www.healthmetricsnetwork.org

Leveraging HIV Scale Up for HIS Strengthening

Interdisciplinary Partnerships for HIS and Health System Strengthening

John Cutler, Chief of Country ProgrammesHMN Secretariat, WHO, Geneva, Switzerland

Overview of Presentation

• Health Metrics Network• HIV/AIDS Scale Up and HIS• Negative and positive effects of HIV/AIDS programmes on HIS

strengthening• The Case of Sierra Leone• The Case of Botswana• Summary

Drawing on Conference Themes

• Targeted programmes v. systems approaches– Including reporting demands and indicator proliferation

• Right to information framing the social contract • ART leading the way to the transition to chronic disease management• Using information for public health impact:

– Planning and policy development– Producing efficiencies and saving money– Improving health services, achieving better health outcomes and saving lives

What is the Health Metrics Network?

• Network of partners to respond to country demand to strengthen HIS• Goal is for countries to use information for decision making to improve

health outcomes• Standards-based approaches and tools

– Modern, business-like approach to information – HMN Framework provides principles a conceptual approach to HIS

strengthening – Not a prescription, a product or system

Origins of HMN

• Millennium Development Goals (MDGs)• Paris Declaration• Hosted by WHO since 2003• HMN launched at the World Health Assembly

in May 2005• HMN Framework endorsed by resolution at

the World Health Assembly in May 2007• But, why was HMN needed?

Growing and Increasingly Fragmented Demand for Information

Confusing System Complexities

Growing Pressures to Deliver InformationGrowing Pressures to Deliver Information

- MDGs reporting

- Performance-based funding

- SWAps and resource allocation

The HMN Framework

Data SourcesData Sources Integrated Health Information SystemIntegrated Health Information System

Policies, Resources and ProcessesPolicies, Resources and Processes

CensusCensus

CivilRegistration

CivilRegistration

PopulationSurveys

PopulationSurveys

IndividualRecordsIndividualRecords

Service RecordsService Records

ResourceRecords

ResourceRecords

HIS Actors Using Evidence for Decision Making

Senior Country Official

National Public Health Official

International M&E Officer

District Health Manager

Senior Country Official

Facility Health Officer

Civil Society

IntegratedData

Repository

IntegratedData

Repository

Extractand

IntegrateData

Extractand

IntegrateData

Allocated Length-Of-Stay Utilization

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100

200

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600

700

Pat

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Status 143 221 412 574 325 172 68 145

25% 50% 75% 100% 125% 150% 175% 200%

Allocated Length-Of-Stay Utilization

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100

200

300

400

500

600

700

Pat

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Status 143 221 412 574 325 172 68 145

25% 50% 75% 100% 125% 150% 175% 200%

Dashboard,Reports, Queries,

Events & Alerts

Routine and Non-RoutineData Collection ActivitiesRoutine and Non-RoutineData Collection Activities

Implementing the HMN Framework

• Assessment and visioning• Strategic planning• Mobilise financing for implementation• Implement HIS/CRVS strengthening activities• Using the information for analysis and

decision making at all levels• Evidence-driven decision making

Countries Using the HNM Framework & Tools

The HMN Assessment Process

• Brings stakeholders together to develop a shared vision of an integrated HIS

• Establishes a baseline to monitor progress in HIS strengthening

• Provides the starting point for strategic planning• Builds consensus and support for implementing a

strategic plan• Assesses the six domains of HIS as defined by the

HMN Framework

The Assessment Tool

197 questions on 6 domains:– Resources– Indicators– Data sources– Data management– Information products– Dissemination and use

Main goal is to convene stakeholders, develop a shared vision leading to the development of the HIS strategic plan

Limitations

Assessment tool was not intended for country comparison– Subjective and qualitative– Different methodologies used– Variations in the number and qualifications of the

participants– Knowledge about the topic will influence the

answer provided

54 countries included in the study

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AFRO EMRO EURO PAHO SEARO WPRO

Upper Middle Income

Lower Middle Income

Low Income

Overall score, 54 countries

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30.0

40.0

50.0

60.0

70.0

Resources Indicators Data Sources DataManagement

InformationProducts

Disseminationand use

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Summary of HIS Assessment Findings

• Need to strengthen HIS policies and data management

• Findings in line with other HIS informal assessments• Over 50 assessments are available online• Assessment process convenes stakeholders and

develops a shared vision for HIS reform• Nearly 30 country strategic plans for HIS

strengthening• Progress tracking tool to monitor implementation

HIV Scale Up and HIS StrengtheningFragmentation and Synergies

• Fragmentation of HIS– Redundant data generation and analysis and reporting

functions– Poor data quality and limited access to informaton– Less information-driven decision making

• Fragmentation has many sources - legacy systems, categorical systems, reporting and M&E focus etc. – linked by lack of awareness

• Synergies: HIV/AIDS programmes bring resources, operate at scale and can drive the HIS reform process in country

HIV Programmes and HIS Systems

• Two main challenges: fragmentation and a focus on reporting information, not its use

• Categorical M&E systems not linkable to country health information systems

• Focus on reporting discourages local ownership of information and its use

• Undermines data quality and value of data and information

Vicious Cycle Leading to Fragmentation

limited capacity to manage or analyse data

Using evidence not perceived as a winning strategy

Data not trusted

Weak demand

Weak HIS

Poor data quality

Limited investment in HIS

Decisions not evidence-basedDonors get their own

Fragmentation

Positive Influence of HIV Programmes on HIS

• Adds resources and value to the information systems– Money, resources, power => political and social importance and

influence• Builds infrastructure and human capacity

– Systems and equipment for data and information management– More and better trained human resources

• Helps to develop major HIS components of prevention, patient management, logistics, programme management etc.

• Stimulates the development of important policies and procedures for the whole sector: individual medical records, unique identifiers, data confidentiality etc.

Sierra Leone

• Initial situation 2005: fragmented and dysfunctional HIS; HIV/AIDS Information System relatively well functioning

• Redundant data collection, incompatible data formats, no discussions among M&E systems

• HIS reform began at the Health Information Unit of the MOH

• Data collection forms were revised and harmonized• HIV/AIDS Information System decided not to join so

duplicate data collection and processing continued

Sierra Leone

• ART tracking software was introduced that made HIV data interoperable with wider HIS

• Current situation: Interoperable systems, HIV/AIDS Information System officer seconded part-time to the MOH HIS unit

• HIV/AIDS programme is now a core actor in HIS strengthening in Sierra Leone

Botswana District Analysis of AIDS Information

• Botswana HIV/AIDS Information System based on UNAIDS CRIS

• Provides information for analysis and decision making at district level for the first time

• Data system is compatible with the national District Health Information System

• Policy and implementation effects at district level: STI and teen pregnancy trends, food rations etc.

Summary and Conclusion

• Individuals and societies have the right to access and make use of quality information

• Use of quality information drives improvements in health status

• HIV/AIDS programmes are a powerful force in HIS development in general

• Shared responsibility to improve the availability and use of quality information to improve health status

Thank You

Some Example Questions

Resources unpacked

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HIS Infrastructure HIS Institutions, humanresources and financing

Policy and planning

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Data Management unpacked

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Metadatadictionary

National datawarehouse

Sub-national datawarehouse

Unique identifyercodes

Written set ofprocedures

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