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SEA/HS/226
I O-Point
Regional Strategy
for Strengthening Health
Information Systems
World Health
Organization
Regional Office for South-East Asia
New Delhi
© World Health Organization. 2006
Publications of the World Health Organization enjoy copyright protection in accordance
with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of
reproduction or translation, in part or in toto, of publications issued by the WHO Regional
Office for South-East Asia, application should be made to the Regional Office for
South-East Asia. World Health House. Indraprastha Estate, New Delhi 1 10002, India.
The designations employed and the presentation of material in this publication do not imply
the expression of any opinion whatsoever on the part of the Secretariat of the World Health
Organization concerning the legal status of any country, territory, city or area or of its
authorities, or concerning the delimitation of its frontiers or boundaries.
Printed in India
103 j8
Contents
Page
Foreword................................................................................................................................................................... ii
Introduction.............................................................................................................................................................. 1
Historical perspective............................................................................................................................................1
Issues and challenges in health information systems................................................................................ 3
Regional strategy for strengthening health information systems in
South-East Asia Region......................................................................................................................................... 4
Strategic area 1: Policy development, regulation and legislation
on HIS-related issues............................................................................................................................................7
Strategic area 2: System analysis (health information system
design/set-up and maintenance)......................................................................................................................9
Strategic area 3: Promotion of data quality............................................................................................. 13
Strategic area 4: Appropriate application of information and
communication technology (ICT)................................................................................................................. 17
Strategic area 5: Enhancement of mechanisms for effective
communication, cooperation and coordination..................................................................................... 19
Strategic area 6: Development and allocation of HIS resources
(human, physical, financial) ............................................................................................................................ 21
Strategic area 7: Strengthening of data sharing, analysis and
utilization, at all levels....................................................................................................................................... 23
Strategic area 8: Strengthening data collection and utilization in
decentralized systems....................................................................................................................................... 25
Strategic area 9: Effective marketing of HIS products......................................................................... 27
Strategic area 10: Strengthening linkage between the national health
information system and the national health research system............................................................ 29
From strategy to action...................................................................................................................................... 31
Suggested reading................................................................................................................................................ 32
10-Point Regional Strategy for Strengthening Health Information Systems
© World Health Organization. 2006
Publications of the World Health Organization enjoy copyright protection in accordance
with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of
reproduction or translation, in part or in toto, of publications issued by the WHO Regional
Office for South-East Asia, application should be made to the Regional Office for
South-East Asia. World Health House. Indraprastha Estate, New Delhi I 10002, India.
The designations employed and the presentation of material in this publication do not imply
the expression of any opinion whatsoever on the part of the Secretariat of the World Health
Organization concerning the legal status of any country, territory, city or area or of its
authorities, or concerning the delimitation of its frontiers or boundaries.
Printed in India
Contents
Page
Foreword................................................................................................................................................................... ii
Introduction.............................................................................................................................................................. 1
Historical perspective............................................................................................................................................ 1
Issues and challenges in health information systems................................................................................ 3
Regional strategy for strengthening health information systems in
South-East Asia Region......................................................................................................................................... 4
Strategic area 1: Policy development, regulation and legislation
on HIS-related issues............................................................................................................................................ 7
Strategic area 2: System analysis (health information system
design/set-up and maintenance) ...................................................................................................................... 9
Strategic area 3: Promotion of data quality............................................................................................. 13
Strategic area 4: Appropriate application of information and
communication technology (ICT).................................................................................................................. 17
Strategic area 5: Enhancement of mechanisms for effective
communication, cooperation and coordination..................................................................................... 19
Strategic area 6: Development and allocation of HIS resources
(human, physical, financial) ............................................................................................................................ 21
Strategic area 7: Strengthening of data sharing, analysis and
utilization, at all levels........................................................................................................................................ 23
Strategic area 8: Strengthening data collection and utilization in
decentralized systems........................................................................................................................................ 25
Strategic area 9: Effective marketing of HIS products.......................................................................... 27
Strategic area 10: Strengthening linkage between the national health
information system and the national health research system............................................................. 29
From strategy to action........................................................................................................................................ 31
Suggested reading................................................................................................................................................. 32
10-l’oint Regional Strategy for Strengthening Health Information Systems
Foreword
Reliable and timely health information is a critical component in health
system development. Collection of relevant data and its related analysis to
provide necessary evidence for assessing the development and performance
of health systems at national and sub-national levels is a major responsibility
of any health information system. Health intelligence, and not merely health
data/information as such, is increasingly being seen as the lifeblood of any
health system by the health planners. To provide timely feedback and
appropriate data to the programme managers for day-to-day action is a
challenging task for the health information system.
In practice, health information systems rarely function systematically.
They are generally fragmented and unresponsive to needs. This is largely
due to the fact that insufficient attention has been paid to country capacity
building in this area. The result is apparent in the inability of most countries to assimilate the data
needed to monitor progress towards achieving the Millennium Development Goals.
Lately, several global initiatives, networks, programmes, and projects have been launched by
development partners to assist countries in the area of health information. It was with this in mind that
the WHO Regional Office for South-East Asia took the initiative to develop a strategic framework to
guide countries in strengthening and reorienting their national health information systems and to meet
the changing needs and increasing demand from development partners for valid and reliable health
information at all levels. In August 2006, the 59lh Session of the WHO Regional Committee for SouthEast Asia endorsed the Regional Strategic Framework which served as a base for this publication.
This Regional Strategy is based on the results of a series of regional/country meetings and consultations.
