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Introduction to RHIS Practical Lecture 2.pptx

  1. Health Systems and Health Information Systems Introduction to RHIS ROUTINE HEALTH INFORMATION SYSTEMS A Curriculum on Basic Concepts and Practice The complete RHIS curriculum is available here: routine-health- information-systems/rhis-curriculum
  2. RHIS in the Spotlight: MA4Health Summit in June 2015 • Call for Action: • Maximize effective use of the data revolution, based on open standards, to rapidly improve health facility and community health information systems, including well- functioning disease and risk surveillance systems, and financial and health workforce accounts 2
  3. Learning Objectives By the end of this module, participants will be able to: • Understand the essential link between the health system and the health information system • Explain who needs health data, what type of data is needed, and how data could be used • Describe the six components of a health information system, according to the Health Metrics Network (HMN) framework • Describe the health data sources and give examples of each data source and its categories • Define a routine health information system (RHIS) • Describe what they will learn in this RHIS course 3
  4. Module 1: Health System and Health Information System Duration: 3 hours Suggested References • International Health Partnership + Related Initiatives (IPH+) and World Health Organization (WHO). (2011). Monitoring, evaluation and review of national health strategies: a country-led platform for information and accountability. Geneva, Switzerland: WHO. Retrieved from n/en/. • Health Metrics Network. Framework and standards for country health information system, 2nd edition. (2012). Geneva, Switzerland: World Health Organization (WHO). Retrieved from • WHO. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. (2007). Geneva: WHO. Retrieved from • WHO, United States Agency for International Development, & University of Oslo. Health facility information system resource kit. (Draft; February 2015). 4
  5. Group Exercise on Health System Strengthening Duration: 30 minutes • Read the speech given by Margaret Chan at the G8 conference in 2009 • List the current health challenges • Identify major themes of health system strengthening 5
  6. The Health Challenges • Inefficiencies in the delivery of services and good governance • Access to care, especially of the poor (protect the poor; guarantee universal access to basic healthcare) • Equity and fairness in health-service delivery • Costs of healthcare pushing people below the poverty line • Stagnancy in improving service coverage • Maternal and child mortality • High-mortality diseases: tuberculosis, HIV and AIDS, vaccine- preventable diseases, malaria 6
  7. The Health Challenges • Inefficient aid: duplication, fragmentation, multiple reporting requirements, high transaction costs, and fierce competition for scarce health staff • Aging population, urbanization, unhealthy lifestyles, chronic diseases brings on heavy healthcare costs • Shortage of healthcare workers and specialized caregivers • Financial crisis • Policies, country leadership’s commitment, and innovative thinking 7
  8. Functions and Goals of a Health System ( FUNCTIONS (6 Building Blocks) GOALS/OUTCOMES OF THE SYSTEM Stewardship Commodities Infrastructure Service delivery Financing I N P U T S Health Responsiveness (the way people are treated and the environment) Fairness in financial contribution Quality Coverage Efficiency Source: WHO, 2000. 8 Human resources Information Safety
  9. Health System and HIS • What is an information system? • “ … a system that provides specific information support to the decision-making process at each level of an organization” (Hurtubise, 1984) • What is a HEALTH information system? • … a system that provides specific information support to the decision-making process at each level of the health system 9
  10. Health Information System Supports Decision Making at All Levels 1) At patient/client management level • Management of the care of an individual patient or client using information on health status, health services, behavior and practices, and risks • Management of health of family and household 10
  11. The Health Information System Supports Decision Making at All Levels 2) At health-unit management level • Monitoring and evaluation (M&E) of health services coverage and quality • Management of resources for efficient and equitable allocation, distribution, and use • Management of vaccines, drugs, cold chain • Planning program interventions; annual planning • Disease surveillance 11
  12. The Health Information System Supports Decision Making at All Levels 3) At system management level (district/regional/national) • Policy and strategy decisions • Health programs planning and management • Resource management • Capacity building • Disease surveillance • Innovations • Research 12
