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Health Information Systems Challenges. But first.. Some Concepts from Yesterday’s Readings/ Lectures . You should be able to explain to a friend what these concepts mean in relation to Health Management Information Systems : 1. Primary Health Care (preventive/curative care)

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but first some concepts from yesterday s readings lectures
But first.. Some Concepts from Yesterday’s Readings/ Lectures

You should be able to explain to a friend what these concepts mean in relation to Health Management Information Systems:

1. Primary Health Care (preventive/curative care)

2. Routine Health Information

3. Individual/patient care / Continuity of Care

4. (Electronic) Medical Record

5. Epidemic disease / disease surveillance

6. Fragmentation

7. Integrated Health Information Architecture

8. Data Warehouse / Data Repository

9. Indicator (covered later in course)

our goal with the health information system
Our goal withtheHealth Information System

“is to produce relevant information that health system stakeholders can use for making transparent and evidence-based decisions for health system interventions” (HMN)

But the challenges here are many:

  • You need access to data
  • You need qualitydata (covered later in the course)
  • You need toknowwhat to do with it
slide4

Accessible data?

Picture: HMN

multileveled fragmentation
Multileveled fragmentation

Uncoordinated Health programs

Different Health informationdomains

Public/private

Manyelectronicformats (and paper still verycommon)

some global trends and goals
Some Global Trends and Goals

Towards more granularpatientbaseddata

Globally, two-thirds (38 million) of 57 million annual deaths are not registered. And every year, almost 40% (48 million) of 128 million global births go unregistered.

Towardsintegrated and shared data

Manyministiresofhealtharefragmented and have vertical programs withtheirownreporting and data analysis systems (+ donors)

From Paper to Digital (integration or more mess?)

From ‘data collection’ to evidencebaseddecisionmaking

Mobiles and ICT oftenproposed as solutions

technicalsolutions to social problems??

registers records
Registers/records

Record data that need follow-up over long periods such as ANC, immunisation, FP, TB

slide15

Paper

Reports

monthly,

Quarterly

but there are many

different reports….

fragmentation of health programs
Fragmentationofhealth programs

One informationstream for Malaria program

One informationstream for TB program

One informationstream for… etcetcetc

Surveys

Data not available for comparison. Double counting, low data quality

Country X (e.g., Malawi): threenationalfiguresof HIV+ rate or infantmortality rate. All different…

many official actors risk of fragmentation
Manyofficialactors: risk offragmentation

Ministryof Health is not alone…

  • Central Statisticsoffice (census)
  • MinistryofLocalGovernment (run theclinics)
  • Ministryof Education (schoolhealth programs)
  • MinistryofDefence (militaryclinics)
  • Special unitson for example HIV

Whatdoesthislook like In Norway?

why program fragmentation
Why program fragmentation?

Health services inherently fragmented due to high level of specialization

Donors (both from necessity and ignorance)

WHO is highly fragmented itself

Interests and ownership

Leads to lack of transparency, some people thrive on that (corruption)

who s history of success with focused programmes
WHO’shistoryofsuccesswithfocusedprogrammes

Smallpox eradicated in 1977

Eliminating polio in the Americas in 1985

Eliminating measles in Southern Africa

Reducing guinea worm disease by 99% in 20 African countries between 1986 and 2005

Relative successful compared to other UN agencies (such as World Bank).

Each disease eradication program operated autonomously, with its own administration and budget and very little integration into the larger health system

but health systems continued to be inefficient
Buthealth systems continued to be inefficient

Short-term successeswere not addressingpoorpopulations overall diseaseburden

Health systems were urban based, high-technology, curativeoriented.

Little contactwiththepopulation for preventive care

Health is socioeconomic:

  • Health services, economy, security, education, nutrition…

More comprehensiveapproachesemerged in a numberofcountries

primary health care
Primary Health Care

Promotive, preventive, and curative

Involvesrelatedsectors (education, food, agricultureetc), and wideraims (equity, affordabilityetc)

Promotescommunity and individualinvolvement and committment

Came as a reaction to older, high-tech, curativeapproaches. Basedonbottom-upexperiences from ”developing world”

How to implement it? Comprehensivevsselective? Overarchingquestion ever since

comprehensive vs selective today
Comprehensive vs. selectivetoday?

Bothexists

WHO is still veryfragmented in specific programs, whicharereplicated at countrylevel

Cross-cuttingunits have beencreated; Health Metrics Network

In other areas, newagencies have beencreated to target specific areas: Global Fund, UNAIDS, GAVI Alliance

a selective approach to his

National: Fragmented reporting; gaps & overlaps

Data sources not linked

CRIS

Excel

Excel

Excel

Facility

Facility

Excel

Excel

Excel

surveys

surveys

ICS

SUM

(hospitals

-

poor)

Other

Other

Excel

Excel

Excel

data

data

sources

sources

Excel

Excel

Excel

Excel

Excel

Excel

Data capture

Excel

Excel

Excel

CRIS

District:

Fragmented

Data management

Data capture

SUM

ICS

Excel

Excel

Excel

Excel

Excel

Excel

Data capture

Summary

reports

Compiled

Summary report

Data capture

Summary report

monthly reports

Facility:

ARV patient

Hospital

Hospital

ARV

ARV

PMTCT

PMTCT

Other

Other

Morb

Morb

Multiple Forms

Paper records

ICS

ICS

idity

idity

.

.

In & out patients

& registers

Records / registers

A selectiveapproach to HIS
comprehensive vs selective icts
Comprehensive vs. selective: ICTs

Comprehensive: integration, comprehensiveinformationneeds, varied outputs

Selective: Silos, fragmentation, inefficientdevelopment and utilizationofinfrastructure. Closed-boundary ICT systems. Potential for cross-comparisonofindicators is lower.

Both: provisionofhealth services decentralized. IS needs to allowlocallevels to collect, process, and useinformation

Scope for varioustechnologies to contribute: Mobile phones, mobile modems to access online services

the mdgs in the phc tradition millenium development goals
The MDGs in the PHC tradition(milleniumdevelopment goals)

Adopted by UN in 2000, to reach by 2015 goals related to:

  • Poverty and hunger
  • Universal primaryeducation
  • Genderequality
  • Childmortality
  • Maternal health
  • HIV/AIDS, Malaria, and otherdiseases
  • Environmentalsustainability
  • Developing global partnership for development
the mdgs in the phc tradition
The MDGs in the PHC tradition

DespitethecomprehensivenessoftheMDGs, selectiveapproacheswithinhealthcontinues

Addressessomecritiqueofselective PHC

  • Takeintoaccountthebroadercontextofdevelopment
  • Doesackowledgetheroleofsocial and genderequity

Still challengesrelated to:

  • Donor-driventechnocraticapproach to priorities, ratherthangrassrootapproachof Alma Ata
  • Verticalobjectives, fighting onedisease at a time
  • Little coordinationamongvertical programs

New actorsfindlegitimacy in theMDGs for focusingonspecific areas, contributing to and sustainingfragmentation

in conclusion
In Conclusion

There is a strong trend towardsindividual and encounter-based data (drilling down)

  • Security, patientconfidentiality, robustness

IncreasedfocusonCivilRegistration and Vital Statisticswill lead to newrequirements for selectivesharingof data

  • Birth data: not all stakeholders shouldget all data
  • Who has access, whoownsthe data
in conclusion ii
In Conclusion II

ICTsonlyas effective as the system they support

International healthcommunitybecomingincreasinglyawareofthelimitationsofICTs:

WhatICTscan do? Help in integration, collection, storage, processing, presenting information. Decentralization. Communityempowerment, but not withoutitschallenges