Strengthening Health Information Systems:
Creating an Information Culture
Manila, June 14, 2011
Theo Lippeveld, MD, MPH, tlippeveld@jsi.com
Objective of this session:
let us be more specific
 Delegates will explore leadership roles
in managing health information
systems as a national asset …
… for improving evidence based decision
making in the health system at all
levels
Overview of this session
 Introduction on the need for HIS
strengthening worldwide
 Brainstorming on how to improve use
of information
 PRISM framework for HIS
strengthening
 Where does information culture fit in
this
 Questions and answers
Global Health: new opportunities and
old constraints
 Recently spectacular increases in money flows
(Gates, PEPFAR, the Global Fund, etc.) to
address priority infectious diseases (HIV/AIDS,
TB, Malaria, etc.)
 The Millennium Development Goals by 2015:
excellent drive for better health outcomes
 Growing interest in health systems
strengthening by the major global health donors
 But major constraints (old and new) continue to
exist
What is going wrong?
• Lack of leadership and country ownership
• Fragmentation of the health system
– Disease oriented stove pipe systems
• Lack of good models for scaling up evidence
based interventions
– How to move from pilot to scale?
• Health workforce crisis
• Weak logistic systems for commodity security
• Weak health information systems (HIS)
What is wrong with existing HIS?
 Plethora, irrelevance and poor quality of
the data collected
 Centralization of information management
without feedback to district and service
delivery levels
 Fragmentation into “program- oriented”
information systems: duplication and
waste
 Poor health information system
infrastructure and resources
As a result…
 Poor demand and use of information by
users at all levels: policy makers, health
managers, as well care providers
So, what can be done to improve use of
information for decision making?
 Take 3 minutes to write down possible
interventions
Is this the HIS final
outcome?
8
Some of the lessons learned from HIS
reform in recent years
• Need for standardized data generation architecture
• Need for well defined HIS performance criteria:
– Production of relevant and quality information
– Continued use of information for DM at all levels
• Empirical evidence shows that availability of relevant and quality
information does NOT NECESSARILY mean that is it used for
decision making
 Need for better understanding of factors influencing HIS
performance
 PRISM framework: Performance of Routine Information Systems
Management
PRISM Framework for Understanding
Health Information System (HIS) Performance
Technical
Determinants
Inputs
HIS assessment,
HIS strategies
HIS interventions
Data generation architecture
Information/communication
technology
Desired Outputs
= HIS performance
• good quality information
• appropriate use of information
Improved Health System
Performance
Improved Health
Outcomes
10
Organizational
Determinants
Behavioral
Determinants
Information culture, health system
structure, roles & responsibilities,
resources
Knowledge/ skills, attitudes,
values, motivation
Prism Tools: Measuring HIS performance
and its determinants
A) HIS Performance Diagnostic Tool
Quality of data
B) HIS Overview
Facility/ Office Checklist
Use of information
D) HIS Process Assessment
Tool
C) Organizational & Behavioral
Questionnaire
PRISM tools allow quantitative HIS
performance measurement over time:
Example of Pakistan
Percent
Improvements in Data Accuracy and Use of
Information Before and After Pilot test in Pakistan,
2006
80
70
60
50
40
30
20
10
0
Accuracy
Use of info
Before
After
OBAT: Competency in Problem Solving
R.Dominicana
100.00
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
Paraguay
Costa Rica
Perceived
Observed
Perú
Ecuador
Mexico
Honduras
Based on PRISM assessment:
HIS performance improvement interventions

Technical interventions

Organizational interventions

Behavioral interventions
Example of technical HIS interventions
(the classic approach)

Matching information offer with health system
demand
 Defining a set of essential indicators
 Improving data generation processes
 Developing user-friendly data collection
formats
 Introducing appropriate ICT for data
management
 Improving integration of data sources
 Building of a national data warehouse
Examples of behavioral interventions
• 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
Examples of organizational interventions
• 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”
Operational definition (from social sectors):
“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.”
• This implies an important role for senior
management (policy makers and managers) in
the health system
• This implies behavioral change (individual and
institutional) = long term process
Rationale for promoting
culture of information
• Communication by senior management to health staff that
information is considered a key organizational value
• Clarify expectations regarding desired behaviors and
performance levels for use of information
• Improve transparency and accountability within the health
system and the health information system
• Creating 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 is required leading to
less costs
How to promote culture of information
• Role modeling by senior managers on using the
information generated for DM
• Emphasis on HIS performance during review
meetings
• Dissemination of success stories of use of info for
service improvement and advocacy
• Institutionalizing and creating incentives for use of
HIS information
– Dissemination of HIS district level indicators through
media (Uganda): creating competition…
– Allocation of resources based on HIS indicators (Brazil)
– Use of HIS info as criteria of the annual performance
appraisal
CONCLUSIONS
• 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 and down to the
service delivery levels
• Senior management needs to promote culture of
information for improving performance,
accountability, transparency in the health system
and to role model use of information
Thank You
For info on the PRISM framework
and tools: see www.rhinonet.org
MEASURE Evaluation is a MEASURE project funded by the
U.S. Agency for International Development and implemented by
the Carolina Population Center at the University of North Carolina
at Chapel Hill in partnership with Futures Group International,
ICF Macro, John Snow, Inc., Management Sciences for Health,
and Tulane University. Views expressed in this presentation do not
necessarily reflect the views of USAID or the U.S. Government.
MEASURE Evaluation is the USAID Global Health Bureau's
primary vehicle for supporting improvements in monitoring and
evaluation in population, health and nutrition worldwide.