Prof. Alan Lopez Health Information Systems Knowledge Hub School of Population Health University of Queensland Global Health Information: strengthening

Prof. Alan LopezHealth Information Systems Knowledge HubSchool of Population HealthUniversity of Queensland

Global Health Information: Global Health Information: strengthening health systems strengthening health systems

through better evidencethrough better evidence

Health Information Systems Knowledge Hub 2009


What do we mean by HIS?What do we mean by HIS?

HIS is an integrated effort to collect, process, report and use health information and knowledge to guide and influence public health policy-making, program action and research.

Without a functioning HIS, the ability to decide public health priorities and to determine the efficacy of health interventions is severely compromised.


WHO Framework for WHO Framework for Health System StrengtheningHealth System Strengthening

System Building Blocks Overall goals

World Health Organisation (WHO) Everybody’s Business: Framework for Action Strengthening Health Systems to Improve Health Outcomes http://www.who.int/healthsystems/round9_2.pdf


Health information system components & standards

Health information system components & standards

Data sourcesData sources

HIS resourcesHIS resources

Indicators Indicators

Data managementData management

Dissemination and useDissemination and use

Information productsInformation products

HMN FrameworkHMN Framework


IndicatorsIndicators needed in each domainIndicators needed in each domain


Sources of Health InformationSources of Health Information

• Census

• Continuous monitoring of births and deaths, with certification of cause of death

• Surveillance and response systems

• Household surveys

• Service-generated data (facilities and patient-provider interactions)


Sources of Health Information – cont’dSources of Health Information – cont’d

• Behavioral surveillance (focus on risk factors)

• National health accounts, financial and management information

• Modeling, estimates and projections

• Health research


Drivers for changeDrivers for change• MDG and other global health goals have

increased demand for data to monitor progress • Donors demand better accountability and many

have introduced performance-based disbursements

• Health sector reforms and decentralization have generated new information needs and challenges for standardization and quality of data

• HIV, SARS, avian influenza, etc have further created awareness of the need for a functioning HIS


Common grievances about health Common grievances about health information information

Incomplete

Inaccurate

Irrelevant

Redundant

Unanalyzed

Unused

Obsolete

Untimely

Biased

Parallel systems

Neglects equity concerns

Underestimates the poor

Too aggregated

Not integrated

Unexploited synergies

Not population-based

High but unknown costs

Ignored in sector reforms


Weak systems Weak systems

• Complex, crowded field; many donors; project and program focused M&E; fragmentation; epidemic of indicators

• Lack of comparability, need for certification and application of common standards

• Weak analytical capacities; health poorly connected to statistics;

• Translation of health data into information for policy action; evidence-based decision making

• Much frustration at all levels, producers and users

• Paris Declaration on Aid Effectiveness; ownership, harmonization and alignment


Fragmentation of demandFragmentation of demand


Key ChallengesKey Challenges

• Lack of comprehensive vital registration systems (record of births and deaths)

• Competing donor and national program requirements (disease specific vertical programs)

• Integrating public and private sector information (incorporating non-state actors)


Operational ConstraintsOperational Constraints

• Measurement and classification – standardisation needed

• Human resource capacity

• Data storage and use – health technology investments


What do we need vital statistics for?What do we need vital statistics for?• Develop key health indicators nationally and for small

areas (fertility, mortality, disease specific rates)

• Generate reliable and timely information for policy-making nationally and sub-nationally

• Help guide efficient resource allocation in health sector

• To identify health inequalities and develop programs and policies to reduce them

• Provide information on patterns of leading diseases and trends

• Identify emerging health problems

• Monitor and evaluate the effectiveness of health programs and policies


Registered causes of death, Sri Lanka Registered causes of death, Sri Lanka (2001) & Australia (2006), selected causes(2001) & Australia (2006), selected causes


Leading causes of deaths registered in Leading causes of deaths registered in Thailand, 2005Thailand, 2005

Cause of death

Ill-defined causes

Septicemia

Other external causes

Other cancers

Stroke

Dis of GU system

Cancer of liver

Pneumonia

Ischaemic heart dis

Road Traffic Acc

% of all deaths

38.2

5.8

4.8

4.0

4.0

3.2

3.2

3.1

2.9

2.8

52.8%


Corrected distribution of causes of Corrected distribution of causes of death, Thailand 2005 death, Thailand 2005 MR certified (urban) COD

COPD 13.4%

IHD 12.7%

Oth.heart dis 8.2%

Stroke 5.2%

HIV/AIDS 4.5%

Diabetes 4.5%

…

Ill-defined 0.7%

VA-assigned(rural) COD

IHD 11.6%

COPD 11.4%

Stroke 8.9%

Diabetes 6.8%

Oth.heart dis 6.2%

Lung cancer 5.5%

….

Ill-defined 2.9%MR: Medical records review VA: Verbal Autopsy


0.05.0

10.015.020.025.030.035.040.0

All Infectious All CVD All Cancers All other non-communicable

All injuries Ill-defined

%

COD

Corrected VR

Broad causes of death patterns (%) Broad causes of death patterns (%) before and after correction, Thailand, before and after correction, Thailand, 2005, males2005, males


The Potential of HISThe Potential of HISBenefits include:

• helping decision makers to detect and control emerging and endemic health issues, monitor progress towards goals and promote equity;

• empowering individuals and communities with timely and relevant health information and supporting improvements in health service quality;


The Potential of HIS – cont’dThe Potential of HIS – cont’d

• strengthening of evidence base for assessing effectiveness of health policies;

• improving governance, mobilising new resources, ensuring accountability in way resources are used.


Good health information is essential Good health information is essential for evidence-based decision making for evidence-based decision making

at all levels of the health systemat all levels of the health system

Documents

Prof. Alan Lopez Health Information Systems Knowledge Hub School of Population Health University of Queensland Global Health Information: strengthening