Health Information Management in Crises: An Introduction

1. Health Information Management in Crises: An Introduction Hearnet, November 2006 Sandro Colombo

2. Objectives of this session • agree with the key definitions, components and features of health information and health information management in a crisis, • be aware of the main challenges in HIM • be familiar with key lessons learned from the experience • better understand the opportunities and obstacles in information exchange and our role in IM

3. The importance of (Health) Information • "in a disaster, accurate information, like clean water, is an indisputable good" Keen & Ryle, 1996

4. Information in crises but "the nature of contemporary disasters militates against the rapid collection of, for example, nutritional and demographic data. …reliable base-line statistics that pre-date the crisis are seldom available. Parties to the conflict may attempt to manipulate information … and relief agencies may promulgate statistics that owe more to guessworkandimagination than research. News media tend to repeatandsimplify these interpretations… information flows outwards; the last people to have access to it are the victims themselves" Keen & Ryle, 1996

5. IM in Crises: any progress? • Some findings from an evaluation of IM in the response to the Pakistan earthquake in 2005: • HIC perceived as being of limited use by many field workers, who felt that their information products were either not timely or not relevant • Senior management not enough involved in IM • Despite the technology advances, still gaps in remote access to the internet • Little coordination of data collection

6. Health information: general

7. A Few Useful Definitions • Data: Raw material that has not been analyzed; on its own data have no meaning, apart from what they state • Information: The meaningful collection, manipulation and transformation of data in a way that enhances the comprehension of the studied events • Intelligence: in-depth knowledge of an issue, information in a context

8. Activity #1. Data, information, knowledge: What is the difference? Break in 4 groups and discuss briefly which of the following statements refers respectively to: a) data or b) information or c) intelligence/ knowledge: • Mortality among IDPs in Alpha camp (country Beta): • CMR: 2.3 (95%CI 1.2 – 2.9); • CMR one year ago: 0.8 (95% CI 0.3-0.9) • CMR among IDPs arrived in the last 3 months: 1.6; CMR among IDPs staying in the camp for over 6 months: 3.2 • In camp Alpha there have been 79 deaths since January 2006 • From the analysis of data of the survey in camp Alpha it can be concluded that mortality has increased substantially over last year, consistently with the findings of other surveys in the same area and the overall deterioration of the security situation, and…

9. What is Data made of? • TIME element • SPATIAL element • POPULATION element • ATTRIBUTE elements For instance: on 29th November in Alpha refugee camp there were 1234 refugees

10. Facts/events deaths Data nr. of deaths counting Indicators mortality rates calculating Information rates by sex, age, analysing provenience, etc Knowledge / trend analysis, interpreting Understanding comparison with other areas, benchmarks, contextual information From Facts to Decisions Stepsexample function Judgement / decisions / actions assessing options / Decision-makingattributing values

11. The Circle of Information Management Data Process Collect Information Activity Learn Apply Knowledge Adapted from: Information Management for non information-managers, 2004

12. Desired Qualities of Information in Crises • Timeliness • Relevance • Validity / accuracy • Precision • Acceptable cost

13. Timeliness / Speed • Information needs and demands are high in a crisis and are often difficult to meet within useful timeframes and with acceptable quality • Time for processing information is often a function of security and humanitarian access • Conflict between speed and the other desired qualities, like completeness, coverage, quality of information

14. Accuracy versus Precision • Assuming that in the area X in August 2002 the “real” (unknown) CMR is 1.6/10,000/day • Accurate (unbiased) & precise estimate: 1.5 (1.4 - 1.7) • Accurate & imprecise estimate: 1.5 (1.0 – 2.2) • imprecise estimate: 1.2 (0.8 - 1.9) • biased estimate: 0.6 (0.3 - 0.8) • biased & imprecise estimate: 0.6 (0.1 - 1.2)

16. The Cost of Information From A..Green, 1999

17. Summing-up: what are the qualities we are pursuing in information in crises? • Accuracyandtimelinessare the key features of good information in a crisis, together with relevance: “It is better to be vaguely right than precisely wrong” John M Keynes and we can add: “it is better to be vaguely right and on time than precisely right and late” • Precisionis a lesser concern: "precise quantification of incidence and prevalence rates rarely influences the choice of programmes offered by the health services”Sandiford, 1992

18. Health Information in Crises

19. The impact of crisis on information 1 • During a crisis, pre-existing information systems deteriorate, and their coverage is reduced: • Insecurity & population movements  lack of reliable denominators • Poor communication, • Collection & analysis of data clash with other priority activities • Proliferation and fragmentation of information systems; they often increase the "background noise": good data are hidden by bad ones

20. The impact of crisis on information 2 • A large part of the collected information remains unused • Old, precious information (and institutional memory) is lost • There are strong incentives for manipulating the information • Information flaws are common (see following slide)

21. Common information flaws • Computing mistakes • Incomplete reporting • Use of different denominators • Inconsistent levels of aggregation • Disregard, or lack of access to information related to partners • Biases, or deviations of results –or inferences- from the truth • "fossil" figures, endorsed by authoritative agencies • Data out of context • The application of elegant, sophisticated presentation techniques to poor datasets

22. The Myth of IM in crises • Persisting MYTH: • No information is available, or what is available is biased to such a degree to be useless. • Two opposite attitudes: • Postpone any decision until new data become available (paralysis by analysis) OR • there is no time to gather good data; proceed quickly with field activities

