Collaborating Across Sectors for Change › 2011 › 03 › asia... · Health Information Systems June 13-16 2011, Manila, Philippines. Collaborating Across Sectors for Change Report

Collaborating Across Sectors for Change

Report on the Asia-Pacific Leadership Forum on Health Information Systems

June 13-16 2011, Manila, Philippines

Collaborating Across Sectors for Change Report on the Asia-Pacific Leadership Forum on

Health Information Systems

Prepared by: Ruben Canlas, Ateneo School Of Medicine And Public Health, Philippines Submitted by: AIDSTAR-Two Project, Management Sciences for Health Submitted to: Laurie Rushton, Contract Officer’s Technical Representative for AIDSTAR-Two, USAID/ Washington Contract No.: GHH-I-00-0700068-00 This document is made possible by the generous support of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID) under contract No. GHH-I-00-0700068-00. The contents are the responsibility of the AIDSTAR-Two Project and do not necessarily reflect the views of USAID or the US Government

Table of Contents

Acronyms ....................................................................................................................... 2

Executive Summary ....................................................................................................... 3

Introduction ...................................................................................................................... 5

Day One: June 13, 2011 ...................................................................................................... 8

Welcome Remarks by Maylene M. Beltran, Director, Philippine Department of Health ...................... 8

Introduction and Lessons to Date by John Novak, Senior Monitoring and Evaluation Adviser, USAID-Washington .............................................................................................................................. 9

Pre-forum HIS Survey Results .................................................................................................... 10

Impact Story #1: Thailand by Dr. Boonchai Kijsanayotin, Research Manager & Secretary of the National Health Information Committee , Health Service Research Institute, Thailand ................................. 13

Technical Overview of HIS by Dr. Ramesh Krishnamurthy, Information Systems Manager, World Health Organization ........................................................................................................................... 15

HIS Country Ownership and Leadership Continuum by Mark Landry, Health Information Technical Officer, Western Pacific Regional Office of the World Health Organization ................................................ 19

HIS Ownership and Leadership Session Summary ........................................................................ 21

Day Two: June 14, 2011 .................................................................................................... 23

A Collective Vision for HIS by Professor Dr. Abul Kalam Azad, Director, MIS, Ministry of Health and Family Welfare, Bangladesh ................................................................................................................ 23

Impact Story #2: Vietnam by Associate Professor Nguyen Hoang Phuong, PhD; Deputy Director, Department of Science & Training Ministry of Health, Vietnam ....................................................................... 25

Creating an Information Culture in HIS ....................................................................................... 27

by Dr. Theo Lippeveld, MD, MPH, Senior HIS Advisor, MEASURE Evaluation ................................... 27

Multi-sectoral Engagement and Coordination ............................................................................. 30

Day Three: June 15, 2011 .................................................................................................. 32

Investing in Multi-sectoral Collaboration by Ummuro Adano, Senior Technical Advisor of Capacity Building, AIDSTAR-Two Project, Management Sciences for Health .............................................................. 32

Resources to Support HIS Strengthening .................................................................................... 34

by Mark Landry, Health Information Technical Officer, Western Pacific Regional Office of the World Health Organization and ..................................................................................................................... 34

John Novak, Senior Monitoring and Evaluation Adviser, USAID-Washington ................................... 34

Day Four: June 16, 2011.................................................................................................... 35

Impact Story #3: Philippines by Crispinita Valdez, MIS Director, Department of Health, Republic of the Philippines .............................................................................................................................. 35

Inter-Team Reporting and Networking ....................................................................................... 36

The Virtual Leadership Development Program by Sarah Johnson, Project Director, AIDSTAR-Two Project, Management Sciences for Health .............................................................................................. 38

Donor/Partner Next Steps by Mark Landry, Health Information Technical Officer, Western Pacific Regional Office of the World Health Organization .................................................................................... 41

Closing Remarks ...................................................................................................................... 42

by Assistant Secretary Nemesio T. Gako, Philippine Department of Health ..................................... 42

Appendices ..................................................................................................................... 44

Appendix 1: Continuum ........................................................................................................ 45

Appendix 2: Request for Follow-on Assistance Form ............................................................ 47

Appendix 3: Participant List ................................................................................................... 48

Appendix 4: Forum Program .......................................................................................... 54

Appendix 5: Forum Evaluation Summary .............................................................................. 60

Appendix 6: Country Team Action Plans ............................................................................... 63

Appendix 7: Technical Note on Multi-sectoral Collaboration .................................................. 95

Asia-Pacific HIS Forum Report 2

Acronyms

ADB Asian Development Bank CCM Country Coordinating Mechanism CDC Centers for Disease Control DFID Department for International Development (United Kingdom) DHIS District Health Information Software (Bangladesh) DOD Department of Defense (United States) DOH Department of Health (Philippines) GAVI Global Alliance for Vaccines and Immunization GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit HIS Health Information Systems HMIS Health Management Information Systems HMN Health Metrics Network ICT Information, Communication Technology ICT4H TWG Information, Communication Technology for Health Technical Working Group IDRC/CRDI International Development Research Center IT Information Technology ITU United Nations International Telecommunication Union JICA Japan International Cooperation Agency MIS Management Information Systems MOF Ministry of Finance MOH Ministry of Health MOPH Ministry of Public Health NECTEC Thailand’s National Electronics and Computer Technology Center NHIC National Health Information Committee NGO Non-Governmental Organization NORAD Norwegian Agency for Development Cooperation PEPFAR U.S. President’s Emergency Plan for AIDS Relief PHIN Philippines Health Information Network PRISM Performance of Routine Information Systems Management SLG Stakeholder Leadership Group SPC Secretariat of the Pacific Community THINK Thai Health Information Network TWG Technical Working Group UNESCAP United Nations Economic and Social Commission for Asia and the Pacific USAID United States Agency for International Development WHO World Health Organization


Executive Summary

Accurate, high quality, reliable data on health outcomes, service delivery indicators and the overall performance of the health system is essential for assessing, planning, implementing, monitoring and evaluating health interventions and health trends in every country. The goal of a functional Health Information System (HIS) is to provide that information at all levels of the system and serve as a tool to help pursue better health outcomes. After the successful implementation of two Health Information System fora in Africa (Addis Ababa, Ethiopia in August 2009, and in Windhoek, Namibia in October 2010), a third HIS Forum was conducted in Manila for the Asia-Pacific region, June 13-16, 2011. Hosted by the Philippine Department of Health (DOH) at the WHO Western Pacific Regional Office (WPRO), the Asia-Pacific Leadership Forum on Health Information Systems was sponsored largely by USAID, with participant sponsorship by the International Development Research Centre (IDRC), Health Metrics Network (HMN), the International Telecommunications Union (ITU), and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ). The four-day event in Manila brought together multi-sectoral teams from nine countries (Bangladesh, Cambodia, Fiji, Indonesia, Lao PDR, Mongolia, Thailand, Philippines, and Vietnam) as well as development partners. It featured discussions and exchanges across different sectors and countries, which enabled participants to compare notes and learn from their stories, issues, and best practices. The last day of the forum produced action plans and commitments from attendees to move forward. The primary goal of the forum series is to foster country ownership and leadership in meeting the challenges to building national HIS. These challenges include governance and multi-sectoral engagement, strategic planning and financing, policy and regulatory environments, infrastructure, human and institutional capital, system standards and interoperability, and information quality and use. The emphasis on ownership acknowledges a change in the relationship between national governments and donors, and the desire to increase recipient control over planning and implementation of donor funded projects. Among the key outcomes achieved at the forum:

Asia Pacific Forum participants recognized and articulated the importance of multi-sectoral collaboration to strengthen country led and country owned HIS.

Each country team developed an action plan to address priority HIS gaps.

It was agreed that future requests for technical assistance and support would be channeled through the WHO WPRO to be shared with donors and partners, who committed to review and respond to support requested as a follow-up to the Forum. A resource request form and guidelines were provided to country delegates.

The Virtual Leadership Development Program (VLDP) was launched, and is taking place from July 18 through October 21, 2011. Country teams from Bangladesh, Cambodia, Fiji, Mongolia, Lao PDR, Philippines, Thailand, and Vietnam are actively participating.

Country teams and donors committed to continue their involvement as leaders and change agents, and stay committed to the HIS strengthening agenda including the promotion of regional networking opportunities.

The 17 donors and development partners associated with the Forum committed to better coordinated follow up and networking to aid with country HIS strengthening.


By bringing stakeholders together in one venue and allowing them to dialogue face-to-face, the HIS Forum planted the seeds from which further collaboration in the region could grow. This report is organized first by an overview of the forum, its participants and donors/sponsors, objectives and goals. The report is organized by day and covers each plenary session and inter-country report-out sessions, includes the transcribed opening remarks on day one, and the closing remarks on day four. An overview of country team working group sessions is included as well. Appendices include the HIS Forum Leadership Continuum, a copy of the follow-on Assistance Request Form, the participant list, the event program, the country action plans, and a technical note on multi-sectoral collaboration.


The Asia-Pacific Leadership Forum on Health Information Systems

Introduction

Low and middle-income countries face a wide range of health-related challenges, and the health systems that tackle these challenges are often under-resourced financially, structurally, and in human capacity, management and leadership. Well-managed and coordinated health information systems are critical to making informed policy and program decisions that have a direct impact on the provision of lifesaving, health-promoting public health services. From the community to the facility to the technical and policy leadership level, accurate and timely data and the use of this data allow resources to be planned and allocated appropriately according to documented need and help to ensure both the sustainability and accountability of health investments by governments and donors, and improved program and policy decisions. Too often, however, health information is hard to access, of poor quality, and fragmented. Coordinated multi-sectoral HIS leadership and systems are frequently lacking. Country-led HIS – sometimes referred to as country ownership – has been broadly embraced by the donor community as a critical element of development aid. Transitioning to a country-owned and managed HIS helps form the basis for planning, sustainability, accountability, and evidence-based decision making. Strengthening a national HIS also involves addressing many non-technical issues: multi stakeholder participation, galvanizing support from policy makers, convincing data owners to share and collaborate, and sustaining HIS projects even without donor funding. Through country ownership of HIS efforts, transforming HIS advocates into change agents, and motivating more leadership collaboration across sectors, real change is possible – change that will lead to better health outcomes at a national and regional level.

After successfully implementing two forums in Africa (Addis Ababa, Ethiopia in August 2009, and in Windhoek, Namibia in October 2010), a HIS Forum was

Date June 13-16, 2011

Location

Western Pacific Regional Office of the World Health Organization;

Manila, Philippines

Numbers Country teams: 9 Participants: 129

Sectors represented:

Health, Finance, Planning, ICT, and the Private Sector

Overview

“… Information is the foundation of sound health policies and plans. Quality information is… essential for health service delivery at all levels in the pursuit of better health outcomes. It is …clear that the health department cannot do the work alone, HIS is a multi-sectoral effort.”

– Assistant Secretary Nemesio Gako, Department of Health, Republic of the Philippines


conducted in Manila for the Asia-Pacific region. The forum was hosted by the Philippine Department of Health (DOH) at the WHO Western Pacific Regional Office (WPRO) from June 13-16, 2011 and sponsored largely by USAID with participant sponsorship by the International Development Research Centre (IDRC), Health Metrics Network (HMN), the International Telecommunications Union (ITU), World Health Organization (WHO) and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ).

The objectives of the Asia-Pacific HIS Forum were the following:

1. Broaden delegates’ perspectives on implementation options, challenges, and roles related to HIS by interacting with colleagues from other countries and sectors.

2. Develop a shared awareness of the roles of various sectors in strengthening HIS and the options and strategies for improving cross sector coordination.

3. Explore leadership roles in managing health information systems as a national asset. 4. For delegates and donor participants: work together to develop preliminary action plans to

promote stakeholder engagement and commitment to HIS. 5. For donor participants: highlight relevant follow-on resources (information, financial, and

technical assistance) available in their respective sectors to strengthen the HIS Forum Agenda. The four-day event in Manila brought together multi-sectoral teams from nine countries (Bangladesh, Cambodia, Fiji, Indonesia, Lao PDR, Mongolia, Thailand, Philippines, and Vietnam) and development partners. It featured discussions and exchanges across different sectors and countries. The Forum allowed participants to compare notes on and learn from their stories, issues, and best practices. By bringing stakeholders together in one venue and allowing them to dialogue face-to-face, the HIS Forum planted the seeds from which further collaboration in the region could grow. The last day of the forum produced actionable plans and commitments from countries and development partners. Multi-sectoral country delegates were joined by representatives from USAID, the World Health Organization (WHO), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), U.S. Centers for Disease Control and Prevention (CDC), Rockefeller Foundation, Japan International Cooperation Agency (JICA), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), the Canada International Development Research Center (IDRC), the International Telecommunications Union (ITU), UN Economic and Social Commission for Asia and the Pacific (UNESCAP), Secretariat of the Pacific Community (SPC), and the University of Queensland HIS Knowledge Hub (HIS Hub). A total of 17 donors, technical agencies, and development partners provided financial, technical, and post-Forum commitment to follow up (see page 8). The Asia Development Bank (ADB), World Bank, Norad, DfID, Health Metrics Network, and AusAID are engaged but were unable to participate in person at the Forum. The donors and partners have agreed to support better coordinated technical assistance and improved networking to aid countries more effectively with HIS strengthening. Forum organization and facilitation were provided by the Training Resources Group, Inc. (TRG). An advance survey on HIS in the invited countries as well as the creation of impact stories was conducted by Futures Group International. The USAID-funded AIDSTAR-Two project with Management Sciences for Health (MSH) served as Secretariat, providing organization, coordination, technical and logistical support services for the event. The Department of Health, Philippines and the WHO Western Pacific Regional Office (WPRO) in Manila provided invaluable local and regional coordination, facilitated the participant nomination and invitation process and generously contributed to many other conference convening services and support.


Forum Sponsors and Donors included:

• Philippines Department of Health (DOH)

• Asian Development Bank (ADB)

• Centers for Disease Control (CDC)

• Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)

• Health Metrics Network (HMN)

• HIS School of Population Health, University of Queensland

• International Development Research Center (IDRC CRDI)

• Japan International Cooperation Agency (JICA)

• Norwegian Agency for Development Cooperation (Norad)

• Secretariat of the Pacific Community (SPC)

• UK Department for International Development (DFID)

• UN Economic and Social Commission for Asia and the Pacific (ESCAP)

• UN International Telecommunication Union (ITU)

• United States Agency for International Development (USAID)

• United States Department of Defense (DOD)

• United States President’s Emergency Plan for AIDS Relief (PEPFAR)

• World Health Organization (WHO)


Day One: June 13, 2011

Welcome Remarks by Maylene M. Beltran, Director, Philippine Department of Health

“It is my honor to welcome you to our beautiful country, the Philippines, for this worthy event.

In the past decade, we have seen the dramatic changes brought about by information and communication technology. Taking all the new innovations being developed, it is high time that we make technology work for health information. As a public health policy maker, I need to know how many mothers suffered from maternal complications and why, how many babies are experiencing harmful disorders that are not apparent at birth, the occurrence of diseases, the available health services, who will pay for these services and many more. Policy makers and program officers need this information at the right time to be able to design new, more effective interventions and to craft more sound policies and standards.

I know that the Philippine Health Sector has already these systems and currently working on the integration of these various systems. But, I also need to know the environment within which these events take place.

We all know that health events do not occur in a vacuum, there are social, economic, environmental health determinants that have to be taken into account in developing sound health policies and strategies.

Corollary, health ministries and departments do not operate in a vacuum, they also need to collaborate and work with other sectors of government and civil society. For this reason, we very much welcome participants from other sectors such as finance, telecommunications, the private sector and of course development partners. With them at our side, we will be able to trail-blaze our way to a more efficient and effective health information system.

The same technology that gave us the internet has made the world a global village. Geographic boundaries have “shrank”, physical distance is no longer a barrier and everybody is just a few keystrokes away. Collaboration, coordination and sharing of knowledge between and among countries have become very easy.

In closing, I would like to thank you and to ask all of you to help ensure the utmost benefit from this forum through sound discussions, open exchange of ideas, and positive commitment to enhancing future actions on health information system development and ownership towards better health outcomes for all our people in this region.

Again on behalf of the Department of Health, welcome to the Philippines and in Filipino we say, Mabuhay!”


Introduction and Lessons to Date by John Novak, Senior Monitoring and Evaluation Adviser, USAID-Washington

Country ownership is rooted in the principles of the Paris Declaration 1 which was signed by donors, multinationals, and governments on March 2, 2005. This requires aligning donors with country-led strategies; emphasizing country leadership to achieve results; and harmonizing efforts, pushing for transparency, and managing for results.

The desired outcomes of this forum include:

• Credible, practical country action plans that build upon policies and plans in place in the country to expand and strengthen multi-sectoral coordination.

• A credible, practical, and timely donor plan to provide coordinated follow-up support at the country level for country teams attending the Forum

• Some demonstration that we have begun to align our behaviors with the principles of the Paris Declaration.

The donors have attended this forum to usher in a new era of partnership, to figure out how to be more responsive to the countries’ needs, and how to support country ownership.

The most important challenges to build HIS are to build political will, institutional capacity, and a supportive policy/regulatory environment. To succeed, we must design and facilitate behavior change at the individual and institutional levels.

One important lesson from the Africa experience is to establish a management unit to coordinate and monitor implementation of a multi-sectoral HIS. This unit must have sufficient authority, resources and the expertise to succeed. Its members must have skills in Task Management, Organizational Development, Change Management and HIS Technical Support.

1 OECD Website: http://www.oecd.org/document/15/0,2340,en_2649_3236398_35401554_1_1_1_1,00.html

“It is now the norm for aid recipients to

forge their own national development

strategies with their parliaments and

electorates (ownership); for donors to

support these strategies (alignment)

and work to streamline their efforts in-

country (harmonization); for

development policies to be directed to

achieving clear goals and for progress

towards these goals to be monitored

(results); and for donors and recipients

alike to be jointly responsible for

achieving these goals (mutual

accountability).”

-- OECD Website

http://www.oecd.org

Highlights of the Paris Declaration

http://www.oecd.org/document/15/0,2340,en_2649_3236398_35401554_1_1_1_1,00.html

http://www.oecd.org/


Pre-forum HIS Survey Results by Anita Datar Garten, CDC Kenya HMIS/Informatics, Project Manager, Futures Group

The Futures Group conducted a pre Forum survey from January – June 2011 to produce a snapshot of the state of HIS in Asia-Pacific countries. Findings show promising practices that highlight country-owned and country-derived solutions. These encourage sharing of information and lessons learned within and across country delegations. The survey results served to provide a more evidence-based foundation from which forum discussions could proceed. Common challenges across countries provide a starting point for developing an action plan and a roadmap for strengthening HIS. The parameters of the pre Forum survey are detailed at the end of the results.

Summary of HIS Challenges Identified by countries. These are the challenges shared by countries developing their HIS:

Governance and Multi-sectoral Engagement Securing political leadership for HIS Reducing siloed HIS activities and increasing multisector coordination Enforcing private sector reporting

Strategic Planning and Financing Ensuring evidence-based decision making in planning Increasing donor coordination and harmonization of systems Information Use Increasing data quality and confidence Strengthening data analysis skills Encouraging health information sharing and use Building strong data culture at all levels Human Capital Development Building stable health care workers trained in HIS Training medical professionals in management System and Data Interoperability Addressing fragmentation of HIS sub-systems Increasing interoperability across HIS sub-systems

Summary of Promising Practices. Countries are adapting these practices worth sharing to other countries:


Country Actions Taken Barriers Broken

Bangladesh • Draft Health Sector Development Plan (2011-2016) emphasizes development and strengthening of routine HIS.

