the role of routine health information systems in the post-2015 development agenda

The role of routine health information systems in the post 2015 development agenda 1 |

The role of Routine Health Information Systems

in the post-2015 development agenda

Vancouver. November 2016


New information demands on the post 2015 agenda

Only in 2016, 18 countries of the WHO AFRO region were developing the M&E plan of the

national health strategy


Why is facility data important in the post 2015 context ?

Continuous; only source

Subnational; Important equity dimension;

Multiple uses – Programme management, performance monitoring, quality of care, disease surveillance, health system performance assessment

Examples of facility-based indicators Availability of essential medicines, commodities; & stock outs; Service availability & readiness (interventions offered, & adherence to standards of care) TB treatment success rate, ART retention; Client satisfaction Coverage : FP use, antenatal care, PMTCT, postnatal care, delivery, immunization, vitamin A, ART Leading OPD diagnosis, malaria case rates (lab confirmation); TB notification; Hospital mortality and causes of death

For 8 out of 26 of the indicators of the SDG-3, the preferred source of data is facility level

data


Sustainable development goals 3: HEALTH CRVS Survey Facility Other

Maternal mortality ratio X X (X) Sampling, sentinel sites

Skilled birth attendants X X

Under-5 mortality rate X X

Neonatal mortality rate X X

Number of new HIV infections per 1,000 X surveillance Spectrum

TB incidence per 1,000 population X surveillance

Malaria incidence per 1,000 surveillance

Hepatitis B incidence per 100,000 population X

Number of people requiring specific interventions against NTDs estimation

Mortality rate from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases

X X

Suicide mortality rate X special studies

Treatment coverage for substance abuse disorders

Alcohol per capita consumption X administrative

Death rate due to traffic road accidents X

Family planning coverage rate X X

Adolescent birth rate per 1,000 women X X

Coverage of essential health services X X

Number of people covered by a health insurance or public health system per 1,000 population

Mortality rate attributed to household and ambient air pollution X

Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene X

Mortality rate attributed to unintentional poisoning X

Prevalence of tobacco use 15 years + X

Access to affordable medicines and vaccines on a sustainable basis X facility surveys

Total net ODA to medical research and basic health sectors

Health worker density and distribution Health worker

registry

IHR capacity and health emergency preparedness Key informants

UHC tracer indicators Surveys Facility Others

1. RMNCH

1. Family planning coverage X X

2. ANC4 X X

3. Immunization coverage X X

4. Care seeking for pneumonia X

2. Infectious disease control

1. TB cases detected and treated X surveillance

2. HIV receiving ART X

3. Insecticide treated bed nets X

4. Improved sanitation X

3. Noncommunicable diseases

1. (Non)-Elevated blood pressure in adults X (X)

2. (Non)-Elevated blood glucose in adults X (X)

3. Cervical cancer screening X X

4. Non-use of tobacco X

4. Service capacity and access

1. Inpatient admissions rate X

2. Health professionals per capita X

3. Availability of essential medicines X (HFAs)

4. IHR core capacity index Key informants

NOTE: blood

pressure and

blood glucose

likely will

change to

treatment of

BP and

diabetes


What are the major challenges /gaps?

Data quality inadequate

Private sector often not captured

Key data gaps/challenges

Hospital reporting of deaths, causes

quality of care

Community service delivery

Poor analytical capacity and use

DISAGGREGATION AND EQUITY

Parallel vertical systems

Separate, single-topic facility surveys

Fragmented, unconnected, unsustainable systems

Mushrooming of indicators; Heavy burden on health workers

Duplication & inefficient investments


In Cambodia, the Time and Motion study identified 20 monthly forms out of 44 reporting forms are in use and require a total of 45 hours per month to complete - the HC Monthly requires 21 hours on its own


In Sierra Leone, there are >15 information systems collecting information routinely from facility and community level. Systems are not interoperable nor integrated currently.

Source: Sierra Leone Health Information Systems Interoperability Meeting 24 August 2016 | Bintumani Hotel


What are the opportunities & innovations?