  13. Small-Group Exercise on Information Needs Duration: 30 minutes • Identify information needs in support of management functions at all levels • Use matrix of next slide 13
  14. Management Functions and Information Support Management Level Functions Information Need Patient/client Provide quality care Provide continuity of care Diagnostic information Past history Family history Health unit Provide pregnancy care to all pregnant women in catchment area Service coverage Geographic pockets of underserved women Commodity supply data Health system Ensure distribution of health commodities in the district Number of stockouts for essential drugs or vaccines Drug cost and efficacy 14
  15. Sources of Health Information Population-based data sources • Census • Surveys • Civil registration 15
  16. Sources of Health Information Institution-based sources Hospitals, health centers, community-based institutions/service delivery mechanisms Generate data as a result of administrative and operational activities from: • Individual records • Service records • Resource records • Health facility surveys 16
  17. Components and Standards of a National Health Information System (HMN, 2008) 17
  18. Definition of a Routine Health Information System • A routine health information system produces information through routine data collection (periods of less than a year) • Data are collected by care providers in communities, in primary care facilities, in hospitals, and by routine health-facility assessment (through supervision of surveys) 18
  19. The Universeof RoutineHealthInformation Systems (Also Knownas Institution-basedInformationSystems) • Individual record systems (facility- and community- based) • Paper-based records • Electronic medical records (EMR) • Service record systems • Health management information systems (HMIS) • Facility- and community-based • Public, private, and parastatal • Laboratory and imaging information systems (LIIS) • Disease surveillance information systems 19
  20. The Universe of Routine Health Information Systems (Also Known as Institution-based Information Systems) • Resource record systems • Financial management information systems (FMIS) • Human resource information systems (HRIS) • Logistics management information systems (LMIS) • Infrastructure and equipment management information systems (IEMIS) • Health facility surveys • Service availability and readiness • Quality of care • Supervisory records 20
  21. The Role and Importance of Decentralized Routine Health Information Systems • Main source of information for (daily) planning and management of quality health services at district level and below • Coverage and quality of health interventions • Disease surveillance • Commodity security • Financial information systems • Also feeding real-time information to national and global levels • Ideal information system in support of integrated management of health interventions 21
  22. Performance Criteria of a Well-Functioning Routine Health Information System Governance and management • Policies, legislation, plans, accountability, and operational procedures • Data standards and accountability • Human resources • ICT infrastructure Data quality • Individual client data • Aggregate facility data • Aggregate community data • Assessment of data quality • Assurance of data quality Information Use • Relevant Indicators • Data analysis • Data visualization • Data interoperability • Problem solving 22
  23. Routine health information system (RHIS) RHIS is defined as the ongoing data collection of health status, health interventions, and health resources for decision making. It includes • Facility based service statistics, • Epidemiological and surveillance data, • Community-based health information, and • Health administration data (e.g. on revenue and costs, drugs, personnel, training, research, and documentation). 23
  24. The guidelines for RHIS The guidelines have been structured around four themes: 1. Users’ Data and Decision Support Needs 2. Data Collection Processing, Analysis and Dissemination of Information 3. Data Integration and Interoperability 4. Governance of RHIS Data Management 24
  25. Three management levels • Beneficiary Management Level • Health Facility Management Level • System Management Level 25
  26. Indicators “Variables that help to measure changes, directly or indirectly.” • Crafting useful indicators is at the center of the process of monitoring health services and systems • One of the most important skills required in RHIS design Look for better indicators, not more indicators 26
  27. Significance of indicators • Monitor progress toward targets and to measure changes over time; • Relate raw data to standardized populations; • Enable comparison among and within different levels of the health system; or • Communicate how numbers compare, based on the same size of population or staff. 27