It was drafted and finalized in collaboration with all Member countries of the Region. Rich experience and
vast expertise of representatives from the Ministries of Health, National Statistical Offices, as well as several
renowned experts, resource persons, partners and colleagues have gone into the preparation of this
document. It includes ten strategic areas with generic guidelines in each which could be addressed in
accordance with the country-specific situation and priority. It proposes actions and initiatives countries
may opt for in drafting their strategic and action plans, lists possible assistance from WHO and partners and
selects indicators for monitoring progress in strengthening health information systems.
I sincerely hope that this Regional Strategy will facilitate harmonization of efforts related to
strengthening health information systems in countries of the South-East Asia Region, particularly in
monitoring progress towards achieving the Millennium Development Goals.
Samlee Plianbangchang, M.D., Dr.P.H.
Regional Director
10-Point Regional Strategy for Strengthening Health Information Systems
Introduction
For the last several years, WHO, together with Member countries of the South-East Asia Region
has undertaken activities to strengthen the countries' health information systems (HIS) and
contributed to improving morbidity and mortality statistics. An intercountry consultation on
strengthening HIS, held in 2001, finalized the generic protocol for monitoring and evaluation
of HIS in the countries. During 2002 and 2003, based on this protocol, country reviews of
health information systems were conducted and the results summarized in a draft regional
framework paper. In addition, during 2002, vital registration reviews were conducted in some
countries of the Region. The issue of transformation of data into information for evidence
based decision-making was addressed by a Workshop on Data Management for Evidence
based Decision Making, held in 2001. In 2003, the WHO Regional Office for South-East Asia
organized a Regional Consultation on Reporting on Data-Sets on United Nations Millennium
Development Coals (MDGs) and WHO Core Health Indicators. It discussed the process and
mechanism at country level for data collection, collating and reporting. The Health Metrics
Network (HMN) initiated by the WHO Director-General was launched during the World Health
Assembly in 2005. Since then a debate on how to integrate tools and methods for health
measurement and to build partnership in health information (World Health Statistics/Health
System Metrics) has continued. A meeting of all WHO regions and WHO Headquarters regarding
database of core health indicators was held and the basic indicator sets proposed. In September
2004, progress towards achieving MDGs in SEAR was discussed in the Health Ministers' Meeting.
Initial discussions with the WHO Regional Office for the Western Pacific on strengthening HIS
in Asia and the Pacific were held in December 2004 which resulted in identification of crucial
areas to be addressed in formulating the regional strategies for strengthening HIS. In December
2005, an Intercountry Consultative Meeting on Strengthening Health Information Systems in
the South-East Asia Region was held and the Regional Strategy for Strengthening Health
Information Systems drafted.
Historical perspective
In countries of the South-East Asia Region, four phases of the health information development
and use can be observed (Table 1). Before the 1980s, health information was limited to the
routine service statistics and priority communicable diseases. After the Alma-Ata declaration in
1978, a concept of integrated national health information systems was recognized to meet the
reporting requirement on the Health for All (HFA) indicators. During that period, the development
and reporting of selected health indicators was emphasized, which included monitoring of the
HFA indicators. During a convergent period of two decades, national health information systems
10-Point Regional Strategy for Strengthening Health Information Systems
had been considered as a link between health management and health policy. Efforts had been
focused on development of composite health indexes and summan,' measures of health within
the health system performance framework. During the current era of global initiatives, i.e. Global
Fund for AIDS, Tuberculosis and Malaria, Global Alliance for Vaccines and Immunization, Poverty
Reduction Strategy Programmes, MDGs and HMN, the focus has been on national health
information systems as a network of sub-components, emphasizing availability, quality, value and
use of timely and accurate health information, particularly to facilitate evidence-based decisions,
and as a network of all partners working in context of norms and standards in which WHO has a
key role to play.
Table 1: Evolution of national health information systems (NHIS) in SEAR countries
Prior to Alma-Ata
declaration
HFA 2000 era
Health systems
performance
assessment
(HSPA) era
Present MDGs era
(health metrics
with networking)
NHIS concept
was recognized
NHIS was seen
as a pivotal link
between health
NHIS is seen as a
network of federated
sub-systems and
management
and health
policy debate
components
Focus was on
summary
measures of
health within
Focus is on
development and use
of routine service
HSPA
framework
service delivery
Development of
Building up time
health indexes
place related
databases common
(1978)
NHIS concept was
rarely practiced
Focus was on routine
service statistics on
communicable diseases,
health activities, and
health resources
Development of
statistical tools
and methods
Focus was on
data to meet
the reporting
requirement on
HFA indicators
Prolific
development
of health
for all partners
indicators
No or little use
of information
records at point of
Beginning of
IT use in full
IT use
swing
technology (IT)
10-Point Regional Strategy for Strengthening Health Information Systems
Mapping of health
resources and
application of CIS/
mapping technology
Issues and challenges in health information
systems
Public health decision-making is critically dependent on the timely availability of sound data.
The role of the health information system is to collect, analyse and disseminate such data.
Ministries of Health in countries of the South-East Asia Region have health information teams
which directly or indirectly oversee the operations of the health-related data recording and
reporting mechanisms. They compile data, produce reports and disseminate these as annual
publications like the country annual health bulletin/annual health report/annual health
information. In most cases, these publications are incomplete, outdated and not very useful for
programme managers or for the policy debate and decision support. The contents and formats
of these publications, expected to provide health information on the country, warrant revision
and revitalization to meet the challenge, especially for global reporting of valid and reliable
health information at national/subnational levels.
The common and main issues and challenges in health information systems strengthening
in a majority of SEAR countries are as follows:
•
Countries have not been able to use the health-related data effectively for policy
debate and decision-making due to:
-
Data collection systems are overloaded with details which may not be required
for policy decision-making;
-
Weak linkage in data transmission from one level to the next;
Required data is not available in a timely manner. Often, it is incomplete and
thus not usable for evidence-based action;
Weak feedback mechanisms and products of HIS, and
-
Organizational culture which values and encourages analytical thinking is limited.
