Information
for Action
Judge Business
School
in Public Health Systems
in Developing Countries
Geoff Walsham
Page 2
Information for action - definition
• The regular and widespread use of information as
an input to processes such as planning,
management, monitoring and evaluation of health
activities and systems with a view to enabling
more effective action in the field and improved
health outcomes
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Health System
Information
Flow
STATE HEAD QUARTER
Data Given
State Level
Feed Back
District TB Department
District Malaria Department
District Leprosy Department
District Level
District Blindness Control Program
District Head Quarter
(DPMU)
Others
Block MOIC
CHC
CHC Level
PHC Level
PHC
PHC MOIC
Sector Level
Health Supervisor
Sub-Centre Level
ANM
ANM Register
Information for action – some examples
Using information at the national level to develop plans to meet the
MDGs
Using information at state level to prioritise particular programmes in
that state and develop action plans to achieve these
Using information at district level to monitor the achievement or
underachievement of district health goals and to generate future plans
to respond to this
Using information at the PHC level to better understand local health
problems and issues in order to target resource use more effectively
Using information on particular villages and sub-centres to develop
ANM activity plans which maximise the use of her capabilities
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Information for action needs good data
Accurate
Complete
Timely
Relevant
Available where and when needed
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Why is data in public health systems often
poor quality?
Misreporting due to unintended mistakes, arithmetic calculations etc
Deliberate misreporting to present a distorted picture of achievements
Under-reporting or no reporting due to time pressures, lack of
motivation to report or excessive number of forms, data elements etc.
Lack of understanding of the importance of data or its role in improving
health outcomes – no ‘information culture’
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What information and communication
technologies (ICTs) can do
Provide the capability to capture data more effectively at local level
e.g. through mobile phones
Provide resources for the processing of data more quickly and
accurately
Provide capabilities for the generation and display of information in a
user-friendly and adaptable way
Provide the capability to integrate information across all levels of
analysis from the global to the local
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What ICTs cannot do
Produce motivated and knowledgeable health workers at all levels
Produce an information culture which places high value on the use of
information for action
Eliminate ‘perverse incentives’ in the health system to misrepresent
data or distort information
Provide the levels of resources and long-term commitment needed to
raise the quality of health care to widely acceptable levels
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Developing the software – HISP/DHIS
Health Information Systems Programme (HISP) started in South Africa in
the mid-1990s
Provides a computer-based district health information system (DHIS) for
health planning and management
Approach extended to a range of other countries in Africa and Asia
Based on open-source software, the latest version being DHIS2
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Developing the people
Ashas
ANMs
Medical officers in PHCs
Block and district personnel
State and central health staff
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Developing the institutional support
Health is known globally to operate in vertical silos
This is often mirrored in vertical institutions who place less emphasis on
horizontal communications
Need for a change of culture to one of cooperation, horizontal
communication and the development of shared goals
This matches the spirit of the original HISP approach
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Conclusions
• Health management information systems (HMIS)
need to be viewed as only one part of
heterogeneous networks composed of people,
technology, standards, institutions, processes etc.
• Change programmes need to address all of these
elements holistically and over extended time
periods
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Thank You