Routine Data Systems
Data Use for Program Monitoring
Learning Objectives
 Differentiate between routine and non-routine
data
 Understand parameters and influences of HIS via
the PRISM framework
 Recognize & use tools available to improve RHIS
function
Session Overview
 General concepts of an RHIS
 Health information systems
 PRISM framework for understanding factors that
influence RHIS
 PRISM Toolset for RHIS1
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RHIS Performance Diagnostic Tool
RHIS Overview & Facility/Office Checklist
Organizational & Behavioral Questionnaire
RHIS Management Assessment Tool
 Activity – Applying the PRISM Tools
1MEASURE
Evaluation, Data demand and information use in the health sector: strategies and tools
Definitions
 Health information system
 A system providing specific information support to
decision-making process at each level of an
organization1
 Health system
 All resources—people, institutions & other—
arranged according to established policies to
protect, promote and improve the health of the
served population2
2
WHO,
1Hurtubise R (1984). Managing Information Systems. Kumarian Press, West Hartford.
http://www.euro.who.int/observatory/Glossary/To
pPage?phrase=H
Definitions: Routine vs. Non-routine
Data
 Routine data
 Are collected continuously at various times
periods (daily, patient by patient, monthly etc.)
 Come from the HIS and its subsystems that are
collected as part of an ongoing system
 Non-routine data
 Are collected at certain periods of time, or over a
specific period of time
 Come from special studies or surveys carried out
for specific purposes
Are we talking about this?
Or this?
Or do we mean this?
All of these, but this is where we really
want to get
Why do programs need
information?
Programs Need Information to
 Understand entire context of program status
 Enhance program performance through
evidence-based decision making
 All major functions
 service delivery, resource mobilization, financing,
stewardship
 All levels
 Community to national level
Health Information Systems (HIS)
 HIS is an integral part of the health system
 Just like a health system, an HIS is not static
 Health systems in continuous process of change
due to pressure from both outside and within the
system
 HIS must amend itself to these changes
HIS Sub-systems:
Frequency of Data Collection
 Routine or continuous data collection
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Health facility-based (pt. info. & service stats)
Community based (service statistics)
Vital registration
Sentinel reporting
Program reporting systems
 Non-routine or periodic data collection
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Household or facility-based surveys
Population census
Rapid assessment procedures (RAP)
Research
HIS and HIV Programs
 A subset of the comprehensive health system
 Data sources can be routine or non-routine
 Contribute to data collection of various HIS
subsystems
 Need harmonization and integration in data
collection & utilization within context of
national HIS (the Third One)
PRISM* Framework for HIS Performance1
Inputs
information system
assessment,
strategies & interventions
Technical
Determinants
• system design
• data collection
forms
• Skills/knowledge of
personnel
Behavioral determinants
Attitudes, motivation, values
Desired Outcomes
= information system
performance
• good quality information
• appropriate use of information
Improved
Health
System
Performance
Systemic/Environmental Determinants:
leadership, structure, culture, roles/responsibilities,
resources
*Performance of Routine Information System Management
1MEASURE Evaluation. 2006. Data demand and information
use in the health sector: Strategies and Tools
Improved
Health
Status
RHIS Performance Diagnostic Tool
HIS Quality & Use Influences
Standard indicators
Data collection forms
Appropriate IT
Data presentation
Trained people
Technical
Determinants
Technical
Determinants
RHIS Overview & Facility/Office Checklist
HIS Quality & Use Influences
Motivation
Attitudes & values
Confidence
Sense of responsibility
Behavioral
Determinants
Behavioral
Determinants
Organizational and Behavioral Questionnaire
HIS Quality & Use Influences
Resources
Health sys. structure
Roles &
responsibilities
Organizational culture
System &
Environment
Determinants
System &
Environmental
Determinants
RHIS Management Assessment Tool
PRISM Tools - Rationale
 RHIS often not produce good information for
health sector decision-making
 Data quality may low
 No processes in place for using data
 Managers/staff not understand importance of role in
information process & have little incentive
 Traditional Assessments of RHIS narrow in focus
 Answer only part of why RHIS not high quality
 Typical focus is on data collection or information
technology alone
PRISM Tools - Rationale
 Well designed interventions to improve RHIS
should address these questions
 Is the organization committed to information-using
culture?
 Do people responsible for data collection have
necessary skills?
 Do they understand & care about importance of
their work?
 Do managers support them with training,
supervision & needed resources?
Description of PRISM Tools
 Systematically provide answers, using an ordered
process of gathering information about RHIS
 Objectively measure performance & identify factors
hindering performance
 Assess performance of RHIS
 Identify technical, behavioral & organizational factors affect
RHIS performance
 Aid in designing/prioritizing interventions to improve
performance
 Support ongoing efforts for M&E of data quality & use in
decision-making.
PRISM Tools - Implementation
 Apply all four Tools for systematic assessment
 Implement Tools in this order:
 RHIS Performance Diagnostic Tool
 RHIS Overview & Facility/Office Checklist
 Organizational & Behavioral Questionnaire
 RHIS Management Assessment Tool
PRISM Tools:
RHIS Performance Diagnostic Tool
 Primary component in the set
 Determines overall RHIS performance
 (like MESS for whole M&E system)
 Examines data quality & information use to
identify gaps
 Identifies overall strengths and weaknesses
PRISM Tools:
RHIS Overview & Facility/Office
Checklist
 Addresses technical determinants of RHIS such
as
 Structure & design of existing information systems
 Information flows
 Interaction between different information systems
 Use to understand availability & status of RHIS
resources & practices
PRISM Tools:
Organizational & Behavioral
Questionnaire
 Addresses behavioral and organizational
determinants to RHIS, examines
 Staff capacity
 Knowledge, skills, confidence and motivation
 Organizational culture
 Promote value of information quality & use?
 Compares these factors with RHIS performance
to identify related gaps
PRISM Tools:
RHIS Management Assessment Tool
 Allows a rapid assessment of management and
supportive RHIS practices
 Results in recommendations for stronger RHIS
management
PRISM Tools – Guiding Principles
 Holistic approach that recognizes
 RHIS performance depends on combination of
technical, organizational & behavioral factors
 Each of these components contributes to whole
system, whole is more than the sum of its parts
 Causal influence of all determinants in 3 areas
must be understood to improve performance
PRISM Tools Guiding Principles
 When data collectors understand importance of
their contributions, they will be more committed
 When decision-makers believe they have high
quality data, more likely to use it for evidencebased decisions
 When people empowered to make decisions,
become champions for accountability and
transparency
PRISM Tools
 Tools are administered, based on
 Observations, document review, information
technology review
 Triangulation of multiple data sources increases
validity of findings
 Self-assessment aspect creates sense of
ownership for results & atmosphere of
collaboration
Steps to use PRISM Tools
 Identify a potential opportunity
 Determine how Tools would be used for the presenting need
 Perform pre-assessment planning
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Determine organization’s readiness to improve RHIS
Assemble core team stakeholders
Identify key informants to interview
Modify Tool to fit application
 Assess & analyze current RHIS performance
 Use the Tools in order (Diagnostic, overview,
organizational/behavioral, management assessment)
 Define plan for reaching desired level of RHIS performance
 Implement plan and monitor progress
Goal of RHIS
 Produce meaningful insights about performance of
health system
 Is our HIV program working?
 Increasing people willing to be counseled & tested
 Decreasing HIV incidence
 Reaching more pregnant, HIV + women
More effective information systems lead to better
health status for more of the population
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.