• All public health hospitals connected to DHIS 2.0, which allows for interoperability in reporting from the field to central level.

• Priority Communicable Disease Surveillance data also updated weekly through web-based software from 64 districts and 6 divisional headquarters.

• Challenges in data reporting are being addressed to improve timeliness and produce a clearer health information picture.

Cambodia • In 2009 MoH redesigned and rolled-out web-based national HIS.

• Ongoing, regular meetings between MoH and URC programmers ensure capacity transfer and ownership of web-based HIS.

• Result: 100% reporting from all public facilities across provinces.

• Next steps include expanding roll-out to NGO hospitals and private clinics.

• Reliance on external expertise decreasing, while simultaneously building in-country capacity to manage national HIS.

Fiji • Health sector issues fall under social sector within MOF.

• MoH and MOF work in close collaboration, meeting regularly to discuss health sector needs and funding priorities.

• When MoH comes up with new policies, they work directly with MOF to understand budgetary implications and determine priority needs.

• “Siloed” agency activities giving way to coordinated strategic planning that ensures stakeholder engagement and buy-in.

Indonesia • MoH currently developing HIS strategic plan (2011-2015) ;

• Led by MoH with strong engagement from educational institutions, the Agency for Population and Family Planning, the Central Bureau of Statistics, and the Ministries of Communication and Information, and Home Affairs.

• Isolated planning replaced with MoH leadership of a multi-sectoral and coordinated process.

Lao PDR • In 2010, adopted Lao PDRInfo, which serves as a national database intended to improve coordination and sharing of information;

• First piloted at the MoH , including training for health workers to understand data needs for M&E and reporting on MDGs;

• By 2011, expanded roll-out to five Ministries including Agriculture, Forestry, Education, Finance, and Commerce.

• Efforts underway to build awareness of data needs and understanding of relationship to better health outcomes.

Mongolia • Currently drafting five-year HMIS strategic plan, which aligns with e-health strategy.

• Established HIS steering committee (led by Vice Minister of Health) to coordinate and harmonize HIS activities among partners, donors, and other key agencies including the Ministry of Finance.

• Emphasis on leadership, political commitment, and multi-sectoral engagement.


Country Actions Taken Barriers Broken

Philippines • 2007, establishment of Philippines Health Information Network.

• PHIN built linkages between stakeholders, assessed the state of HIS, and formulated the strategy for HIS development.

• Drafted plan outlining need to implement standards and improve access to and dissemination of health information.

• Fragmented HIS giving rise to improvements in sub-system data flow, interoperability, and a clearer health information picture.

Thailand • Assessed status of eHealth to understand ICT uptake and identify and areas for improvement.

• Strength: Thailand is leading with respect to use of ICT.

• Challenge: Need to strengthen eHealth foundation with emphasis on establishment of governing body.

• Efforts underway to establish national level, multi-sectoral authority to support e-Health.

• Expanding definition of HIS strengthening to go beyond the technology challenge and focus on leadership.

Viet Nam • In 2010, revised National Statistical Indicator System.

• Government Statistical Office collects data on over 350 indicators including 20 health indicators from the MoH.

• Established central repository, which serves as the source for annual statistical publication.

• Transparency and increased access to information leading to emerging information picture.

Sectoral Reflections. These reflections from different sectors reinforce the importance of collaboration and the critical role that delegates from sectors other than health will play in building HIS:

• Health and improving communication. “We recognize the need to have a multi-sectoral approach. The forum will help us create dialogue in-country.”

• Statistics and strengthening the data culture. “We hope to increase access to health data and encourage data use to improve health outcomes.”

• Finance and evidence-based decision making. “We really need to have reliable information in place to ensure proper financing.”

• Telecommunications and forming communities of practice. “There is a growing demand to apply ICT to solve health challenges…. *The forum+ will help *us+ establish a community of practice for the region and strengthen South-to-South collaboration.”

Parameters of the Pre Forum Survey

Methodology. The survey used a semi-structured interview guide that posed the questions:

• Who is currently coordinating, contributing, and using HIS data?

• What are some challenges to strengthening HIS?

• What steps have been taken to strengthen HIS?


The Futures Group interviewed 27 resource persons from February to June 2011. Interviewees were technical experts in health, finance, statistics, and telecommunications.

Limitations. The study had the following limitations: (a) technology and scheduling challenges, (b) language limitation, (c) not representative of all sectors in each country, and (d) resulted in broad, thematic summaries.

Impact Story #1: Thailand by Dr. Boonchai Kijsanayotin, Research Manager & Secretary of the National Health Information Committee , Health Service Research Institute, Thailand

Development and Status of Health Information Standards in Thailand

Health data standards are essential for interoperability. But the reality is that HIS are often fragmented, with different health data definitions. Facing this barrier, we set out to establish national health information standards to facilitate information-sharing and exchange.

The key players for this undertaking were the Ministry of Public Health, National Statistics office, National Economic and Social Development Boards, Thai Medical informatics, national insurance schemes, hospitals, universities, vendors, and research institutes. Here is a brief timeline of our journey towards health data standards:

• 2008: Initiated collaboration via the Thai Health Information Network (THINK). THINK now meets every two months to share information.

• 2010: Developed a 10-year Strategic Plan for National Health Information Systems with inputs from key stakeholders and support from the National Health Commission. This is chaired by the Prime Minister.

• 2011: Established the National Health Information Committee (NHIC) and selected 4 priority areas of focus: (1) national health information standards, (2) national health indicators, (3) community based HIS, and (4) health information security.

Current Actions. Thailand is now developing health data standards to serve the health financing central mechanism (e.g. case mix information system). This is being done in collaboration with the National Healthcare Financing Development Office. With support from MoPH, NECTEC, and NHIC, we are now developing a national standard data set to be used by the chronic disease registry, the referral system, and public health reporting systems. Thailand plans to establish the Thai Health Data Standards Maintenance Office (TH-DSMO), whose mandate is to study and select health data standards from international and national standard development organization (SDOs) and to advocate the use and maintenance the selected standards.

Impact. Our efforts resulted in the establishment of highly engaged working groups from different government agencies and the academe and increased awareness about HIS projects and enhanced information exchange and better collaboration across agencies.

Healthcare workers in Thailand spend 40% of

their time collecting and forwarding

information to higher authorities.

Notes


Next steps. We are now collaborating with the National Healthcare Financing Development Office to develop a central mechanism for national health insurance reimbursement with the following components: the Thai CaseMix Center, Thai Health Data Standards Maintenance Office, central health claim data clearing house, national health financing data repository, Central Information auditing mechanism.

We intend to push for the creation of the Thailand Health Data Standards Maintenance Office (TH-DSMO) and resolve health data standards gaps by employing international standards like LOINC, HL7, HIE, and SDMX-HD. We are also working to increase our health information human resources: health information management personnel, health IT professionals, and health informatics experts.

Lastly, we would like to share the following key lessons we learned from our journey: Involve all stakeholders.

Create awareness among high level executives.

Don’t reinvent the wheel.

Proceed through a stepwise approach rather than a Big-Bang approach.

Questions and Answers following Dr. Boonchai Kijsanayotin’s presentation

Q: What is the importance of HIS in a universal healthcare scheme and health financing? How different would it be if insurance were not in the picture?

There are three (3) types of insurance schemes: civil servant, social security and national universal coverage schemes. Each scheme requires a different set of requirements. As such, health providers and hospitals are burdened by information requests by these agencies. On the other hand, health providers are motivated by financing, which is a lever for requiring them to comply.

The CaseMix information system churns out a lot of administrative data, but we need more clinical data. We want information to be used at the point of care for decision making. We want a national electronic health record, but we know it is very difficult, so we started first by computerizing our administrative and finance systems. Eventually, we will get to clinical information and gradually will introduce clinical decision support systems.

Q: Regarding building agreement on standards, what is the level of participation of the private sector?

80% of hospitals in Thailand are managed by the Ministry of Health. Thus, the private sector is important, but not a major player. Still, we need to engage the private sector and we are doing this through networking. In the case of standards, we are adopting international standards (as opposed to creating one) in order to encourage private hospitals to abide by this.

Q: How is the community HIS important to national HIS?

National health indicators are integrated with other data fields from community sources, so the national level must know what is happening at the grassroots level. For example: education is linked to immunization of school-age children and environment is linked to local industry effects to the community.

There is value in implementing HIS in small provinces because it is more manageable than implementing on a national scale. We could study the model and best practices at less risk, then scale this up to the national level. At the same time, the national level should not lose sight of national priorities.


Technical Overview of HIS by Dr. Ramesh Krishnamurthy, Information Systems Manager, World Health Organization Key Messages. Reliable HIS are essential for better healthcare delivery and better health outcomes. A well-functioning HIS depends on harmonized and interoperable data elements. To achieve harmonization, it is important to take a multi-sectoral approach to strengthening HIS at national and sub-national levels. Urgent Need for HIS. HIS are essential for rapid detection and containment of infectious diseases. These systems allow us to respond to health emergencies and deliver healthcare to population at all levels. Reliable HIS are needed for countries to produce mandatory data reports to international institutions. Yet, our fragmented HIS pose a threat to healthcare delivery. This presentation will show a technical overview of how we envision a well-functioning HIS, the challenges of developing an HIS, and solving the problem through frameworks and standards.

Frameworks and Standards for HIS. The Health Metrics Network drafted a document called Framework and Standards for Country Health Information Systems (or The Framework). The Framework gives us an approach to building modern, interoperable health information systems. It provides a structure for defining the country-specific needs for HIS strengthening. Its strengthening approach is based on situational analysis; ultimately helping us forecast financial needs for HIS implementation. Over 80 countries have adopted The Framework as part of the country HIS planning process. Of this, 62 countries have conducted the HIS assessment and submitted their reports to HMN.

Technical Overview of HIS. A major component of The Framework is based on an approach called Enterprise Architecture (EA) which recommends looking at HIS from a wider perspective, taking into account its various players -- that is, the producers and consumers of information (Figure 1-1, above). This allows us to identify shared functionalities, making it possible to avoid overlapping systems and promoting re-use of features among the players.

Figure 1-1. An overview of a national HIS, identifying the inputs, outputs, and the producers and consumers of

information.


Figure 1-4. Layers of data collection in India.

Figure 1-2.

A Complex Landscape of Different Stakeholders. The collage on Figure 1-2 (right) gives a snapshot of the multitude of stakeholders and initiatives that are relevant to HIS. We need to coordinate these efforts or else there would be program overlaps that compete for resources.

Vertical Programs. The landscape is complicated further by the presence of donor-funded and disease-based vertical programs (Figure 1-3, below). It highlights the problem of lack of coordination, creating duplication of efforts and non-credible data. It may be possible to intelligently extract data from these vertical systems but it requires agreeing on standards for defining and exchanging data.

Illustrative Example: India. Figure 1-4 (below) shows the various levels of collecting data in India. Each level presents its own challenges. Note the transition from paper forms to spreadsheets at the district level, and the use of email and web forms for data entry.

The following pictures present a glimpse of the challenges of collecting data from disparate sources in India.

Figure 1-3. Vertical information systems contribute to the complexity of the challenge of interoperability.


Harmonization, Standardization, and Alignment. India’s example is common to all other nations building their HIS. It underscores a need to harmonize various aspects of HIS: data definition, collection, and processing. Different systems and sub-systems contributing to HIS must also be able to interoperate with each other. But to do these, we need the collaboration of different sectors involved in collecting and producing information. The HMN’s Framework is leading to a more systematic approach for HIS design, implementation and management. The Framework contributed to an emerging eHealth Architecture (ISO TR 14639) and this has made possible the recommendations for standards in health informatics. Ownership through Multi-sectoral Engagement and Alignment. Coordination among different agencies and partners is essential to owning and sustaining HIS at national and sub-national levels:

• Ministry of Health

• Ministry of Finance

• Ministry of Education

• Ministry of Labor

• Ministry of ICT/Telecommunications

• Ministry of Infrastructure

• Private Health Sector

• Donors and Implementing Partners

Harmonization also requires the alignment of health information activities and strategies throughout the value chain of solutions driven by Public-Private Partnerships for producing better health outcomes. The table below shows various components needing alignment in the value chain:


Health Information Activities Strategies

Governments

Patients, Hospitals, Practitioners

Community

SMEs

Technical Experts

Entrepreneurs

HIS Strategy

mHealth Strategy

HMIS Strategy

EMR Strategy

ICT for HIS Strategy

HR Capacity Strategy

It is important to note the need for supplementing all these activities and strategies with a strategy for building the capacity of human resources who will develop and maintain the various information systems.

Questions and Answers

Q: Do the administrators realize these complexities of developing and maintaining HIS? Domain experts may understand the standards, but how about the non-technical decision makers?

It is not easy to explain HIS to senior managers. However, they feel the impact when you cannot create reports by aggregating data or by trying to mix aggregated with disaggregated data. It is also important to simplify the language so that everyone will understand. WHO is now engaged in the ISO process, both in the aspects of ICT and disease.

The need for donor coordination is emerging, as well. Donors should provide more support for countries developing their HIS, but should be less specific on what they want these countries to do, to minimize fragmented efforts.

Q: Donors put money into HIS. That is why they want immediate results -- in a year or maximum of five (5) years. But results take time and results don’t show immediately. There must be a transition period. As an implementer, what can we do to meet these challenges?

You will be discovering more answers to your question in the next three days of the forum. One important thing is coordination – a loaded term –is not well practiced in many countries. Creating a health information system involves efforts beyond the ministries of health. Ministries within countries have to coordinate to make things work. The private sector will have a bigger role in the next 5-10 years. To prepare for this, governance and stewardship have to happen soon. Have a good strategy for roll-out. To do this, you have to identify problems so you can identify solutions. Translate activities to outputs that are measurable.

Also, donor coordination is an underpinning process. It is important so that health information initiatives are not fragmented.


HIS Country Ownership and Leadership Continuum by Mark Landry, Health Information Technical Officer, Western Pacific Regional Office of the World Health Organization

The HIS Country Ownership and Leadership Continuum (or Continuum) is based on the six (6) components of HIS in the HMN Framework. We use the Continuum as a foundation for discussion, breaking down the complexities of HIS and considering the enabling factors for HIS. It provides a handle towards a development approach for HIS. (See the Continuum in Appendix 1; a snapshot is provided below.)

It gives us an organizing framework for action in various domains: technical, organizational, political, social, and environmental. It helps us plan our communications and because it is simple and non-technical, we can use it as an advocacy tool for engaging decision makers.

The first three components of the continuum – Governance and Multi-sectoral Engagement, Strategic Planning/Financing, and Policy and Regulatory Environment – lay the foundation for change. They cover the groundwork needed to support intervention-specific improvements. The last four components address intervention-specific improvements needed to build HIS: Information Use, Infrastructure, Human Capital Development, and System and Data Interoperability.

It is important to note that the Continuum is not an assessment tool or a scorecard to gauge countries. It is not meant to be precise.

We will use the Continuum during the forum to open up the discussions on HIS, to shift focus towards strategic areas, and to recognize specific actions for technical assistance.


Questions and Answers

Q: Regarding Strategic Planning/Financing in the Continuum: in Vietnam, we often have different development plans for different ministries and donors. Are there any guidelines to help countries select which plan to prioritize?

Landry: You are right about strategies repeating, overlapping, and even competing with each other. It is important to align plans and strategies with each other. I challenge the Vietnam delegation to take this up this week. Assess where you can achieve the most efficiency.

Ramesh: It’s like a macro- and micro-economy discussion. Right now, we are discussing the macro. There are not too many strategies from the macro perspective. However, we have a lot of micro-strategies. There are no global guidelines yet on how to do it. Our process is self-instructive and the answers will vary from country to country.


HIS Ownership and Leadership Session Summary Each day of the Forum, country teams met individually to discuss the country’s priority action items for strengthening HIS. On Day 1, the teams discussed who the leaders and stakeholders of HIS in their country are among other topics (questions listed below).

Working Group Session 1 (Individual Countries)

In Working Group Session 1, country delegates were asked the questions listed below.

Refer to the last column of the continuum. How might you refine the definition of a

mature/high level/country-owned HIS in your country context?

What are leaders doing to promote ownership of HIS?

What are the consequences of lack/limited use of information in HIS?

Who are the key stakeholders contributing to HIS strengthening in your country?

What are three to four key leadership and ownership challenges in HIS?

Which key stakeholders have the potential to play a stronger role?

Countries focused on only a few of the questions or modified the questions to improve their relevance. They were then asked to report a key message or highlight during the wrap-up of the day. The following were the wrap-up highlights:

COUNTRY HIGHLIGHT

Bangladesh • Fine-tune the last column of the Continuum.

• Challenges: identifying and building the capability of staff responsible (national and sub national levels).

• Resources must be available on time.

Cambodia • We have a strategic plan and a multi-sectoral group pushing for HIS. But we have limited financial support. We also need to create a legal framework to strengthen HIS.

Fiji • Decided as a multi-sectoral team: MoH will take the lead. It will need to define HIS functions before other sectors coordinate and collaborate.

• Primary goal is to get MoH in order first.

Indonesia • A high level official needs to lead the HIS. MoH plays the most important role among stakeholders.

Lao PDR • Planning cycle needed.

• Need for capacity building.

Mongolia • Common language between centers.

• Action points: capacity building of people who will build and run HIS.

Philippines • Leadership and ownership are keys to a functional information system that will contribute to better health outcomes for Filipinos.


COUNTRY HIGHLIGHT

Thailand • Thailand intends to veer away from data silos that result from “intra-country ownership” (different agencies owning but not willing to share data) and “inter-country ownership” (donor-sponsored information systems that may not necessarily be aligned with the country’s priorities).

• With those connotations of “ownership” in mind, the delegates proposed to “promote a national HIS” instead of “increasing ownership of HIS”.

Vietnam • We will develop a common HIS platform and one common HIS strategic plan led by the Ministry of Health with full stakeholder participation. We will establish a coordinating body to oversee and implement this process.


Day Two: June 14, 2011

A Collective Vision for HIS by Professor Dr. Abul Kalam Azad, Director, MIS, Ministry of Health and Family Welfare, Bangladesh This presentation is an attempt to describe how we are trying to make things happen in a short time. In March 2008, the Management Information System (MIS) of the Ministry of Health and Family Welfare barely had an office. We had no internet connection, used paper forms, and a poor working environment. Our staff had poor understanding of MIS. Their skills were low and there were no career prospects for them in MIS. Requests for data were sent through snail mail and took at least six (6) weeks to fulfill. Even calling all 64 District Health Managers from our office would take about three (3) days. We planned to improve the ICT backbone and data communication system, the staff skills and motivation, and the physical facility. But the reality is that we had resource constraints. Competing health priorities regarding maternal and child health service plus a shortage of skilled ICT staff made the problem more difficult. Given the limitations, we made remarkable changes. Our IT solutions had to be simple, low cost, innovative and locally appropriate. Using these principles, we were able to focus on our priorities and improve quickly. We were able to build a new office in June 2010. We established internet connectivity in April 2009, connecting the national level to the sub national levels. We established a way to exchange information through email, web database, and bulk SMS. Now, information travels instantly.

Strategies to motivate our HIS workforce included training of field health workers starting last November 2009, with continuous follow-up. Thanks to the training, the community started recognizing our staff as more knowledgeable. The MIS is now working on enhancing the career path for our HIS workforce. We also created a support system for end-users, employing friendly real-time support and guide books.

