Strengthening Information Systems for Social Development

Indicators and Targets for a Post-Millennium Development Goal

Fatima Marinho

marinhof@paho.org

Coordinator of Information and Health AnalysisPan America Health Organization – PAHO/WHO

Global Health Metrics & Evaluation

Seattle, Mar 14-16 2011

Information is one of the main MDG weaknesses.

For two and a half days we have discussed methods, metrics, discrepancies, models, strategies, accountability etc

In all of those discussions the problem of the information has been pointed.

If we look at the situation of the information in the world we could say:

Although efforts have been made to strengthening the Health Information Systems (HIS).

Introduction

WHY HAS IT BEEN SO HARD STRENGTHENING THE HEALTH INFORMATION SYSTEM?

Problems

1- Replace routine systems by surveys and estimates. The easy option for surveys and estimations as a primary way of understanding and measuring progress occurred in detriment of the strengthening of the HIS in most countries.

2- Accountability issues: both governments and international organizations need to be responsible for improving health information.

3- Parallel information.In the Americas there are many international agencies with projects to prevent children and maternal mortality or disease prevention and control (like Global Fund), but those projects collect parallel information without strengthening national HIS.

4. The use of the statistical models for estimates instead of strengthening the local capacity for analysis.

5- Non-ownership or non-usage of results.Production of external knowledge that is given to national governments causes non-ownership or non-usage of results by many countries.

HIS ASSESSMENTS

• The main investment to strengthen HIS has been to promote assessments through the use of standardized tools.

• We keep recognizing the problem, but we don’t show a way out.

• The assessment is not enough to generate the knowledge of how to respond to the identified problems.

• How to do it? That is the question.

How to do it as a Regional Organization?

• Key actors: Health administrators, health workers and the civil society are the most interested parties in having good information, in knowing their reality.

• Partners: Health services have an important role in the construction and attainment of local information, and the communities too.

• Goal: To build good information is a processes of identifying health problems and producing actions to improve population health.

• Experiences in the region

Process of Construction of Information: Regional Strategy

Strengthening the HIS: using good practices to build a good information

Accountability and Empowerment of the Civil Society: the Brazilian Experience

• Civil society’s participation and agency on the definition and implementation of health policies was key to improve accountability over the production of health information in Brazil.

• By law, the health policy has to be discussed and approved by a national council which is composed as follows:• 50% civil society, 25% health workers, 25% government.

• There are councils in all administrative levels down to the health facility level

• There are 80,000 member of health councils in the country, 40,000 of which are from the civil society

• National agreement of 50 indicators

• The government has to report the progress of the National Indicators to the counselors

• Indicators for improving quality and coverage of vital statistics

• Intergovernmental agreement involving all admin levels.

• Decentralization of the Health System as well the as HIS was strategic.

• The work alongside health councils and local communities gave sustainability to the process of information strengthening and made local governments accountable.

• The mayors have to monitor the information.

• Micro data is publicly available.

• This process provided the basis upon which it was possible to build a successful project of increasing the coverage and quality of mortality and birth information:

– Strengthening of the information of mortality and birth was associated to the expansion of health services, especially the primary care (Family Health Program).

– Obligatory investigations: Maternal death, infant death, ill-defined cause of death and women death (age 10-49)

– Pro active search for non-registered deaths (mapping of illegal cemeteries within communities)

– Progress report for the National Health Council, and national authorities.

Brazilian Experience: strengthening vital statistics

Proportion of Ill-defined causes of death by municipalities - Brazil (darker areas have higher proportion of ill-defined causes)

20032005*

2008

RESULT

*project started

Research of the underlying cause of death Analysis of Health Information System Verbal Autopsy - Pilot Test - Paraguay 2010

•Proposed PAHO/WHO and MoH, to implement a pilot test of the Verbal Autopsy (based in Brazilian experience)

•Regional Plan Strengthening Vital and Health Statistics (component of quality of data) - Analysis of % ill defined causes of death (mortality database September-December 2009) by departaments

Selection of the district: Regional Hospital Luque- Reference Center

- Review, translation and adaptation of tools (Brazil)

-Approval of local authorities

- Mapping the area

Training: interviewers and certifying physician

-Pilot test: April with support of PAHO/WHO - HA

Well accepted by the population, interviewers and hospital medical team

Documentation and revision of each case by physicians team Reviewing and coding of all deaths by coders and physician

Reclassification of ill defined causes of death

Presentation and discussion of results to all staff of the hospital and the area selected for the pilot test

Discussion on the advantages of the use of verbal autopsy with the Minister of Health

Next Step

- To establish a working group in order to implement the use of verbal autopsy as one of the alternatives for improving the quality of mortality information

Results

Topics for Discussion

• The most important tangible and sustainable impact will be reached when the project promotes strategies at the local level, as well as promoting activities that address the problems where they are produced/originated.

• Behavioral changes related to the production and usage of the information in the countries by the health services managers, civil society, and governments.

• Empowerment of the Civil Society and local governments as a key actors in this process.

• Intergovernmental agreements to improve the information.

Indicators for improving quality and coverage of vital statistics.

The Post-Millennium has startedLets move it!