1
Federal Ministry of Health
Directorate General of Health Planning and
Development National Health Information Center
5-YEAR National Health Information
Strategic Plan
2007
Table of contents
2
Item Page No
Acknowledgement
Acronyms and abbreviations
1 Background 1
1 . 1 Rationale 2
1 . 2 Policy context of national Health Information system 2
1 . 3 Overall Health Information System Assessment 5
1 . 4 Template for Analyzing Results of the Assessment Tool 6
1 . 5 Analysis of Strength, Weakness, Opportunity and Threat 7
1 . 6 Process of the strategic plan development 7
2 Situation analysis of national the health information system. 9
2 . 1 The national and international partners 10
2 . 2 Human resources 11
2 . 3 The Health statistical technicians Training centre (HSTTC) 12
2 . 4 HIS infrastructure 12
3 Challenges and opportunities 13
4 Guiding principles 14
5 Vision 14
6 Mission 14
7 Values 15
8 Priority areas for the NHIS 15
9 Strategies and key interventions 16 - 23
10 Monitoring & evaluation framework 24 - 30
11 Budget 31
12 References 32
3
Acknowledgements
It is important to acknowledge that the preparation and finalization of this national health
information centre NHIC Strategic plan is a joint effort of all concerned bodies, stakeholders and
partners, without the efforts of all, and their continuous encouragement, the review and
reporting process would not be finalized.
It is worth mentioning that the finalization and submission of this plan is the initial step
towards improving the national health information system.
The political support of The Minister of Health Dr Tabita Botrus .and The under
Secretary FMOH Dr. Abedalla Sead Ahmed Osman was one of the main milestones of
this effort .
All the thanks to the Health Metrics Network consultants and officers for their
valuable technical and financial support which is the backbone for the whole work, the
thanks are also to be extended to the WHO and UNPFA for their fruitful support .
The National Health information Center is profoundly grateful to the strategic plan
design committee.
Dr . Mahgoub Makki Ali
Dr. Mustafa Khader Nimeiri
Dr. Mustafa Salih Mustafa
Mr. Elsheikh Eltijani Elsheikh
Dr. Amel Elamin Mohammed
Last but not least we would like to grantee to all partners and colleagues that their
efforts in this strategic plan would conclude the main guidance towards strengthening and
developing pioneer Sudanese National Health Information System
National Health Information Centre
Dr. Mahagoub Makki Ali
i
4
LIST OF ACRONYMS &ABBREVIATIONS
AIDS Acquired immune deficiency syndrome
CBS Central Bureau of Statistics
FMOH Federal Ministry of Health
HICs Health information centers
HMN Health Metrics Network
HIS Health information system
HIV human immune deficiency virus
HSTTC Health Statistical Technicians Training Center
MDGs Millennium Development Goals
NGOs Non-governmental organizations
NHIC National Health information Center
PHC. Primary health care
SMOH State Ministry of Health
UNFPA United Nations Fund for Population Activates
UNICF United Nations Children Fund
WHO World Health Organization
ii
5
1. Background:
The health information system has been aptly described as “an integrated effort to collect,
process, report and use health information and knowledge to influence policy-making,
programme action and research” (1).
Investing in the development of effective health information systems would have
multiple benefits and would enable decision- makers at all levels to:
Detect and control emerging and endemic health problems; monitor progress
towards health goals; and promote equity.
Empower individuals and communities with timely and understandable health related
information; and drive improvements in quality of services.
Strengthen the evidence base for effective health policies; permit evaluation of
scale-up efforts; and enable innovation through research.
Improve governance; mobilize new resources; and ensure accountability in their use.
The domains or areas of interest that a health information system should address can be
grouped into four main types (1):
Health determinants – socioeconomic, environmental, behavioral, and genetic
factors and the contextual environments within which the health system operates.
Health system inputs – the structures and processes of the health system (policy and
organization, health infrastructure including facilities, human and financial resources, and
health information systems.
Health system outputs – the quality, use and availability of health information and
services.
Health outcomes – mortality, morbidity, disease outbreaks, and health status.
Health information systems have evolved in a haphazard and fragmented way following
administrative, economic, legal or donor pressures. Responsibility for health data is often
divided among different ministries or institutions, and coordination may be difficult owing to
financial and administrative constraints (1).
Health information systems are further fragmented by disease-focused programme
demands which often relate to donor requirements and international initiatives
6
directed to specific disease areas (e.g. malaria, HIV/AIDS or tuberculosis). There are
intense pressures for the rapid availability of data to guide decisions about resource
allocation. Countries resources are being overwhelmed by multiple parallel information
demands that may stretch their resources beyond limits (1).
Few countries have sufficiently strong and effective health information systems in place
to permit adequate monitoring of progress towards the United Nations Millennium
Development Goals. Even where data are available, they are often out of date, which renders
the challenge of assessing trends particularly difficult (1).
1.1. The rationale:
Better health information means better decision-making, which results in better health.
Strong and effective health information system is needed permit adequate monitoring of
progress towards the United Nations Millennium Development Goals.
The decision makers need information to identify need and problems, assess the impact
of intervention and to make evidence-based transparent decision on policy and allocation
of the resources.
In the context of health sector reform and decentralization, health systems are managed as
close as possible to the level of service delivery. This shift in functions between the
central and peripheral levels has generated new information needs and led to a profound
restructuring of information systems, with changing requirements for data collection,
processing, analysis and dissemination.
