The politics of HIS restructuring in Pakistan: the importance of policy analysisby Dr Mursalin and Dr. Nasim Haque, Ministry of Health, Pakistan Abstract In 1991, the Ministry of Health decided to transform its routine reporting system for first level care facilities into an integrated and comprehensive health management information system (HMIS/FLCF). This paper illustrates the importance of contextual and process factors involved in the restructuring process. HMIS/FLCF was designed through a consensus-building process involving future information users at all levels of the health services. Senior managers from provincial health departments, vertical program managers, district health officers and peripheral users were involved in the design process from the very first stage of planning. Initial with financial support from USAID, HMIS/FLCF implementation of the new system started at the end of 1992, but came to a halt in 1994 when USAID's bilateral assistance program ended. At that time, barely 50% of health districts had been trained to use the new system. It took major advocacy efforts to identify support from other donors. Eventually, with financial assistance from UNICEF and the World Bank, HMIS/FLCF was implemented nationwide by 1997. The restructured system's integrated and simplified information generating process tailored to the needs of the peripheral health services makes it a potentially powerful tool for planning and management of health services in Pakistan. Unfortunately, the overall weak management environment of the basic health services together with the absence of a real "information culture" seriously limits appropriate use of the information generated by the new system. Without appropriate strategies to improve the health services management environment and to develop more accessible and more relevant health services, the information system will remain underutilized. Three main lessons can be learned from this effort regarding the design of appropriate health information systems:
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