Judge Business SchoolInformation for Actionin Public Health Systemsin Developing Countries

Geoff Walsham

Page 2

Information for action - definition

• The regular and widespread use of information as an input to processes such as planning, management, monitoring and evaluation of health activities and systems with a view to enabling more effective action in the field and improved health outcomes

Page 3

ANM ANM Register

PHC MOICPHC

Sector LevelHealth Supervisor

Block MOIC

CHC

District Head Quarter (DPMU)

STATE HEAD QUARTER

District TB DepartmentDistrict Malaria DepartmentDistrict Leprosy DepartmentDistrict Blindness Control ProgramOthers

Sub-Centre Level

PHC Level

CHC Level

District Level

State Level

Health System Information

FlowData GivenFeed Back

Information for action – some examples

Using information at the national level to develop plans to meet the MDGs

Using information at state level to prioritise particular programmes in that state and develop action plans to achieve these

Using information at district level to monitor the achievement or underachievement of district health goals and to generate future plans to respond to this

Using information at the PHC level to better understand local health problems and issues in order to target resource use more effectively

Using information on particular villages and sub-centres to develop ANM activity plans which maximise the use of her capabilities

Page 5

Information for action needs good data

Accurate

Complete

Timely

Relevant

Available where and when needed

Page 6

Why is data in public health systems often poor quality?

Misreporting due to unintended mistakes, arithmetic calculations etc

Deliberate misreporting to present a distorted picture of achievements

Under-reporting or no reporting due to time pressures, lack of motivation to report or excessive number of forms, data elements etc.

Lack of understanding of the importance of data or its role in improving health outcomes – no ‘information culture’

Page 7

What information and communication technologies (ICTs) can do

Provide the capability to capture data more effectively at local level e.g. through mobile phones

Provide resources for the processing of data more quickly and accurately

Provide capabilities for the generation and display of information in a user-friendly and adaptable way

Provide the capability to integrate information across all levels of analysis from the global to the local

Page 8

What ICTs cannot do

Produce motivated and knowledgeable health workers at all levels

Produce an information culture which places high value on the use of information for action

Eliminate ‘perverse incentives’ in the health system to misrepresent data or distort information

Provide the levels of resources and long-term commitment needed to raise the quality of health care to widely acceptable levels

Page 9

Developing the software – HISP/DHIS

Health Information Systems Programme (HISP) started in South Africa in the mid-1990s

Provides a computer-based district health information system (DHIS) for health planning and management

Approach extended to a range of other countries in Africa and Asia

Based on open-source software, the latest version being DHIS2

Page 10

Developing the people

Ashas

ANMs

Medical officers in PHCs

Block and district personnel

State and central health staff

Page 11

Developing the institutional support

Health is known globally to operate in vertical silos

This is often mirrored in vertical institutions who place less emphasis on horizontal communications

Need for a change of culture to one of cooperation, horizontal communication and the development of shared goals

This matches the spirit of the original HISP approach

Page 12

Conclusions

• Health management information systems (HMIS) need to be viewed as only one part of heterogeneous networks composed of people, technology, standards, institutions, processes etc.

• Change programmes need to address all of these elements holistically and over extended time periods

Page 13

Thank You