We are now implementing DHIS, building from the HMN framework. DHIS is used in the public health facilities in Bangladesh. For private sectors that may not be using this, they have to comply with requirements set by the MIS. If they cannot comply with this, there may be consequences in the registration process. Initially there was a huge amount of resistance, but with training and communication, they eventually started complying.


DHIS was developed from open source technology. Through DHIS, data is entered at the source. We can check who sent data and who did not. We can automatically produce reports and even GIS maps. Bangladesh is currently scaling up its HIS and the fact that it is web-based makes it easier to proceed with bigger steps. The current government plans to improve HIS until 2021 and has increased funding for it. Lessons Learned:

• If there is a will, there is a way. • High Level political commitment needed. • Top-down framework and bottom-up implementation boost project success. • A Few quick win projects may help to gain policy support for bigger HIS projects. • National HIS needs enterprise solution with alignment of all stakeholders.


Impact Story #2: Vietnam by Associate Professor Nguyen Hoang Phuong, PhD; Deputy Director, Department of Science & Training Ministry of Health, Vietnam Strengthening Vietnam’s HIS through System Design, Standards and Interoperability

The HIS challenge. In principle, a strong national HIS improves evidence-based decision making, informs health policy and planning, enhances monitoring of public health, and can better address the continuity of care of individuals. The reality is that in many countries, HIS remains fragmented, with little emphasis on aligning various information systems within an integrated national HIS framework. Only a few of our staff have skills for handling and managing health information and health IT.

Our goal is to improve our understanding of HIS standards to increase timeliness, reliability and quality of information flow across systems, and to strengthen human resources for health information. The key players for our journey were MOH DST, USAID, GIZ, CDC, WHO, and the Rockefeller Foundation.

Action taken. We organized a regional workshop in HoiAn, Vietnam 4-7 April, 2011 with the following objectives:

• Increase awareness of importance for adopting national HIS standards: about the different types available, how they could be used, and local applicability.

• Promote awareness, applicability, and use of the enterprise architecture (EA) approach.

• Develop an interoperability framework to support the implementation of priority HIS interventions.

Impact. The Vice-Minister of MoH, Prof. Nguyen Thi Kim Tien, deemed HIS strengthening a priority for Vietnam and identified several issues to focus for 2011-2015:

• EMRs and Hospital Information Systems, focusing on developing an exchange data protocol based on HL7 standard

• Unique patient identifiers

• National medical database

• Developing remote health consultation services and examination, treatment (telemedicine)

• Health statistics information systems

• Health information technology human resources

• HIS and IT policy and legislation

• Infrastructure

• Memorandum of Understanding (MOU) between MOH and key donors: USAID, WHO, CDC, the Rockefeller Foundation, etc

• Establishing MOH working group on HIS: technical group on IT, policy and legislation group, IT human resource group

• Identify proof of concept/pilot projects within the MOH department on HIV/AIDS

• Interoperability across LIS, PMIS

Often, we only focus on the technical factors for the success of HIS. In fact, there are three factors to consider: people, technology and finance. Of these, the people factor is the most important. So at the workshop, the Vice-Minister called a meeting of 20 high level directors, partners, and experts to better understand the issues and challenges of HIS. This demonstrated a strong political will to develop HIS and was considered a demonstration of best practice in governance.


Next steps:

• Propose establishment of MOH Department of IT.

• Establish IT technical group within MOH to work with donors for HIS development where DST is a coordinator.

• Establish health information technology working group to help MOH with IT applications in medical sector where DST is a coordinator.

• Cooperate with Asia-Pacific countries to develop the standards and inter-operability of HIS.


Creating an Information Culture in HIS by Theo Lippeveld, MD, MPH, Senior HIS Advisor, MEASURE Evaluation

New opportunities, old constraints. Donor agencies like the Gates Foundation, PEPFAR, the Global Fund, etc. have increased the funding for priority infectious diseases like HIV/AIDS, TB, Malaria, etc. The Millennium Development Goals provide countries a clear drive towards better health outcomes by 2015. There is also a growing interest by major global health donors to strengthen health systems. Despite these drives, however, major constraints (old and new) continue to exist:

• Lack of leadership and country ownership

• Fragmentation of health systems

• Disease-oriented stovepipe systems (silos)

• Lack of good models for scaling up evidence-based interventions

• Moving from pilot project to wider scale

• Health workforce crisis

• Weak logistic systems for commodity security

• Weak HIS

What is wrong with existing HIS? There is a plethora of data collected, often irrelevant and of poor quality. When information management is centralized, the information is not fed back to the district and service delivery levels. Fragmented “program-oriented” information systems result to duplication and waste. Countries have poor infrastructure and resources for maintaining HIS. These result in the lack of appreciation (demand and use) for information at all levels: policy-makers, health managers, and healthcare providers. Some of the lessons learned from HIS reform in recent years include:

• The need for standardized data generation architecture.

• The need for well defined HIS performance criteria: (a) production of relevant and quality information and (b) continued use of information for DM at all levels.

• Empirical evidence shows that availability of relevant and quality information does not necessarily mean that it is used for decision making.

• The need for better understanding of factors influencing HIS performance.

• Using the PRISM (Performance of Routine Information Systems Management) framework to understand HIS performance. For more information, see www.rhinonet.org.

http://www.rhinonet.org/


PRISM has a set of tools for

measuring HIS performance

and its determinants:

HIS

Performance

Diagnostic

Tool (for

quality of data

and use of

information)

HIS Overview

Facility/Office

Checklist

Organizational and Behavioral Questionnaire

HIS Process Assessment Tool

PRISM guides HIS advocates to understand not just technical issues, but also organizational and behavioral determinants.

Technical Interventions Behavioral Organizational

• Matching information offer with health system demand: defining a set of essential indicators.

• Improving data generation processes: developing user-friendly data collection formats and introducing appropriate ICT for data management.

• Improving integration of data sources: building a national data warehouse.

• Improve confidence level by asking people to do simple tasks and then add complexity in tasks

• Capacity building to improve data analysis, problem solving and advocacy skills of district and facility staff

• Organization of in-service training courses

• On-the-job training through supportive supervision

• Include module in pre-service training programs

• Institutionalize interventions focused on improving use of information

• Self-assessment

• Problem solving approach

• Advocacy

• Promotion of Culture Of Information


What is a “culture of information”? The operational definition from social sectors is, “The capacity of an organization (the health system) to promote among its members the values and beliefs for generation of quality data, and for use of information to accomplish its goals and mission.”

A culture of information implies an important role for senior management (policy makers and managers) in the health system. It implies a long-term process of behavior change from the individual and institutional levels. The rationale for promoting an information culture:

• Communicate the organizational value of information from senior management to health staff.

• Clarify expectations regarding desired behaviors and performance levels for the use of information.

• Improve transparency and accountability within the health system and the health information system.

• Create ownership and demand for information, leading to improved use of information for DM.

• Ultimately, in the presence of a culture of information, less supervision and less external control are required, thus leading to less cost.

How to promote an information culture. The following are some examples of how to promote demand for information in organizations and governments:

• Role-modeling by senior managers on using the information generated for decision makers.

• Emphasis on HIS performance during review meetings.

• Dissemination of success stories about the use of information for service improvement and advocacy.

• Institutionalizing and creating incentives for use of HIS information:

o Dissemination of HIS district level indicators through media (e.g., Uganda): creating competition.

o Allocation of resources based on HIS indicators (e.g., Brazil).

o Use of HIS information as criteria of the annual performance appraisal.

Use of the PRISM framework to assess HIS performance and plan more effective interventions has been validated in several countries. A successful HIS not only produces quality information but also makes sure that the information is used to improve health system management functions at all levels, down to the service delivery levels. Senior management needs to promote a culture of information for improving performance, accountability, and transparency in the health system. One of the most important methods to promote an information culture is act as role models for the use of information in making decisions and policies.

Comments and Discussion:

• The PRISM framework was used in the Philippines because it was the most available (forms were downloadable), it had been validated in other countries, and it was simple and easy to understand. It helped users to focus more on the analysis. However, the framework focuses more on the organizational structure to support the production and use of health information. Technical people needed something more detailed: enterprise architecture and agreement on standards.


• Stovepipe fragmentation (or keeping information in silos) is one of the main problems of HIS. There are technical, organizational and behavioral factors to this. Technically, ICT can help deal with this via storing the database in a central data warehouse. For others, it’s a question of combining capacity and having a comprehensive approach. This often requires simplifying things, which also generates tremendous resistance from technical people. Also, what sometimes happens is that another level is put on top of the stovepipes, creating more layers of complexity.

• In Bangladesh, there is also a problem of stovepipe fragmentation. Before this can be dealt with, people who maintain these systems need to be reassured of job security. They resist integration because they fear that they will lose their jobs.

• In Vietnam, HIS used to be paper-based and information was based on indicators. Majority of the programs are vertical and not very modernized but they are trying to address this and simplify the process by modernizing the system and using IT applications.

Multi-sectoral Engagement and Coordination Working Group Session 2 For this session, delegates from various countries were grouped together by sector and asked to identify the potential role of their sector in HIS. Delegates were also asked to identify the information needs and challenges of their sector. The following are the highlights of the discussions as reported during the plenary session. Detailed discussion notes are available

Health Sector 1

Delegates agreed that a unique identifier is an important building block for an integrated information system. A unique identifier also poses great challenges. The health sector relies on a lot of data from different sectors.

Health Sector 2

Common challenges: delayed data and sustainability. Delegates agreed that HIS could be sustained and enhanced through collaboration with others.

Health Sector 3

• Challenges:

- It takes a long time for data to reach the intended users

- Unavailability of funds

- Bureaucracy

- No established MOA/MOU between sectors on HIS

- No coordination body

• Opportunities:

- Train and educate leaders who are not just from the top but also from bottom

- Promote a culture of information. Show leaders and stakeholders what HIS can do

- Develop collaboration/coordination mechanism

Health Sector 4


• Challenge: lack of protocols for conducive information exchange

• Success Factor: proper financial backing (Bangladesh and Mongolia)

• Opportunity: HIS is a tool or instrument for success. Leadership, commitment needed at all levels to make sure of HIS success

Telecommunication

HIS is a big enterprise with many players. Collaboration is needed at the policy and technology level. Health data provides value to ICT.

Planning

• Planning agencies are users of data. Require only a small set of data that is timely, accurate, and reliable in order to better allocate resources. There are gaps between the data that we need and what is available. Currently, this is dependent on the ministries of health and statistics.

• Give value for information in its importance for decision making

• Give value for money (investment) to create economic value for limited resources

• Planning agencies have an important role to play to promote a culture of information

Statistics

Challenges: different methodologies to obtain same data. Example: statistic sector’s census data is not the same as health sector’s data from the catchment areas.

Finance

• Value of Data:

- Promote the well being of the people

- Better productivity and happiness

• Use Information:

- To allocate and prioritize appropriate resources

- To identify needs and allocate the resource to match the skill set, if the recipient does not have the capacity to absorb

• Maximize resources:

- Strengthen the capacity of officials at the ministries of health

- Increase efficiency in the use of resources


Day Three: June 15, 2011

Investing in Multi-sectoral Collaboration by Ummuro Adano, Senior Technical Advisor of Capacity Building, AIDSTAR-Two Project, Management Sciences for Health

Multi-sectoral collaboration is not a new concept especially in the health sector. Yet, challenges to the implementation of healthcare systems persist because the different actors do not always see the big picture. Many life-or-death situations could have been avoided if only the different actors started to share information.

Here is an alternative approach. HIS should be understood as a network of information flows among multiple actors. The central purpose of HIS is to determine what information is needed where, and making that information available. Beyond the separate concerns of each sector, we need a service-oriented view of HIS, where the focus is on the benefits that HIS could bring to us. What matters most is not the technology, but what information is needed, by whom and for what purposes.

• Benefits of a multi-sectoral planning and implementation:

- Broadened awareness and sense of common purpose

- Defining clear HIS needs and goals

- Streamlining data collection

- Enhancement of data quality, use and accountability

- More efficient use of resources

- Increased access to resources

- Investing in a common fit-for-purpose technology

- Development of innovations

- Broad sharing of responsibility for different activities

- Use of strengths and expertise of different partners

- Sustainable development of HIS activities

- Better health outcomes for citizens

The key predictors of success are leadership at all levels – both formal and informal; context and motivation; partnership resources; structure; common understanding/vision; collaborative capacity; and trust and legitimacy

Leadership

• Effective leadership inspires commitment and action. • Creates common ground for people to talk and work together. • Sustains the vision and participation of the members. • Creates a sense of ownership and empowerment.

Context and motivation

• Helps bring clarity to the purpose of the collaboration. • Lays out scope, goals, accountability mechanisms, roles and responsibilities. • The HIS strategic plan should be the “magnet” that attracts/pulls people together.


Partnership resources

• Human, technical, logistical, financial and operational resources. • Sharing or re-allocation of resources in a spirit of transparency and mutual agreement.

Structure

• Formal and informal mechanisms that allow people to meet and work together. • Procedure for meetings, agenda development, decision making, and follow-through on actions. • Team communication. • Monitoring progress and celebrating results. • Managing differing expectations, resolving differences. • Flexible arrangement that allows institutional space for each partner to contribute, in their own

way.

Common understanding, collaborative capacity, trust and legitimacy

• Foundational factors that underlie any successful collaborative venture. • Talking together to develop common understanding, creating shared purpose and appreciation. • Working together to develop collaborative capacity: developing skills and experience in joint

decision making; monitoring process and results; sharing resources; leadership; and compromise. • Building trust together through respecting and honoring all collaborators and partners.

Comments and discussion:

• There is a need to develop a regional strategic plan in HIS. It is important for the decision makers of each country to get together and reach out with each other, to share information with each other, and to work with each other. It is important to improve capacity building. We should focus not only on building HIS, but also for the ultimate purpose of HIS, which is to strengthen healthcare services, especially for poor people.

• It is important to note that other countries share the same problem of building HIS. There is a challenge in the development of a platform that could be useful at many levels.

• It is also important to maintain the ties that were built in this forum. Solutions that have been established in this forum may also be used in other countries, making it easy to collaborate with other countries.

• Pam Foster (Facilitator): “Ummuro’s talk highlighted the moment where the intellect and the heart connect, a reminder that above everything else, the beneficiaries of HIS are the ordinary people. Please use the energy raised by Ummuro’s talk for the sessions today and the days after the forum.”


Resources to Support HIS Strengthening by Mark Landry, Health Information Technical Officer, Western Pacific Regional Office of the World Health Organization and John Novak, Senior Monitoring and Evaluation Adviser, USAID-Washington

Preparing for the Donor Panel

• Refer to the Request for Follow-on Assistance Form (Appendix 2)

• As needed, consult the notes and outputs from the previous sessions.

• Possible decision-making filters:

- Within your sphere of influence

- Aligned with country priorities

- Doable

- Will show impact or enable other critical actions

- Build on relationships and networks established at the forum

- Leverage strengths, not just address gaps


Day Four: June 16, 2011 Impact Story #3: Philippines by Crispinita Valdez, MIS Director, Department of Health, Republic of the Philippines Strengthening national HIS through multi-sectoral coordination and collaboration

A responsive HIS requires political will, along with sustained stakeholders’ cooperation and collaboration and user involvement. The reality is that coordination and collaboration across sectors is minimal and securing buy-in is difficult. Support from upper management is superficial. Our goal was, “To establish a modern information system that shall provide evidence for policy and program development and for immediate and efficient provision of health care and management of province-wide health systems.”

The key players for this undertaking were the Department of Health (DOH), National Statistics Office, National Statistical Coordination Board, University of Philippines, Local Government Units, Department of Science and Technology, other government agencies, NGOs, and the private sector.

Actions Taken. DOH began in 2005 by spurring better collaboration within its office in 2005. It clarified the roles among offices with HIS or HIS-related mandates. The role of information management services was expanded from internal management support to a Sectoral Management Coordination Office. HMIS and ICT functions were subsumed under one undersecretary.

Next, it formed an inter-agency Committee on Nutrition and Health Statistics, under the National Statistics and Coordination Board and chaired by DOH. In 2007, it created the Philippine Health Information Network (PHIN), a coalition of government stakeholders. PHIN started to build linkages among agencies to create shared goals and to coordinate efforts and investments. It fostered ownership and leadership, led to the assessment of the current state of HIS, and the formulation of strategies and plans.

Other initiatives included the Philippine Network for Injury Data Management – a multi-sectoral organization composed of government and non-government agencies for injury data, and the ICT for Health Technical Working Group (ICT4H TWG). These are now leading to the following:

• Drafting of a Health Sector Enterprise Architecture (EA), the national standards for HIS and interoperability framework.

• Capacity building framework, with minimum competencies required of health human resources for health information and ICT.

• Compliance framework based on EA and standards for various HIS to gauge eligibility for adoption at sub-national levels and by national health facilities.

Impact and Outcomes. These efforts helped prepare support for universal health care (UHC), one of the primary thrusts of the government. It also led to increased cooperation or solidarity among stakeholders at DOH (i.e., plans, activities, responsibilities, and budgets). Specific impact and outcomes include:

• Philippine Health Information Network

- Better linkages among key stakeholders

- Formulation of the joint strategies and priority programs

- Mapping of data sources, and responsible agencies,

- Philippine Health Information System Plan

- Development and use National Health Data Dictionary, version 2

- MOA with National Statistics Office to evaluate civil registration systems


• Philippine Network for Injury Data Management

- Increased reporting completeness, better data quality and timeliness

- Improved prevention and health promotion mechanisms & activities

- Strategic positioning for provision of better services

• ICT4H /ICT for Health Forum

- Definition of private sector requirements

- Availability of relevant products, tools, capability building, and services

- Access to free technical expertise

Next steps:

• Establish a stronger HIS governance

• Further promote and solicit support to collaborate at the national and sub-national levels

• For DOH to initially to lead

• Use PPP to push and accelerate improvements in HIS

Key messages. Collaboration is difficult, time consuming, a lot of work, stressful, and expensive but it is necessary. The work becomes easier if HIS is part of the national agenda and health sector reform agenda and requirements are clear. Political will and leadership are essential elements for building towards this.

Inter-Team Reporting and Networking

At the end of Day Three, delegates from the nine (9) countries were divided into four groups and asked to discuss the HIS ownership and leadership and come up with a list of strengths and better practices, priority gaps, priority actions, and a priority requests for donor support. The Action Plans are summarized on the following page. Detailed Action Plans are in Appendix 7.


Summary of Priority Gaps and Actions

Country Priority Gaps Actions

Bangladesh • Human resource capacity

• Accountability and incentive systems

• Develop a comprehensive human resource plan, such as on recruitment, appraisal and retention

• Conduct workshop on appropriate accountability content and information use

• Recommendation: WHO should also organize similar workshops on countries within the region

Cambodia • Lack of multi-sectoral engagement in HIS

• Lack of an enterprise architecture TWG

• Develop an action plan and include capacity-building

• Create an HIS TWG

• Identify interoperability issues in the existing parallel systems. Use open standards and take note of confidentiality

Fiji • Absence of a multi-sectoral working group

• Lack of coordination between development partners in line with national policy

• Get an approval to establish a multi-sectoral working group by writing a cabinet paper and presenting to the MOH

• Fill a donor matrix, which will be submitted to the Ministry of Finance for evaluation

• Develop evidence-based reporting for a universal health care system

Indonesia • Secure commitment from steering committee at all levels

• Low data quality

• Arrange a technical meeting, which will be followed-up by several other meetings

• Conduct a steering committee meeting which will approve terms of reference

Lao PDR • Human capacity building

• Infrastructure

• In human resource development, develop training program that will be provided for all HIS staff

• Recruitment of experts in HIS

• Development of a unified electronic database system

• Development of a vital registration system

• After the Manila HIS forum, share lessons learned with the MOH and development partners, to be held at the end of the month

Mongolia • Lack of capacity in HIS

• HIS infrastructure

• Learn about best HIS practices in the region by conducting study tours. Australian HIS is seen as a model, especially in leadership and multi-sectoral collaboration.

