Health Information Systems should produce relevant information that health system stakeholders can use for making transparent and evidencebased decisions for health system interventions HMN ID: 622645
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Slide1
Health Information System ChallengesSlide2
Health Information Systems should..
“produce relevant information that health system stakeholders can use for making transparent and evidence-based decisions for health system interventions” (HMN)
…limited
access
to
data,
poor data
quality
, lack
skills
in data useSlide3
Picture: HMN
(in)accessible data?Slide4Slide5Slide6
Lack
of
access to
health information
Why
?Slide7
Multilevel fragmentation
Uncoordinated Health
programs
Different
domains/rationalities
(
Heeks
2006,
Chilundo
and
Aanestad
, 2004)
Medical
Managerial
Epidemiological
Statistics
I
nformatics
Public/private divide
Many different electronic and paper
formats/standards in useSlide8
Fragmentation of health programs
One information stream for Malaria program
One information stream for TB program
One information stream for…
etc etc etc
pluss
Demographic and Health Surveys, household surveys etc.
Data not available for comparison
Double counting
Low data qualitySlide9
Why health program fragmentation?
Health services inherently fragmented due to high level of specialization
Donors (both from necessity and ignorance)
Interests of power tied to ownership and control of dataLack of transparency (corruption may thrive)Slide10
Health
I
nformation System Projects are fragmented and they often “fail”
Project funding secured only for a few years
Isolate variables to demonstrate feasibility and effect/outputs
Project-oriented incentive structures collapse at end of project
Not
seen as a winning strategy to
pay attention
to others
+ Design reality gaps within individual projects (
Heeks
)Slide11
Uncoordinated government bodies
=>
fragmentation
Ministry of Health is not alone…
National/Central Statistics office /NSO (census)Ministry of Local Government (run clinics)Ministry of Education (school health programs)
Ministry of Defense (military clinics)
Special units and structures on HIV and IDSRSlide12
Health (information) domain fragmentation
Various subsystems deal with different types of data
Patient data: name, address
etc
HR data: name, diplomas, employment historyLogistics: drug batch No., expiry dateHas “naturally” led to different systemsThe links between domains have been neglected
Lack of “boundary spanners”Slide13
Why public/private fragmentation?
Business ”secrets” and Taxation reasons
Lack of capacity at MOH to follow up
Not
one private sector, or umbrella organizationPrivate clinics, traditional medicine, religious organizations, NGOs
No incentives for private sector to share
Traditional private sector often not well documented
Lack of appropriate policies and legal frameworks
MALAWI:
President
lifts ban on traditional birth assistantsSlide14
limited capacity
and competence
to manage or analyse data
Using evidence not perceived as a winning strategy
Data not trusted
Weak demand
Weak HIS
Poor data
quality
Limited investment
in HIS
Decisions not evidence-based
Donors/NGOs
get
their own
Fragmentation
How does fragmentation influence data quality and vice versa?Slide15
Key points
Lack of access
to health information
Fragmentation
is a key reasonDifferent types and levels of fragmentation
Data quality
is often a big issue
ICTs only as effective as the (social) health system they support
What ICTs
can
do? Help in integration, reduce manual steps, store data safely, process and present information