Growing demand for accountability & better results

Major growth in innovations in ICTS

Advances in data standards & methods, survey tools

Web-based facility systems- (e.g DHIS 2.0) Electronic health records - (e.g. ART, TB patient monitoring) Mobile devices to manage stock outs of medicines (e.g Rapid SMS); notification of events Automated systems for coding of cause of death (e. IRIS, CODEIT) Visualization tools & analytics, scorecards, dashboards, observatories Rapid tools for assessing service delivery & quality eg SARA, SDI SPA)


The Heath Data Collaborative

January 2015 June 2015 September 2015 January 2016 March 2016

Draft roadmap

for measuring

health SDGs

M4Health Summit:

5 point call to action

Global Health Agency Leaders meeting

Calls for agencies to develop joint plan to support countries

HDC operational work-plan scope and key deliverables agreed

HDC launch at

UN Statistical

Commission

with over 32

partner

commitments

11

The approach: to enhance efficiency of current investments in health information systems

CHANGING THE WAY WE WORK TOGETHER

Measurement and accountability for health:

The role of health facility information systems in the post 2015 development agenda 12 |

Country & regional platforms

Existing collaborative platforms

HDC Working Groups

Operating through thematic technical Working Groups

13

Facility and community information

Routine HMIS (+ disease surveillance)

1. Review, harmonize & disseminate standards for improved facility and community based reporting

2. Identify ways in which investments in HMIS can be better aligned to ensure scale-able integrated, sustainable systems

3. Identify & agree on protocols and standards for integrating disease surveillance into routine HMIS

4. Catalyse joint support to countries to scale up and strengthen integrated facility systems, based on international standards and good governance

5. Joint support for analysis and use of facility data for action

Global deliverables •Package of data standards & tools - indicators, metadata, data quality, ICD coding, master facility lists, analytical outputs, template forms, open access

•Standards & protocols for integrating disease surveillance into routine HMIS

•A joint investment plan for DHIS 2.0 development, implementation and maintenance

Country deliverables

•Aligned support to scale up and strengthen integrated facility based health information systems, including IDSR, based on international standards

•Documented country best practices & guidance for sound governance

Technical working group on routine health information systems Scope of work



Significant uptake by

countries for monitoring

national health sector

performance

Aligned with health SDGs

monitoring agenda, UHC

2030, Global Strategy for

Women, Adolescents &

Children, NCD

monitoring..

2016 update due by end

of year

Global Reference List of 100 Core Health Indicators



Progress:

More and more programmes

& countries moving towards

DHIS 2 platform

Partners begin working on

joint investment & core

functional requirements

But .. much more required :

− to establish sound

governance at country level

− To integrate public heath

surveillance into RHIS

− To build adequate capacity in

analysis and use

From vertical reporting systems … towards a common data platform



“Monitoring the Global Strategy requires substantial investments in data collection, compilation, analysis, communication and use in countries. The Health Data Collaborative and others must play a critical role to:

•Advocate for and invest in strengthening CRVS systems through the CRVS window of the Global Financing Facility;

•Ensure every country has a regular programme of health surveys;

•Focus on disaggregated data to address equity and human rights considerations so that no one is left behind:

•Improve monitoring of health system resources such as financing, workforce and access to medicines”

Progress:

Joint curriculum developed with

other tools including data quality

review, analyses, best practices for

governance

Combining efforts to build regional

networks in data analysis & use

But :

− Much more needed to avoid

development of separate tools &

guidance & capacity building

programmes

Joint curriculum on data analysis & use Working together to build institutional capacity



……… ON-SITE DATA VERIFICATION

(OSDV) ……….

From multiple disease-specific data quality tools … to a harmonized approach



ALL STAKEHOLDERS SUPPORTING KENYA’S M&E PRIORITIES

•Data analytics capacity •Quality of Care •Kenya Health Observatory •CRVS •Mid-term review

“WE NOW EXPECT ALL HEALTH

DATA COLLABORATIVE PARTNERS

TO PULL IN THE SAME

DIRECTION.”

Dr Nicholas Muraguri, Principal

Secretary, Kenya MOH

Kenya Health Data Collaborative (launched May 2016)



Role of regional networks

Promote peer learning and review

Promoting a culture of data use in countries

Roll-out public goods to country level- need of strong global and regional networks

What is next ?

Some Health Data Collaborative progress • Inter country conference on measurement. AeHIN

(Bangladesh, April 2016) • African Regional Health and Accountability Dialogue

(Lagos, 2016) • BIG (Better use, Improved action, Good data) campaign • West and Central Africa work on DHIS2

CONCLUSION: Something needs to change…

Thank you

WHO. Global Platform for Measurement and

Accountability Kathy O’Neill- Unit coordinator [email protected]

Eduardo Celades- Technical officer [email protected]

Maki Kitamura- Communications officer [email protected]

mailto:[email protected]



the role of routine health information systems in the post-2015 development agenda

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