• Develop HIS policy, such as in data projection and data transfer standardization


Country Priority Gaps Actions

Philippines • Limited membership in PHIN • By 2012, an executive order should be signed creating a high-level multi-sectoral development council

• By 2011, finalize and present a DOH-wide enterprise architecture

• By 2011, formulate a comprehensive HIS plan

• By 2011, conduct several HIS forums

Thailand • Health data standard development and implementation

• Limitation of ICT and HIS skill and competencies

• Create awareness, technical training and specification on one standard

• Educate and produce material for all end-users that will be using the standard

• Recruit more personnel, especially in health informatics

• Conduct curriculum development and postgraduate training

Vietnam • System is not integrated

• Use of standards

• Develop enterprise architecture for health information system

• Make the standards a priority of the health information system

The Virtual Leadership Development Program by Sarah Johnson, Project Director, AIDSTAR-Two Project, Management Sciences for Health

Introduction. Leadership is an important driver of institutional change. We can define leading as “enabling others to identify and face real challenges in complex environments and produce results.” Leadership can -- and should be -- exercised at all levels, not just at the top---whether you are an HIS officer in a health facility, the director of HIS, a manager in another sector or the minister of health responsible for the performance of an entire health system. Leadership is a key factor in the effectiveness of any multi-sectoral collaborative initiative and any change initiative. What is important to know is that we can all learn to manage and lead. Leadership is different from management. As leadership development and change management expert John Kotter said, they are “*t+wo distinctive and complementary systems of actions… both are necessary for success... Management is about coping with complexity... leadership is about coping with change.”

Managers who lead well use all of the leading and managing practices:

• Scanning

• Planning

• Focusing

• Organizing

• Aligning/Mobilizing

• Implementing

• Inspiring

• Monitoring and Evaluating


Managers who lead well also use leadership competencies and skills including communication, problem solving, negotiation, systems thinking, emotional intelligence, change management, and focused perseverance. All of the country teams represented at this Forum will participate in the Virtual Leadership Development Program following the Forum. The objective of the Virtual Leadership Development Program (VLDP) is to strengthen the leadership capacity of teams of HIS professionals to identify and address real institutional challenges and achieve improved institutional and health outcomes. Teams will continue to work on their action plans during the VLDP, implementing them in order to produce results.

The VLDP, an internet-based program that enrolls teams of health/HIS professionals can be offered and adapted to assist health professionals to address challenges in all areas of health. It is 14 weeks long, during which participants dedicate 4 to 6 hours a week to the program. VLDP enrolls up to 12 teams of 4 to 10 people each. Participants do not need to leave their worksites in order to participate. The program uses a “blended learning” model, which combines individual work with face-to-face meetings, print workbooks with a website, etc. The website consists of reading and interactive materials. There is a supplemental printed participant workbook given to each participant. The HIS VLDP will be facilitated by two leadership and organizational development specialists and will be supported by an M&E specialist. In the HIS VLDP, Mr. Mark Landry, WHO, will provide technical review of all final HIS action plans. The content of VLDP is based on MSH’s field-tested leadership development approach and principles. The heart of the program is found in Module 3, where teams identify organizational challenges and develop an action plan to address their challenge using the MSH Challenge Model. The program is results-oriented. The objective of the program is that teams will implement their action plan and achieve results. VLDP also results in improved teamwork and workgroup climate. Important information:

• VLDP will take place in July 18 to October 21, 2011 (14 weeks)

• All country teams will receive an email about VLDP registration after returning to your countries. Everyone, please register immediately.

• Essential to participate actively from the beginning and not fall behind.

• Teams that successfully complete the program will receive certificates.


What to expect at VLDP:

• Improve and implement the action plans that you developed at the HIS Forum.

• Gain leadership and team work skills and competencies to support the implementation of your plans and lead to results.

VLDP Outline: Module 1: Getting Started

• Module 2: Leadership in HIS

• Module 3: Identifying Challenges

• Module 4: Leadership Competencies

• Module 5: Communication

• Module 6: Managing Change

• Module 7: Coming to a Close

We wish you great success in the VLDP and in implementing your action plans and documenting your results. The work that each of you do contributes to improved HIS and health systems and improved health!

Questions and Answers:

Q: Will 1-2 key people who did not attend the HIS Forum be allowed to attend?

The maximum per country team in the VLDP is 10 people. We could add more on a case-to-case basis. VLDP is an extremely popular program, so take advantage of the program. From 2002 to 2011, 35 VLDP courses have been run on 60+ countries involving 2,800+ participants.

Q: How is the time schedule of the program?

Each module has prescribed dates. Each module is 2 weeks long, with exception of Module 3 which is longer. The first week of each module is mostly individual work; the second week is for face to face meetings and it is a key activity. VLDP is therefore not self-paced. All the teams will move through the modules on the same schedule and will be strongly supported by the facilitators.


Donor/Partner Next Steps by Mark Landry, Health Information Technical Officer, Western Pacific Regional Office of the World Health Organization

Commitments and Actions (so far)

The following are concrete steps that donors/partners have resolved to take after the HIS Forum:

Networking:

• Enhance the website www.hisforum.org with more functionality and resource links, such as:

- www.healthunbound.org

- www.hiwiki.org

- www.healthmetricsnetwork.info

• Donor mapping, matrix of HIS support, contacts

• Build up donor/partner profiles

• Capture knowledge and learning as case studies

Collaborating and Coordinating:

• Share opportunities openly and widely:

- GIZ: BACKUP Initiative www.gtz.de/backup

- ITU: Telecom sector work plan requests

- WHO: Formal requests for TA through MoH

- USAID: VLDP

• Share information routinely on donor/partner collaboration, and regular communications.

• Capture and forward opportunities as they emerge.

Requests for follow-on technical assistance:

• Country teams should complete the Technical Assistance Form (distributed on your flash drive and also as an appendix to this Final Report)

• Submit the form to WHO: Mark Landry, WPRO, [email protected]

• WHO will circulate to donors and partners for review, discussion, coordinated follow up, and timely response (status and leads).

Questions for the country delegates:

• Will you continue business as usual?

• Will you be an agent for change?

• Will you remind others that information is care?

• Will you lead and take action?

http://www.hisforum.org/

http://www.healthunbound.org/

http://www.hiwiki.org/

http://www.healthmetricsnetwork.info/

http://www.gtz.de/backup

mailto:[email protected]


Closing Remarks by Assistant Secretary Nemesio T. Gako, Philippine Department of Health

“Ladies and gentlemen, distinguished guests, friends: good afternoon.

Over the last four days, it has been inspiring to see leaders in health, planning, technology and finance from Cambodia, Indonesia, Bangladesh, Philippines, Thailand, Fiji, Vietnam, Mongolia and Lao PDR, work hard and plan for the improvement of each of their country’s health information system.

As has been repeatedly emphasized in this forum, information is the foundation of sound health policies and plans. Quality information is also essential for health service delivery at all levels in the pursuit of better health outcomes. It is also clear that the health department cannot do the work alone, HIS being a multi-sectoral effort.

You have also identified country gaps, priorities and strategies in critical domains of health information: governance, strategic planning, policy/regulation, information use, infrastructure, human capital development and interoperability and data exchange. These are the interventions that would strengthen core domains in health information.

Today, you will be going home with your newly minted action plans. Please do not let it go to waste by gathering dust in your shelves. Act on them. Remember, what is unique with this Forum is, that countries will be able to request for immediate and short term technical assistance to institute your action plans to the 17 donors that are here today.

The Forum has given health information stakeholders an opportunity to network, share knowledge and collaborate in the future. It has also given the opportunity for donors to coalesce and work seamlessly and in a concerted effort with country stakeholders as well as with other donors.

I would like to reiterate that the output of this forum should translate into actions. I call on the country HIS stakeholders to take on the leadership of their health information systems. And be committed to the execution of the action plan for HIS. And I also call on the development partners support the country HIS strengthening.

Let me thank the sponsors of this Forum, all 17 of them, for their invaluable contribution. I now declare the Asia-Pacific Leadership Forum on Health Information System formally closed.”

Conclusion The strategic participant invitation process and a meeting design that capitalized on having the right people in the room resulted in a successful Forum. In an evaluation, one participant wrote: “HIS is a multi-sectoral concern. It is not just for the health sector alone, [it] needs other sectors to effectively and efficiently deliver its services.” An unusually intense and effective depth and level of discussion characterized the plenary and, especially, the country team working sessions. Because country level participants had a professional level and technical language in common and chose which topics to work on, the discussions were driven by shared HIS concerns and questions and quickly got to the point. Little time was wasted in needing to define terms or create understanding about HIS topics or issues. Workshop staff facilitated the working groups effectively and added their own expertise into discussions in a targeted manner.


Each country group developed an action plan. It is important to note that the process of producing the plan is as valuable as the plan itself, as it proved to be a time when participants from each country could work together in a summative activity to choose, from the rich discussions and shared lessons, which approaches are most relevant for their particular context. While the plans themselves will be helpful, they will undoubtedly change with appropriate input and discussions in-country. We hope to learn of these revisions and support country-level progress in suitable ways. Additionally, the commitment exists to maintain the positive network that emerged as a result of the Forum. Participants cited that “Inter-country networking was a good strategy of this forum” and that “Much of the *HIS+ work ahead involves partnership, negotiation, collaboration, new structures, blending institutional cultures. Regional networking is essential”.

Evaluations The evaluations were extremely positive. Participants reported that the workshop objectives were generally achieved, and they provided many helpful qualitative statements to support positive ratings. There were also several helpful suggestions for future Forums. A summary of the evaluations can be found in Appendix 5 of this report.

***

“You know you’re dealing with something more than a technical issue when

people’s hearts and minds need to change.” -- Ronald Heifetz and Martin Linsky, Leadership on the Line.

Asia-Pacific HIS Forum 2011 44

Appendices

Appendix 1: HIS Ownership and Leadership Continuum ...................................................... 45

Appendix 2: Request for Follow-on Assistance Form ............................................................ 47

Appendix 3: Participant List ................................................................................................... 48

Appendix 4: Forum Program ................................................................................................. 54

Appendix 5: Evaluation Summary ......................................................................................... 60

Appendix 6: Country Team Action Plans ............................................................................... 63

Appendix 7: Technical Note on Multi-sectoral Collaboration .................................................. 95


Appendix 1: HIS Ownership and Leadership Continuum



Appendix 2: Request for Follow-On Technical Assistance

TA Country: Requesting authority: Country POC and contact information: Problem statement (no more than 200 words):

How does this request support the national HIS strategy (no more than 100 words):

What resources can the country team contribute?

Support required:


Appendix 3: Participant List Title First name Last Name Affiliation: Country of

residence:

Mrs. Maxine Whittaker University of Queensland Australia

Mr. Tanvir Ahmed Ministry of Health and Family Welfare Bangladesh

Dr. Abul Azad Management Information System (MIS), DGHS, Bangladesh Bangladesh

Mr. MD. Zahir Uddin BABAR

Directorate General of Family Planning Bangladesh

Mr. Muhammed Emranul Haq GIZ Bangladesh

Mr. Md. Najmul Hassan Ministry of Health & Family Welfare Bangladesh

Mr. Rafiqul Islam Ministry of Posts and Telecommunications Bangladesh

Mr.

Muhammad Abdul Hannan Khan GIZ Bangladesh

Dr. Helga Piechulek GIZ Bangladesh

Mr. Sukhendu Shekhor Roy

MIS, Directorate General of Health services, MOHFW Bangladesh

Mr. Saben Buth Planning and health Information Department, Ministry of Health Cambodia

Dr. Khemrary Khol Ministry of Health Cambodia

Dr. Reatanak Sambath Mean URC Cambodia

Mr. Bandith Phun Ministry of Posts and Telecommunications of Cambodia Cambodia

Mr. Bunyoeui Siea Battambang Provincial Health Department Cambodia

Dr. Mok Sokuntheary MoH Cambodia

Mr. Phyorith Tep Ministry of Economy and Finance Cambodia

Mr. Kheam They National Institute of Statistics, Ministry of Planning Cambodia

Mr. Sam Ol Yim Ministry of Interior Cambodia

Ms. Chaitali Sinha International Development Research Centre (IDRC), Canada Canada

Mrs. Esitia Lolohea Baro

Births, Deaths and Marriage Registry, Fiji Fiji


Title First name Last Name Affiliation: Country of residence:

Mr. Shivnay Naidu Ministry of Health Fiji

Dr. Devina Nand Ministry of Health - Republic of Fiji Fiji

Mrs. Merewalesi Raikoti Fiji Bureau of Statistics Fiji

Mrs. Kelera Cilakawa Ravono MINISTRY OF FINANCE Fiji

Mr. Timoci Savu Ministry of Health Fiji

Mr.

Chee Ning Yuen Thompson Yuen

Ministry of Strategic Planning, National Development & Statistics Fiji

Dr. Amol Deshmukh EPOS Health Management Germany

Mrs. Jyotsna Chikersal World Health Organization India

Dr. Yok Ching Chong WHO Indonesia

Mr. Boga Hardhana Ministry of Health Indonesia

Mr. Salvator Happy Hardjo BPS-Statistics Indonesia Indonesia

Mr. Kelvin Hui GIZ Indonesia

Mr. Jery Kwan WHO Indonesia

Mr. Malyono Mawar Ministry Of Home Affairs Indonesia

Ms. Aurora Rubio Head, ITU Area Office for South East Asia Indonesia

Mr. Imam Subekti Ministry of National Development Planning Indonesia

Mr. Iskandar Zulkarnaen Center For Health Data, MOH Republic Indonesia Indonesia

Mrs. Athi Susilowati Rois Ministry of Health Indonesia

Dr. Valeria De Oliveira Cruz WHO Lao PDR

Mr. Somvang Inthavong State Authority of Social Security Lao PDR

Mr. Swady Kingkeo Planning And Finance Department, MOH LAO PDR

Mrs. Bounthay Leuangvilay Ministry of Finance, Deputy Director General of Budget Lao PDR

Dr. Bounfeng Phoummalaysith Ministry of Health, Cabinet Lao PDR

Dr. Boupha Samaychanh Lao Department of Statistics LAO PDR



Mr. Chaleun Sibounheuang National Authority of Post and Telecommunication Lao PDR

Mr. Viengsy Souphakdy Champasak Provincial Health Office Lao PDR

Mr. Nikone Vongsavath Ministry of Labor and Social Welfare Lao PDR

Mr. Amgalanbat Batsuren Information, Communications Technology and Post Authority Mongolia

Mrs. Jargalsaikhan Dondog Ministry of Health Mongolia

Mr. Otgonbaatar Dondonkhuu the Ministry of Health, Mongolia Mongolia

Ms. Tsogzolmaa Jargalsaikhan National Statistical Office Mongolia

Mr. Ganbayar Javkhlan National Development and Innovation Committee Mongolia

Mrs. Altangerel Radnaabazar Information, communications technology and post authority Mongolia

Dr. Enkhbold Sereenen Ministry of Health Mongolia

Dr. Gerald Haberkorn Secretariat of the Pacific Community New Caledonia

Dr. Simon Reid Secretariat of the Pacific Community New Caledonia

Ms. Jovita Aragona Department of Health Philippines

Dr. Ryan Banez National Telehealth Center - University Of The Philippines Philippines

Mr. Noel Banez National Telehealth Center - University Of The Philippines Philippines

Asec. Gerardo Bayugo Department Of Health Philippines

Dir. Maylene Beltran Department Of Health Philippines

Mr. Ruben Canlas Ateneo School Of Medicine And Public Health Philippines

Mr. Isi Cardenas National Telehealth Center - University Of The Philippines Philippines

Ms. Belinda Castro Department of Interior and Local Government Philippines

Roy Consulta National Comupter Center Philippines

Mr. Bobby Crisostomo Phillipine Health Insurance Corporation Philippines

Mr. Ian Christopher de Jesus SMART Communications Philippines

Mr. Ramon Duremdes Jr. SMART Communications Inc. Philippines



Dr. Melecio Dy Department of Health Philippines

Mr. Randy Fernandez National Telehealth Center - University Of The Philippines Philippines

Ms. Grace Fernando Department of Health Philippines

Asec. Nemesio Gako Department Of Health Philippines

Mr. JR Gavino National Telehealth Center - University Of The Philippines Philippines

Dr. Beverly Ho National Telehealth Center - University Of The Philippines Philippines

Mr. Masanori Kurisu JICA Philippines Philippines

Mr. Mark Landry World Health Organization Philippines

Mr. Robert Manuel Department of Health Philippines Philippines

Mr. Wayne Manuel National Telehealth Center - University Of The Philippines Philippines

Dr Alvin Marcelo National Telehealth Center - University of the Philippines Philippines

Dr. Portia Grace Marcelo National Telehealth Center - University of the Philippines Philippines

Mr. Mario Matanguihan Philippine Health Insurance Corp. PHILIPPINES

Dir. Raul Nilo Philippines

Mr. Art Ongkeko National Telehealth Center - University Of The Philippines Philippines

Ms. Merlita Opeña

Philippine Council for Health Research and Development-Department of Science and Technology Philippines

Ms. Melissa Pedrena National Telehealth Center - University Of The Philippines Philippines

Jimmy Recilla Philippines

Ms. Aurora Reolalas National Statistics Office Philippines

Dr Vito Roque NEC Philippines

Arlene Ruiz National Economic and Development Authority Philippines

Dr. Agnes Segarra Department Of Health - Philippines Philippines

Mr. Mario Matanguihan Philippine Health Insurance Corporation Philippines

Julie Sudario Philippines

Ms. Marie Irene Sy National Telehealth Center - University Of The Philippines Philippines



Ms. Charity Tan Department of Health Philippines

Ms. Crispinita Valdez Information Management Service, Department of Health Philippines

Dr. Angela Wee National Telehealth Center - University Of The Philippines Philippines

Benedicta Yabut Philippines

Dr. Ramesha Saligrama Krishnamurthy World Health Organization Switzerland

Dr. Margarita Guerrero United Nations ESCAP Thailand

Dr. Tongyai Iyavarakul NESDB, Office of the Prime Minister of Thailand Thailand

Dr. Asanee Kawtrakul

National Electronics and Computer Technology Center, National Science and Technology Development Agency Thailand