  28. CORE INDICATOR SET A parsimonious set of broadly agreed indicators is the basic tool for countries and subnational areas to promote the shift from a data-led to an information-led information system— the foundation of evidence based decision making. Each country should have a core indicator set for both national planning as well as for lower-level management of clients, facilities, and systems. 28
  29. Qualities of a good indicator set Should target all major attributes of the health system to end up with a well-balanced set of indicators Should provide complete, concise information on important aspects of the health system Health determinants, health systems, and health status A good indicator is… • Reliable • Appropriate • Valid • Easy to collect • Sensitive and Specific 29
  30. Domains of Health indicators 30
  31. SYSTEMS CLASSIFICATION OF INDICATORS Five classes of indicators • Input, • Process, • Output, • Outcome, and • Impact 31
  32. National Indicators State/Provincial Level Indicators District-Level Indicators Facility-Level Indicators 32
  33. Use of indicators at various levels 33
  34. Operationalizing Indicators • Data definitions. • Data sources. • Reporting frequency. • Targets. • Indicator reference sheets. 34
  35. Data definition • Standardize definitions of individual data elements and indicators, applying international standards as feasible. 35
  36. Service delivery data definitions 36
  37. Health Metrics Network population- and institution-based data sources. 37
  38. TARGET POPULATIONS • At all levels, and particularly at facility level, it is important to know how many people live in the catchment area and how many need health services. 38
  39. INDICATOR REFERENCE SHEETS • Documentation of these operationalized indicators should be put together in an indicator compendium. For each indicator, an indicator reference sheet needs to be developed; it should include: • A definition of the data elements • The data source. • The frequency of reporting 39
  40. Data Collection, Processing, Analysis and Dissemination of Information • Collection of data is by two ways; 1) routinely 2) non-routinely • All national systems use both routinely and non-routinely collected data for planning and managing their health services. • The choice of appropriate data collection methods is linked to frequency of decision making, and complexity and cost of data collection. 40
  41. You will learn the following concepts: • Methods of health facility and community-based data collection. • How to report and transmit data. • How to ensure data quality. • How to ensure data confidentiality. • How to analyze data. • How to store data. • How to disseminate data. 41
  42. Overview of data collection tools • Individual patient records (including electronic records). • Family record cards. • Tally sheets. • Registers. • Tickler files. • Electronic systems. • Mobile phones 42
  43. INDIVIDUAL RECORD CARDS • All individual beneficiaries need a card or file in which to record the details of their interaction with the health service provider. • A variety of categories of individual patient records exist, defined by • age group or disease category • the Road to Health card, • the Child Health booklet, • the Women’s Health book, • the Chronic Disease card, • the TB • patient treatment card. 43
  44. Family record cards • All information for an entire family is collected in one place, complete with individual record cards, providing a wealth of community information at household level 44
  46. TB ID Card 46
  47. TICKLER FILE SYSTEM • Tickler file systems are a paper-based equivalent for managing patients’ appointments and ensuring quality of care. For the most part, the system requires just two appointment boxes —one for months and one for days. 47
  48. ELECTRONIC HEALTH RECORDS • Data is entered only once, saving staff much time and trouble. • Such systems can help ensure continuity of care and can be used to remind clients and service providers to follow up. • Electronic systems can improve quality of care by building in diagnostic algorithms and service provider support. • Communication can be facilitated between different medical and administrative units. • Coordination can be facilitated between clinical provider, pharmacies, and laboratory so that requests from clinicians can be acted on quickly and results can be fed back immediately. 48
  49. Facility Record Systems • Registers • Tick registers • Tally sheets 49
  50. Registers 50
  51. 51
  52. MOBILE TECHNOLOGY FOR THE COLLECTION OF COMMUNITY HEALTH DATA • Community health workers can enter individual patient data directly into databases. • Health facilities can report on notifiable diseases and other immediately reportable conditions. • Management of public health logistics (e.g., essential medicines) and ordering critical supplies are facilitated. 52
  53. ROUTINE HEALTH INFORMATION SYSTEMS A Curriculum on Basic Concepts and Practice This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID- OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government.