23. Summing up In a crisis we deal with: • information that is fragmented: • information is a precious asset in a competitive market for funding, • new data collection systems are implanted by newcomers; most aid agencies support information initiatives; surveys proliferate; as a result: • “amidst the chaotic and rapidly changing situation, no single organization has all the necessary information" King & Dilley, 2001 • limited understanding or uncertainty: • Crises are complex and dynamic and the information base is weak; • "Uncertainty is a characteristic of scarcity of information (knowledge/understanding). In abundance of information, ambiguity becomes an issue: the more information I get, the more difficult my choice will be"L.Hoebeke, 2001

24. Main Sources of Information in a Crisis Data exist, almost always. They are often hidden among various sources, for example: • Routine information collected by government agencies • Documentation centres (UN, donor agencies, government, etc.) • Surveillance systems • Evaluation and supervision reports • Demographic and Health Survey (DHS) • Multiple Indicators Cluster Survey (MICS) • Other Surveys • Personal files maintained by knowledgeable people • Informal information networks • Journals

25. Improving available information: tips • Cross-checking and cleaning data • Identifying, and dealing with outliers, oddities • Triangulating; choosing among diverging data • Comparing indicators with those of similar contexts • Identifying important missing information (HIV/AIDS, the ongoing war, etc) • Checking the plausibility of data with knowledgeable people

26. Lessons learned • Before embarking on new data collection, find and analyze (and learn from) what is already available = use local knowledge "much of the information remains unprocessed, or if processed unanalyzed, or if analyzed not written up, or if written up, not read, or if read not used or acted upon. Only a minuscule proportion, if any, of the findings affect policy, and they are usually a few simple totals" Chambers, 1989

27. Lessons learned • Do not discard information for being incomplete or weak • Be pro-active: • Try and get beyond the idea of only providing the information that is asked for. Intelligent professionals should be able to figure out what would be helpful for partners to know, summarize and volunteer the informationJim Tulloch, February 2003

28. Information Management

29. Activity • In groups, build a list of the different types of information you exchange on a regular basis • Agree on 3 main types of information

30. Information Management Definition: • “the range of processes by which information is handled by individuals and organisations. These processes aim to define, collect, process, analyse, interpret, present, distribute and incorporate information internal and external to the organization, aiming to make the work of the organisation more effective” Adapted from: HIC Handbook • The goal: to get the relevant information to the right person at the right time

31. What is IM for? • In a crisis, the main aim of IM is to improve the humanitarian response in saving lives and reducing suffering • Rationale of IM: Good information management = better decisions, more effective humanitarian response

32. INFORMATION AND COMMUNICATIONS Dissemination Advocacy Dispellingrumors Reporting to investors Web site Maintenance Proposals & Reports Media briefs Q&A Position papers Policy/strategicclearances Positioning Minutes Share point/ Myetic village Dialogue for coordination List serves Tele/video- conferences Tracking sheets Bulletin boards Protected sites Situation reports Tech validation Adm. clearances Addressee/ circulation lists Decisions Templates Filters Energy Connectivity as a service to partners: e.g. cybercafé for NGOs Access to the Web Connectivity as a product for beneficiaries: e.g. PCs etc for MOH Compatibility of ware Computer skills Connectivity for operations Robustness of equipment Information from the field Access to sources COSTS Analysis Individuals' competencies Protocols, checklists, forms, etc Geography Demography Periodicity/time-sensitivity Level of disaggregation ( national/local) Levels of elaboration (data/indicators) Hierarchy of causation( Determinants/Outcomes) The Known and The Unknown: I.e. How much of the reality are we grasping ? can we expand our catchment area or do we need to plan for contingencies ?

33. Focus of Information Management in this session • Two main purposes of IM in crises: • it supports coordination and management • it provides public information services, raising awareness on the crisis

34. IM functions • Assessment (needs, capacity, damage, etc) • Gap analysis, prioritization, allocation of resources • Monitoring: early warning, surveillance, evaluation

35. Information Management: what's new? • Much progress in the area of information management in emergencies : • Establishment of OCHA/HICs • Advances in IT: • GIS, led by the mine action sector • LSS (ex-SUMA) • Net Hope IT consortium for improved internet connectivity • Sahana project, open-source web based software for disaster management • etc • 2002 Symposium on Best practices in Humanitarian Information Exchange: operational principles

36. Humanitarian Information Management & Exchange: Operational Principles • Accessibility • Inclusiveness • Inter-operability • Accountability • Verifiability • Relevance • Objectivity • Humanity From the Symposium on Best Practices in Humanitarian Information Exchange, OCHA, 2002

37. Metadata and standards Data Infrastructure: the basis for exchanging information

38. Data Security Issues Main reasons for not making public humanitarian information: • Privacy/Confidentiality • Security • Sensitivity • Quality Adapted from: Information Management for non information-managers, 2004

39. Benefits of Sharing Information • Creates a shared understanding of the situation for decision-making, supporting coordination activities • Makes a wider range of resources available to individual organisations – more than they could develop by themselves • Enables individual organisations to make their projects more effective, since they have a better picture of the situation • Builds relations between organisations which will support future cooperation • Contributes to a culture of openness and accountability that improves data collection and ensures information continues to flow

40. Factors Preventing Information Sharing • Technical issues • Political issues • Bureaucracy • Timeliness of data collection… and data release • Unclear priorities

41. Exchanging information, not just asking for it!