Dr. Boonchai Kijsanayotin Health Service Research Institute Thailand

Mr. Wilas Suwee National Statistical Office Thailand

Dr. Chairoj Zungsontiporn Central Office for Healthcare Information Thailand

Mr. Ummuro Adano Management Sciences for Health USA

Ms. Teri Brezner Management Sciences for Health USA

Mr. Karl Brown The Rockefeller Foundation USA

Dr. Christoph Bunge GIZ Vietnam USA

Ms. Lisa Carrier USAID USA

Ms. Alyson Clark Management Sciences for Health USA

Ms. Anita Datar Garten Futures Group USA

Ms. Pamela Foster TRG, Inc. USA

Dr. Dennis Israelski InSTEDD; Stanford University School of Medicine USA

Ms. Rachelle Jacobson TRG, Inc. USA

Ms. Sarah Johnson Management Sciences for Health USA

Ms. Karin Lane USAID USA

Dr. Theo Jozef Constant Lippeveld MEASURE Evaluation USA

Dr. John Novak USAID USA

Dr. Janise Richards CDC USA



Mr. Gregory Russell OGAC/Noblis USA

Ms. Margaret Saunders Futures Group Global USA

Dr. Amy Gottlieb USAID - Vietnam Vietnam

Dr. Son Ha Thai Ministry of Health of Vietnam Vietnam

Dr. Van Hoi Le

Central Health Information and Technology Institute, Ministry of Health Vietnam

Mr. Toan Nguyen Duc Ministry of Information and Communications Vietnam

Mrs. Hoang Thanh Huong Health Statistics Division, Planning & Finance Dept. Ministry of Health Vietnam

Prof. Hoang Phuong Nguyen Ministry of Health Vietnam

Ms. LeDung Nguyen Duc

Central Health Information and Technology Institute, Ministry of Health Vietnam


Appendix 4: Forum Program Delega SUNDAY, 12 JUNE 2011te Registration

Time Session

6:00 – 9:00pm Registration – Hyatt Meeting Room 2

DAY 1: MONDAY, 13 JUNE 2011

Time Session

7:45am Buses depart Hyatt for WPRO Conference Hall

7:45 – 8:15 am On-site Registration – WPRO Conference Hall* *on-site registration is only for participants unable to attend Sunday’s registration at the Hyatt

MORNING PLENARY: Opening Session

8:30 am

Opening Remarks Maylene M. Beltran, Department of Health, Republic of the Philippines

Welcome Dr. Hans Troedsson, World Health Organization

Introduction to the Forum John Novak, United States Agency for International Development

Introduction of Delegates and Partners

Pre-Forum Interview Results Anita Datar Garten, Futures Group

Overview of the Forum -Objectives, Agenda, Methodology, Norms

HIS Impact Story – #1 Thailand

10:20 – 10:50 am Tea Break

Intro of Keynote Speaker Lucille Nievera, World Health Organization

Keynote Speaker Assistant Secretary Gerardo Bayugo, Department of Health, Republic of the Philippines


Technical Overview of HIS Ramesh Krishnamurthy, World Health Organization

Overview of the Country Leadership and Ownership Continuum

Mark Landry, World Health Organization

Logistics and Preview of Afternoon Breakout Sessions

12:30 – 1:30 pm Lunch (go directly to breakout rooms after lunch)

Assigned Breakout Rooms: WORKING GROUP SESSION #1 [Country-Specific Groups]

1:30 – 5:00 pm Working Group Session #1 – HIS Ownership and Leadership

Session Objectives • Establish working groups. • Orient delegates to expectations, process, norms, and working in teams. • Enhance understanding of HIS ownership and leadership.

AFTERNOON PLENARY

5:00 – 5:30 pm Wrap up for the Day

5:30pm Buses depart for Hyatt

7:00 - 11:00 pm

RECEPTION – Hyatt, Ballroom II


DAY 2: TUESDAY, 14 JUNE 2011

Time Session

MORNING PLENARY

7:45 am Buses depart Hyatt for WPRO Conference Hall

8:30 am

Overview of the Day

A Collective Vision for HIS Professor Dr. Abul Kalam Azad, Directorate General of Health Services, People’s Republic of Bangladesh

Impact Story #2 Vietnam

Creating an Information Culture in HIS Dr. Theo Lippeveld, JSI

9:45 am Group Photo

Assigned Breakout Rooms: WORKING GROUP SESSION #2 [Sector-Specific Groups]

10:00 am – 12:30 pm Working Group Session #2 – MultiSectoral Engagement and Coordination / Demand for Data Session Objectives • Identify the potential role of each sector in HIS. • Identify information needs by sector.

12:30 – 1:30 pm Lunch (go directly to breakout rooms after lunch)


1:30 – 5:00 pm Working Group Session #3 – HIS Strengths & Gaps Analysis Session Objectives • Assess HIS strengths and gaps in relation to the seven dimensions of HIS.

Concurrent Donor/Sponsor/Resource Agency Working Group Session #1

AFTERNOON PLENARY

5:00 – 5:30 pm Wrap up for the Day

5:30pm

Buses depart for Hyatt


DAY 3: WEDNESDAY, 15 JUNE 2011

Time Session

MORNING PLENARY


8:30 am

Overview of the Day

Effective MultiSectoral Collaboration Ummuro Adano, Management Sciences for Health

[Country-Specific Working Groups]

9:10 – 10:15 am Working Group Synthesis and Preparation for Report Outs


10:15 – 10:45 am Tea Break

Groups of 2-3 Country Teams

10:45 am – 12:00 pm Inter-Team Reporting and Networking

12:00 – 1:00 pm Structured Networking Lunch

AFTERNOON PLENARY

1:00 pm

Highlights from Inter-Team Networking

Resources to Support HIS Strengthening – Donor Panel Panel Objectives

Share preliminary plan to improve donor coordination.

Describe the donor secretariat and how to access follow-on resources.

Reconfirm donor commitment to a country-led process.

Question and Answer

Overview of Action Plans

3:00 – 3:30 pm Tea Break


3:30 – 5:30 pm Working Group Session – Action Planning (To be continued Day 4) Note: No plenary wrap-up this day

Session Objective:


• Outline a preliminary strategy for addressing priority gaps in HIS. • Identify potential national and donor resources to implement the plan.


5:30pm Buses depart for Hyatt

6:45 pm Buses depart hotel for dinner sponsored by Philippines Department of Health


DAY 4: THURSDAY, 16 JUNE 2011

Time Session

MORNING PLENARY


8:30 am

Overview of the Day

Impact Story #3 Philippines


9:00 – 11:00 am

Action Planning Continued

11:30 – 12:30 pm Working Group Synthesis and Preparation for Report Outs

12:00 – 1:00 pm Lunch

Groups of 2-3 Country Teams

1:00 – 2:30 pm Inter-Team Reporting and Networking

2:30 – 3:00 pm Tea Break

AFTERNOON PLENARY (Closing 3:15 -5:05 PM)

3:00 pm

Highlights of Country Team Priority Actions

Virtual Leadership-Development Program (VLDP) Sarah Johnson, MSH

Evaluations

Closing Remarks Mark Landry, World Health Organization

Closing Remarks Assistant Secretary Nemesio Gako, Department of Health, Republic of the Philippines

Awarding of Certificates

5:00 pm Buses depart for Hyatt


Appendix 5: Summary of Final Participant Evaluations Please rate the quality and usefulness of… Very

High

Somewhat High

Somewhat Low

Very Low

1. Monday plenary – Keynote Address Overall positive opinion: 97% 33/67 32/67 2/67 0/67

2. Monday plenary – Overview of the HIS Continuum Overall positive opinion: 100% 44/70 26/70 0/70 0/70

3. Monday plenary – Technical Overview of HIS Overall positive opinion: 100% 45/74 29/74 0/74 0/74

4. Tuesday plenary – Creating an Information Culture in HIS Overall positive opinion: 99% 40/68 27/68 1/68

0/68

5. Wednesday plenary – Effective Multi-Sectoral

Collaboration Overall positive opinion: 99%

46/69 22/69 1/69 0/69

6. Impact Stories from the Field Overall positive opinion: 99% 31/70 38/70 1/70 0/70

7. Country Team Report Out presentations Overall positive opinion: 99% 25/68 42/68 1/68 0/68

8. Networking opportunities Overall positive opinion: 99% 26/67 40/67 1/67 0/68

Comments:

Dr. Hans presentation really brought home that each one of us can be catalysts for change.

Would be good to have equal opportunity for all countries to share their experience and best practices (not 3 countries only)

Very good conference

A good avenue to leverage the linkages and share available ideas Impact stories provide opportunities to identify experts in Asia Pacific

Please rate your satisfaction with… Very

High

Somewhat High

Somewhat Low

Very Low

9. Pre-Forum Web Information Overall positive opinion: 94%

30/70 36/70 4/70 0/70

10. Organization of the Forum Overall positive opinion: 97%

45/71 24/71 2/71 0/71

11. Forum Facilitation Overall positive opinion: 99%

57/74 16/74 1/74 0/74

12. Conference space (general session and breakout rooms) Overall positive opinion: 100%

53/70 17/70 0/70 0/70

13. Participant Package and Forum materials Overall positive opinion: 99%

37/70 32/70 1/70 0/70

Comments:

Enjoyed and appreciated the environment created for achievement of objectives

Inter-country networking was a good strategy of this forum

Experience stories of other countries was also useful to help us realize that no system is perfect and there are limitations but strategies can be set up to ensure the usefulness of their existing system

I liked allowing the country teams to speak and work in their own languages. I also really liked the inter-country team report outs


20. Did you feel the length of this Forum was too long, just about right, too short?

_4_ Too long _65_ Just about right _4_ Too short

21. Did the sponsors provide clear guidance and information on follow-up and/or next steps once you arrive back in country? If not, how could it be made clearer?

Yes, we are ready with our TORs, we will refocus based on our outputs/discussions in this workshop for submission to funding agencies and development partners

Donor presentation on next steps could have been a little clearer

Donors should elaborate their areas of interest to work with country in HIS area

Would be good to have more detailed information, like a print out or weblink summary with a description of funds available, deadlines, requirements

Yes but we need practical mechanism

Opportunity to have a continued partnership on the HIS website

Comments (continued):

Good opportunity to meet other delegates from other countries

The support from WPRO and DOH was extraordinary. Mark Landry was pivotal in this conference, just excellent.

The pre-forum meeting was a great way of providing a base of the team not only to get to know each other well but also to share our role for others to understand.

We could feel the effort given to organize the workshop

Would be good if country participants are given the per diems to arrange on their own.

Facilitators were very helpful and are HIS experts themselves

Facilitation of group work discussions was excellent but facilitation of plenary sessions was overdone.

Rapporteurs did a great job and it was a very good idea to have contracted them.

Organization of the flights was not ideal as our route required transit visas.

This conference … Strongly Agree

Agree Disagree Strongly Disagree

14. Was conducted in a manner that is consistent with the principles of country ownership and leadership. Overall positive opinion: 99%

32/73 40/73 1/73 0/72

15. Produced a useful action plan and/or possible approach for engaging with multiple HIS stakeholders in country. Overall positive opinion: 100%

36/71 35/71 0/71 0/71

16. Provided information and resources that will support my taking a stronger leadership role in HIS. Overall positive opinion: 99%

35/73 37/73 1/73 0/73

17. Provided information and ideas that I will share with my colleagues back home. Overall positive opinion: 100%

38/73 35/73 0/73 0/73

18. Will help me face the challenges job with renewed enthusiasm. Overall positive opinion: 99%

30/72 41/72 1/72 0/72

19. Showcased the importance of multisectoral collaboration in strengthening HIS. Overall positive opinion: 100%

41/73 32/73 0/73 0/73


22. What one or two “take aways” from the Forum will have the greatest positive impact on your continued work in HIS strengthening?

Need to develop HIS Standards.

Collaboration among stakeholders is critical, we need to expand and formalize existing collaboration

Sharing of success stories of selected country

The VLDP presentation

Much of the work ahead involves partnership, negotiation, collaboration, new structures, blending institutional cultures. Regional networking is essential.

HIS is a multi-sectoral concern. It is not just for the health sector alone. The MOH cannot do this on their own but need other sectors to effectively and efficiently deliver its services

Identified gaps and preparing action plan

Better understanding of HIS, what others are doing. Knowledge sharing about interoperability, data quality.

The importance of presenting accurate data for decision making in all levels to improve health services

Promote DPs contribution in line with Government’s plan

Developing close relationships between country team members. Can now better understand my country member’s team perspective on HIS

At the country level we’re committed to come up with a multi-sectoral and committed action plan. Donors committed to align their support to country agenda in a harmonized manner.

Better understanding of common challenges faced by participating countries in terms of effective, accurate HIS for evidence based decision making. A multi-sectoral approach will strengthen HIS for well targeted resources.

Leadership strengthening, integrated HIS plan

Human resource development through capacity building of staff

Collective support for common challenges across different countries

As a donor the forum was a helpful reminder to be aware of the political contexts and structures within which we provide grants. Moreover, I feel the parallel sessions with donors and partners helped break down some of the capacity around our different modus operandi

23. We welcome any comments you wish to share about this Forum (e.g., workshops, keynote presenters, topics, themes, locations, etc.). Please include suggestions for how we might improve the next Forum.

Excellent organization

This conference is a success and it’s an avenue to learn from other countries. Good time management!

Best features were time management, facilitators’ execution of assigned tasks both during plenary and break out groups.

Needed: Internet connection to better access information and for data to use as a reference in break out groups

Overall the Forum has been useful in the sense that it has provided some clear understanding of our role and the need to constitute effectively strengthen HIS in our country. How useful this system is to our economy. We will need to provide some better mechanisms in ensuring a workable HIS even with the limited resources we have. Also to know the importance of this information.

The Philippines hospitality was excellent, continue to organize workshops within developing countries.

This type of workshop should be organized for the WHO-SEAR

This workshop should be organized regularly

It was a good opportunity for networking and bringing together country partners but more work of fundraising in advance could have helped countries to know what they could expect and prioritized their action plans accordingly. There were expectations raised which were not clear if/how they will be met.

Mr. Adano’s presentation as an eye opener, I think not only for me but also the rest of the participants

Fiji’s inclusion in this workshop is really appreciated.

You should include the principal of HIS standard to be present including legal framework, experiences of collaboration between multi-sectoral groups.

Provide conference materials before the meeting via email


Appendix 6: Country Team Action Plans Bangladesh Priority Gap or Opportunity #1

Actions to Address the Gap Relevant Stakeholders Indicator of Success

Person Responsible Timeframe Cost estimate

Resources Needed

There is a need to accelerate the expansion of the human resource capacity, at all levels and in all areas, particularly ICT capacity and information use.

1.1 Assessment of human resource needs in HIS/ICT

MoH (MIS-H, MIS-FP, HRM), BBS, LGRD, PMO, MoPA, MoF

HR needs assessment report available.

Director, MIS-H Director, MIS-FP Line Director, HRM

September – December 2011

Budget to be prepared

TA

1.2 Development of HIS human resource plan

Categories and number of new positions to be created.

Categories and number of in-service training to be provided.

Procedures for recruitment.


Availability of the plan.


January – February 2012


TA

1.3 Preparation/development of job description for each category of new position.


Availability of job description.


January – February 2012


TA

1.4 Completion of administrative process to create new positions (including approval).


All planned new positions created.


January 2012 – June 2013


National - lobbyist

1.5 Recruitment for new positions: interim, outsourced and permanent.

MoH (MIS-H, MIS-FP, HRM1),

BBS, LGRD, PMO, MoPA, MoF All planned positions filled.


January 2012 – December 2013


National - secretarial

1.6 Development of operational training plan.

MoH (MIS-H, MIS-FP, HRM1) Training plan

available. Director, MIS-H Director, MIS-FP Line Director, HRM

March - April 2012


TA

1.7 Development and production of training materials.

MoH (MIS-H, MIS-FP, HRM1) Training

materials available.


May – October 2012


TA

1.8 In-service training according to human resource plan in terms of number and category.

MoH (MIS-H, MIS-FP, HRM1) All staff trained

according to plan.


August 2012 – June 2014


TA + National

1.9 Development of operational plan for monitoring and supervision.

MoH (MIS-H, MIS-FP, HRM1) Operational plan

available. Director, MIS-H Director, MIS-FP Line Director, HRM

May – June 2012


TA

1.10 Monitoring and supervision of HIS staff.

MoH (MIS-H, MIS-FP, HRM1) Monitoring and

supervisory system in place and functional.


July 2012 - ongoing


National


Bangladesh Priority Gap or Opportunity #2



Resources Needed

There is room for improvement in use of information, specifically at sub-national levels, including creation of an accountability context and incentive package for data quality, sharing/ reporting, interoperability, and use.

2.1 Preparation of a consensus building workshop on the creation of an accountability context and incentives package for data quality, sharing/reporting, interoperability, and use.

MoH, MoPT, MoP, MoLGRD, MoF, MoPA, MoScICT, MoSW, PMO, DPs, Private Sector, NGOs, TelCos, Academia, Research Organizations

Workshop held. Director, MIS-H September –October 2011

TBD TA + National Director, MIS-FP

LD, HRM

2.2 Organization of a consensus building workshop.


Workshop report available.

Director, MIS-H Nov-11 TBD TA + National Director, MIS-FP

LD, HRM

2.3 Development of an operational plan (including monitoring and evaluation plan) for accountability context and incentives package for:


Operational plan available.

Director, MIS-H December 2011 – January 2012

TBD TA + National

· data quality Director, MIS-FP

· sharing/reporting LD, HRM

· interoperability

· use

2.4 Establishment of baseline on the HIS performance (data quality, sharing/reporting, interoperability, use).

MoH, MoLGRD, MoPA Availability of baseline.

Director, MIS-H February - April 2012


LD, HRM

2.5 Implementation of operational plan.


Progress against baseline.

Director, MIS-H May 2012 - ongoing


LD, HRM

2.6 Monitoring and evaluation of the implementation of the accountability context and incentives package.

MoH, MoLGRD, MoPA Evidence of ongoing monitoring and periodic evaluations, and corrective actions.

Director, MIS-H May 2012 - ongoing


LD, HRM





Resources Needed

Need for detailed guidelines on HIS procedures.

3.1 Preparation of a consensus building workshop on outline for guidelines on HIS components (resources, indicators, data collection and management, data quality, dissemination, and use).

MoH, MoPT, MoP, MoPT, MoLGRD, MoScICT, MoF MoSW, PMO, DPs, Private Sector, NGOs, TelCos, Academia, Research Organizations

Workshop held Director, MIS-H Feb-12 TBD TA + National Director, MIS-FP

LD, HRM

3.2 Organization of a consensus building workshop.

MoH, MoPT, MoP, MoPT, MoLGRD, MoScICT, MoF, MoSW, PMO, DPs, Private Sector, NGOs, TelCos, Academia, Research Organizations

Workshop report available

Director, MIS-H Mar-12 TBD TA + National Director, MIS-FP

LD, HRM

3.3 Development of an HIS guideline.

MoH, MoLGRD, MoP, MoPT, DPs

HIS guideline available

Director, MIS-H May – August 2012


LD, HRM

3.4 Approval of the guideline by the ministry.

MoH Director, MIS-H Sep-12 TBD TA + National Guideline

approved Director, MIS-FP

LD, HRM

3.5 Publication and dissemination. MoH, HIS guideline published and disseminated

Director, MIS-H October 2012 - ongoing


LD, HRM





Resources Needed

Need to adopt standards for data interoperability.

4.1 Literature review and study tour.

MoH, MoPT, MoP, MoLGRD, PMO

Report on literature review and study tour.

Director, MIS-HS July – September 2011

TBD TA

Director, MIS-FP

LD, HRM

4.2 Preparation of the workshop. MoH Workshop held. Director, MIS-HS Oct-11 TBD TA

Director, MIS-FP

LD, HRM

4.3 Organization of the workshop. MoH, MoPT, MoP, MoPT, MoLGRD, MoScICT, MoF MoSW, PMO, DPs, Private Sector, NGOs, TelCos, Academia, Research Organizations

Workshop report available.

