Paraguay Improving Health Information System

USAID, MEASURE Evaluation and PAHO formed a technical cooperation initiative to improve the national health information system in Paraguay.


The National Health Information System (HIS) in Paraguay is highly fragmented.  Health data and information are produced by multiple sectors and institutions that are poorly coordinated. As a result, the HIS in Paraguay has information subsystems that overburden health professionals so that they cannot deliver timely, accurate, and complete data.  National health authorities in Paraguay recognize that reliable and timely health information is the foundation of a population’s improved health status.  However, initial investments in information subsystems have suffered from the lack of an efficient overall health information system.  


To address these problems, USAID supported the Pan American Health Organization (PAHO), in collaboration with MEASURE Evaluation to lead the implementation of an assessment and monitoring process to improve HIS performance in Paraguay.  These activities were part of a regional effort to implement improvements to health information systems through cost-effective strategies. 

In Paraguay, the work of the collaborators improved the performance of the national health information system, based on three main elements:

  1. Documentation and dissemination of successful experiences, key processes and lessons learned in order to establish standardized protocols and tools for quantitative assessment of HIS in the region.
  2. Establishment of an assessment and monitoring process as best practices for strengthening and developing HIS based on measuring determinants and factors associated with HIS performance.
  3. Improvement of availability of core health indicators and standardized methods, model and techniques in order to support health situation analysis and evidence-based decision-making in public health. 


Technical assistance enabled the national HIS team to design, enhance, and increase use of health information at both the central and peripheral levels. It helped to improve the description and explanation of the population’s health status, which allowed health institutions to respond to the population’s health needs.  There has been an increased demand for and use of health information through the development of a 5-year national HIS strategic plan and the production and dissemination of reports for planning and management.

Initiative partners supported the national HIS team to implement a comprehensive assessment and monitoring process which consists of consecutive incremental cycles of a determined duration usually of one or two years. Every cycle has specific objectives and goals to reach. The five phases are: 1)preparation;  2)assessment; 3)planning;  4)intervention and 5)evaluation. During this process, the technical team learned the necessary steps for HIS development while at the same time, adapting and adjusting the associated tools according to the national context and priorities.

This is the first experience in implementing the HIS assessment and monitoring process in the LAC region. USAID supported regional initiative has inspired similar processes in Mexico, Brazil, Honduras, Peru and the Dominican Republic.


Paraguay recognizes the importance of the HIS development process as a strategic priority for improving the availability of sound data and information that will support evidence-based decision-making in public health.

The development of an evidence based strategic plan has led to strong lobbying by the Ministry of Health to establish a dedicated line item in the national budget for the Health Information System (Law 3148/2006).  The Ministry of Finance allocated the equivalent of US$1.1M to the MOH to be used for further strengthening of health information system activities in country. This is the first time in Paraguay’s history that resources are allocated specifically to the health information system.

HIS is considered crucial in laying the groundwork for producing and using quality health data to guide a national plan and policies in health. The financial boost to the HIS unit has reinforced not only their commitment to continually monitor the performance of the system at all levels  but also given them the confidence to share solid information and make better decisions with the information produced. 

Paraguay acknowledges that by eliminating the existing vertical systems and the duplication of key health information, they are able to produce quality data based on evidence. Policy makers will then be able to make better and informed decisions that will impact the health status of the population.

The lessons learned and experiences acquired from the implementation of the HIS development process will help other countries in the LAC region develop and strengthen a regional strategy for strengthening health information systems.

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