Restructuring and Strengthening Existing Routine Health Information Systems

To be delivered by Steve Sapirie, Director INFORM Program
Management Sciences for Health, Boston, USA

The purpose of this presentation is to challenge the participants of the meeting with a number of key issues pertaining to national and international efforts to foster the practical and sustainable development of routine health information systems including the improvement of data use for case, facility and community health management. Country experiences and the results of a number of national HIS assessments will be drawn upon to substantiate a list of such issues, many of which will be familiar to the participants, but some of which could be challenged during the meeting. The effects of these issues will be described, and questions raised on how this new network might collectively begin to address them. Finally, the presenter will begin to suggest some steps and guiding principles that could be applied to help tackle the issues.

The presentation will start with the premise that there are very few examples of successful, sustainable routine health information system (RHIS) development efforts. Further, it will be suggested that there are even fewer examples of effective international technical cooperation in RHIS development and that some of such cooperation is actually counter-productive.

A number of common, and some more debatable issues will be defined which are felt to characterize most RHIS development efforts. These may include:

• While recording and reporting requirements in most health services continues to grow, the use of the data thus generated, at the originating level, as well as at higher levels of the health system, does not
• Overuse of record review and revision, and in-service training for RHI systems development
• The folly of undertaking comprehensive and integrated RHI systems design
• The risk of allowing statisticians and epidemiologists to design RHI systems
• The artificial distinction between health and management information
• The elusive "decision-making" for which data is presumably being generated
• The failure to clearly define the important health service functions requiring routine health information
• International indicator imperialism, and the difficulty in implementing indicators in RHIS
• Inappropriate and unmaintainable computerization efforts
• The tendency of international and bilateral agencies and NGOs to persist in delivering ineffective and self-serving "technical cooperation," presumably in support of RHIS development

Following a discussion of the obvious and not-so-obvious effects of some of these issues and practices, the presenter will begin to suggest some ideas, and ultimately some principles that might help address these issues. It is hoped that the presentation will generate debate, and further ideas for improving national RHIS development and international cooperation, during the meeting and later, within the RHINO.

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