The Public Health Information Standards (PHIS) · Populations: Products • Population mortality estimation Population mortality is arguably the single most important measure of health

Collective action for better health outcomes

HEALTH CLUSTER COORDINATION TRAINING

May 2019, Brazzaville, Congo

The Public Health Information Standards (PHIS) for activated health clusters and other health coordination mechanisms


Moving from data to decision making

Source: DIKW pyramid through the eyes of AGT as mentioned on Electronics 360 – a focus on decisions and actions; adapted from R.L. Ackoff, From data to wisdom, Journal of Applied Systems Analysis 16 (1989) 3–9


Why introduce PHIS Standards?

• Availability of timely, reliable, and robust information is a key pre-requisite for any effective humanitarian response.

• To provide systematic IM support for HC coordination staff and partners for effective humanitarian crisis response (planning, implementation, coordination, resources mobilization, … )

• To apply standardized approaches for data collection and public health information generation

• To integrate all possible sources of information into a comprehensive view of the emergency

• To design a competency-based development programme for all HC roles

• To support fund raising for HC staffing worldwide & required infrastructure

5



HEALTH INFORMATION DOMAINS

Crisis-

emergent

risk factors

Excess

morbidity and

mortalityHumanitarian

public health

services

(+ protection

and IHL

advocacy)



HEALTH INFORMATION DOMAINS (Checchi et al., Lancet)

Physical health

Reproductive and neonatal

health

Burden of NCDs

Burden of endemic

infectious diseases

Epidemic occurrence and

severity

Burden and typology of

injuries

Exposure to armed

attacks or

mechanical force of

nature

Forced

displacement

Interruption of

chronic treatment

(HIV, TB, NCDs)

Upstream DownstreamCausality:

Addiction

Excess

Baseline

Averted

Population

mortality

Sexual and gender-based

violence

Food

insecurity

Feeding

and care

practices

Mental health and

psychosocial functioning

Nutritional status

(including

undernutrition and

overnutrition)

Humanitarian public health services

Service availability

and functionality

(by level and thematic

area)

Service coverage

(including barriers and

facilitators for

utilisation)

Service effectiveness

(including quality of

curative services)xRelative impact = x


ONE WAY TO ORGANISE THE BOXES

Physical health

Reproductive and neonatal

health

Burden of NCDs

Burden of endemic

infectious diseases

Epidemic occurrence and

severity

Burden and typology of

injuries

Exposure to armed

attacks or

mechanical force of

nature

Forced

displacement

Interruption of

chronic treatment

(HIV, TB, NCDs)

Upstream DownstreamCausality:

Addiction

Excess

Baseline

Averted

Population

mortality

Sexual and gender-based

violence

Food

insecurity

Feeding

and care

practices

Mental health and

psychosocial functioning

Nutritional status

(including

undernutrition and

overnutrition)

Humanitarian public health services

Service availability

and functionality

(by level and thematic

area)

Service coverage

(including barriers and

facilitators for

utilisation)

Service effectiveness

(including quality of

curative services)xRelative impact = x

Health Status and Threats

Health Resources and Service Availability

(Humanitarian) Health System Performance




Health System Performance



What are the main causes of morbidity and mortality?

What are potential health threats attributable to the crisis?

Exacerbation of existing conditions

Emerging conditionsWho are the partners in the field?What services are available? Staff, infrastructure, supplies?Access to services by affected population?

What is the coverage/ utilisation of preventative and curative services?Do services achieve quality standards?


• Which Public Health Information Services are expected from an activated health cluster/humanitarian coordination mechanisms?

• Which specific methods, tools and software applications are available?

• How quickly and at what frequency of update should services be delivered

• What staffing and other resources are required• Which PHIS technical competencies cluster staff should display

What do the standards provide?


