System Management Framework (PRISM), and the MA4Health Roadmap for Health Measurement and Accountability. But progress towards a fully functional HIS is gradual. How can a country know what is realistically within its reach in the next year or two, and which system components are foundational for the others?
There also is thinking that may offer guidance in answering the “how” question about investing in HIS strengthening. A Development Continuum Working Group recently recommended that the Global Fund structure its donations (unrelated to HIS) according to countries of three broad types: (1) those generating little revenue through taxes and receiving a lot of development aid (ODA), (2) those declining aid but still characterized by low revenue, and (3) those with high tax revenues and low incidence of aid.
The Global Fund invests primarily in programs for service delivery. But they may be onto something. Should those investing in HIS strengthening consider similar categories and targeting? If so, in addition to financial resources, donors and the recipient countries themselves might consider a similar structure according to type. For example, (1) the proportion of health facilities in the country that have access to the Internet; (2) the proportion of health data collectors who are skilled in data collection; and (3) the existence of management or governance systems to ensure data quality. A country with high Internet penetration and high proportion of personnel trained to collect data might benefit from training in sophisticated data analyses and data visualization programs to inform decision making. In contrast, a country at the other end of the spectrum might be better served by assistance to develop a country M&E plan, and a thorough data quality assessment.
In an effort to identify stages and relevant actions to take, the MEASURE Evaluation project is developing a HIS Strengthening Resource Center that documents what is known about each country’s current HIS capabilities. Eventually, this information will help countries identify priorities that are relevant to their stage and available resources and help donors and stakeholders to make informed decisions about where and how they can help.
For more information
Jim Thomas is an associate professor of epidemiology in the Gillings School of Global Public Health, and Director of the MEASURE Evaluation project in the Carolina Population Center at the University of North Carolina in Chapel Hill. MEASURE Evaluation is USAID’s flagship project for health information system strengthening in low- and middle-income countries. JC Thomas et al. (2016) What systems are essential to achieving the sustainable development goals and what will it take to marshal them? Health Policy and Planning, Nov. 2016, 1–3 doi: 10.1093/heapol/czw070