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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) - PowerPoint PPT Presentation
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Health Information Systems Challenges
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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“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 quality data (covered later in the course)– You need to know what to do with it
Picture: HMN
Accessible data?
Picture: HMN
The lack of access to health information
Why?
Multileveled fragmentation
Uncoordinated Health programs
Different Health information domains
Public/private
Many electronic formats (and paper still very common)
Some Global Trends and Goals
Towards more granular patient based dataGlobally, 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.
Towards integrated and shared dataMany ministires of health are fragmented and have vertical programs with their own reporting and data analysis systems (+ donors)
From Paper to Digital (integration or more mess?)
From ‘data collection’ to evidence based decision making
Mobiles and ICT often proposed as solutions technical solutions to social problems??
Example Routine PHC data (clinic/outreach)
Special programme activities
Reproductive healthChild health & nutritionHIV/AIDS, STI and TBChronic diseases
Routine Service Activities
Minor ailmentsNon-priority activities
Epidemiological surveillance
Notifiable diseasesEnvironmental health
Administrative Systems
Infrastructure, equipmentHuman resourcesDrugs, transport, labs, finances, budget, staff
Population Census: age, sex, placeBirths & deaths registration
Registers/records Record data that need follow-up over long periods such as ANC, immunisation, FP, TB
some registers in Practice…
PaperReports
monthly,Quarterly
but there are many different reports….
Fragmentation of health programs
One information stream for Malaria program
One information stream for TB program
One information stream for… etc etc etc
Surveys
Data not available for comparison. Double counting, low data quality
Country X (e.g., Malawi): three national figures of HIV+ rate or infant mortality rate. All different…
Many official actors: risk of fragmentation
Ministry of Health is not alone…– Central Statistics office (census)– Ministry of Local Government (run the clinics)– Ministry of Education (school health programs)– Ministry of Defence (military clinics)– Special units on for example HIV
What does this look like In Norway?
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 programmesSmallpox 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
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But health systems continued to be inefficientShort-term successes were not addressing poor populations overall disease burden
Health systems were urban based, high-technology, curative oriented.
Little contact with the population for preventive care
Health is socioeconomic:– Health services, economy, security, education,
nutrition…
More comprehensive approaches emerged in a number of countries
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Primary Health Care
Promotive, preventive, and curative
Involves related sectors (education, food, agriculture etc), and wider aims (equity, affordability etc)
Promotes community and individual involvement and committment
Came as a reaction to older, high-tech, curative approaches. Based on bottom-up experiences from ”developing world”
How to implement it? Comprehensive vs selective? Overarching question ever since
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Comprehensive vs. selective today?
Both exists
WHO is still very fragmented in specific programs, which are replicated at country level
Cross-cutting units have been created; Health Metrics Network
In other areas, new agencies have been created to target specific areas: Global Fund, UNAIDS, GAVI Alliance
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HMN Framework: An example of comprehensive appraoch to HIS
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A selective approach to HIS
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ARVARVARV patient
Paper records
CRIS
HospitalHospital
In & out patients
Records / registers
Compiled
monthly reports Data capture
Data capture
PMTCTPMTCT OtherOther
Data capture
ICSICSMorb
idity .
Morb
idity .
ICSSUM
Summary report
Summary report
District:
Fragmented
Data management
Facility:
Multiple Forms
& registers
ExcelExcelExcel
ExcelExcelExcel
ExcelExcelExcel
Data capture
ExcelExcelExcel
ExcelExcelExcel
Summary
reports
National: Fragmented reporting; gaps & overlaps
Data sources not linked
(hospitals - poor)
ExcelExcelExcel
SUM
CRISExcelExcelExcel
ICSOther
data
sources
Other
data
sources
Facilitysurveys
Excel
Facilitysurveys
ExcelExcel
Comprehensive vs. selective: ICTsComprehensive: integration, comprehensive information needs, varied outputs
Selective: Silos, fragmentation, inefficient development and utilization of infrastructure. Closed-boundary ICT systems. Potential for cross-comparison of indicators is lower.
Both: provision of health services decentralized. IS needs to allow local levels to collect, process, and use information
Scope for various technologies to contribute: Mobile phones, mobile modems to access online services
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The MDGs in the PHC tradition(millenium development goals)Adopted by UN in 2000, to reach by 2015 goals related to:
1. Poverty and hunger
2. Universal primary education
3. Gender equality
4. Child mortality
5. Maternal health
6. HIV/AIDS, Malaria, and other diseases
7. Environmental sustainability
8. Developing global partnership for development
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The MDGs in the PHC traditionDespite the comprehensiveness of the MDGs, selective approaches within health continues
Addresses some critique of selective PHC– Take into account the broader context of development– Does ackowledge the role of social and gender equity
Still challenges related to:– Donor-driven technocratic approach to priorities, rather than
grassroot approach of Alma Ata– Vertical objectives, fighting one disease at a time– Little coordination among vertical programs
New actors find legitimacy in the MDGs for focusing on specific areas, contributing to and sustaining fragmentation 27
In Conclusion
There is a strong trend towards individual and encounter-based data (drilling down)
– Security, patient confidentiality, robustness
Increased focus on Civil Registration and Vital Statistics will lead to new requirements for selective sharing of data
– Birth data: not all stakeholders should get all data– Who has access, who owns the data
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In Conclusion II
ICTs only as effective as the system they support
International health community becoming increasingly aware of the limitations of ICTs:
What ICTs can do? Help in integration, collection, storage, processing, presenting information. Decentralization. Community empowerment, but not without its challenges
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