The Interface between Routine Health Information, Rapid Assessment and Survey-based Information

Peter Sandiford

ABSTRACT

Routine health information is a resource of tremendous value that in recent years has been neglected in developing countries in favor of survey-based information. The reasons are obvious: it is often incomplete, poorly recorded, difficult to access, and unable to represent the experiences of whole populations. Service-based routine information suffers from the additional problem that the more it is used for managerial purposes, the greater the incentive to 'cook the figures'. Survey data on the other hand tends to be more carefully gathered, more representative of entire populations, less vulnerable to manipulation, more widely available in summarized and raw formats, and is generally designed with specific management and evaluation purposes in mind. In developed countries however, routine health information sources are widely used. This paper presents some of the uses that routine data have been put to in developed countries.

The paper argues that routinely collected data can provide useful inputs for service management, and health policy formulation in developing countries. It also suggests that some of the greatest potential benefits of routinely collected health information could accrue if it is made available to the general public in a format that enables citizens to make more informed choices with regard to their utilization of health services.

For routine health information to yield its potential there are a number of organizational issues that need to be addressed. Of tremendous importance is the need to acknowledge that in most developing countries the private sector provides a significant proportion, sometimes even the majority, of health services, particularly for ambulatory care. Effective strategies have yet to be developed for involving and integrating the private sector in the collection and collation of health information. In recognizing the plurality of modern health systems, responsibility for gathering, analyzing and disseminating health information may need to be devolved to an independent, non-governmental authority, particularly in countries where the Ministry of Health retains a major role in service provision. Health information also needs to become more freely available to all stakeholders, but in particular to the general public.

To date, there has been a tendency for those concerned with the improvement of routine health information systems in developing countries to be excessively focussed on technological 'fixes.' Whilst the advantages offered by developments in computing and network technology should continue to be exploited, the real challenge that lies ahead will be a different one. It will be to skillfully secure the support of key stakeholders for a radical change in the 'ownership' of health information, independently of whether is derived from routine, survey, or rapid assessment sources, to one which views all such information as being at the service of citizens and users of health services rather than a jealously guarded possession of specific institutional or political interests.