• Health Management Information System (HMIS)

• Vaccination coverage estimation

• Health Cluster Bulletin

• Ad hoc Infographics

• Public Health Situation Analysis (PHSA)

• Rapid Assessment

• Humanitarian Emergency Settings Perceived Needs (HESPER) Scale

• Early Warning Alert and Response System (EWARS)

• Population mortality estimation

• Surveillance System for attacks on health care

• Who, What, Where (3W) matrix• Partners’ List• Health Resources Availability Monitoring System (HeRAMS)

SERVICES EXPECTED OF AN ACTIVATED CLUSTERH

ealth

cluste

r action

Op

eration

al ind

icator

mo

nito

ring

OCHA / inter-cluster processes (e.g. HRP)


Health System Performance




Health Status and Threats for affected Populations: Products

• Public Health Situation Analysis (PHSA)Background composite information product, synthesizes the already available information from various sources. COVERED IN DETAIL LATER.

• Rapid Health AssessmentAims to complete information gaps detected by PHSA. New version design is ongoing. COVERED IN DETAIL LATER.



• Humanitarian Emergency Settings Perceived Needs (HESPER) ScaleQuestionnaire that emphasizes beneficiary perceptions of the needs, and includes psychosocial functioning. Should become available by day 14 after emergency’s onset .(Under Review)

• Early Warning Alert and Response System (EWARS)Information management system that support generating alerts and enables timely response in an efficient manner to predict, prevent and control outbreaks and national epidemic threats. Aims to reduce the number of cases and deaths that occur during infectious disease outbreaks. COVERED IN DETAIL LATER.



• Population mortality estimation

Population mortality is arguably the single most important measure of health status. However, the considerable effort, cost and technical expertise required to produce robust and interpretably precise mortality estimates means that this service requires a supplementary budget, operational support, and dedicated epidemiological and statistical expertise.

• Surveillance System for Attacks on Health Care (SSA)

The system should be implemented in crises where at least one attack against health workers, or assets has been reported (more detail tomorrow).

• Vaccination Coverage Estimation (also a Performance measure)

A key indicator to evaluate the performance of vaccination services, assess the risk of epidemics, and establish whether remedial vaccination activities are required and what the most efficient strategies would be for such activities.


Health Resources and Availability: Products

• Who, What Where (3W) matrixSystematically maps HC partner activities across the crisis-affected population, thereby strengthening analysis of response gaps, planning and coordination of actors.

• Partners’ ListConstantly updated database of contact details for HC partners, observer agencies and other important HC stakeholders.

• Health Resources Availability Monitoring System (HeRAMS)Systematically monitors the availability of health resources & services to affected populations. It maps all health delivery points within the crisis-affected area. COVERED IN DETAIL LATER.

• Operational Indicator Monitoring (also a Performance measurement)Because OIM relies on data from other sources, it should be put in place after other services are in place. COVERED IN DETAIL LATER.


Health System Performance: Products• Health Management Information System (HMIS)

collects, analyses and reports data from health providers and facilities on causes of consultation and hospitalization, services provided and patient clinical outcomes. HMIS data are used to construct a variety of indicators of proportional and absolute morbidity and mortality, service utilization, and quality of care.

• Health Cluster BulletinFrequent publication that provides an overview of the main public health needs, key health information including trends, and activities of HC partners. Aims to keep all HC partners and other stakeholders informed.

• Ad hoc InfographicsAny visual representation of information to improve cognition and thus understanding of data patterns and key observations. Infographics for PHIS can include: Tables, Graphs, Diagrams, Dashboards, Maps…


Core Products

• PHSA

• EWARS

• Operational Indicator Monitoring

• Health Cluster bulletin

• HeRAMS


APPLICATIONS, TOOLS AND GUIDANCE

http://www.who.int/health-cluster/resources/publications/PHIS-Toolkit/en/


Local

Adaptation

Setup Data

Collection

Analysis Interpretation Dissemination

/action

Decide on

which

services are

warranted

Customise

services to

suit the

setting (local

adaptation)

Set up data

collection tools

Set up software

applications

Design

questionnaire

Etc.

Observe trends

Appraise data

quality, bias,

reliability

Decide on public

health action

Share

information

products

Coordinate

actors

Undertake

resource

mobilisation

Do advocacy

ROLES AND RESPONSIBILITIES

Public health information is a core function of all coordination staff!