Director, MIS-HS Nov-11 TBD TA

Director, MIS-FP

LD, HRM

4.4 Production and dissemination of guidelines on interoperability.

MoH Interoperability guidelines published and disseminated.

Director, MIS-HS Director, MIS-FP

December 2011 - January 2012

TBD TA

LD, HRM


Cambodia Priority Gap or Opportunity #1



Resources Needed

Inconsistency in terms of representatives attending meetings. No concrete roles for each group, more on information sharing as supposed to action plans. Issues on political will and commitment.

Creation of multisectoral decision making group to achieve the power of authority and they would meet less frequently than the multisectoral group.

MoH, MoI, MoP, MoTC, MEF, Donors and Partners

Quarterly review on the outcome.

High ranking political level and technical level

At least one year

Donor and government counterpart

Review terms of reference for HIS stakeholder working groups to include frequency of meetings, strengthening capacity of the multisectoral group, and project actionable items.


Performance monitoring.


At least one year


Develop an action plan for the multisectoral group, identify technical assistance needs, and create a budget line item. Financial budget line item to support coordination in small projects/pilots.



At least one year


Identify capacity building needs of the HIS stakeholder working group to better provide oversight and technical support.

Advocate for HIS policy on standards, security, and confidentiality. Also advocate for a policy in recruiting ICT graduates.





Resources Needed

Presence of different vertical data programs.

Cross access database flow and database system among the multiple ministries. Commitment from policy leaders, open standards, and reusability.

MoH, MoI, MoP, MoEF,, MoPT MoSF, MoEDU, Donors and Partners

Mapping report. Cambodia Team Delegates

September, 2011

Present the result of a mapping exercise that explores the data of different databases to stakeholders, and build consensus case data set to share to all parties.


Core indicator asset.

Cambodia Team Delegates

November, 2012

Create criteria for system requirements.

Interface development with appropriate technology solution. Also to include testing the system. (A need to have a policy framework to address to the standards, security and confidentiality.)

Technical team Established database. System implemented.


July, 2012

Implementation and introducing Interoperability of Database system.


Increasing number of organizations who access the system.


August, 2012

Document all the information gathered and disseminate.


Base practice identification.


May, 2013

Technical Team

TA site evaluation. MoH, MoI, MoP, MoEF,, MoPT MoSF, MoEDU, Donors and Partners


TBD

Cascade to lower levels. Lower levels develop their own system.


TBD





Resources Needed

Retention and capacity building – problems in public sector job opportunity/ private sector offer higher salary.

Recruit ICT by strengthening university/government collaboration and identify roles/projects for students. To expose to the benefits of working to the public sector.

MoH, MoTC, MEF, MoI, MoP, donors and partners

Increasing job impact. Quality assurance.

MoH 2012 - 2015 Financial support

Identify which institutions will offer informatics program and develop health informatics curriculum.

Universities, MoH Health informatics curriculum developed.

MoH, MoEYS 2012 - 2015 Technical and Financial Support

Increasing number of university applied curriculum.

Training basic computer skills to HIS staffs at local levels

MoH, MoI, MoTC, MoP Increasing number of HIS staff trained.

MoH, MoI 2012 - 2015 Financial support

Training on data use and data management on HIS staff from the top level to the local level.

MoH, MoI, MEF, MoP, MoTC MoH 2012 - 2015 Financial support Increasing

number of HIS staff trained.

Training for stakeholders. MoH, MoI, MoP, MoTC, MEF Increasing number of HIS staff trained.

MoH 2012 - 2015 Technical and Financial Support

Motivating mechanisms MoH, MoI, MoP, MEF Increasing number of HIS staff trained.

MoH 2012 - 2015 Financial support

Financial incentive and recognition and encourage personal growth and satisfaction

MoH, MEF


Fiji Priority Gap or Opportunity #1



Resources Needed

Establishing a multisectoral working group

Reconvene the country team meeting to discuss the key messages from the HIS forum (everyone to bring draft key messages) and identify recommendations for the multisectoral working group.

FIBOS, MoH, MoF, MoP, RG Meeting has convened.

Devina Nand, MD 1 week n/a n/a

Present a report to the Permanent Secretary and Minister of Health, including all key messages and recommendations for the multisectoral working group.

MoH Report submitted, presentation made.

Shivnay Naidu 2 weeks n/a n/a

Write the draft of Terms of Reference (TOR) for the multisectoral working group.

MoH Completing the draft of TOR.

Shivnay Naidu 2 weeks n/a Local Technical Assistance

Identify membership of the multisectoral working group.

MoH Have a list of members submitted to DIP.

Permanent Secretary, (Devina Nand, MD), MoH

2 days after completing draft TOR

n/a n/a

Send invitation to stakeholders for membership to the multisectoral working group.

MoH Successful delivery.

Shivnay Naidu 3 days after identifying membership

n/a n/a

Set an agenda for the first meeting of the multisectoral working group.

MoH Draft agenda completed.

Shivnay Naidu 3 days after identifying membership

n/a n/a

Convene first meeting of the multisectoral working group.

FIBOS, MoH, MoF, MoP, RG Meeting undertaken.

Shivnay Naidu July Facilitation, cost of attendance, logistics

Financial & Technical Assistance

Draft a Cabinet Information Paper to inform the cabinet of the outcomes and key messages from the Health Information System (HIS) Forum and to inform them of the intent to create a multisectoral working group.

FIBOS, MoH, MoF, MoP, RG, Cabinet

Cabinet paper prepared and presented.

Shivnay Naidu; 2 weeks n/a n/a

Country Team Members


Fiji Priority Gap or Opportunity #2



Resources Needed

Coordinate Development Partners Assistance in line with National Policies

Wait for feedback on the metrics from the development partners.

MoF, MoH, Development Partners

Metrics received.

Kelera Ravono & Shivnay Naidu

2 weeks n/a n/a

Check the metrics for alignment of assistance with the national government policies and provide a report to the Ministry of Health (MoH) which includes the list of development partners, the areas of assistance, and the analysis of alignment.

MoF, MoH Report submitted from MoF to MoH.

CEPO Overseas Development Assistance (ODA) unit

2 weeks after receiving feedback

n/a n/a

Prioritize the projects for funding by development partners and complete costing.

MoF, MoH Report submitted by MoH to MoF.

Shivnay Naidu Until August n/a n/a

Overseas Development Assistance (ODA) unit (under Ministry of Finance) to conduct consultation with development partners to renegotiate assistance in alignment with national priorities.

MoF, MoH, Development Partners

Final ODA matrix completed.

CEPO Overseas Development Assistance (ODA) unit

Until October n/a Bringing in an outside group for negotiation with development partners and ODA

Send expression of interest through email to potential development partners for assistance on unfunded priority projects.

MoF, MoH Expression of interest submitted.

CEPO Overseas Development Assistance (ODA) unit & Shivnay Naidu

Until September

n/a n/a


Indonesia Priority Gap or Opportunity #1



Resources Needed

Difficult to secure commitment from members and stakeholders at all levels on the steering committee

Conduct technical committee meeting to:

Technical committee and secretariat

Draft of revised TOR

Head of Center for Data and Information, MoH

July 2011 ( 2nd

week)

TBD National

Review TOR (defining roles for stakeholders, membership)

Schedule and agenda of SC

Prepare SC meeting

Conduct SC Meeting to : SC TOR approved Head of Center for Data and Information, MoH

July 2011 ( 4th

week)

TBD National

Obtain the approval of draft of TOR

Socialize the importance of HIS strengthening

Conduct technical committee meeting to:

TC Finalize strategic plan (roadmap)


August 2011 (2

nd week)

TBD National

Follow up the SC meeting

Review the strategic plan of HIS (road-map)

Special meeting of MoHA and MoH to obtain circular letter on HIS for the governors and mayors (head of province and district/city)

MoH, MoHA Circular letter distributed


Sep-11 TBD National

National workshop on HIS strengthening for province level (health sector)

TC, province Draft Provincial POA


Oct-11 TBD Partner (technical)

Multi-sectoral workshop on HIS strengthening for province level (regional wise)

TC, province, key stakeholders at province level

Provincial POA Head of Center for Data and Information, MoH

Nov-11 TBD Partner (technical)


Indonesia Priority Gap or Opportunity #2



Resources Needed

Data quality still requires substantial improvement

Develop data quality standards and data quality control mechanism

MoH, BPS, NIHRD, MoHA, TA Draft of data quality standard and data QC mechanism


January-March 2012

TBD National, Partner (technical)

Develop health data dictionary

Develop data repository

Improve methodology for estimating indicators

Organize technical workshop on data quality standard and data quality control mechanism

TC Data quality standard and data QC mechanism


Apr-12 TBD National

Training needs assessment and conducting training on data quality standard and data quality control mechanism at all levels in health services

TC, MoH, TA Training strategy and plan


TNA: Feb-Mar 2012

TBD National, Partner (technical) Number of HIS

officers trained Training module devt: May-June 2012

Training: July-Sept 2012

Monitoring and evaluation of data quality standard and data quality control mechanism

MoH, Statistics Indonesia M&E report Head of Center for Data and Information, MoH

July-Dec 2012 TBD National

Improve vital registration system and cause of death

MoHA, Statistics Indonesia, NIHRD, school of public health, TA

Vital registration system updated and improved

Director of Information Population, MoHA

Mar-12 TBD National, Partner (technical)

Conduct training on ICD-10 MoH, HIS PHO, MoHA, TA # of HIS DHO, Medical Record Officers at Hospitals trained


Sept-Dec 2012 TBD National, Partner (technical)

Finalize policies on HIS Finalize HIS guidelines and SOP Government regulations on HIS

SC, TC, TA Finalized HIS guidelines and SOP


Sep-11 TBD National, Partner (technical)


Lao PDR Priority Gap or Opportunity #1



Resources Needed

I. Human Capital Development

Short term: Conduct succeeding meetings with other key stakeholders.

MoH, MoF, WHO, DoS-MPI, MoE, MoLSW, Prime Minister Office, PACSA

Current and possible resources are identified.

TBD TBD TBD Possible Donors:

A. Training programs for all aspects of HIS (curriculum development, accredited training institutions, pre-service/in service training) B. HIS Training for health professionals C. Recruitment of HIS experts

Identify types of trainings needed and for whom.

NAPT, NAST, Universities ADB (Northern Lao PDR) Lux Development (Middle Lao PDR) GAVI UNDP UNFPA World Bank (Southern Lao PDR) GFATM Round 11 EC/EU USAID UNESCAP

Determine other possible local resources (donors might be available only on 2012 specifically Global Fund).

WHO (for coordination of current and possible donors)

Determine possible donors (already current and possible donors).

Long term: Partnership with Universities/institutes to ensure graduates have the necessary IT skills

University of Health Sciences, Training Institutes, MoH, MoF

Appropriate training programs/course developed.

University of Health Sciences

5 Years – establish courses

TBD

July 4 – 8 education development center workshop

ADB, WHO (for July 4-8 workshop)

Review of current curriculums in place

Strengthening the capacity of University of Health Sciences

Opportunity to engage

Ensure existing training programs are teaching latest technology

Develop training for programmers through donor funding






Resources Needed

Long term: - Pre-service and in-service of data users, end-users on:

DoS – MPI (LaoInfo) Appropriate training programs/course developed.

University of Health Sciences

3 Years – establish courses

TBD AUSAID

LaoInfo Internet MS Access MS Excel MS Word EpiInfo

MoH, MoF, University of Health Sciences

UNICEF

Nursing, Midwifery schools MoH – Statistics Division


Long term: Increase staff capacity (workforce).

MoH, MoE, MoF, DoS-MPI, NAPT, NAST, PACSA, Universities

Number of staff increased in specified areas.

MoH, PACSA 5 Years TBD (by March 2012)

Engage PACSA.

Recruit biostatistics, epidemiologists, demographers, public health, IT professionals.

Engage training with Universities, Education, Statistics.

Need equipment for the staff.





Resources Needed

A. No Vital Registration B. No Unified Database

Short term: Series of meetings on establishing the Vital Registration (who, what when, how).

MoH, WHO, MoF, DoS-MPI, MoE, MoLSW, Prime Minister Office, PACSA NAPT, NAST, University WHO (for coordination of current and possible donors) Private sector

Core Team established. Proposal / Roadmap developed. Resources are identified.

Electronic system for Hospital-case-mix developed. Unified forms developed for pregnant women follow-up.

Data dictionary developed. Individual identification established. OPD, IPD records computerized.

PACSA DoS – MPI MoH MoH DoS – MPI

MoH MoLSW DoS – MPI PACSA

2 Years – core team established 5 Years – Vital Registration in place

5 Years - Electronic system for Hospital-case-mix completed July 2011 – Unified forms for pregnant women

2 Years - Data dictionary developed 2 Years - Individual identification established 5 Years – Electronic OPD, IPD records completed

TBD Possible Donors: NUDP ADB (Northern Lao PDR) GFATM Round 11 GAVI World Bank (Southern Lao PDR) Lux Development (Middle Lao PDR) USAID AUSSAID EC/EU UNICEF UNESIA

Development of a core team. Determine other sector involvement. Develop joint proposal / roadmap. Develop proposal for additional resources.

Short term: Identify parts of unified database. Hospital case-mix: Paper-based systems exist. Need to develop electronic-based system. Pregnant women follow-up (tracking). Vital Registration. Determine technology needed for unified database. Short term: Strengthen interoperability. Develop data dictionary. Develop individual identification. Followed by OPD, IPD Computerization of records.

TBD

TBD

Long term: 5-year Technical Assistance. Mapping of donor assistance. Mix between short-term and long-term technical assistance.

Technical assistance provided within the span of 5 years.

MoH 5 Years TBD

MoFA

MPI





Resources Needed

Governance, Multisector Engagement

Short term: Create Lao HIS forum. MoH, MoF, WHO, DoS-MPI, MoE, MoLSW, Prime Minister Office, PACSA, NAPT, NAST

TBD TBD TBD TBD National Budget

A. Strengthening & restructuring HIS B. Creation of HIS Coordination Committee C. Resource Mobilization for HIS Structure Functioning D. Unification of National HIS

· Determine other possible partners, sectors.

Equipment (workstations, servers)

Short term: Include more sectors for HIS coordination.

TBD TBD TBD TBD *Possible donor support to be determined

· Include donors in RTP.

· Include more sectors for HIS coordination.

· Develop TOR for this committee.

Short term: recruit Biostatistics, Public Health, HIS professionals.

TBD TBD TBD TBD

· Provide assistance for Dr. Swady Kingkeo (MoH).

Short term: Specifics of Strategic, Annual Operation Plan.

TBD TBD TBD TBD

· Costing.

· Human Resources.

· SWG Engagement.

· Timeframe (2-3 years).


Mongolia Priority Gap or Opportunity #1



Resources Needed

Lack of Human Resource Capacity for Health Information System (HIS)

Conduct research on best practices in Health Information Systems (HIS) · Multi-country research and multi country assessment on HIS

Health Science University • Focus is on HIS standards

HIS roadmap Dr. Jargalsaikhan Dondog Department of Information and Monitoring Ministry of Health

Start by January 2012, completed by June 2012

USD 200,000 (for local costs) + international experts

For Donors:

Mongolian Science and Technology University – for IT · Business model (roles and responsibilities) · Standard data dictionary · HIS infrastructure Ministry of Health ICT, PA

A report on models for standards based from research results

Includes: · Exchange forum · Training costs of the researchers · Field visits and observations · In depth interview with users · Data management and systems analysis

Fund the conduct of the research activity on best practices.

Study Tour: · Nearby Asian countries (rural areas) Objective: Strengthen HIS

For the nearby Asian countries: · Statisticians · IT · Medical systems users

Improved knowledge.

Dr. Enkhbold Sereenen

For the nearby Asian country visit: 10/01/2011

Participant’s travel and per diem

Donors: Time of the experts, payment for travel

· Developed countries (Australia) Objective: Rural telemedicine

How to set-up the system.

For Developed Countries (Australia): Ministry of Health · ICT, Post-Authority · Ministry of Finance National Statistical Office

Positive change in the attitudes of the stakeholders.

For Developed Countries (Australia) 08/01/2011

Government: contribute the time of the participants





Resources Needed

National Workshop with the participation from the regional experts.

Mongolian high level decision makers in different sectors and ministries.

Better understanding of HIS and multi-sectoral collaboration among high level decision makers.

Dr. Jargalsaikhan Dondog Department of Information and Monitoring Ministry of Health

09/01/2012 Important Consideration: (Mongolian National election by end of June 2012 and newly elected officials will take the office in August 2012)

About 120 participants

National Government (Ministry of Health) can provide: · Organizers · Host

Experts from different countries in the region focusing on HIS and multi-sectoral collaboration: Ministry of Health ICT, Post-Authority National Development and Committee National Statistics Office

Improve HIS and multi-sectoral collaboration.

Costs for: ·Location/venue ·Food · TA: experts ·Seminar organization planning ·Logistics ·Translators ·Resource materials

For Donors: ·Financial support for experts ·Technical assistance for program planning and design and resource materials ·Per diem of the participants





Resources Needed

Lack of Human Resource Capacity for Health Information System (HIS), cont’d.

Develop eHealth training program and content for medical staff based on training needs assessment.

· Ministry of Health Development of in-service training program.


September 2011 – November 2011

5,000 USD Technical assistance for curriculum program design and training materials

· ICT-Post Authority

· Department of Health

Conduct local training for medical staff and IT specialists on eHealth applications at the national level.

Ministry of Health 70% of the medical staff and IT specialists attended the eHealth training.


November 2011 – December 2011

20,000 USD Technical assistance for curriculum program design and training materials

ICT-Post Authority

Department of Health

Infrastructure for IT (internet

service and costs are dependent on

other sectors)

Develop policy, laws and regulations on:

ICT-PA Development of national regulations and standards.

Mr. Amgalanbat Batsuren ICT, Post Authority with support from the Ministry of Health

Start September 2011 and completed by end of September 2012

50,000 USD for standards development

Technical assistance for standards development and financial assistance

· Information security · Data protection · Data transfer standardization Steps towards the development of policy, regulations and laws: 1. Research and review on other country’s standards. 2. Creation of a multi-sectoral technical working group meeting monthly. 3. Presentation of the output of the multi-sectoral working group to the parliament including meetings with the key members and standing committee. 4. Development of the policy paper.

Ministry of Health

Ministry of Justice and Home Affairs

Ministry of Finance

National Development and Innovation Center

National Statistics Office

Important Note: ICTPA just granted a loan from Chinese Government to establish the high speed broadband internet network but the government needs to support it by submitting enabling laws and regulations and to keep costs low in rural areas.





Resources Needed

Develop internet access package tariff to make the costs transparent and to:

ICT-PA Development of internet package tariff and rates.

Mr. Amgalanbat Batsuren

January – December 2012

Will mobilize own resources.

Technical assistance for the development of package and set rate

· Reduce accessed costs to the internet

Ministry of Finance ICT, Post Authority

· Coordinate all the high speed internet service

Ministry of Health

· Connect Mongolia nationwide to high speed internet

National Statistics Office

Advocacy campaign to high level decision makers (members of the parliament on why to authorize allocation of funds).

ICT-PA Ministry of Health National Development and Innovation Center

Increased knowledge on how to change attitude in HIS strengthening.

Mr. Batkhurel Galsandorj Director, Policy Department National Development and Innovation Center

Start on July 2011 and completed by December 2011

30,000 USD Includes:

Technical assistance for the:

Specific Steps: · Meetings with the parliament members and high level decision makers · On-site observation and developed HIS champions · Development of policy briefs materials

Increased financing for HIS.

