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:
https://www.measureevaluation.org/our-work/ routine-health-
information-systems/rhis-curriculum

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

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

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
http://www.who.int/healthinfo/country_monitoring_evaluation/documentatio
n/en/.
• Health Metrics Network. Framework and standards for country health
information system, 2nd edition. (2012). Geneva, Switzerland: World Health
Organization (WHO). Retrieved from
http://www.hrhresourcecenter.org/node/746
• WHO. Everybody’s business: strengthening health systems to improve health
outcomes: WHO’s framework for action. (2007). Geneva: WHO. Retrieved from
http://www.who.int/healthsystems/strategy/en/.
• WHO, United States Agency for International Development, & University of
Oslo. Health facility information system resource kit. (Draft; February 2015).
4

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

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

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

Functions and Goals of a Health System
(http://www.who.int/whr/2000/en/)
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

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

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

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

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

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

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

Sources of Health Information
Population-based data sources
• Census
• Surveys
• Civil registration
15

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

Components and Standards of a National Health
Information System (HMN, 2008)
17

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

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

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

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

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

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

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

Three management levels
• Beneficiary Management Level
• Health Facility Management Level
• System Management Level
25

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

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

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

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

Domains of Health indicators
30

SYSTEMS CLASSIFICATION OF INDICATORS
Five classes of indicators
• Input,
• Process,
• Output,
• Outcome, and
• Impact
31

National Indicators
State/Provincial Level Indicators
District-Level Indicators
Facility-Level Indicators
32

Use of indicators at various levels
33

Operationalizing Indicators
• Data definitions.
• Data sources.
• Reporting frequency.
• Targets.
• Indicator reference sheets.
34

Data definition
• Standardize definitions of individual data elements and
indicators, applying international standards as feasible.
35

Service delivery data definitions
36

Health Metrics Network population- and
institution-based data sources.
37

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

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

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

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

Overview of data collection tools
• Individual patient records (including electronic
records).
• Family record cards.
• Tally sheets.
• Registers.
• Tickler files.
• Electronic systems.
• Mobile phones
42

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

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

INDICATOR REFERENCE SHEETS
45

TB ID Card
46

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

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

Facility Record Systems
• Registers
• Tick registers
• Tally sheets
49

Registers
50

51

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

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.