ServiceLocal

AdaptationSetup

Data

CollectionAnalysis Interpretation Dissemination Action

He

alth

Sta

tus

an

d T

hre

ats

for

Aff

ec

ted

Po

pu

latio

ns

Public Health Situation Analysis

(PHSA)

n/a n/a IMO, GHC Unit n/a IMO, HCC,

PHO

IMO, HCC,

Comms

HCC, PHO

Rapid Assessment IMO, HCC, PHO,

HC partners

IMO (with

OCHA)

HC Partners IMO IMO, HCC,

PHO

IMO, HCC,

Comms

HCC, PHO

Humanitarian Emergency Settings

Perceived Needs (HESPER) Scale

IMO, HCC, PHO IMO IMO, HC

Partners

IMO IMO, HCC,

PHO

IMO, HCC,

Comms

HCC, PHO

Early Warning Alert and Response

System (EWARS)

IMO, HCC, PHO IMO HC Partners IMO IMO, HCC,

PHO

IMO, HCC,

Comms

HCC, PHO,

Epidemiologis

t

Population mortality estimation IMO, HCC, PHO,

Epidemiologist

IMO,

Epidemiologist

IMO,

Epidemiologist

IMO,

Epidemiologis

t

IMO, HCC,

PHO

IMO, HCC,

Comms

HCC, PHO

Surveillance System for Attacks on

Health Care (SSA)


PHO

IMO, HCC,

Comms

HCC, PHO

He

alth

Re

sou

rce

s

an

d A

va

ilab

ility

Who, What, Where (3W) matrix IMO, HCC, PHO IMO HC Partners IMO IMO, HCC,

PHO

IMO, HCC,

Comms

HCC, PHO

Partners’ List n/a IMO IMO n/a n/a HCC, Comms n/a

Health Resources (or Services)

Availability Monitoring System

(HeRAMS)


PHO

IMO, HCC,

Comms

HCC, PHO

He

alth

Syst

em

Pe

rfo

rma

nc

e

Health Management Information

System (HMIS)

IMO, HCC, PHO IMO HC Partners IMO, HC

Partners

IMO, HCC,

PHO

IMO, HCC,

Comms

HCC, PHO

Vaccination coverage estimation IMO, HCC,

PHO

IMO,

Epidemiologist

IMO,

Epidemiologist

IMO,

Epidemiologis

t

IMO, HCC,

PHO

IMO, HCC,

Comms

HCC, PHO

Operational Indicator Monitoring IMO, HCC, PHO IMO IMO IMO IMO, HCC,

PHO

IMO, HCC,

Comms

HCC, PHO

Health Cluster Bulletin IMO, HCC, PHO n/a IMO n/a n/a IMO, HCC,

Comms

n/a

Ad hoc Infographics n/a n/a IMO IMO n/a IMO, HCC,

Comms

n/a

ROLES AND RESPONSIBILITIES


Service

Acute phase (including IPC phases 3-5) Protracted phase (including IPC phases 1-2)

Should be available by Frequency of update When to discontinue† Frequency of updateWhen to

discontinue*

He

alth

Sta

tus

an

d T

hre

ats

fo

r a

ffe

cte

d

po

pu

latio

ns

Public Health Situation Analysis

(PHSA)

Pre-emergency: review

secondary data

48h (initial analysis)

14d (full analysis)

Monthly (or sooner if

sudden change)

Cluster de-activation Quarterly (or sooner if

sudden change)

Cluster de-

activation

Rapid Assessment 14d Repeat if a new

emergency occurs

n/a (stand-alone) Repeat if a new

emergency or a sunder

change occurs

n/a (stand-alone)

HESPER Scale 14d Quarterly (or sooner if

sudden change)


sudden change)

Cluster de-

activation

EWARS 7d (initiation)

14d (first bulletin)

Weekly Never: instead, hand

over to MoH

Weekly Never: instead,

hand over to MoH

Population mortality estimation 1mo or later (see

guidance)

Weekly or monthly (see

guidance)

Cluster de-activation Quarterly

(see guidance)