•
NHIS are often not adequately equipped with tools and techniques of data analysis.
•
Appropriate tools for transforming data into information for decision-making are not
always applied properly.
•
Disaggregated data are often not available in the form required by programme
managers for day-to-day decision-making at the point of delivery of health service.
•
Existing human resources are not sufficiently trained for applying the analytical tools
and methods to synthesize information for decision-making.
•
Health information systems are not well equipped for emergency preparedness and
vulnerability reduction. Therefore, not responsive enough to help contain natural
disasters and emergencies.
•
Limited capacity (human and other resources) in HIS area.
10-Point Regional Strategy' for Strengthening Health Information Systems
Regional strategy for strengthening health
information systems in South-East Asia Region
Goal
To improve the availability, quality and use of health information for enhanced efficiency and
effectiveness of health programmes.
Objectives
•
To validate, analyze and disseminate information on the regional health situation
and trends;
•
To enhance national capacity and capability in health planning and management by
strengthening country health information systems, and
•
To make sound evidence available for use in developing efficient and effective health
policies.
The Strategy, developed and endorsed by Member States, consists of ten strategic areas as
follows:
(1)
Policy development, regulation and legislation on HIS-related issues.
(2)
System analysis (health information system design/set-up and maintenance);
(3)
Promotion of data quality;
(4)
Appropriate application of information and communication technology (ICT);
(5)
Enhancement of mechanisms for effective communication, cooperation and
coordination;
(6)
Development and allocation of HIS resources (human, physical, financial);
(7)
Strengthening of data sharing, analysis and utilization, at all levels;
(8)
Strengthening data collection and utilization in decentralized systems;
(9)
Effective marketing of HIS products, and
(10)
Strengthening linkages between Health Information System and Health
Research System.
A conceptual framework is pictured in the diagram below. It shows improving health
status as a goal (in the centre), to be achieved by a well-functioning health system as one of the
important determinants of health, in which health information plays a crucial role. It also shows
the relation of the 10 strategic areas to all aspects of data management for evidence-based
decision-making.
10-Point Regional Strategy for Strengthening Health Information Systems
In each strategic area, a strategy consists of:
•
proposed actions and initiatives indicated by a decimal number;
•
possible areas of WHO and partners' assistance indicated by light orange
box, and
•
indicators for monitoring implementation at the regional level indicated by
light green
box .
10-Point Regional Strategy' for Strengthening Health Information Systems
S
Strategic area 7: Policy development, regulation and
legislation on HIS-related issues
1.1
Advocacy for HIS to be given higher global and national priority.
•
Advocacy with governments in general, and health ministries in particular
for greater political will and resource allocation for development and
strengthening of HIS.
•
Number of countries which have increased resource allocation for activities
related to development and strengthening of HIS.
1.2
Develop policies on HIS-related issues (release of public information, confidentiality
of medical records, electronic exchange of information, etc.).
•
Support for the development of HIS-related policies.
•
Number of countries which have developed and implemented policies on
important HIS-related issues.
1.3
Provide/strengthen the legal basis and define regulatory mechanisms for different
HIS-related activities (example, data collection from the private health sector, vital
registration system, release of public information, and use of electronic medical
records, etc.).
•
Advocacy with countries in the development of important HIS-related
legislation, like those related to vital registration systems, collection of private
health sector data, etc.
•
Support for the formulation/development of legislation, regulatory
mechanisms and operational guidelines for HIS-related issues.
•
•
Number of countries which have passed legislation related to HIS.
Number of countries which have developed and disseminated operational
guidelines for different HIS-related legislation and policies.
1.4
Develop and implement operational guidelines for HIS-related policies, regulations
and legislation.
•
Support for the development of operational guidelines.
•
Number of countries which have developed operational guidelines for HISrelated policies, regulations and legislation.
10-Point Regional Strategy for Strengthening Health Information Systems
1.5
Advocate for more rigid/stricter implementation of HIS-related legislation and policies.
•
Support for the conduct of meetings and seminars for heightening awareness
on the need for strict and rigid implementation of HIS-related legislation
and policies.
•
Number of countries which showed improvements in HIS performance as
a result of stricter implementation of HIS-related legislation and policies
(example, increase in the percentage completeness of birth and death
registration; increase in the percentage coverage of reporting notifiable
diseases by private physicians, etc.).
10-Point Regional Strategy for Strengthening Health Information Systems
Strategic area 2: System analysis (health information
system design/set-up and maintenance)
2.1
Conduct periodic, in-depth and comprehensive assessment of HIS and its sub
systems.
•
Support for the conduct of HIS assessment studies.
•
Number of countries conducting periodic, comprehensive and in-depth
HIS assessment.
2.2
Develop and implement systematic plans for HIS development and strengthening
(example, HIS masterplan for the country; IT masterplan; short-term HIS action plans;
HIS strategic plans, etc.), including well-defined resource allocation.
2.3
•
Support for the preparation of HIS masterplans/strategic plans.
•
Number of countries which have developed HIS strategic plans.
Identification/periodic review of minimum essential datasets and core health
indicators to be used and shared by different programmes within and outside of the
MoH, and to meet international reporting requirements (example, MDGs).
•
Support for the conduct of national workshops to identify/review minimum
essential datasets and core health indicators.
•
Number of countries which have systematically identified and collected
minimum essential datasets, and are regularly generating core health
indicators, including those needed for international reporting requirements
(example, MDGs).
2.4
Link and harmonize different information systems and sub-systems among
programmes and other units within the MoH.
•
Support for the development/strengthening of HIS sub-systems.
•
Support for the development/strengthening of a harmonized HIS.