1.2. Policy context of the National Health Information System:
A typical well functioning health information system ideally comprises: disease
surveillance; household surveys; registration of vital events; patient and service records; and
program specific monitoring and evaluation. In Sudan, due to the absence of robust health
information system, surveys are held periodically. These are often purpose specific and rarely
comprehensive.
Statistics since play an important role in measuring and monitoring the progress of the
country on road to development, including MDGs, National Health Policy envisages designing
and implementing a comprehensive health information system, revamping the existing disease
surveillance; household surveys; registration of vital events; patient and service records; and
program specific monitoring and evaluation. Such a tool, which will also bring the private sector
7
into its net, will promote evidence based decision making and enhance the capacity of managers
to effectively analyze and use statistics.
This policy emphasizes upon governments at all levels to, as part of the health
information system, arrange compiling and analyzing the data for publication at regular time
intervals, making it useful not only for the managers, planners and policymakers, but also for the
researchers, academics, students and institutions. Training of relevant staff for capacity building
in the monitoring and evaluation functions of all three levels of government shall be ensured (2).
Health information system (HIS) is inadequate for informing the decision making process
on priorities for resource allocation and for monitoring trends in health needs and programs. The
HMIS needs revision and redesigning to make it broad based including information pertaining to
community, private sector and vertical programs and also responsive enough to provide specific
information required for monitoring, planning and programme improvement... The emergency
information system needs to be established and strengthened to aid in early warning, information
sharing among partners, evidence-based decision making, as well as research and documentation
to add to the institutional memory of the ministry of health.
Inequities in the health system: Despite gaps in information on distributional data, there is
anecdotal evidence that years of war and conflict have created serious inequities in the financing
as well as the provision of health care in the Sudan. The inequities are not only between the
states of the north and the south but also within the various states (3).
Sudan has suffered from civil conflict for much of the period since independence in
1956, with the present civil war having started in 1983. Most of the fighting has occurred in
southern Sudan, as well as areas of Southern Kordofan and Blue Nile states. Civil conflict has
also flared up in other parts of Northern Sudan in recent years, in particular Darfur, Kassala and
Red Sea. The National Health Information system has been adversely affected especially in the
war-affected areas in Darfur States and post-conflict areas in South Kordofan and Blue Nile
States. The war-affected and the post-conflict states need on
The National Health Information Centre Policy document identified the health information
system as a federal system for reference, standardization and support of the performance at the
state and local levels. In addition the policy document emphasizes the following essential policy
frameworks:
8
Commitment for the current governmental administrative and managerial hierarchy as
base for collection and flow of the health information.
Activation and issuance of the legislation and laws to ensure and support the
effectiveness of the health information system at different levels including the private
and voluntary sectors.
Incorporation of modern, advanced and appropriate systems of information technology.
Collaboration and coordination with other information bodies in all related sectors.
Conduct of the technical processes for the health data to generate health indicators
needed by the planners, decision-makers and researchers with provision of technical
support for the states.
Ensure privacy and security of the personal information obtained from the patients’
records.
Intensify advocacy efforts among the health care providers and information users
including high level managers, planners and decision-makers to increase the utilization
of information in decision making.
Organization of standard training programs and formulation of curricula for statistics and
health information.
Provision of technical supervision and monitoring for the states health information
centres to ensure quality statistical services, advancement of the centres and timeliness of
surveillance and reporting (4).
The five years health information strategic plan preparation depends much on the results of
the HMN assessment, which was attained through the health policy and decision makers
participation , and those were also deeply involved in the strategic processes preparing ,
reviewing and modification .
9
Overall Health Information System Assessment
Main categories Score
(Process) Data management 17%
(Impacts) Dissemination & use 40%
(Process) Data sources 41%
(Inputs) Resources 42%
(Outputs) Information products 62%
(Process) Indicators 69%
Impacts on dissemination and use Resource allocation 5%
Implementation/action 44%
Planning & Priority Setting 46%
Analysis and Use of Information 41%
Policy and Advocacy 65% Process of Data sources
B. Vital statistics 15%
A. Census 53%
F. Administrative records 27%
E. Health service records 46%
C. Population-based surveys 74%
D. Health & diseases records 30%
Resources Policy and Planning 25%
HIS institutions, human resources and financing 46%
HIS Infrastructure 61%
Overall quality of Information products Estimation method/transparency 76%
Periodicity 62%
Data collection method 58%
Timeliness 69%
Consistency/ completeness 50%
Representative ness/ appropriateness 65%
Desegregations 57%
Quality of Information products by type of indicator Mortality 64%
Health system 56%
Overall health indicators quality 62%
Health status 70%
Risk factors 63%
10
Template for Analyzing Results of the Assessment Tool
Categories Number
of Question
s
Total
Possible Score
Highly
adequate
Adequate
Present but
not adequate
Not
adequate
Not
functional
1.Resources 23 69
A. policy and planning 8 24
B. HIS institutions, human
Resources and
financing
9 27
C.HIS infrastructure 6 18
11. Indicators 5 15
111. Data sources 83 249
A. Census 9 24
B. Vital statistics 13 39
C. Population- based Surveys
11 33
D. Health and disease
Records (e.g. surveillance )
12 36
E. Service records 12 36
F. Administrative records 25 78
i. infrastructure 6 78
ii. human recourses 7 21
iii. financial 8 24
iv. equipment, supplies,
commodities
7 21
IV. Data management 5 15
V. Information products:
Selected indicators
137 411
A. Health status 33 99
1. Mortality 21 63
2. Morbidity 12 36
B. Health system
information
54 162
C. Determinants 18 54
VI. Dissemination and use 20 60
A. Analysis and use 6 18
B. Policy and advocacy 4 12
C. Planning and priority
setting
3 9
D. Resource allocation 4 12
E. Implementation and
action
3 9
11
Analysis of Strength, Weakness, Opportunity and Threat
STRENGTHS WEAKNESSES
1. Identified core indicators.
2. Specified methods for measurement of the
indicators.
