PARIS 21 Meeting
Ghana
27-28 July 2005
• Challenges in health information
• Health Metrics Network
• HMN Framework and profiling tool
An Information Paradox:
Reporting of Mortality in the World
Data, Data, Everywhere ….
Data Collection in Ghana 1991-2008
(non-routine only)
GHS
report
Maternal
health
survey
SPA
CWIQ
CWIQ
DHS 2
DHS 3
DHS 4
DHS 5
WHS
Census
MICS 3
91
19
92
19
Living
Standards
Survey 5
Living
Standards
Survey 4
Living
Standards
Survey 3
93
19
94
19
95
19
96
19
97
19
98
19
99
19
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
The Vicious Cycle
Sectional interests,
donor demand,
inertia etc.
Decision
Making
Donors
focus on
theirs
own
data
Little investment in
needs
health information
systems.
Data not trusted
or used for
policy-making
at country level.
Weak
Demand
Weak
Health
Information
Limited capacity
System
to generate
or analyse data.
HMN Goal, Principles, Objectives
Goal: Increase the availability and use of timely and
reliable health information in countries and globally
through shared agreement on goals and
coordinated investments in health information
systems
Principles: Country ownership; Stakeholder
involvement
Objectives:
– Develop framework and standards for health
information systems
– Support countries to implement plans adherent
to the HMN framework
– Develop incentives for enhanced dissemination
and use of sound health information
HMN Framework
 Description and standards for core
data elements, data collection
methods, data management,
resources, data analysis and use.
 Diagnostic tool; standardized selfassessment and learning tool
DQAF for health
 Principles and processes for
strengthening country health
information systems
Health Information System
Comprehensive Approach
Facility-based data
Population-based data
disease surveillance
patient & facility records
facility surveys
health system data
census
vital statistics
household surveys
demographic surveillance
(infrastructure, supplies,
human, financial resources)
Ministry of Health
HMN
National Statistics Office
Health Information System Profile
1. Context,
processes &
resources
2. Data platforms
Country
Health
Information
System
Profile
4. Data synthesis,
analysis and use
3. Outputs/results
for selected
indicators
Rating Context, Resources and Processes;
Thailand & Ghana 2005
% rating
Ghana
• Legal framework,
coordination and
planning
• Human resources
availability and skills
• Infrastructure,
equipment,
information
technology
• Data flow and
management,
feedback
0
20
40
Inadequate
60
80
100
Satisfactory
Rating Context, Resources and Processes;
Thailand & Ghana 2005
% rating
• Legal framework,
coordination and
planning
Thailand
Ghana
• Human resources
availability and skills
• Infrastructure,
equipment,
information
technology
• Data flow and
management,
feedback
Inadequate
Satisfactory
Assessment of Data Sources
& Data Collection Methods
Criteria for
assessment
Data collection
methods
• Contents
• Census
• Capacity
• Vital statistics
• Practices
• Population surveys
• Dissemination
• Surveillance (acute &
chronic)
• Integration
• Services data (health
facilities)
• System (administrative,
financial)
Rating Data Collection Platforms:
Thailand & Ghana, 2005
Ghana
Health system info
Service statistics
Surveillance
(chronic)
Surveillance (acute)
HH Surveys
Vital registration
Census
Inadequate
Satisfactory
Rating Data Collection Methods:
Thailand & Ghana, 2005
Thailand
Health system info
Ghana
Service statistics
Surveillance
(chronic)
Surveillance (acute)
HH Surveys
Vital registration
Census
Inadequate
Satisfactory
Assessment of Outputs % Indicators
Criteria for
assessment
• Data collection
method
• Timeliness
• Periodicity
• Consistency
• Representativeness
• Disaggregration
• Estimation method
Core
indicators
• Child mortality
• Maternal & adult
mortality
• HIV/AIDS, TB,
malaria
• Smoking,
hypertension
• Immunization
• Service utilization
• Water & sanitation
Reconciling Data Sources
Under five mortality per 1,000 live births,
Ghana, 1985-2004
200
180
160
120
Estimate 2003
(WHO/UNICEF)
DHS 1988
100
DHS 1993
140
80
DHS 1998
60
DHS 2003
40
20
0
1985
1988
1991
1994
1997
2000
2003
Reconciling Data Sources
Measles coverage among children aged 1 year,
Ghana, 1995-2004
Estimates (WHO/UNICEF)
Reported
Survey
100
80
60
40
20
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Reconciling Data Sources
Improved water supply, urban and rural households,
Ghana, 1995-2004
Estimate-urban
Survey-urban
Estimate-rural
Survey-rural
100
80
60
40
20
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Rating Outputs/Indicators:
Selected Countries, 2005
Niger
Central African Republic
Senegal
Uganda
Eritrea
Ghana
South Africa
Inadequate
Satisfactory
Rating Outputs/Indicators:
Selected Countries, 2005
Niger
Central African Republic
Senegal
Uganda
Eritrea
Ghana
South Africa
Inadequate
Satisfactory
Data synthesis, analysis and use
• Indicators in national data set linked to
planning
• Data available and compared across public,
voluntary and private sectors
• Summary reports covering key indicators
produced at all levels
• Summary reports targeted to different
audiences, including policy-makers,
parliamentarians, media, civil society
• Evaluation of data and indicators documented
• Ghana score:
Inadequate
Satisfactory
From Diagnosis to Action
• Establish national coordinating mechanism - MOH, Bureau
of Statistics, research & academic bodies, disease-specific
programmes
• Select essential indicators and develop integrated
database – Data warehouse
• Develop national health information system plan; better
planning and coordination of household surveys
• Develop health information system components; sample
registration that includes causes of death; avoid less costeffective methods such as maternal mortality surveys
• Enhance synthesis and use of data for decision-making
(linking inputs and outcomes) by combining data from all
sources and linking to budgets and expenditure.
• Support Health Statistics Resource Centre (software
library, PDF electronic library).
HMN Support to Countries
• Low and lower-middle income countries:
technical and financial support up to $500,000 in
a given year. Highest priority for HMN action.
• All countries except high income countries:
technical assistance plus limited financial support
up to $100,000 in a given year
• All countries except high income countries:
technical assistance if they generate their own
in-country financial resources. These countries
can serve as regional centres of excellence and
facilitate sharing of experiences.