•
Support for the conduct of training activities on harmonized HIS.
•
Support for the pilot-testing, evaluation, modification and finalization of
design of the harmonized HIS, prior to nationwide implementation.
10-Point Regional Strategy for Strengthening Health Information Systems
9
tl
•
Number ol countries with the following HIS sub-systems in place: vital
item
registration system; hospital information system; disease surveillance systems
(for both communicable and noncommunicable diseases); finance, health
facilities and equipment, and human resource information systems.
•
Number of countries which have developed/designed, pilot-tested,
evaluated, and implemented a harmonized HIS.
J
J
J
J
J
2.5
Develop linkage with/access to routinely produced health-related database collected/
generated by agencies/entities outside the MoH (example, vital registration system,
population data from the census office, private health sector, national health accounts,
health insurance, socio-economic data, etc.).
•
Advocate for the establishment of intersectoral linkages to facilitate access
to and sharing of information with external agencies collecting health and
health-related data.
•
Number of countries in which the MoH have established linkages with
other agencies like the National Statistics Office, and Ministry of Finance,
etc. for the sharing of health and health-related information.
1
I
1
a
a
i
i
2.6
Develop/strengthen capacity to conduct on a periodic basis, research and special
studies to supplement routine data collection systems (example, national health
survey, demographic and health survey, sample registration system, and collection
of biomarkers, etc.).
•
Support for staff training on research methodologies (example, sampling
designs, and development of data collection tools, etc.).
•
•
Support for the conduct of research and special studies.
Number of countries which have institutionalized the conduct of research
and special studies to supplement routine data collection (example, number
of countries which conduct a national health survey every 5/10 years, etc.).
2.7
Develop/strengthen/implement maintenance plan for HIS-related resources (example,
improvement and maintenance of physical facilities; upgrading and replacement of
computer hardware and software, etc.).
•
Support for the development of maintenance plans.
•
Support for the improvement of physical facilities; upgrading and
replacement of computer software and hardware.
i
i
i
I
i
i
i
i
I
I
I
l
I
1
10-Point Regional Strategy (or Strengthening Health Information Systems
i
•
Number of countries which have developed, documented and disseminated
maintenance plans for HIS-related resources.
•
Number of countries which have regular budgetary allocation for the
implementation of the maintenance plan for HIS resources.
•
Number of countries which have implemented activities in accordance
with the maintenance plan (example, number of computers upgraded/
replaced using country maintenance budget, etc.).
2.8
Develop/enhance mechanisms for active involvement of different stakeholders in
undertaking management functions for HIS (example, provide general directions;
standardization of system inputs and outputs; clearinghouse for data collection forms;
periodic and regular review of data requirements, and periodic HIS performance
assessment, etc.).
•
Advocacy with countries in eliciting active stakeholder involvement in HIS
management.
•
Support for developing effective mechanisms and defining management
functions for HIS.
•
Number of countries which have developed functional mechanisms for
stakeholder involvement in HIS management (example, number of countries
with a functional multi-sectoral national HIS Committee).
2.9
Develop and disseminate User's Manuals for HIS and its sub-systems.
•
Support for the preparation of the HIS User's Manual.
•
Support for the production/publication of the HIS User's Manual.
•
Number of countries which have developed, reproduced and disseminated
their HIS User's Manual.
10-Poinl Regional Strategy for Strengthening Health Information Systems
Strategic area 3:
3.1
Promotion of data quality
Develop, document, disseminate and implement data quality standards and data
quality control mechanisms (example, completeness of medical records, and use of
ICD).
•
Support for the development of data quality standards and data quality
control mechanisms.
•
Support for the documentation, reproduction and dissemination of data
quality standards and data quality control mechanisms.
•
Number of countries which have developed, documented and disseminated
data quality standards and control mechanisms.
3.2
Produce and disseminate documents (example, instruction manuals, ICD manual,
data dictionary, etc.) which can be used as reference materials by staff in
accomplishing data collection and reporting requirements.
•
Support for the development of reference materials (example, instruction
manuals, data dictionary, etc.), including translation services if necessary.
•
Support for the reproduction/purchase and dissemination/distribution of
reference materials (example, ICD10 manuals).
•
Number of countries which have developed, reproduced and disseminated
reference materials (example, data dictionary, instruction manuals, etc.) for
HIS staff in accomplishing data collection and data reporting requirements.
3.3
Develop/strengthen capacity of surveillance and early warning systems to produce
real-time data, especially during disease outbreaks, epidemics and disasters.
•
Support for the design and development of early warning and rapid
surveillance systems.
•
Support for the installation of communication and other facilities needed
for the rapid transmission and easy access to data.
•
•
Support for staff training on early warning/surveillance systems.
Number of countries with functional surveillance and early warning systems
in place.
10-Point Regional Strategy for Strengthening Health Information Systems
3.4
Provide staff training on data quality, including the use of ICD and other international
classification standards, the vital registration system and International Health
Data
Regulations.
3.5
•
Support for the conduct of training on data quality, including ICD training.
•
Support for the purchase and distribution of ICD Manuals.
•
Number of ICD trainings conducted, by country and type of staff trained.
Design and implement a regular and institutionalized system for the monitoring and
evaluation of data quality at all levels.
•
Support for the design and development of an institutionalized system for
monitoring and evaluation of data quality at all levels, including the
development and documentation of operational guidelines for such a
system.
•
Support for training on the implementation of institutionalized system for
monitoring and evaluation of data quality at all levels.
•
Number of countries which have developed an institutionalized system for
the monitoring and evaluation of data quality at all levels.
•
Number of countries which have allocated a budget for activities related to
the monitoring and evaluation of data quality control at all levels.