3. Core indicators include those related to
MDGs indicators.
4. Adequate overall health indicators
quality.
5. Adequate HIS infrastructure.
6. Adequate national capacity for conduct of
population-based surveys.
.
.
1. Poor use of information in resource
allocation.
2. Weak vital registration system.
3. Non-availability of electronic centralized
data depository.
4. Poor integration of the vertical
surveillance systems with the NHIS.
5. Inadequate resources of the NHIS.
6. Poor capacity for analysis and use of
information at sub-national level.
7-The NHIS is facility-based rather than
community-based.
8. Weak monitoring and supervision system.
9. Non-existence of feed-back systems.
OPPORTUNITIES THREATS
1. More information users are concerned.
2. Increased utilization of modern
information technology and communication.
3. Upgrading of the health statistical
technicians Training centre.
.
.
.
1. Turnover of the qualified/trained staff
2. Different information users with
different information needs.
1.3. Process of the strategic plan development
The strategic plan was based on the findings of the recent review and analysis of the
health information system. The process of the assessment was initiated and continuously
supported by the HMN. The HMN organized an orientation workshop in Cairo which was
attended by 5 national experts in health information. Those experts were actively involved in the
12
process of assessment and later in the formulation of the strategic planning using the assessment
results. As well it came out as a translation of the endorsed national health policy, the 5-year
strategic plan of the health sector and the national health information policy. The process of
development of the strategic plan can be summarized as follows:
Nomination of the technical task force for development and finalization of the plan: the
technical task force was composed of the 5 experts and other information professionals
with experience in the strategic planning process. The technical task force held 8
meetings to discuss and monitor the process.
Identification of a national consultant with specific terms of reference for development of
the first draft with follow up of the comments and modifications raised by the technical
task force.
Finalization and review of the plan document by the technical task force.
The final draft was disseminated to all partners in order to have their inputs and
comments before the workshop. The partners include high officials and policy-makers,
academic staff, NGOs, state information officers and other officials within the ministries
of health and other line ministries.
Two international consultants on information technology reviewed the final draft and
raised observations and comments which were incorporated before the presentation of the
document in the workshop.
Organization of a one-day workshop with participation of all partners for finalization and
endorsement.
The comments and observations recommended by the participants were included and the
adjusted document was distributed to the participants to have their consensus.
13
2. Situation analysis of the national health information system.
The Sudan health information system (HIS ) is one of the oldest systems in the
region . It started as data collection from 1902 in all health units serving the military
troops during the invasion of Sudan . The documented annual reports started in 1921, but
the central unit in the Federal Ministry of Health was founded in 1955 which then
developed to be the national health information centre
(NHIC). However it does not fulfill all the required criteria , but the system seems
to be well shaped . It is a bottom up system which starts from the health centers at the
bottom , those units send their reports to the State Ministry of Health (SMOH) where those
reports are compiled in a single report and then sent to the Federal Ministry of health
(FMOH). Currently the system is health facility based. Even though not all health facilities are
regularly reporting to the state level especially the health centers, the dispensaries and the PHC
units. This has resulted in confinement of the reported data from the tertiary level hospitals.
Community level information are not collected or pooled in the health information system.
However some vertical programs collect data for their own activities at the community level but
stop short of disseminating their findings to other programs or organization. In addition the
health information form the private health facilities are still not covered by the NHIS.
This is currently by far the largest “health data/information” operation in the Sudan. Such
data is acquired through the State health directorates, primarily via periodically filled forms
which are then keyed in. Increasingly, such data arrives on CDs or diskettes. Some direct
downloading from the states has started but is severely limited by the lack of nation-wide
networking of the health care institutions.
All data are fed into the National Health Statistics Data Base, after validation, and
processed. A few applications process such data to produce periodic reports (e.g. with Health
Indicators) and to serve Surveillance purpose. Sometimes, and when possible, it is used to
respond to specific queries. These applications are mostly programmed on Access, the Microsoft
data base management system. The resultant reports are usually shared back with the states also
printed reports, CDs and diskettes.
14
The system reports are quarterly and annually received from the states , which also
receive their reports monthly from state health facilities and localities.
All these information are essential for health planning, decision making and
identification of priorities. High quality information is crucial for prioritization of health
problems and appropriate utilization of the limited scarce resources.
About 65% of the localities in the Northern states have information centers. This is
indicative of the inadequate coverage of the system at the locality level. The system is challenged
by the expansion to attain 100% coverage of the localities in the coming future. In addition, the
expansion has to be accompanied by capacity building of the information centers at different
levels including the localities and the community level.
The system is suffering from many problems regarding the quality of data , data
collection , systematic storage, timeliness , utilization and dissemination .
The efficient collection , processing, utilization and dissemination of the most relevant
information at different levels of the health system are essential. Nevertheless, the
utilization of the health information for policy formulation, planning and decision–making
remains as the most challenging at both the federal, state and locality levels.