Cluster de-

activation

Surveillance System for Attacks

on Health Care (SSA)

1mo

(or sooner if events

warrant)

Monthly Cluster de-activation

(sooner if attacks clearly

cease)

Quarterly Cluster de-

activation (or

sooner if attacks

clearly cease)

He

alth

Re

sou

rce

s a

nd

Av

aila

bili

ty

3W Matrix 24h Weekly (or sooner if

new information)

Cluster de-activation Monthly Cluster de-

activation

Partners’ List 24h Weekly (or sooner if

new partners added)

Cluster de-activation Monthly (or sooner if new

information)

Cluster de-

activation

HeRAMS 1mo (services module)

3mo (all modules)

Monthly (or sooner if

new information)


new information)

Cluster de-

activation

He

alth

Syst

em

Pe

rfo

rma

nc

e

HMIS 14d (light version)

3-6mo (DHIS-2)

Weekly Never: instead, hand

over to MoH

Monthly Never: instead,

hand over to MoH

Vaccination coverage

estimation

See guidance As needed (see

guidance)

n/a (stand-alone) As needed (see

guidance)

n/a (stand-alone)

Operational Indicator

Monitoring

1mo Monthly Cluster de-activation Weekly Cluster de-

activation

Health Cluster Bulletin 48h Weekly Cluster de-activation Monthly Cluster de-

activation

Ad hoc Infographics 7d (start of service

availability). 24h after

urgent request

Upon request Cluster de-activation Upon request Cluster de-

activation


TIMING AND FREQUENCY


1.0

1.2

Infographics 0.1

0.5Rapid assessment

0.35

0.2

0.2

0.4

0.3

1.5

RESOURCE REQUIREMENTSEstimated number of IMOs required for core services only:


24 h 48 h 7 d 14 d 1 mo 3 mo 6 moOnset

0.2

PHSA 0.2

0.2 0.2 0.1

1.0EWARS

0.2

0.2

Partners’ list

3W

HESPER

HC bulletin

123

# IM

OS

HeRAMS


Integration for Efficiency – Integrated Information

Management Units (IIMUs)

• The best way to achieve these PHIS Standards is through the

integration of all of the existing IM capacity available within WHO

offices into a cohesive Information Management Unit (IMU).

• This model is being promulgated because of the efficiency gain and

maximization of available assets to all programmes including the

Health Cluster.

• This model is also consistent with the WHO Emergency Response

Framework’s Incident Management System (IMS) structure, in which

all information management functions are contained within the

dedicated function of “Information”.

• Should be adapted to context

http://apps.who.int/iris/bitstream/10665/258604/1/9789241512299-eng.pdf?ua=1


Integrated Information Management Unit (example)


Integrated Information Management Unit – Tasking

(example)


Code Baseline competency IMO EpidB1 Apply strong understanding of database structures to build and

maintain high-quality, robust databases, while proficiently using majordata management applications, including Microsoft Excel andMicrosoft Access.

CV evidence:

▪Undergraduate or post-graduate degree in a discipline driven byquantitative data (e.g. statistics, software engineering, geography); or

▪Previous experience as main developer and manager of at least onelarge dataset

Y Y

Code Competency HCC PHO IMO Epid

Basic

C1 Understand the humanitarian aid architecture, thecluster approach and inter-cluster coordination ofpublic health information.

Y Y Y

C6 Able to design a survey or assessmentquestionnaire, applying good practices forquestion formulation and layout.

Y Y

TECHNICAL COMPETENCIES


TECHNICAL COMPETENCIES

ROLES COVERED:

• Information Management Officer

• Health Cluster Coordinator

• Public Health Officer

• Epidemiologist

USE THIS COMPETENCY FRAMEWORK FOR:

• Recruitment

• Appraisal, evaluation, management

• Capacity development

• Identify learning gaps


QUESTIONS AND COMMENTS

http://www.who.int/health-cluster/resources/publications/Final-PHIS-Standards.pdf

Documents

The Public Health Information Standards (PHIS) · Populations: Products • Population mortality estimation Population mortality is arguably the single most important measure of health