Congratulations to Mongolia on its
800 Anniversary from HMN
Reforming Health Information Systems:
The HMN Framework
High Level Forum on Strategic Planning for Statistics
Ulaanbataar 9-11 October 2006
Dr. Lene Mikkelsen
www.healthmetricsnetwork.org
What is health information?
Information about:
“…all resources, organizations and actors that are
involved in the regulation, financing, and
provision of actions whose primary intent is to
protect, promote or improve health”
WHO 2000
Typical organizational structure of a health
information system
Ministry of Interior,
Local Government
Other sectors
Ministry of Health
Dept. of Statistics
Insurance
Donors
Private sector
Disease surveillance
Districts
Researchers
Facilities
Integrating Health Statistics
into Overall Statistical System
Edu.
Agri.
Health
Labour
National
Strategies
for the
Development
of Statistics
A complex field
Users: general public, patients, communities,
service providers, managers, policy-makers,
donors and global agencies.
Information covering: mortality, morbidity, disease
outbreaks, determinants of health, access to,
coverage and quality of services, cost and
expenditure.
Sources: vital registration, census, household,
facility and district surveys, routine clinic based
data, disease surveillance, national health
accounts and modeling.
HIS consists of several subsystems
Household
surveys
Vital events
Cause of death
Administrative
and resources
HIS
Disease
surveillance
Disease specific
monitoring
Censuses
Patients &
Service records
Health information
sub-systems rarely interact
costs
resources
Administrative
data
MCH/FP
HIV
malaria
Water/san
EPI surveys
TB
HIV
Routine
MCH/FP service
EPI
data
Household
surveys
STI
Census
MCH
Vital
cause registration
of
death
Sexual
behaviour HIV
surveys
Disease
surveillance
HIV
Ebola
cancer
Behavioural
risk
surveys smoking
exercise
nutrition
Data, Data, Everywhere ….
Why do we need to reform HIS?
• Widespread dissatisfaction among both users and
producers of HI
• Complex and unwieldy; fragmented by diseasefocused programs and donors;
• epidemic of indicators; burdensome demands on
health personnel;
• Poor quality of data; lack of common standards;
data inconsistencies and inefficiencies; difficult to
analyze and synthesize
• Oversupply of data coexisting with large unmet
needs
• Poorly integrated into national statistical system
and into broader statistical and development
processes
What is Health Metrics Network?
• Global health partnership launched in 2005
to assist LDCs in improving their HIS
• Partners include developing countries, global
agencies, foundations and technical experts
in various countries
• Funding
USD 50 millions from Gates Foundation
Also Danida, DFID, USAID, EC & WHO
• Timeline
First phase 2005-2012
HMN Support to Countries
• All countries have access to HMN
framework, assessment and monitoring
tools.
• Low and lower-middle income countries
are eligible for long-term technical and
financial support up to $500,000 in a given
year.
• All countries can participate in HMN
workshops and training activities but only
low and lower-middle income countries will
be funded
HMN Goal and Objectives
Goal:
 Increase availability and use of timely, reliable
health information through shared agreement on
goals and coordinated investments in health
information systems
Objectives:
 Promote a harmonized framework for health
information systems
 Strengthen country health information systems
by assisting them applying the framework, by
offering technical and financial support
 Improve access, quality and use of health
information nationally and at the global level
HMN Guiding Principles
The process should be:
- nationally led and owned
- link health and statistical constituencies and involve
all stakeholders
- respond to country needs and build upon what
exists
- draw on best international standards and be guided
by the Fundamental Principles of Official Statistics
- be tackled as a gradual process requiring long-term
investment
HMN Framework
Health information system
components & standards
HIS resources
Roadmap
for implementation
Principles
Indicators
Process
Data sources
Data management
Information products
Dissemination and use
Tools
HMN Goal
Increase availability, accessibility, quality and
use of health information that are critical for
decision making at country and global levels.
Health Data Sources
Health administrative
records
Census
Civil
registration
Service records
(HMIS)
Pop based
surveys
Population-based
Health &
disease
records
Health services based
HMN’s Assessment and Monitoring
Tool
Purpose:
- to provide a diagnosis of the national HIS
What it is and does:
- a set of structured questions (274) and a scoring
mechanism
- identifies strengths, weaknesses and gaps in all six
components of current HIS
- establishes a baseline for the country
What is its value-added:
- involves all major stakeholders
- encourages consensus building
- provides the evidence for the strategic plan
- ensures that the same measure is used for all countries
Countries Receiving Catalytic Grants
From HMN - Round 1
Use of Initial HMN Grants
• Assessment of the current status of the health
information system, using HMN tool, standardized
framework for quality review
• Development of a 2015 plan for health information
system development, linked to national health
sector and poverty monitoring strategies and
planning cycles
• Building capacity for data generation, analysis and
use
• Focus on specific issues: monitoring vital events ,
private sector data, data dictionaries, data
warehousing
Round 2 Grants
In 2006 HMN has had workshops in L-A, Caribbean
and the Middle East
• 2nd Call for Proposals. Deadline August 31, 2006.
• Limited to countries not receiving support in
Round 1
• Grant ceiling set to $50,000 covering only the
assessment with stakeholders and developing a
10 year strategic improvement plan
• 58 Proposals received which will be reviewed by
HMN Secretariat, (based on criteria set forth by
Independent Review Ctte)
Ways that NSO statisticians can
contribute to strengthening HIS
• Provide high level support and guidance for the
assessment and strategic improvement plan
• Active and continued participation in the
assessment of the HIS together with other
stakeholders to ensure a good outcome
• Send participants to HMN training workshops
• Participation in the group tasked with drafting the
strategic 10 year plan for reforming the HIS
• If requested, organize training to health staff in
data collection and data quality issues
• Help link to broader statistical and development
processes as well as integrating health statistics
into NSDS
The Vicious Cycle
Decision-making
based on sectional
interests,
donor demand,
inertia etc.
Donors focus
on their own
data needs;
Little investment in
health information systems.
Weak demand
for data for policy-making.
Data not trusted or used.
Weak health
information
Systems.
Limited capacity
to generate or analyse data.
Creating a Virtuous Cycle
GFATM, GAVI.
President's
Initiative,
MDGs:
results-based
decision-making
Global
initiatives
Donors
agree
to align
efforts
Focus on
building
systems able to
respond to country
and donor needs.
Increased
Demand
Increased
Coordination
Health sector
reform,
SWAPs. PRSP,
civil society,
media, use
of IT
Multiple
stakeholders –
health and
statistics
www.healthmetricsnetwork.org