2.1 The national and international partners:
The national partners include: National Health Information Centre (federal & states)
health planners, Federal Directorate of Health Research, Ministry of Finance, Civil Registration
Authority, Central Office of Statistics (COS), National Vertical programmers, Epidemiology
Departments at both the federal and state levels, Representative of the universities and institutes,
Police and Military health services, National NGOs, Sudan Medical Specialization Board and
information consultants. The national partners are of different roles within the information
context. Some partners are concerned with the management of the information sources and
products; others are concerned with training and capacity building of different information
human resources. Some partners are information producers and users.
Establishing coordination bodies (committees) to facilitate easy exchange of national and
states health information.
To allow active paved channels with CBS to capture the most recent population census
results and data specially GIS data.
15
To allow active paved channels with civil registration department as a main partner in the
vital events information.
To allow active paved channels with private sector health services providers as a real
partner in health services provision.
To enable active participation in performing national health surveys to insure capturing of
information and capacity building.
The international partners include: WHO, UNICEF, UNFPA, International NGOs which are
funding agencies for the health information projects and programs, national surveys and national
census.
2.2 Human resources:
The total number of the health statisticians mounted to 1461 distributed within the
health facilities across the country. The ratio of the health statistician per 100,000
populations is 4. The ratio reflects the marked shortage of the cadre for the whole system.
48.1% of the health statisticians are employed in the health facilities in Khartoum State
and other Federal Health facilities. This indicator reflects the uneven distribution of the
cadre and its concentration in the National Capital with poor coverage of most of the
states. Some states like upper Nile, Bahr El Gabel and South Kordofan showed to be
poorly staffed with the health statisticians (1).
The total number of hospitals in the Northern states is 315, about 266 of them is
staffed with health statisticians (84.4%). The majority of the health centers in the Northern
states except Khartoum state are without statistical units.
The National Health Information Center is staffed as follows:
Community physicians: 3
Health statistician: 1
Demography statisticians: 2
General statisticians: 2
Information technologists: 2
University graduates (locally trained): 6
Health statisticians (Medium Diploma): 1
Secondary school graduates( locally trained): 6
16
The HIS is funded by both government and external donors. It has to be mentioned that the
available financial resources for the HIS at different levels are limited and most of the health
information centers especially at the state and locality levels do not have adequate allocated
budgets.
2.3 The Health statistical technicians Training centre (HSTTC)
This centre was established in 1976 in collaboration with WHO. The target of the
centre is to provide quality training on health statistics to qualify statistical technicians in
order to cover the needs of health care delivery system. Two training cycles (4-5 months) are
usually conducted every year for candidates from MOH facilities , military, police and
private health facilities . The candidates are secondary school graduates fulfilling the selection
criteria of the center. The average number of the recruited candidates per cycle is 35. The total
number of the batches graduated from the institute is (63) batches with an average of 35
candidates each, but there is a high rate of staff drainage inside and outside the country.
The subjects covered in the cycle include health, hospital and population statistics. In
addition the candidates are exposed to epidemiology, computer sciences, medical records and
statistical reports and medical terminology. Currently, the institute is adequately staffed
(including part-time staff) with a ration of 1 staff per 15 candidates. The physical resources of
the institute including buildings, teaching rooms, audiovisual aids, and library showed marked
limitations and insufficiencies.
The NHIC adopted the Sudan declaration for upgrading the health personnel and the first
batch to have the intermediate diploma is expected to be recruited soon.
2.4 HIS infrastructure
At the federal level: The NHIC infrastructures are adequate and these include telephone lines,
electricity, internet access and computers.
At the state and locality levels: The infrastructures for the HIS in Khartoum State and its 7
localities are adequate with availability of computers, printers, telephone lines, electricity and
internet access. The same is applicable for El Gazeira State and to a lesser extent Kassala,
Northern, River Nile, Gadarif, Sennar and White Nile States.
The HICs in South Kordofan, North Kordofan, Blue Nile, and Red Sea, South Darfur, West
Darfur and North Darfur states have only functioning computers. The other infrastructures are
17
poor at these HICs. The situation of the infrastructures at the locality level is extremely
inadequate. .
3. Challenges and opportunities:
The current health information system is faced with the challenges of limited coverage and
confinement to the health facilities rather than the community level. This is aggravated by
weaknesses in the supervision and monitoring mechanisms with poor capacity available at the
state and the locality levels. The system is paralleled by number of vertical health information
systems without clear coordination and integration. The utilization of the produced information
in policy and strategy formulation, in planning and decision making especially at the state and
locality levels is not widely practiced. The health information system is lagging behind in
generation of information needed to address health inequities and its key determinants.
Alongside the current challenges, opportunities are emerging to reform the health systems. These
can be summarized as follows:
The implementation of the decentralization across the country with increased demands for
locally relevant and useful health information.
Health sector reforms also magnify the need for standardization and quality of information,
presenting a further challenge to national health authorities.
The marked improvement of the information tools and methods and technological
innovations which are potentially significant to improve both the coverage and quality of
health information.
Marked efforts and capacity building of information systems outside the health sector
represent a valuable opportunity to be invested for health system improvement and
development.
The control of major diseases should also be approached in a holistic and comprehensive
manner, and be based on a coherent health information system that binds together individual
and community health interventions.
The health information system is challenged by the need to increase it capacity for
production and dissemination of quality health information appropriate for all producers and
users.
There is an increased demand for accountability and evidence-based decision-making initiated in the
call for evidence-based clinical practice; it has now been extended to evidence-based policy
18
development, planning, management and evaluation of health services, to ensure the best use of
limited resources.