3.6
£
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s
i
c
i
c
s
s
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Conduct special studies in situations where data collection and data quality are big
problems (example, sentinel surveillance system, sample vital registration system, etc.).
3.7
•
Support for the conduct of special studies.
•
Number of countries conducting special studies to determine data quality.
Establish linkages with relevant institutions to improve the coverage and timely
transmission of information for the vital registration and disease surveillance systems.
•
Support for the planning and design of linkages with other institutions to
improve the coverage and timely transmission of data.
•
Number of countries wherein the MoH have established linkages with other
I
R
I
I
I
I
institutions to improve the coverage and timely transmission of information
for vital registration and disease surveillance systems.
I
t
I
10-Point Regional Strategy for Strengthening Health Information Systems
I
3.8
Conduct activities to heighten community awareness on the need for birth and death
registration.
•
Support for the implementation of activities to heighten public awareness
on birth and death registration.
•
Number of countries which have conducted activities to heighten public
awareness on the need for birth and death registration.
3.9
Provide incentives for the collection and reporting of good quality data.
•
•
Support for the provision of incentives.
Number of countries providing incentives for the collection and reporting
of good quality health information.
10-Point Regional Strategy for Strengthening Health Information System-
Strategic area 4: Appropriate application of
information and communication
technology (ICT)
4.1
Strengthen capacity to transmit, access and share information at different levels as
well as between MoH and other public health and health-related institutions: conduct
needs assessment, provide computer hardware, software and other information
infrastructure (example, email and internet access, networking, eHealth, etc.) at
appropriate levels, ensuring sustainability.
•
Support for the assessment and design of ICT inputs appropriate for the country.
•
Support for procurement/installation of communication equipment/
infrastructure necessary for the rapid transmission and access of data from the
peripheral to higher levels (example, radios, fax machines, modems, etc.).
•
Support for the procurement/provision of computer hardware, software
and other information infrastructure.
•
Number of countries which have strengthened communication facilities for
the rapid transmission and access of data from the peripheral to higher levels.
•
Number of countries with computerized HIS at national and sub-national
levels.
4.2
Expand IT application (example, geographic information system (GIS), service
availability mapping (SAM), etc.).
•
Support for staff training on expanded IT application (example, GIS,
SAM, etc.).
•
Support for the procurement of software and equipment necessary for
expanded IT application (example, GIS software, PDAs, etc.).
•
4.3
Number of countries applying GIS, SAM, etc. as part of their HIS.
Develop and implement training programme on IT for HIS staff at different levels.
•
Support for the development and conduct of training programmes on IT
for HIS staff at different levels.
•
Number of countries which have developed and conducted training
programmes on IT for HIS staff at different levels.
10-Point Regional Strategy for Strengthening Health Information Systems
3.4
Provide staff training on data quality, including the use of ICD and other international
classification standards, the vital registration system and International Health
Regulations.
3.5
•
Support for the conduct of training on data quality, including ICD training.
•
Support for the purchase and distribution of ICD Manuals.
•
Number of ICD trainings conducted, by country and type of staff trained.
Design and implement a regular and institutionalized system for the monitoring and
evaluation of data quality at all levels.
•
Support for the design and development of an institutionalized system for
monitoring and evaluation of data quality at all levels, including the
development and documentation of operational guidelines for such a
system.
•
Support for training on the implementation of institutionalized system for
monitoring and evaluation of data quality' at all levels.
•
Number of countries which have developed an institutionalized system for
the monitoring and evaluation of data quality' at all levels.
•
Number of countries which have allocated a budget for activities related to
the monitoring and evaluation of data quality control at all levels.
3.6
Conduct special studies in situations where data collection and data quality are big
problems (example, sentinel surveillance system, sample vital registration system, etc.).
3.7
•
Support for the conduct of special studies.
•
Number of countries conducting special studies to determine data quality.
Establish linkages with relevant institutions to improve the coverage and timely
transmission of information for the vital registration and disease surveillance systems.
•
Support for the planning and design of linkages with other institutions to
improve the coverage and timely transmission of data.
•
Number of countries wherein the MoH have established linkages with other
institutions to improve the coverage and timely transmission of information
for vital registration and disease surveillance systems.
14
10-Point Regional Strategy for Strengthening Health Information Systems
3.8
Conduct activities to heighten community awareness on the need for birth and death
registration.
•
Support for the implementation of activities to heighten public awareness
on birth and death registration.
•
Number of countries which have conducted activities to heighten public
awareness on the need for birth and death registration.
3.9
Provide incentives for the collection and reporting of good quality data.
•
•
Support for the provision of incentives.
Number of countries providing incentives for the collection and reporting
of good quality health information.
10-Point Regional Strategy for Strengthening Health Information Systems
Strategic area 4: Appropriate application of
information and communication
technology (ICT)
4.1
Strengthen capacity to transmit, access and share information at different levels as
well as between MoH and other public health and health-related institutions: conduct
needs assessment, provide computer hardware, software and other information
infrastructure (example, email and internet access, networking, eHealth, etc.) at
appropriate levels, ensuring sustainability.
•
Support for the assessment and design of ICT inputs appropriate for the country.
•
Support for procurement/installation of communication equipment/
infrastructure necessary for the rapid transmission and access of data from the
peripheral to higher levels (example, radios, fax machines, modems, etc.).
•
Support for the procurement/provision of computer hardware, software
and other information infrastructure.
•
Number of countries which have strengthened communication facilities for
the rapid transmission and access of data from the peripheral to higher levels.
•
Number of countries with computerized HIS at national and sub-national
levels.
4.2
Expand IT application (example, geographic information system (GIS), service
availability mapping (SAM), etc.).
•
Support for staff training on expanded IT application (example, GIS,
SAM, etc.).