· Meetings with the parliament members and high level decision makers.

· Research synthesis and findings.

· On-site observation and developed HIS champions.

· Support for training champions

· Development of policy briefs materials.

· Development of materials.


Philippines Priority Gap or Opportunity #1



Resources Needed

Government and Multisectoral Engagement

Set up high level multisectoral governing council with governing council secretariat

DOH + PHIN + ICT4H Executive Order (EO) signed by the President

DOH Secretary (Champion)

National ICT month on June 2012

US$ 1,200 National

PHIN has limited membership of needed stakeholders.

DILG, NSO, PhilHealth, NSCB, NEDA, CICT, UP, LGU, DOST, NGO, civil society and private sector

Dir. Nitz Valdez of IMS-DOH (Responsible)

Policy Issues:

·There is an MOA but the provisions are not fully implemented. ·No IRR to address issue of sustainability. · Many non-connected networks.

Conduct Philippine HIS forums to be attended by all stakeholders discussing the National HIS framework based on the agreed template

DOH + PHIN + ICT4H EA Framework PHIN members Online/Face-to-Face Awareness activities:

Cascading activity:

National and Regional

·Technical Assistance for Enterprise Architecture development including review of PHIN MOA (6 months)


Conduct of conferences

DOH USec Ted Herbosa (Champions)

US$ 120,000

·Sharing of EA framework with HIS forum alumni (USD 1,000)

Commitment document signed by stakeholders

Dir. Nitz Valdez of IMS-DOH / PHIN Secretariat (Responsible)

June 29-30, 2011: National ICT month

Advocacy materials:

·Cascade HIS forum and EA to sectors/agencies

August 10-12, 2011:

US$ 50,000 (distributed until June 2012)

·(2-3days) – USD 120,000 PNHRS Week

Develop awareness and advocacy campaign materials for national and sub-national levels – USD 50,000

June 2011 - June 2012: series of forums





(Policy and Regulation Environment)

Inventory/Analysis of Policies and Laws that will enable HIS to create recommendations for HIS policy

DOH-HPDPB, PCHRD, NIH Health Policy Institute, CICT

Web portal of inventory of policies


Oct-11 TBD by proposal

·No overarching policy for HIS.

Dr. Alvin Marcelo, UP-NThC

·No multisectoral analysis.

Merle Opena, PCHRD-DOST

·No Unique Patient ID law, only a circular (PhilHealth).

Dr. Beth Matibag, DOH-HPDPB (Responsible)

Need to update laws and regulations on health information

DOH-HPDPB, NIH Health Policy Institute, CICT, COMSTE, COMHEALTH, UP Law Center, Civil Society Organizations (CSOs)

Analysis Report DOH Secretary (Champion)

Jan-12 USD 1,000 (policy expert)

Dr. Alvin Marcelo, UP-NThC

Merle Opena, PCHRD-DOST

Dr. Beth Matibag, DOH-HPDPB (Responsible)





(Strategic Planning/Financing)

Review and harmonize existing HIS-related plans, and prioritize HIS agenda.

DOH + PHIN + ICT4H Philippine Health Information System (HIS) Plan


Finding all of the plans (3 months)

TBD

· No overarching HIS plan (Planning is agency-specific).

Development of comprehensive and coordinated HIS: common framework and aligned and harmonized efforts


UPM-NThC (1.) / Dr. Alvin Marcelo

Harmonization/Consolidation (6 months)

· No mechanism to know HIS-related plans of each sector.

1. Finding all of the plans; 2. Harmonization/Consolidation 3. White Paper

PHIN TWG (2. and 3) White Paper (1 month)

· Already existing DOH-ISSP but gaps between local and central.

· Already existing National Government Agencies (NGAs) have their own ISSPs but not harmonized.


Philippines

Priority Gap or Opportunity #4



Resources Needed

Human Capital Development · No official job description for HIS professional and no job delineation between IT and health professional. · No standard competency for HIS person.

Develop an action plan for strengthening HR capacity for HIS based on the National HIS Strategic Plan, and for input into the Human Resources for Health (HRH) Master Plan.

Health: DOH-HHRDB Education: CHED, TESDA, Academe Labor: DOLE, Private Sector

Multisectoral Governing Council-approved plan. (Dependent on the 1st component: Governance/ Multisectoral).

DOH Secretary (Champion) (People Responsible) Dir. Kenneth Ronquillo, DOH-HHRDB Dir. Nitz Valdes, DOH-IMS DG. Julie Sudario, CICT

Jun-12 TBD (General support for salaries)

· Analysis expertise · Editorial expertise · Meeting reviews · HR expertise · HIS expertise




Resources Needed

Systems and Data Interoperability Develop an action plan for identifying priorities for systems and data interoperability based on the HIS strategic plan. Gaps: No policy on use of Standards · No HIS Standards Body (DOH, NCC) Policy Issues: No data sharing policies

Inventory and Review of existing standards

PHIN ++(Philhealth DOH, DILG and others) ICTH ICT4H

Standards are ratified by the multisectoral GC for HIS and disseminated and used by the stakeholders

IMS (Jovi Aragona) and NEC (Herdie Hizon) NCDPC (TBA) NCHFD (TBA)

3 months ** Technical

Financial Resources: PCHRD Research Resources

ICT4H (Dr Kenneth Hartigan-Go, Dr Alvin Marcelo, Mario Matanguihan)

DOH realigned Budget

Donor (Technical and Financial)





Resources Needed

Existing policies of different agencies might hinder data sharing (agencies are silos)

Consultation with the Private Sector

PHIN Consultative Meeting and Participation of more stakeholders

GC on HIS (Assistant Secretary Gako and Undersecretary Herbosa)

3 months ** Technical Assistance

Financial Resources:

PCHRD Research Resources


Donor (Technical and Financial)

Logistics:

ICT4H

Dissemination of Data Dictionary PHIN Receive reports that are using Data Dictionary from major/national stakeholders

DOH (Charity Tan) 1 year ** Technical Assistance

NSO (Aurora Reolalas)

Financial Resources:

Philhealth (Dr Art Alcantara)

PCHRD Research Resources

ICT4H (Dr Kenneth Hartigan-Go, Dr Alvin Marcelo)


Donor

Creation of an HIS Standards Body within PHIN

PHIN (NCC, DOH, Philhealth, etc.)

Joint Circular signed to create HIS Standards Body

NCC Policy and Standards Office (Director Raul Nilo) With DOH HPDPB (Virginia Ala/Assistant secretary Bayugo)

3 months ** Joint Circular





Resources Needed

Infrastructure Review of existing inventories and take inventories for gaps (Physical, Internet Facilities, Mobile)

NCC/CICT NTC/DOTC Major Players (PLDT/SMART/Globe/ SunDigitel) Health Facilities (Private / NCHFD)

Inventory Report Done (Mapped)

Director Juli Ana Sudario/Roy Consulta

6 months *** Technical Financial Donor

Develop an action plan to identify the infrastructure needs and make a comprehensive inventory of existing infrastructure based on HIS strategic plan.

Defined HIS infrastructure needs

Undersecretary Herbosa

Gaps: Collaboration with DOST (Advanced Science and Technology Institute) for usage of PREGINET

DOST (ASTI) Connection with PREGINET of stakeholders

Director Juli Ana Sudario/Roy

Consulta Undersecretary

Herbosa

6 months *** Technical Financial

Donor · Incomplete physical inventory of current facilities

PhilCeCNet

Policy Issues: CICT is only a temporary body (created by an Executive Order) Three Telcos and how does government interact with them (expensive, government and NGAs are dependent on them) à Monopoly? · Lack of integration of Health Facilities, ICT and NCC activities for HIS budget for the next cycle





Resources Needed

Information Use Review, Conduct Gap Analysis, Extend and Ratify Data

Management Guidelines

DOH: NEC, IMS, NCDPC DILG and LGUs

NSO Private sector

Receiving Proper Reports

According to Approved Data Management

Guidelines from LGUs and Private

Sector

Governing Council for HIS Assistant Secretary Gako (DOH)

1 year after creation of GC

**** Standards Expertise Analysis Editorial Expertise Information Specialist Meeting Resources

Define information need/Define data flow across sectors and at all levels; conduct inventory.

Gaps:

· No mapping of information needs and data flow (Frequency of collection of data)

Policy Issues: Devolution (LGC 1991) · Evidence Based Policy · Data Management Guidelines still in the process of approval (June 25, 2010)

· No minimum data sets that should be available (standard data)

· Multitasking of government officials


Thailand Priority Gap or Opportunity #1



Resources Needed

Health Data Standards Development and Implementation

PHASE I: Development:

Physicians/ Med Tech NHIC MICT + Nation body to be established (Data standard maintenance organization (DSMO)) Related parties (SSO, NHSO, CGD)

Modified standard for use by Thailand

Dr. Boonchai Kijsanayotin * Dr. Tongyai Iyavarakul Dr. Asanee Kawtrakul Mr. Wilas Suwee Dr. Chairoj Zungsontiporn

July 2011 – June, 2012

1-2 experts for technical study of LOINC (2 weeks) from Regenstrief Institute, Indiana: · Review training. · Assist in customization / localization. LOE (level of effort ) for two experts to travel to Thailand for the technical training. Meeting expenses in 10 locations on technical meeting for customization

Donor support requested for week-long technical training on LOINC.

Selection, scenario impact/benefit analysis.

Public and private hospitals Donor support for technical meeting.

· Kick-off seminar: To get discuss health data standards and develop stakeholder consensus on the specific standards that will be worked on for development or modification.

· Technical training of the LOINC standard. Technical meetings /customization customize LOINC training. · Verification and approval of different stakeholders. · Registry: Formalization.

PHASE II: Implementation Physicians/ Med Tech 80 % of select hospital personnel receive training

Dr. Boonchai + MoPH,

July 2012 – June 2013

· Hospitals (1200 places x 2

persons x 2 days) NHIC

· Prepare documentation. · Software for data standard conversion. · Conduct training.

MICT + Nation body to be established (Data standard maintenance organization (DSMO)) Related parties (SSO, NHSO, CGD) Public and private hospitals





Resources Needed

Limited technical capacity in ICT and HIS among Ministry of Public Health workforce and other related sectors

Executive: (Directors) Executive administrators e.g. CIO from relevant ministries, physicians, academia Trainers

80% attendance Thai team, + MoE November – December, 2011

2 trainers, 2 weeks to assist in developing a Training of Trainers for the Thailand team in HIS in raising leadership awareness and commitment

Donor support for trainers to work with Thailand team once they complete the VLDP.

HIS leadership training to raise awareness and mobilize support among senior managers and executives:

Improved knowledge in HIS.

· Raise importance of awareness.

End users: (Health care providers, Health centers, Hospitals)

MoH, NHSO, CHI (Central Office for Health Care Information)

80% attended the training.

MoPH + NECTEC + NHIC

August 2011 – August 2013

300 units National

· Develop the curriculum and roll-out the curriculum to the end-users (Thailand team has ICT curriculum on ICT network, software, and data security).

· Develop curriculum for HIS skills.

· ICT + HIS skills and competencies for operation and maintenance at the community level.

70% of facilities trained, with properly trained equipment, and sustained operations and maintenance.

subsequently 1000 hospitals 10,000 health centers.

Research and development · Analytic model for health care. · Standardized data generation

architecture development. · HIS enterprise architecture

development. · Unstructured data extraction. · Smart tools for data collection.

NECTEC and universities Physicians software vendors

Enhanced efficiency in HIS and high quality national health information system.

NECTEC and universities

5 years TBD Technical assistance to develop the certificate program (100 hrs), MSc degree hours (200 hrs) and donor support.





Resources Needed

Integrated Heath informatics curriculum development: · In service / health professional certificate program (Approximately 100 hrs). · Formal training for Master’s Degree program (200 hrs).

MoPH, MoE, Universities, MICT, NHC

Curriculum for Heath Informatics Certified health informaticians Graduates

Dr. Boonchai, NHIC, MoE

5 years TBD · Technical assistance and donor support to develop the certificate program (100 hrs), MS degree program (200 hrs) · Donor support and assistance for curriculum development for in-service training and post-graduate degrees · Support from a University that has a good medical and informatics program


Thailand

Priority Gap or Opportunity #2



Resources Needed

Systems and information use

Research and development: NECTEC and universities Enhanced efficiency in HIS and high quality national health information system.

NECTEC and universities

5 years TBD Technical assistance to develop the certificate program (100 hrs), MSc degree hours (200 hrs) and donor support.

· Analytic model for health care.

· Standardized data generation architecture development.

· HIS enterprise architecture development.

· Unstructured data extraction.

· Smart tools for data collection.

Physicians software vendors

Service research innovation: · Data as a service platform

development. · Knowledge as a service

platform development. · Infrastructure as a service

platform development.

PPPs Information utilization Knowledge and best practice sharing.

NSTDA, SRI (Service Research Innovation Thailand Chapter)

2 years TBD Technical assistance and donor support.


Vietnam Priority Gap or Opportunity #1



Resources Needed

Lack of Integrated System

Debriefing of all stakeholders:

Ministry of: ICT, Finance, GSO, Justice,

Number of invited participants who attended.

To be decided by Minister of Health.

Before 07/15/2011

$10,000.00 Venue and Food Interpreter

Summary of Manila HIS Forum. Objectives and priorities for HIS development and strengthening.

Health (CHITI, Admin of Preventive Medicine, Admin of Medical Services, Dept of Planning and Finance, Dept of Health System and Personnel administration of preventive Medicine)

Meeting Report Available.

Per Diem of participants Facilitator Materials

Donors:

WHO, GIZ, EU, USAID, ADB, UNICEF, Rockefeller, University of Queensland, JICA, KOICA, WB

Develop clear terms of reference for HIS TWG:

Same as above, but include TOR developed. To be decided by Minister of Health

Last week of July

$5,000.00 Venue and Food Interpreter Per Diem of participants Facilitator Materials

· Streamline composition of TWG.

Private Sector Representative and District and Provincial Health Representative.

Finalize HMIS Strategic Plan with input from all stakeholders:

Same as above. HMIS Plan finalized and approved.

National HIS Steering Committee

End of July 2011

To be discussed.

Venue and Food Interpreter Per Diem of participants Facilitator Materials

· Consultative meeting with donors.


Vietnam Priority Gap or Opportunity #2



Resources Needed

Lack of National HIS Standard

Review current HIS architecture and plans:

Same as above. Comprehensive HIS Architecture Assessment Report approved by _______.


July to August 2011

To be discussed.

Technical Assistance from Donors and National Experts

· Develop common HIS Framework.

Financial Support

Identify and organize a trip to a country with international standard application.

Relevant agency Trip planned and accomplished.


2012 Financial Assistance for Travel Expenses

Trip report available.

Adopt International HIS for Vietnam:

CHITI, Department of Science and Training, Department of Planning and Finance, Medical Services Administration, Medical Health Office of selected provinces, Administration of Preventive Medicine


2012

· Develop Scope of Work.

· Pilot Standards in 1-2 provinces.

Develop Health Information Database standards at different levels.

CHITI, Department of Science and Training, Department of Planning and Finance, Medical Services Administration, Medical Health Office of selected provinces, Administration of Preventive Medicine


2012


Appendix 7: Technical Note on Multi-Sectoral Collaboration


Acknowledgment

This Technical Note was produced by the Forum Planning Committee in collaboration with the US Agency for International Development (USAID) Office of HIV/AIDS, Washington, DC. It serves as a background and guidance document for the country teams and other participants attending the Asia Pacific Leadership Forum on Health Information Systems in Manila, June 2011. Ummuro Adano, AIDSTAR-Two Capacity Building Technical Advisor was the principal author but several people provided extremely useful reviews and suggestions to improve the content and sharpen the focus of the document. We gratefully acknowledge the contributions of Pamela Foster, Training Resources Group; Anita Datar-Garten, Futures Group; John Novak, USAID, Washington and Chair of the HIS Technical Working Group; Steve Sapirie, HIS specialist with Management Sciences for Health, Cambridge; Theo Lippeveld, JSI, Boston; and Sarah Johnson, AIDSTAR-Two Project Director, Management Sciences for Health.


Table of Contents

Acronyms ....................................................................................................................... 98

Introduction.................................................................................................................... 98

Understanding Multi-Sectoral Collaboration ..................................................................... 99

Box 1: Mapping Data Flow ...................................................................................................... 100

Box 2: Illustrative examples of HIS collaboration: Sources and types of data shared ...................... 100

The Benefits of Multi-Sectoral HIS Planning and Implementation ..................................... 102

Box 3: What can collaboration in HIS planning and implementation deliver? ................................ 102

What Makes Multi-Sectoral Collaboration Work? ............................................................ 102

The Levels and Levers of Effective Multi-Sectoral Collaboration: Evidence from the Literature . 103

Leadership ............................................................................................................................ 103

Information and evidence ....................................................................................................... 104

Context and motivation .......................................................................................................... 104

Structure .............................................................................................................................. 104

Resources ............................................................................................................................. 105

Common understanding, collaborative capacity, trust and legitimacy .......................................... 105

Box 4: Collaborating for a common purpose: Ghana Global Fund Country Coordinating Mechanism ..... 106

Conclusion .................................................................................................................... 107

References and Resources ............................................................................................. 107


Acronyms CCM Country Coordinating Mechanism GAVI Global Alliance for Vaccines and Immunization HIS Health Information Systems ICT Information, Communication Technology MOH Ministry of Health NGO Non-Governmental Organization SLG Stakeholder Leadership Group

Introduction

Developing countries face a wide variety of health-related challenges, and the national health systems that address those challenges often struggle with limited resources and capability. Health leaders and managers must focus on maximizing the value of scarce human, financial and material resources, and on finding ways to make health systems operate as efficiently and effectively as possible. Accurate, good quality, and reliable health data on health outcomes, service delivery indicators and the overall performance of the health system is essential for assessing, planning, implementing, monitoring and evaluating health interventions and health trends in the country. The goal of a functional Health Information System (HIS) is to provide that information at all levels of the system and serve as a tool to help pursue better health outcomes. Owned and managed by the country, a functional HIS has its basis in the establishment of common standards and a unified architecture that can help stakeholders focus on building awareness about the importance of data driven decision making; strengthening demand for information; enhancing governance, leadership and various capabilities within the national health and information system to meet that demand; improve quality of data and foster a culture of information use. A functional HIS implies that there is a sustainable system in place that produces and disseminates various reports and


information products aimed at different audiences for use in surveillance, program planning, service and resource management, decision making and national and international reporting. A functional HIS also requires effective multi-sectoral collaboration since the HIS typically involves the collection of a wide range of data from multiple sources. In most countries, health information comes not only from Ministries of Health, but also from Ministries of Planning and Economic Development, Finance, the Census Bureau, Population Council, Department of Vital Statistics, research bodies and non-governmental organizations. The purpose of this Technical Note is to underscore the important role that multi-sectoral collaboration can play in contributing to a functional country-led and country owned health information system, and expand our knowledge base and practice in this area. First, the technical note provides examples of the various institutions that normally serve as conduits or sources of health information, and the kinds of data that they collect and report on. Next, it examines the important challenges and opportunities associated with creating and sustaining effective multi-sectoral collaboration for a functional HIS. Finally, it provides an example from the health sector that demonstrates the value and success of multi-sectoral collaboration, and suggests some principles of good practice and lessons for multi-sectoral HIS collaborative ventures. For our purposes, and in the context of HIS, a multi-sectoral collaboration or partnership refers to: a cross-sector group working together under some form of recognized structure, towards a common strategic direction and goals, which would be difficult to achieve if tackled by any single organization.