4. Guiding principles:
The health information system is seen as a public good and emphasized as stewardship
and not just as part of data collection process.
Programs and peoples need to be transformed from collectors of data to generators of
knowledge and practitioners of using such knowledge for actions and interventions.
Health information strengthening should be seen within the broader context of
strengthening statistical capacity and should adhere to the general criteria common to all
forms of information including impartiality, scientific soundness, professional ethics,
transparency, consistency and efficiency, coordination and collaboration.
Health information system reform should be integrated into broader efforts to improve
health systems including country poverty reduction and development strategies.
The value of better health information is its impact on health outcomes – better health
information is the foundation for better health.
Advocacy for strengthening health information systems should focus on the value of
health information as a public good – it can be shared by everyone and no-one can be
excluded from the benefits resulting from greater knowledge.
Valuing health information, at all levels of the system, is associated with a culture of
accountability, a desire to improve performance, and a realization that improving health
outcomes requires not just more technical inputs but also the more effective use of
available resources.
Fostering an equity-based health information system with focus on human rights and
increasing opportunities for the poor sectors of the communities.
5. Vision:
The vision of the NHIC is establishment of a comprehensive national health information
system which is based on modern technologies and characterized with accuracy, timeliness,
comprehensiveness, adequacy and standardization. The system is capable of generating high
quality of health, social and environmental information addressing the purposes and needs of all
the health information users including the health personnel and others.
6. Mission:
19
The mission of the NHIC includes:
Emphasis is laid on the federalism of the system with unified work in data collection,
compilation and analysis aiming to generate quality information for production of
indicators for empirical demonstration of social justice and equity within the health
sector.
Development and strengthening of the national health information network.
Values • Information for equity and social justice
• Decentralization - the use of information at local level
• Evidence based decision making
• High quality information addressing customer needs
• Integrated health information system
• Creative health information environment
7. Priority areas for the NHIS.
The goal:
The overall goal of the NHIS is increase the availability, accessibility, quality and use of
health information that is critical for decision-making at the federal, state and the locality
levels.
The priority areas for the NHIS:
HIS resources.
Data management processes.
The capacity, practices, dissemination, integration and use of health and disease records
including the vertical surveillance systems.
Information – based policy, decision-making and planning at different levels.
Vital registration system.
Capacity building for conduct of research and surveys to supplement the routine data
collection systems.
Essential health indicators.
20
9. Strategies and key interventions
HIS resources
Strategic objectives:
1. To mobilize extra resources in support of the HIS and HI institutes at different levels to
ensure effectiveness of the system in all states and 50% of the localities.
2. To address the HIS as a priority within the national and all state health policies.
Strategies:
Objective (1): To mobilize extra resources in support of the HIS and HI institutes at
different levels to ensure effectiveness of the system in all states and 50% of the localities.
1. Political commitment and support for the HIS.
2. Establishment of partnerships with the main users and producers at the national, state and
locality levels.
3. Development of human resources for health information, including recruiting, training,
deploying and motivating health information officers.
Intermediate steps:
Strategy (1): Political commitment and support for the HIS.
Finalization, printing and dissemination of the HIS policy document.
Intensification of the advocacy efforts among the policy-makers, decision makers at the
national and 50% of the states and localities.
Addressing of the HIS within the national and all states policy agenda.
Strategy (2): Establishment of partnerships with the main users and producers at the
national, state and locality levels.
Advocacy among users and producers at the national level and all states and 50% of the
localities.
Identify and encourage the potential partners to enter into partnerships at the national
level and all states with emphasis on the war-affected areas (Darfur States) and the
post-conflict areas (South Kordofan and Blue Nile States).
21
Preparation and signature of the partnership protocols.
Monitoring and evaluation of the implementation of the partnership protocols.
Strategy (3): Development of human resources for health information, including recruiting,
training, deploying and motivating health information officers.
Increase staffing of the different rural health facilities with qualified statisticians in order
to achieve the standard of 8 statisticians per 100,000 population.
Increase staffing of the different rural health facilities in the war-affected areas and the
post-conflict areas.
Capacity building of the HI Training center in order to qualify 100 statisticians per cycle.
Establishment of new health information units within the hospitals and the health centers
to accomplish 100% coverage and 60% respectively.
Data management processes
Strategic objectives:
1. To increase the response rate of the state health information units to the NHIC from 84% up
to 100% with emphasis on inclusion of the community-based information.
2. To scale up the capacity data management in all states and 50% of the localities.
Strategies:
Objective (1): To increase the response rate of the state health information units to the
NHIC from 84% up to 100% with emphasis on the community-based information.
Strategies:
1. Establishment of network for the NHIC to cover all the states.
2. Upgrading of the electronic data storage, dissemination, and feed-back practices at the
federal level and all states.
Objective (2): To scale up the capacity data management in all states and 50% of the
localities.
Strategies:
1. Capacity building of the data management process at the state level.
2. Integration with the national vertical programs at both the federal and state level
Intermediate steps:
Strategy (1): Establishment of network for the NHIC to cover all the states.
22
Selection/upgrading of the appropriate technology for networking all the state
information units.
Enhancement of the technical capability of all the state health information staff to ensure
efficient functioning of the network. .
Strategy (2): Upgrading of the electronic data storage, dissemination, and feed-back
practices at the national and state levels.
Establishment of the Meta dictionary and the data ware house at the national level.
Strengthening the feed-back mechanisms from national level to all states health
information units.
