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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

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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

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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

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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

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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

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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

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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:

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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 .

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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%

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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

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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

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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.

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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.

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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.

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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

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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

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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

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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:

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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.

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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).

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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.

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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).