Regarding your previous memo to our office on October 25, 2012, which stated that the Stovepipeland current issues in addressing its Health Information System (HIS). As an expert health consultant, it is a great pleasure for me to have this opportunity to help the country in addressing its national HIS. With respect to the country HIS improvement, it is important for this country to conduct an assessment of its current HIS. This assessment will enable the country to identify the strengths and weaknesses of its national HIS, which will be used as basic information for the HIS developing matter. Therefore, in this memo, I will give a general description about indicators of a well designed HIS and recommendations for the country related to the HIS improvement and the process for its initial HIS assessment. A Well-Designed Health Information System
Before Stovepipeland conducting the evaluation of its current HIS and making improvement for the system, it is better to have a better understanding about the components of a well designed HIS. A good quality of HIS; data collection, analysis, dissemination, and use, will support the country National Health System (NHS) by helping the stakeholders to identifying community’s health problems and needs, tracking the progress of health care interventions, evaluating the impact of the services, and making decision about the health policies, programs design, and resource allocation (HMN, 2008). Based on the HMN tool-book (2008), the standard HIS has six components; resources, indicators, data sources, data management, information products, and dissemination and use, which are subdivided into three major components; inputs, processes, and outputs.
* Input of a better HIS is the resources which consists of human resources (skilled people that accountable for health data collection, analysis, and reporting), financing, logistic support (development and supporting system that can optimize the HIS resources uses), information and communications technology (ICT) that can improve the availability, dissemination, and used of health related data, and coordinating mechanism within and between the HIS components. Above all these aspects, HIS resources also include the legislative, regulatory and planning frameworks that have roles to ensure the HIS is fully functioned. * Processes of HIS have three main components; indicators, data sources, and data management. A best information system can provides important indicators and related targets for determinants of health, health status, and health system of the country.
Health related data within a country can be gathered from two main data sources; population and institutional. Both data sources are needed to support each other in order to avoid data duplication or overlap data that can mislead the data user in the future. Censuses, civil registration, and population surveys are some examples of population-based information, while individual, service, and resource records are the methods for institutional-based. Furthermore, there are two methods to collect the health related data; routine and non-routine methods of data collection. Health related data is collected based on patients information in the health facilities, while non-routine method on the other hand is collected by surveys, quantitative and qualitative rapid assessment methods, and other special studies (Lippeved, et al,. 2000).
The last component of HIS processes, data management, encompass in all aspects of data handling; collection, storage, quality assurance and flow, to processing, compilation, and analysis. The most important thing in data management is how to ensure the data timeliness, because the late information would not help the stakeholders to make a right decision. * Outputs of HIS cover the information products, and its dissemination and use. A well designed HIS can produce good quality information that can be used as evidence and knowledge to improve the NHS, make the information accessible for the stakeholders, and provide the incentives for using the health related information. Improving the Stovepipeland Health Information System
After having a sense about what makes a better HIS, it is better to have an assessment of the current HIS condition in Stovepipeland. This evaluation will give us detailed information about HIS strengths and weaknesses, which will be used to identify what particular areas are needed to be improved in order to make a better HIS; using the standard of a well-designed HIS. In regards of improving the HIS, there are some HIS improvement tools; provided by international organizations and already proved its effectiveness to improve the HIS in several developing countries (Aqil, A., 2008), available for use in Stovepipeland. Furthermore, I personally recommend Stovepipeland to adapt and combine the Health Metrics Network (HMN) framework and Performance of Routine Information System Management (PRISM) framework. Even though these frameworks have the same intention; strengthening HIS, each of them has different specific methods to achieve an adequate HIS.
HMN is a tool that can use to strengthening national HIS while PRISM specifically strengthens the daily information management, mainly in front liner health services. According to Health Metrics Network (2009), in order to develop the HIS using the HMN framework there are three important things needed to address; role of leadership, coordination, and assessment, priority-setting and planning process, and implementation of HIS strategies activities. On the other hand, PRISM framework is emphasis on utility and effectiveness the routine health information system (RHIS) by gauging health workers performance, placing RHIS performance in the system, and providing evaluation mechanism, and focusing on problem solving and continuous improvement (Aqil, A. 2008 and 2009). The main reason why I am thinking that these two frameworks can help, because these frameworks can be complementary to each other and make the HIS system is better.
Due to its focus on assessing and improving the HIS at national level, it will take time for HMN framework to achieve the goal. Additionally, we know that health services cannot be stopped just to wait for the results of HMN. Thus, the PRISM is helpful to provide adequate information for RHIS then support the implementation of HMN in the future. Assessment of the Health Information System in Stovepipeland Furthermore, in terms of the HIS assessment, in this case combining the HMN and PRISM tools, I will recommend some scenarios how these evaluation will be done in Stovepipeland. In HMN assessment tools (2008), all major stakeholders; producers, users and financers of health information, and other social statics at various national and subnational level, should be involve in assessing the national HIS (NHIS) and planning for its improvement. Several workshops then will be conducted in order to build the consensus among these stakeholders.
Furthermore, there will be three phases; leadership, coordination and assessment, priority setting and planning, and implementation of HIS strengthening activities, that these stakeholders are going to do in the process of improving and strengthening the NHIS using the HMN method. On the other hand, due to the main objectives of PRISM framework; strengthening the RHIS, the PRISM method will be use at health facility levels and conducting by health workers at that facility levels. At this level, we will evaluate RHIS data generation process, start from its indicators, data collection, transmission, processing, analysis, and its management.
As a result of combining the HMN and PRISM frameworks for evaluating, improving, and strengthening the Stovepipeland NHIS, I strongly believe, the outcomes is not only the ability to produce a good-quality health related data, but also the ability to produce relevant information for the decision makers will use to make transparent and evidence-based decision for the health system improvement. Finally, considering the importance of strengthening HIS in order to supporting the health system in Stovepipeland, I hope you can take my recommendation to use the HMN and PRISM frameworks into your consideration. I would be very happy to discuss your thoughts about my proposed solutions and any ideas for addressing this NHIS issue in your country. I appreciate your time and look forward to hearing from you.
Aqil, A. (2008). PRISM Case Studies: Strengthening and Evaluating RHIS. USAID – Measure Evaluation.
Aqil, A., Lippeveld, T., & Hozumi, D. (2009). PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information
systems. Health Policy and Planning, 24(3), 217-228.
Health Metrics Network. (2008). Framework and Standards for Country Health Information Systems [Second Edition]. World Health Organization.
Health Metrics Network. (2009). Guidance for the Health Information Systems (HIS) Strategic Planning Process: Steeps, Tools, and Templates for HIS System Design and Strategic Planning, Version 6. Health Metrics Network.
Lippeveld, T., Sauerborn, R., & Bodart, C. (Eds.). (2000). Design and implementation of health information systems. Geneva: World Health Organization.