Strategy (3): Capacity building of the data management process at the state level.
Development, finalization and printing of the training materials and the national
guidelines on data management process.
Training of the staff in all states and in 50% of the localities on data management
process.
Strategy (4): Integration with the national vertical programs at both the federal and the
state level.
Establishment and activation of joint bodies for data management at both the federal and
the state level.
Consensus on data management standard procedures between different players at both
the federal and state level.
The capacity, practices, dissemination, integration and use of health and
disease records including the vertical surveillance systems
Strategic objective (1):
To improve the capacity, practices, dissemination of all the health information systems at the
national level and all states.
Strategic objective (2):
To harmonize and integrate the health information systems at the national level and all states.
23
Strategies:
Objective (1): To improve the capacity, practices, dissemination of the health information
systems at the national level and all states.
(1) Capacity building of the human resources available for the national health information
system and the vertical surveillance systems.
(2) Improvement of the quality of the practices and dissemination of the health information.
Objective (2): To harmonize and integrate the health information systems at the national
level and all states.
1) Establishment of integrated and harmonized national and state data base to facilitate data
sharing and exchange.
Intermediate steps:
Strategy (1): Capacity building of the human resources available for the national health
information system and the vertical surveillance systems.
Identification of the training needs of the NHIS and the vertical surveillance systems at
the national level and all states.
Upgrading of the human resources of the National Health information Center to improve
the quality of training on health information.
Strategy (2): Incorporation of the national health information standards to improve the
quality of the practices and dissemination of the health information.
Development, finalization and printing of the national health information standards for
practices and dissemination at different levels.
Operationalization of the national health information standards for practices and
dissemination at the national level and all states on the health information standards.
Strategy (3): Establishment of integrated and harmonized national and state data base to
facilitate data sharing and exchange.
Consensus of all the partners and stakeholders at the national and state level on
integration and harmonization of the national and state data base.
Establishment of joint bodies for harmonization of the health information systems at the
national level and all states.
24
Information-based policy, decision-making and planning at different levels.
Objectives:
1. To increase the use of information in policy formulation, decision-making and planning
at the national level and all states.
Strategies
1. Advocacy among the policy, decision makers and planners to address the use of
information within the national and state policies and plans.
2. Establishment of mechanisms to facilitate linkage of information with policy.
3. Active involvement of the different stakeholders in development of effective mechanisms
for utilization of information.
Intermediate steps:
Strategy (1): Advocacy among the policy, decision makers and planners to address the use
of information within the national and state policies and plans.
Conduct of information needs assessment of the main health information users in all
states.
Capacity building of the health information staff in all states on effective advocacy
approaches based on the results of the needs assessment.
Production of effective training materials and guidelines for information utilization.
Implementation of one 3-day training workshop in each state on information utilization
targeting 300 policy and decision- makers.
Strategy (2): Establishment of mechanisms to facilitate linkage of information with policy.
Review of the national and all states MOHs organizational structure in relation to the
flow and transmission of health information from data providers to data users and policy
makers.
Capacity enhancement of the staff on data utilization for programme planning,
management, monitoring and evaluation, and policy formulation (including exposure of
MOH top management to HIS) and all states.
25
Strategy (3): Active involvement of the different stakeholders in development of effective
mechanisms for utilization of information.
Establishment of effective mechanisms in all states for information sharing between routine
health statistics with other non routine data collection systems.
Enhancement of capacity for utilization of information through monitoring and supervision at the
federal and state levels.
Vital registration system
Strategic objective:
To expand the vital registration system to ensure that at least 80% of the births and 50% of
deaths are registered and reported.
Strategies:
1. Improve coverage of the birth and death reporting and registration at both the community
and the health facility level.
2. Community participation in the reporting and registration of births and deaths.
Intermediate steps:
Strategy (1): Improve coverage of the birth and death reporting and registration at both
the community and the health facility level.
Establishment of new health information units at the locality level to accomplish 100%
coverage.
Enhancement of the capacity of the states and localities health information units.
Strategy (2): Community involvement in the reporting and registration of births and
deaths.
Intermediate steps:
Development and finalization of the training manuals on vital registration of the
community leaders, volunteers and the village midwives.
Training of the community leaders, village midwives and volunteers in 50% of the
localities on death and birth reporting.
Raising community awareness towards the reporting of death and births in 50% of the
localities.
26
Production and dissemination of IEC materials to raise the community awareness.
Enhancement of channels of coordination with the CBS, Civil registration, the private
sector and the NGOs, civil society organization at federal and state level.
Capacity building for conduct of research and surveys to supplement the
routine data collection systems.
Strategic objective: To upgrade the capacity on research methodology at the national level,
the vertical programs and all states to conduct effectively the health surveys and research.
Strategies:
1. Establishment of channels of coordination with the Federal Directorate of Research and
other academic institutes and universities.
2. Upgrading of the quality of the national surveys and research needed for supplement of
the health information.
Intermediate steps:
Strategy (1): Establishment of channels of coordination with the Federal Directorate of
Research, CBS and other academic institutes and universities.
Joint technical task force within the NHIC for facilitation of research and survey
activities within the priority areas for supplementing the health information.
Strategy (2): Development and finalization of national standards for conduct of health
surveys and research relevant to health information.
Assessment of the quality of the current practices and methodologies adopted for conduct
of the national surveys.
Development and finalization of national standards for conduct of surveys and research
relevant to health information.
Essential health indicators.