•
Support for the procurement of software and equipment necessary for
expanded IT application (example, GIS software, PDAs, etc.).
•
4.3
Number of countries applying GIS, SAM, etc. as part of their HIS.
Develop and implement training programme on IT for HIS staff at different levels.
•
Support for the development and conduct of training programmes on IT
for HIS staff at different levels.
•
Number of countries which have developed and conducted training
programmes on IT for HIS staff at different levels.
10-Point Regional Strategy for Strengthening Health Information Systems
4.4
Coordinate donor requirements, especially in relation to the use of specialized
softwares.
•
•
Establish mechanisms for the coordination of donor requirements.
Number of countries which have coordinated donor requirements,
especially in relation to specialized softwares.
18
10-Point Regional Strategy for Strengthening Health Information Systems
Strategic area 5:
5.1
Enhancement of mechanisms
for effective communication,
cooperation and coordination
Advocate for the development and implementation of a harmonization mechanism
among donors at the international level.
•
•
Conduct activities for the development and implementation of a
harmonization mechanism among donors at international levels.
Development and existence of a harmonization mechanism among donors
at international levels.
5.2
Develop and implement a strong country policy on HIS coordination/partnerships
•
Support for the development and implementation of policies on HIS
coordination/partnerships among countries, donors, agencies and HIS
stakeholders.
•
Number of countries which have developed and implemented policies on
HIS coordination/partnerships among countries, donors, agencies and HIS
stakeholders.
5.3
Involve donors and other stakeholders in designing the HIS.
•
•
Support for the conduct of activities involving donors and other stakeholders
in designing the HIS.
Number of countries where donors and stakeholders are involved in
designing the HIS.
5.4
Develop/enhance strategies for effective communication between data providers and
data users at all levels, including the provision of feedback mechanisms.
•
•
Support for the development of strategies for effective communication
between data users and data providers, including feedback mechanisms.
Number of countries with operational and effective communication
strategies for data users and data providers, including feedback mechanisms.
10-Point Regional Strategy for Strengthening Health Information Systems
Communication,
Cooperation
and
Coordination
among countries, donors, agencies and HIS stakeholders.
6.1
Advocate for stronger development and greater allocation of HIS resources:
strengthening of the HIS workforce; greater budgetary allocation for HIS-related
activities and needs, and improvement of HIS-related facilities, including ICT.
•
Advocacy with governments for greater allocation of resources for HISrelated activities.
•
6.2
Number of countries which have increased their resource allocation for
HIS-related activities.
Assess/review HIS human resource requirements at different levels in both public
and private sectors (example, number and type of staff needed, job descriptions,
staff qualifications, etc.) and implement corrective measures as needed.
•
Support for the conduct of HIS human resource assessment at different
levels.
•
Number of countries which have conducted an assessment of their HIS
human resource requirements at different levels.
6.3
Develop/enhance and implement career development plan for HIS workforce
resources
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Strategic area 6: Development and allocation of
HIS resources (human, physical,
financial)
(example, development of career path, provision of benefits and incentives, etc.).
•
Advocacy for countries to develop career development plans for the HIS
workforce.
•
Number of countries which have developed and implemented career
development plans for the HIS workforce (example, number of HIS
positions created, number of countries which have developed and allocated
a budget for the implementation of incentive schemes for HIS staff, etc.).
6.4
Develop and implement training programmes on health information sciences and
related fields (example, biostatistics, epidemiology, demography, etc.) and other forms
of specialized training for data providers and data users at all levels.
•
Support for long/short-term fellowships (both degree and non-degree, local
and abroad) for training in health information sciences.
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Support for the development of training materials to be used for local training
on health information sciences.
•
Support for the conduct of in-country short-term non-degree training in
health information sciences and related fields.
•
Number of fellows trained in health information sciencesand related fields,
by type of training and country.
•
Number of in-country short-term non-degree training courses in health
information sciences and related areas conducted, by country.
6.5
Assess/improve HIS-related physical facilities (example, storage space for medical
records, computer room, etc.).
•
Support for improvement of HIS-related physical facilities.
•
Number of countries which have implemented improvement projects for
HIS-related physical facilities.
6.6
Allocate funds for HIS-related activities, including the conduct of special studies and
sample surveys.
•
Advocacy for regular allocation of funds from the country health budget,
for HIS-related activities.
•
Number of countries which have regular allocations in their country health
budgets for HIS-related activities.
6.7
Resource sharing for HIS development, strengthening and maintenance by units within
the MoH, donor agencies, private organizations and NGOs.
•
Advocacy with countries and donor agencies for the adoption of a resource
sharing mechanism for HIS development and maintenance.
•
Number of countries which have implemented a resource-sharing
mechanism among units within the MoH and among donors, for HIS
development and maintenance.
22
10-Point Regional Strategy for Strengthening Health Information Systems
Strategic area 7: Strengthening of data sharing,
analysis and utilization,
at all levels
7.1
Develop/strengthen mechanisms to facilitate vertical and horizontal transmission of
information within the MoH.
•
Support for the design and installation of mechanisms to facilitate easy
access/sharing/interfacing of databases among different information sub
systems within the MoH (example, LAN for computerized systems).
•
Number of countries which have developed and implemented mechanisms
to facilitate easy access/sharing/interfacing of database among different
information sub-systems within the MoH.
7.2
Provide/facilitate access to relevant external data sources, both local and international
(example, Memorandum of Agreement with other agencies for the exchange and
sharing of data, creation of/membership in multi-sectoral technical working groups,
membership in local and international health information networks, etc.).
•
Advocacy for the establishment of linkages between the MoH and other
local and international institutions for the exchange and sharing of health
and health-related data.