Understanding Multi-Sectoral Collaboration

The concept and practice of multi-sectoral collaboration is not new to the health sector. In fact, the health sector in many parts of the developing world is replete with both large and small scale initiatives and programs that involve multi-sector collaboration or partnerships. For example, health sector strategic plans; the strategic plans of most national AIDS Commissions; projects supported by major global health initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM); the US Government President’s Emergency Plan for AIDS Relief (PEPFAR); GAVI and others all call for multi-sectoral partnerships as a core strategy for planning, implementing and scaling up national programs in HIV/AIDS, TB, Malaria, Child Health and other areas. Some of the key tools and resources developed by the Health Metrics Network that provide general guidance on HIS planning and implementation all stress the role and importance of multi-agency stakeholder working groups as an integral part of the collaboration process. There are many benefits from these multi-sectoral efforts, although efforts to implement these collaborative partnerships sometimes pose challenges for governments, donors, private institutions, the rapidly expanding private sector and other sources of health care related services around the world. In some cases, government officials in the health sector understand multi-sectoral to mean “from other ministries” or “health ministry and non-governmental organizations working in health”. NGOs may understand multi-sectoral as “government and NGOs” (Severo and Helfenbein, 2004).


However, in the case of HIS, given the nature of health information (e.g., types of data, data sources, data flows and the thousands of facilities where data are collected and transmitted), an effective multi-sectoral landscape is a bit more complicated and often less apparent. It should include the Ministry of Health, other Ministries in the public sector, NGOs, private for profit entities, the faith-based sector, the community and their families. The hypothetical example below illustrates how information originating from a single event in a remote village in northern Kenya flows through not only the health sector but other sectors as well.

Box 1: Mapping Data Flow Bubisa (meaning a place of gusty winds), is a remote, wind-swept, small settlement in Northern Kenya. It is home to the local Gabbra people – a small tribal group of camel nomads. The nearest health center managed by a registered nurse and run by the Catholic Church is 20 miles away. The nearest government health facility, a district hospital managed by a medical doctor and a small team of health workers, is 65 miles away. Imagine that a trained community health worker (CHW) in Bubisa attends a birth in the village. The following day, the CHW reports the birth to the nurse at the health center, and the information on the delivery is added to the mother’s health record. A new health chart is also opened for the child and immunizations will be administered and documented for the district health office. In a different register, the live birth is documented for vital registration. The nurse sends that information to the office of the local Chief, (representative of the Provincial Administration, Office of the President) who submits it to the office of the district registrar of births and deaths in the Ministry of Home Affairs. The parents will be issued with a birth certificate. Without a birth certificate the child will not obtain a Kenyan national identity card when he turns 18.

This example illustrates how the birth of a child in a remote village triggers the flow of information between and across four different government agencies, a faith-based organization and the community, making a strong case for multi-sectoral collaboration. Given the multiplicity of players and interest groups that need to be working together, coordinating and sharing information is clear. Unfortunately, the reality in such places is that information often fails to flow as described in this hypothetical case and even births fail to be reported and all the other subsequent activities don’t happen.

Box 2 provides a real snapshot, with country examples, of some of the typical types and sources of information and Ministries involved. As shown below, much of this information is collected outside the Ministry of Health, again illustrating the need for multi-sectoral collaboration in building and sustaining

a functional HIS.

Box 2: Illustrative examples of HIS collaboration: Sources and types of data shared

Collaboration with the Ministry of Home Affairs/Interior in Afghanistan on the design and conduct of population census, particularly with regard to the inclusion of questions pertaining to health; and sharing of census results down to the lowest possible levels.

Collaboration with the Ministry of Home Affairs/Interior on the strengthening of the civil (birth and death) registration system.

Collaboration with the Ministry of ICT or Communications (in Rwanda) on the development of


m-Health applications in the country (i.e. use of mobile phones for communications between levels of the health system).

Collaboration with several ministries and agencies (in Afghanistan and Pakistan) who are involved with response to emergencies and disasters, natural and man-made including investigation and control of epidemics.

Collaboration with the police and Public Safety commissions with regard to use of emergency communications for the notification and transportation of trauma patients.

Collaboration with various ministries on the design, coordination, conduct and sharing of health and social surveys results.

Collaboration with the Ministry of Education and various training and research institutions with regard to staff training in HIS, monitoring and evaluation, and data use.

Communication by the MoH on trends of various infectious diseases such as HIV/AIDS with other Ministries and Institutions who are involved in the education, prevention and control of these diseases.

Engagement of district and community offices and organizations for collaborating on notification of suspected cases of infectious disease, and in educating the community and patients about prevention and treatment adherence.

Source: Personal correspondence with Steve Sapirie, Lead HIS Specialist, Management Sciences for Health, March, 2011


The Benefits of Multi-Sectoral HIS Planning and Implementation

Multi-sectoral partnerships are often associated with attempts to address difficult issues that span the public, private and voluntary sectors. It is clear that the Ministry of Health alone cannot address all the challenges that come with the planning and implementation of a functional national HIS system. Without downplaying the potential challenges that any HIS multi-sector collaborative venture is likely to encounter, there are multiple benefits that can be accrued from coming together and working across sectors to conduct HIS planning and implementation. Box 3 outlines some specific examples of such benefits.

Box 3: What can collaboration in HIS planning and implementation deliver?

Broadened awareness and sense of common purpose

Defining clear HIS needs and goals

Streamlining data collection

Enhancement of data quality, use and accountability

More efficient use of resources

Increased access to resources

Sharing of knowledge and technology

Investing in a common fit-for-purpose technology

Development of innovations

Broad sharing of responsibility for different activities

Setting clear priorities for HIS reform

Stronger ownership by stakeholders

Use of strengths and expertise of different partners

Sustainable development of HIS activities

Better health outcomes for citizens

What Makes Multi-Sectoral Collaboration Work?

Successful multi-sectoral collaboration is often marked by the following:

The desire for change comes from the institutions themselves. In other words, the motivation to succeed is internal and the “prize” is clear. In the case of HIS, ideally the ultimate prize should be the full implementation of the country’s national HIS Strategic Plan where it already exists;

A small stakeholder leadership group that acts as “guardians of purpose” exists and they have a clear plan that they seek to accomplish.

The goal and expected end-results of the collaboration are defined by the sector partner institutions together;

The roles, responsibilities, and mutual obligations of each partner are clearly defined in a document available to staff and concerned stakeholders;

There is a genuine and continuous effort for transparency and feedback among all partners, including collaboration in monitoring progress towards objectives and documenting results.


The Levels and Levers of Effective Multi-Sectoral Collaboration: Evidence from the Literature

There is a paucity of information and data on multi-sectoral collaboration in the published literature, despite a preponderance of multi-sectoral initiatives in the field of health and development. Very few good studies on this topic exist, although the factors which contribute to effective inter-organizational collaboration are known, and most of these have been summarized above. Health issues and health information flows cut across sectors and institutions at different levels and communities. When it works well, multi-sectoral collaboration can bring people and organizations together to tackle challenges on many different fronts. When different groups of people come together with a common goal, clear vision and a desired end result, their skills, knowledge and experience always add up to more than the sum of their parts – another reason why multi-sectoral collaboration is an important part of any HIS strengthening initiative. The limited evidence from the literature on multi-sectoral collaboration; primarily drawn from the fields of health, economic development, road safety and disaster management; cite the following eight factors as having the broadest impact on the effectiveness of any multi-sectoral collaborative initiative:

1. Leadership at all levels – both formal and informal 2. Information and evidence 3. Context and motivation 4. Resources 5. Structure 6. Common understanding 7. Collaborative capacity 8. Trust and legitimacy

Source: Multi-sectoral collaboration and economic development, Morris, M, Dec. 2010

The challenge for national HIS leaders is how to translate these success factors and make them work for HIS multi-sectoral collaboration. How can HIS national stakeholders organize themselves and apply the same predictors of success to their own efforts? This section provides a brief description of each of the factors and highlights some examples of how to apply them to build and sustain effective national HIS multi-sectoral collaboration.

Leadership The role of leadership in any collaborative endeavor is to create common ground for people to talk and work together, to support others to identify and address challenges and produce results. In any collaborative space, both formal and informal leaders at all levels emerge and give direction to the effort. They do so by listening; translating meaning across sectors; and building common understanding with respect to the information, evidence, and decisions under consideration. They also keep people focused on strategic purposes and outcomes which helps to overcome vested or narrow interests. A leadership style that is open, inclusive, and respectful often helps build trust and inspire collaboration. Leadership in collaborative environments is achieved through inspiring and motivating commitment to a common goal and action; building broad based involvement and participation; and sustaining hope, engagement, and commitment (Chrislip and Larson, 1994). In Uganda, the HIS Stakeholder Leadership Group (SLG) was established in 2006 to create an environment where stakeholders with a variety of perspectives could collaborate and share ideas about the implementation of a USAID-funded human resource information system (HRIS). The SLG’s first step


was to bring together all leaders and decision-makers that would have an interest in the HRIS. The purpose of the Uganda SLG was to agree on a shared common goal and to determine the specific priorities the system needed to address. The SLG included representatives from the MOH, the four national health professional councils, training institutions, NGOs, the Ministry of Education, Public Service Commission and donor agencies. SLG members met and communicated regularly to address implementation challenges, identify necessary customizations and reports, and make decisions as needs arose. Leadership was shared amongst the various partners and even meeting venues were rotated to give each partner a chance to host and chair various sessions. Over the years, the SLG assumed advisory responsibility for all HIS related activities in Uganda’s health sector – not just for the human resource information system. One of the key results of this group was the development of an integrated HRIS for the health sector in Uganda. The group continues to thrive and make useful contributions to Uganda’s country-owned HIS work.

Information and evidence Any multi-sector initiative must rely on commonly shared information and evidence that helps to create a common starting point for discussions and decisions, and keeps people focused on issues rather than interests. For example, in the case of HIS, the process of planning a national health information system should include all key stakeholders, and establish and elicit their information needs and interests as well as their technical input and support at all stages of plan development and implementation. A collaborative process around a shared purpose can help broker and ease the process of collaboration, and make choices clear.

Context and motivation Context and motivation brings clarity to the purpose of the collaboration. It helps to lay out the mission, scope, goals, accountability mechanisms, roles and responsibilities, and provides a basis for decisions around making the collaboration accomplish its mission. Here again, the national HIS Strategic Plan, where it exists, should be the magnet that attracts and pulls together all the partners who become the driving force motivating the implementation of the plan.The strategic goals contained in the plan should also help provide the rationale and explanation for any decisions. No decisions or parallel activities need to be undertaken outside the rubric of the agreed upon plan.

Structure Multi-sectoral collaboration does not function without some kind of mutually agreed upon structure. Structure refers to both formal and informal settings and arrangements that facilitate the work of a multi-sectoral group. In most cases, the design of the structure is dictated by context and circumstances. For example, in the case of HIS, the initial multi-sectoral consultation that brings together various stakeholders requires a consultation design structure that guides even basic decisions like agenda development, and where and how meetings are held. Efforts to develop or implement an action requires other types of structures that inform distribution of responsibilities, ways in which decisions are made, managing differing expectations and allowing institutional space for different partners to participate in their own flexible way. What is important to remember is that the structures that are adopted should enable the organizations and individuals involved to view issues systematically, and in a way that allows them to identify the web of factors and underlying causes that impact their collaborative venture. Only then will the unique and valuable role of each sector become clear, resulting in more equitable and balanced relationships amongst the partners.


Resources Obviously, financial, technical, human, logistical and operational resources play an important role in the work of any multi-sector collaboration, especially to support activities and to overcome resistance to involvement and collaboration. Evidence in the literature shows that once a collaborative group begins adopting and implementing plans, access to financial resources, technical assistance and similar implementation support is required. No national HIS plan will succeed without the availability of these resources, which in some cases may need to be shared or re-allocated between departments or units in a spirit of mutual agreement. For example, in Vietnam, resources from another department were applied to another, in support of a shared initiative.

Common understanding, collaborative capacity, trust and legitimacy These three factors are inter-related, and must be discussed together. Time and space to talk and work together give rise to these foundational factors that underlie any successful initiative. These factors are the biggest predictors of success with any collaborative venture, and need to be intentionally and carefully planned for and nurtured. The conditions for the emergence of these factors should not be limited to “good news and wins” only; the conditions are also created through transparency and fairness in difficult situations. The research also suggests that a previous positive experience with a collaborative undertaking is the best predictor of whether an organization or team will engage in subsequent collaborative initiatives. In summary, the literature on multi-sectoral collaboration point to the importance of this three-in-one process that all multi-sectoral groups should consider in order to produce results:

Talking together to develop common understanding, creating shared purpose and appreciation;

Working together to develop collaborative capacity: developing skills and experience in joint decision-making, monitoring process and results, sharing resources, leadership and compromise;

Building trust together through respecting and honoring all collaborators and partners.

Box 4 describes an example of an effective multi-sectoral collaboration in the health sector, and highlights some of the factors that contributed to the positive outcomes.


Box 4: Collaborating for a common purpose: Ghana Global Fund Country Coordinating Mechanism

The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (Global Fund), is a multilateral donor with a unique approach to country-ownership and country-led development. The Global Fund does not design or implement programs; they leave this to the countries that are supported. The Fund’s approach to country-led development is distinguished by a unique decision-making structure and an unrelenting focus on performance at every stage of program development. Decisions on how Global Fund resources are used are made by developing country governments and civil society. The Global Fund requires beneficiary countries to establish a Country Coordinating Mechanism (CCM) to administer the funding with at least 40 percent of its members drawn from civil society. The CCM model brings together multiple stakeholders to collectively identify country needs, design programming, and oversee implementation of Global Fund-supported projects. The CCM is a concept that recognizes that many kinds of groups and people – including government agencies, private sector, providers, civil society, researchers and affected communities – must be engaged in planning and optimizing resources to deliver services. In its early days, the CCM in Ghana was often cited as a successful example of multi-sectoral collaboration. Ghana had one of the best implementation records of GFATM projects. For example, it was the first country in the world to fulfill the conditions for disbursement in 2003. Several factors played a critical role in the success of Ghana CCM’s multi-sectoral engagement, including:

The government of Ghana’s genuine commitment to scale up the national response to the 3 diseases;

The government’s belief in the value of public-private partnerships and willingness to involve civil society;

Ghana’s successful ongoing experience with sector-wide approach (SWAp) in the health sector - a common-basket funding and planning mechanism that requires the collaboration of several partners;

Early integration of the GF programs into national strategic plans and existing systems;

A strong secretariat and regular CCM meetings;

Participatory decision making. The CCM functions in a democratic way, each member has a voice and representatives of all sectors feel ownership and their contributions are valued;

Seamless and open communications.

Source: Ghana Country Coordinating Mechanism: A Case Study, The Global Fund 2003


This example from Ghana illustrates several key themes that made them successful, including: motivations behind the collaboration that are driven by a common vision, clearly defined goals and objectives, fostering respect and trust, encouraging inclusiveness and openness, combining perspectives, harnessing resources and skills of various partners, and helping the partnership reframe issues and be creative in developing new partnership solutions to key issues. These factors are essential to the success of HIS multi-sectoral partnerships as well.

Conclusion

A comprehensive health information system is a relatively new phenomenon in the developing world. However, strengthening functional HIS will remain critical to all health system strengthening efforts in developing countries, including strengthening multi-sectoral collaborations. Without good information and good performance from the different segments of the health system and other sectors, it will be exceedingly difficult to put scarce resources to best use. It is important to focus on strategies and initiatives to establish, improve and sustain multi-sectoral collaboration – one important element in a country-led and country owned HIS national platform. Such a national platform that is supported and maintained by all key players will serve several purposes: improving the quality and consistency of available data; enhancing data use for policy formulation, program planning, management and monitoring; and improving health care at the point of service delivery. As such, the information that a functional HIS generates should meet the needs of a wide variety of users. As discussed in this technical note, health information flows do not just occur within a single organization like the central Ministry of Health, but tend to occur between different levels of the Ministry of Health, and between the Ministry of Health and other ministries and non-governmental organizations. Information also flows in different directions – up, down and across different systems and organizations. Effective multi-sector collaboration can greatly contribute to efforts for optimizing the quality of information, the timeliness of information, and how information flows among multiple organizations, and also advocate for building the necessary leadership, governance, technology, and human capacity to use information to improve the performance of the health system. At the end of the day, what matters is that good quality and timely information is available when and where it is needed to inform planning and improve the quality of health services.

References and Resources

Axelrod, R (1984): The Evolution of Co-operation. New York: Basic Books Severo, C. and Helfenbein, S (2004): Scaling Up HIV/AIDS Programs: A Manual for Multi-Sectoral Planning. Management Sciences for Health, Boston, MA. Chrislip, David D. and Carl E. Larson (1994): Collaborative Leadership: How Citizens and Civic Leaders Can Make a Difference. San Francisco: Jossey-Bass Healthcare Systems in Asia, Hitotsubashi University, Tokyo http://www.imf.org/external/country/VNM/rr/sp/012105.pdf Byron, John M. and Barbara C. Crosby (1992) Leadership for the Common Good: Tackling Public-Problems in a Shared-Power World

http://www.imf.org/external/country/VNM/rr/sp/012105.pdf


Veasnakiry, L. and Sovanratnak, S. (2007, January): Cambodia Health Information System: Review and Assessment USAID, RTI international, Rwanda MoH. (2009) Rwanda HMIS Assessment Report Kibet, Dr. Sergon et al (June 2008) Report of the Health Information System of Kenya Huxham, Chris. And Siv Vangen (1996) Working Together: Key themes in the management of relationships between public and non-profit organizations. International Journal of Public Sector Management, 9 (7), pp.10 – 17 World Health Organization, Health Metrics Network. “Review of health information systems in selected countries: Mexico”, Geneva. www.who.int/entity/healthmetrics/library Krickeberg, K. (2007). Principles of health information systems in developing countries. Health Information Management Journal, 36 (3) Weddi, Davis (2006). Using information systems to manage health in Uganda. International Institute for Communication and Development. www.ftpiicd.org/iconnect/ICT4D_health/HMISUganda.pdf Health Metrics Network: Guidance for the HIS Strategic Planning Process. 2009 http://www.who.int/healthmetrics/tools/HISStrategicPlanningProcessGuidance_2009_March_3.pdf Additional resources and tools on Leadership, Team Building, and Partnerships can be found at the

following sites:

www.aidstar-two.org Managers Who Lead: A Handbook for Improving Health Services: http://www.msh.org/resource-center/managers-who-lead.cfm http://www.team-building-leadership.com/ Leading Together: Complex Challenges Need a New Approach: http://media.wiley.com/assets/162/02/jrnls_LIA_JB_drath2301.pdf

http://www.who.int/entity/healthmetrics/library

http://www.ftpiicd.org/iconnect/ICT4D_health/HMISUganda.pdf

http://www.aidstar-two.org/

http://www.msh.org/resource-center/managers-who-lead.cfm

http://www.team-building-leadership.com/

http://media.wiley.com/assets/162/02/jrnls_LIA_JB_drath2301.pdf

Documents

Collaborating Across Sectors for Change › 2011 › 03 › asia... · Health Information Systems June 13-16 2011, Manila, Philippines. Collaborating Across Sectors for Change Report