Strategic objective: To update and review regularly the essential health indicators with
emphasis on data sources and core indicators for national and international reporting
requirements i.e. health-related MDGs.
Strategies:
27
1. Involvement of all the stakeholders and the partners in achieving national consensus on
the essential health indicators.
Intermediate steps:
Strategy: Involvement of all the stakeholders and the partners in achieving national
consensus on the essential health indicators based on specific criteria.
Identification of the concerned partners and the stakeholders at the national level.
Development of the national metadata sheets for the essential health indicators based on
specific criteria and minimal sources of information.
28
10 . Monitoring & evaluation framework:
Target Indicator Base-
line
Target periodicity Sources of
information Y1 Y2 Y3 Y4 Y5
HI resources
1. Finalization and
dissemination of the
HIS policy document
The HIS policy
document
finalized and
disseminated
- X - - - - Monitoring
reports of the
NHIC
Final HI policy
document.
2. Advocacy among the
policy-makers,
decision makers at
the national and 50%
of the states and
localities
The % of the
localities
covered with
advocacy
targeting the
decision, policy
makers
- 10% 20% 30% 40% 50% NHIC
monitoring
reports.
Annual states
reports.
3. Addressing of the
HIS within the national and all
states policy agenda.
The % of states
addressed the HIS within the
policy agenda
- 10% 40% 60% 80% 100% Monitoring
reports of the NHIC.
Annual states
reports.
Target Indicator Base-
line
Target periodicity Sources of
information Y1 Y2 Y
3
Y4 Y5
4. Advocacy among
users and producers at the
national and all
states and 50% of
the localities.
The % of localities
covered with advocacy activities
- 10% 20% 30
%
40% 50% NHIC
monitoring reports.
Annual states
reports.
5. Identify and
encourage the
potential partners
to enter into
partnerships at
the national level
and all states.
% of the states
developed
partnerships
- 10% 20% 40
%
80% 100% NHIC
monitoring
reports
6. Capacity building
of the HI
Training Center
in order to qualify 100 statisticians
per cycle.
Number of
qualified
statisticians per
cycle
35 50 60 75 85 100 Graduation
reports of the
NHITC
7. Establishment of new health
information units
within the hospitals
and the health centers
The percentage of hospitals with HI
units
The percentage of
health centers with
84%
30%
95%
40%
100
60%
NHIC monitoring
reports.
Annual states
reports
29
to accomplish 100%
coverage and 60%
respectively
HI units
1. Increase staffing
of the different
rural health
facilities with
qualified
statisticians in order to achieve
the standard of 8
statisticians per
100,000
population.
The statistician per
100,000 population
4 5 5 6 7 8 NHIC
monitoring
reports.
Annual states
reports.
Vital registration
2. Establishment of
new health
information units
at the locality
level to
accomplish 100%
coverage.
The percentage of
the localities with
HI units
65%
75%
85%
95
%
100
%
NHIC
monitoring
reports
Annual states
reports.
3. Training of the
community
leaders, village
midwives and
volunteers in
50% of the
localities on
death and birth
reporting.
The percentage of
the localities
covered with VR
training.
Number of
community
leaders/volunteers
trained on
death/birth
reporting
-
-
10%
120
20%
240
30
%
36
0
40%
480
50%
600
Training
reports.
Training
reports.
4. Community awareness raising
towards the
reporting of death
and births in 50%
of the localities
% of localities covered with
awareness raising
activities
- 10% 20% 30%
40% 50% Community awareness
reports.
Target Indicator Base-
line
Target periodicity Sources of
information
Data management processes
5. Selection/upgrading of the
appropriate technology for
networking all the state
information units.
% of the
states
covered with
the HI network
-
Y1 Y2 Y3 Y4 Y5
NHIC
monitoring
reports
20%
40%
60%
80%
100%
6. Enhancement of the
technical capability of all
the state health information
Number of
technical
staff of the
_ 10 20 30 40 50 NHIC
monitoring
reports
30
staff to ensure efficient
functioning of the network.
network.
7. Establishment of the Meta
dictionary and the data
ware house at the national
level.
The Meta
dictionary
and the data
ware house
were
established and
functioning
at the NHIC
- NHIC
monitoring
report
Target Indicator Base-
line
Target periodicity Sources of
information
8. Strengthening the
feed-back
mechanisms from
national level to all
states health
information units.
The
percentage of
the states
covered with
feed-back
reports from
NHIC
- Y1 Y2 Y3 Y4 Y5
Annual states
reports.
Feed-back
reports from
the NHIC to
states.
20%
40%
60%
80%
100%
9. Conduct of
information needs
assessment of the
main health
information users in
all states.
% of states in
which
information
needs
assessment
conducted.
- 50% 100% Information
needs
assessment
reports
Target Indicator Base-
line
Target periodicity Sources of
information
10. Capacity building of the
health information staff
in all states on effective
advocacy approaches.
Number of
staff capable
of conduct of
advocacy.
- Y1 Y2 Y3 Y4 Y5
Annual states
reports.
Advocacy
training reports
50 100
11. Establishment of
effective mechanisms in
all states for
information sharing between routine health
statistics with other non
routine data collection
systems
% of states
with
established
effective mechanisms
- 20% 40% 60% 80% 100% Annual states
reports.
Monitoring
reports of the NHIC
12. Enhancement of
capacity through
monitoring and
supervision in all states.