•
Number of countries where the MoH has established linkages with local
and international institutions for the exchange and sharing of health and
health-related data.
Establish/enhance an integrated health database or "data warehouse" at national
and sub-national (example, region, province, district, sub-district) levels.
•
Support for the design and development/enhancement of a health "data
warehouse" at national and sub-national levels.
•
Number of countries which have established/enhanced a health "data
warehouse" at national and sub-national levels.
7.4
Develop country-level capability for data analysis and the application of
methodologies to address data problems (example, use of census data to estimate
mortality levels; derivation of country-level estimates for important parameters and
indicators like the prevalence and incidence of diseases, etc.).
•
Support for the conduct of short-term non-degree training in quantitative
methods in the Region and in countries.
10-Point Regional Strategy for Strengthening Health Information Systems
and
utilization
7.3
•
Number of training programmes in quantitative methods conducted in the
Region and in countries.
7.5
Develop/apply appropriate data analysis techniques to address specific areas of
interest to data users (example, generation of specific morbidity and mortality rates
according to geographic (by region, province, etc.) and demographic variables (by
age, sex, cause), time series analysis for determination of trends, risk factors, gender
sensitivity, equity, poverty reduction, etc.).
e
Support for the application of appropriate data analysis techniques to address
specific areas of interest to data users.
o
Number of countries producing data or maintaining database in a form
amenable to further analysis to address specific areas of interest (example,
disaggregated data; time series data, risk factor data, etc.).
7.6
Develop and implement training programmes on data utilization for programme
planning, management, monitoring, evaluation, and policy formulation for MoH staff
at different levels.
o
Support for the development and reproduction of training materials on
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Support for the conduct of training programmes on data utilization for
data utilization.
different types of data users at different levels.
o
Number of countries which have conducted training programmes in data
utilization for different types of data users at different levels.
7.7
Develop mechanisms to facilitate the transmission of essential health information/
evidence to policy and law makers, and its transformation into policy and action
(example, creation of Technical Working Group, conduct of regular briefings with
policy-makers, etc.).
•
Support for the design and development of mechanisms to facilitate
transformation of health information/evidence into policy and action.
•
Number of countries which have developed mechanisms for the
transformation of health information/evidence into policy and action.
•
Number of legislations enacted/policies developed/important decisions
made based on data from the HIS.
7.8
Provide incentives to government units, organizations, etc. for good performance in
utilization of health information for action.
•
Support for the development of operational guidelines for the provision of
incentives for good performance in utilizing health information for action.
•
Number of countries which provide incentives for good performance in
utilizing health information for action.
10-Point Regional Strategy lor Strengthening Health Information Systems
Strategic area 8: Strengthening data collection and
utilization in decentralized systems
8.1
Develop and implement mechanisms to improve the quality of district-level data
and their complete and timely transmission from the districtto provincial and national
levels, under a decentralized system.
•
Support for the development and implementation of mechanisms to
improve data quality at the district level, and ensure the timely transmission
of data from the district to the provincial and national levels.
•
Number of countries with decentralized systems, which have improved
data quality at the district level.
•
Number of countries with decentralized systems which have developed
mechanisms for complete and timely transmission of data from the district
to the provincial and national levels.
8.2
Train district-level staff on data analysis and utilization for programme planning,
monitoring, management and evaluation.
•
Support for the training of district-level staff on data analysis and utilization
for programme planning, monitoring, management and evaluation.
•
Number of countries which have trained district-level staff on data analysis
and utilization.
8.3
Develop and implement mechanisms for the proper dissemination of integrated
district-level data.
•
Support for the development and implementation of mechanisms for the
proper dissemination of integrated district-level data.
•
Number of countries with decentralized systems which have disseminated
HIS in
1
10-Point Regional Strategy for Strengthening Health Information Systems
decentralized
systems
integrated district-level data widely.
Strategic area 9: Effective marketing of HSS products
9.1
Conduct needs assessment and situational analysis for the marketing of HIS products.
•
Support for the conduct of needs assessment and situational analysis for
the marketing of HIS products.
•
Number of countries which have conducted needs assessment and
situational analysis for the marketing of HIS products.
9.2
increase awareness of data users (both within and outside the MoH) on HIS products
(example, types of health information available, how they can be accessed, etc.),
using the services of a professional for the marketing of such products, as needed.
•
Support for the implementation of activities aimed to create awareness of
HIS products.
•
9.3
Number of countries implementing marketing strategies for HIS products.
Regularly publish integrated HIS summary reports covering the core health indicators,
including the MDGs (example, annual health bulletins, health system profiles, etc.).
•
Support for the preparation, publication and distribution of integrated HIS
summary reports.
•
Number of countries which regularly publish integrated HIS summary
reports.
9.4
Improve the quality and content of HIS-related reports and publications.
•
Support in improving the quality and content of HIS reports (undertaking
comparative analysis, inclusion of analytic write-ups, including data and
analysis on topics of current interest, etc.).
9.5
•
Support for the publication and distribution of analytic reports.
•
Number of countries with regular HIS publications which include not only
presentations (graphs and tables) but also critical analysis of data.
Increase the types/modes, coverage and frequency of dissemination of HIS products
for all types of audience, from the general public to policy-makers and national
Support for the design and development of different modes of dissemination
of HIS products appropriate for different types of audience and users.
10-Poinl Regional Strategy for Strengthening Health Information Systems
of HIS
•
products
international community.
Marketing
government officials (example, members of the cabinet, parliament, etc.), and the
•
Financial support for the reproduction and distribution/conduct of different
kinds of dissemination materials/activities.
•
Number and types of dissemination materials/activities for HIS products
developed/implemented by countries.