% of states
with
established
monitoring &
supervision
- 20% 40% 60% 80% 100% Annual states
reports
Monitoring
reports of the
NHIC
31
system
Target Indicator Base-
line
Target periodicity Sources of
information
The capacity, practices,
dissemination, integration and
use of health and disease
records including the vertical
surveillance systems
13. Identification of the
training needs of the
NHIS and the vertical
surveillance systems at
the national level and all
states.
Training needs of
the NHIs, vertical
programs and 50% of the states
identified
-
Y1 Y2 Y3 Y4 Y5
Training needs
reports
X
14. Upgrading of the human
resources of the
National Health
information Center to
improve the quality of
training on health
information.
Staff/candidate
ratio
1:15 2:15 3:15 4:15 1:5 1:5 NHIC reports
15. Development of the
national health
information standards
for practices and
dissemination at
different levels.
The availability of
the final
document of
standards at
different levels.
- X NHIC reports.
16. Operationalization of
the national health
information standards for practices and
dissemination at the
national level and all
states on the health
information standards.
The % of the states
used operationalized
health information
standards.
-
Y1 Y2 Y3 Y4 Y5
Annual
states
reports.
NHIC
reports
20%
40% 60% 80% 100%
32
17. Consensus of all the
partners and
stakeholders on
integration and harmonization of the
data base at the
national and state
level.
Consensus on
integration and
harmonization
obtained.
- X NHIC
reports.
18. Establishment of joint
bodies for
harmonization of the
health information
systems at the
national level all
states.
% of states with
established bodies
for harmonization
- 20% 40% 60% 80% 100% NHIC
reports.
Target Indicator Base-
line
Target periodicity Sources of
information
Use of information in policy,
decision-making, planning and
resources allocations at
different levels.
19. Identification of the
information needed by
the policy, decision
makers and planners at
the national level and all
states.
The needed
information
identified.
-
Y1 Y2 Y3 Y4 Y5
NHIC reports
Annual states
reports
X
20. Advocate effectively
among the policy,
decision makers and
planners at the national
level and all states.
% of states
covered with
advocacy
efforts
- 20% 40% 60% 80% 100% NHIC reports
Annual states
reports.
Advocacy
reports
21. Review of the national
and all states MOHs
organizational structure
in relation to the flow
and transmission of
health information from
data providers to data
users and policy makers.
% of states
with
reviewed
flow of HI
charts
- 20% 40% 60% 80% 100% NHIC reports
Annual states
reports.
33
Target Indicator Base-
line
Target periodicity Sources of
information
22. Capacity enhancement of
the staff on data
utilization for programme
planning, management,
monitoring and evaluation, and policy
formulation (including
exposure of MOH top
management to HIS) and
all states.
% of the
states with
capacity for
data
utilization
- Y1 Y2 Y3 Y4 Y5 NHIC reports.
Annul states
reports.
Documents of
the national and state
plans.
20% 40% 60% 80% 100%
Essential health indicators 23. Identification of the
concerned partners and
the stakeholders at the
national level.
The
concerned
partners &
stakeholders
identified
-
X
NHIC reports
24. Development of the
national metadata sheets
for the essential health indicators based on
specific criteria and
minimal sources of
information.
The national
meta sheets
developed and used.
- X NHIC reports.
National
metadata sheets.
34
Target Indicator Base-
line
Target periodicity Sources of
information
Capacity building for conduct of
research and surveys to
supplement the routine data
collection systems.
25. Joint technical task force
within the NHIC for
facilitation of research
and survey activities
within the priority areas
for supplementing the
health information
Joint
technical
committee
formed.
-
Y1 Y2 Y3 Y4 Y5
NHIC reports.
Minutes of the
technical task
force.
X
26. Assessment of the quality
of the current practices
and methodologies
adopted for conduct of the national surveys.
Quality of the
current
practices
assessed
- X Quality
assessment
report.
27. Development and
finalization of national
standards for conduct of
surveys and research
relevant to health
information
National
standards for
conduct of
research and
surveys
finalized.
X NHIC reports.
Document of the
National
standards of
research and
surveys.
35
11. Budget
ESTIMATED BUDGETARY
ALLOCATIONS
Y1 Y2 Y3 Y4 Y5 TOTAL
HI resources $55400 $52250 $46550 $40150 $40120 $234470
.Vital registration
system.
$25200 $25200 $20225 $21355 $21000 $112860
Strengthening of the
data management
processes.
$100880 $98300 $95250 $95750 $92134 $482234
Improvement of the
capacity, practices,
dissemination,
integration and use of
health and disease
records including the
vertical surveillance
systems.
$18500 $47552 $26127 $26122 $25520 $143821
Use of information in
policy, decision-making,
planning and resources
allocations at different
levels.
$12155 $12125 $9125 $9125 $9125 $51655
Updating/periodic
review of essential
health indicators to be
used and shared by
different vertical
programmes within and
outside of the health
sector.
$6525 - - - - $6525
Capacity building for
conduct of research and
surveys to supplement
the routine data
collection systems.
$15350
- - - - $15350
36
Grand total $234010 $235427 $197277 $192002 $187899 $1046615
10. References
1) World Health Organization, HMN, Framework and standards for the development of country
health information systems (2006)
2) Republic of Sudan, Federal Ministry of Health, Sudan National Health Policy Document
(2006).
3) Republic of Sudan, Federal Ministry of Health, 5-year Health Sector Strategy:
28. Investing in Health and Achieving the MDGs 2007-2011 (2007).
4) Republic of Sudan, Federal Ministry of Health, National Health Information Center, National
Health Information Policy Document (2007).