9.6
Develop, maintain and market the MoH website.
o
Support for the development, maintenance and marketing of the MoH
website.
a
Number of countries which have developed, maintained and marketed
the MoH website.
o
Number of countries posting updated health information on the MoH
website.
10-Poinl Regional Strategy for Strengthening Health Information Systems
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Strategic area 70; Strengthemng linkage between
the national health information
system and the national health
research system
10.1 Advocate for generation of research-based evidence in the health information area.
•
Support for orientation meetings and workshops for increasing awareness
on the need for research-based evidence to support health information.
•
Number of countries which have developed and implemented policies for
research in the health information area.
10.2
Develop/enhance mechanisms to facilitate the dialogue between national HIS and
health research institutions to undertake operations research on issues related to
health information.
10.3
•
Support in identification of issues and the strategic plan.
•
Number of countries which have developed plans for operations research.
Advocate for involvement of research institutions, collaborating centres, and individual
researchers engaged in health system research to undertake studies on issues related
to application of health measurement tools and methods.
•
Support for studies on application of global burden of disease methodology,
health system performance assessment, and other summary measures of
population health.
•
Number of countries which have developed plans for measuring health
status.
•
Number of countries which have developed adequate human resource
capacity and analytical capability for such measures.
10.4
Enhance facilitation/mechanisms for transmission of results of research studies to
help validate the estimates produced based on disease surveillance data.
•
•
Support to facilitate easy access/sharing/interfacing of databases.
Number of countries which have developed and implemented mechanisms
to facilitate easy access to health system research studies.
10-Point Regional Strategy for Strengthening Health Information Systems
Meetings/workshops/fellowships to raise awareness of the importance of a
c oser look at routine records for reporting to initiate timely action where it
is needed most.
Number of countries which have developed and implemented mechanisms
lor health system research at point of health service delivery.
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Develop at national/sub-national-level, the capacity for probing into the routine service
recor s, ringing up any issue requiring action by programme managers, and relating
it to meta-data of research studies.
10-Point Regional Strategy for Strengthening Health Information Systems
From strategy to action
Using the strategic framework as a guide and considering country priorities and the level of
development in the HIS area, countries may wish to further elaborate the country action plans
for strengthening HIS, which were drafted and presented during the intercountry consultative
meeting in December 2005.
It is a Regional Strategy, drafted after several consultative meetings and discussions with
Member countries. Since the health information systems in countries of the Region are at
various stages of development and strengthening, the countries may opt for different steps in
their plans related to improving their HIS as follows:
•
situation analysis/assessment of their HIS, by involving all stakeholders and by
using available assessment tools; or
•
selecting strategic areas to be addressed as a priority based on previous reviews,
assessments and changing needs, and
•
based on results of the assessment, prioritizing and making a short- and long-term
plan of activities for strengthening their HIS including indicators, time-frame and an
estimation of the cost.
Alignment of the stakeholders and partners in health with the countries' plan for
strengthening HIS would be crucial for successful implementation of the action plan. To achieve
this, bringing the partners together during both the planning and implementation phases is
essential. Ownership of the data by countries at both the national and sub-national levels
should be emphasized and expressed by its use at various levels of the health system for evidence
based decisions.
WHO is prepared to technically support the countries in their planning and implementation
efforts. In addition to its technical assistance, WHO would play a catalyzing role in harmonization
of the partners in health and their work related to the countries' HIS.
Regional indicators proposed in this Strategy will be used for monitoring, and reviewing
the progress and for evaluation of the achievements related to countries implementation of the
national strategies, 2006-2015. Periodic programme managers meetings and external reviews
of the countries' HIS in view of the possible changing needs would be held. The Health Metrics
Network tool for assessment of the national HIS might be considered as a standard for reviewing
the progress in strengthening various components of the HIS at the national and sub-national
levels.
10-Point Regional Strategy for Strengthening Health Information Systems
10358
World Health Organization, Design and implementation of health information
systems. Geneva, 2000.
2.
World Health Organization, Regional Office for the Western Pacific. Improving data
quality: a guide for developing countries. Manila; 2003.
3.
AbouZahr C, Boerma T. Health information systems: the foundations of public
health. Bulletin of the World Health Organization. 2005; 83(8): 578-83.
4.
Setel PW, Sankoh O, Rao V, Velkpff VA, Mathers C, Gonghauan Y, Hemed Y, Jha P,
Lopez AD. Sample registration of vital events with verbal autopsy: a renewed
commitment to measuring and monitoring vital statistics: Bulletin of the World Health
Organization. 2005; 83(8):611-7.
5.
Macfarlane SB. Harmonizing health information systems with information systems
in
other social and economic sectors. Bulletin of the World Health Organization.
2005;
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83 (8): 590-96.
World Health Organization, Regional Office for South-East Asia. Data management
for evidence-based decision-making: report of an intercountry workshop, Bangkok,
Thailand, 3-7 December 2001. New Delhi; 2002. Document SEA-HS-221.
7.
Managing performance improvement of decentralized health services. The Manager.
2004; 13(1): 7-25.
8.
United Nations Children's Fund. A statistical analysis of birth registration. The rights
start to life. New York; 2005.
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10.
World Health Organization, WHO Framework for Health Statistics, Geneva, 2005.
World Health Organization, Improving WHO's work in health information: WHO
programme on Health Statistics. Geneva. http://www.whQ.int/healthinfo/statistics/
programmedoc/en/index.html duly 2006).
11.
World Health Organization, Regional Office for South-East Asia. Strengthening
Health Information Systems in countries of the South-East Asia Region: report of an
intercountry consultative meeting, Chiang Mai, Thailand, 14-17 December 2005.
New Delhi; 2006. Document SEA-HSD-285.
10-Point Regional Strategy for Strengthening Health Information Systems
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