Forum Introduction & Some Lessons to Date John A. Novak PhD USAID/Washington

Country Ownership Strategies:Asia Pacific Leadership Forum on

Health Information SystemsWHO WPRO Conference Center

13-16 June, 2011

Forum Introduction & Some Lessons to Date

John A. Novak PhDUSAID/Washington

• Background & Purpose of Forum

– Delegates to broaden their perspectives on implementation options, challenges and roles related to health information systems (HIS)

– Delegates will develop a shared awareness of the roles of various sectors in strengthening HIS & strategies for improving cross sector coordination

– Delegates will explore leadership roles in managing HIS– Country teams will develop preliminary action plans to promote

national stakeholder engagement and commitment to HIS

– And, Donors will highlight their follow-on support to strengthen national HIS initiatives at the country level

Forum Purpose

• Commitment to Country Ownership & the other Paris Declaration Principles

– Donors, multinationals & country governments have signed on to the Paris Declaration principles – including USG – see Amb. Goosby’s letter (August, 2009)

– This will require a new relationship including:– Donor alignment with country strategies– Country leadership to achieve results– Harmonization, transparency, managing for results, etc.

– To be successful, we will have to manage major individual & institutional behavior changes in the way we relate to each other

– This process begins today…….. – The Nigeria example -

Forum Purpose

“HIS is not a technology issue alone…

Strategy alone will not resolve problems…

The biggest challenge is changing how people do things.”

Southern Africa Region Delegate

• Credible, practical country action plans that build upon policies and plans in place in country

• A credible, practical & timely donor plan to provide coordinated, follow-up support at the country level

• Some demonstration that we have begun to align our behaviors with the principles of the Paris Declaration.

Forum Outcomes

• Why the donors are present:

– We have our work to do in figuring how to support country ownership

– We have to better manage our own institutional change and behavior change process

– We have to usher in a new era of partnership and how to be more responsive to country expectations of us

– We’re here to participate in the development of a donor plan

– We will participate in a series of meetings to discuss and agree to a coordinated plan for supporting follow-on activities

Donor Involvement

• HIS strengthening is NOT primarily a technical challenge.

• Rather, your most important challenge is to establish sufficient:

– Political will – Institutional capacity– Supportive policy/regulatory environment

• The primary challenge, then, is to design and facilitate individual & institutional behavior change

Lessons Learned to Date

• Establish a management/coordination unit to monitor implementation with sufficient authority, resources and expertise to succeed, including these specific skills:

– Task Management– Organizational Development– Change Management– And, HIS Technical Support

Lessons Learned to Date

Thank you!

Country Ownership Strategies:Asia Pacific Leadership Forum on

Health Information SystemsWHO WPRO Conference Center

13-16 June, 2011

– Bangladesh

– Cambodia

– Fiji

– Indonesia

– Lao

Introduction of Delegates

– Mongolia

– Philippines

– Thailand

– Vietnam

Introduction of Sponsors and Donors

• Philippines Department of Health• Asian Development Bank (ADB) • Centers for Disease Control (CDC)• Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) • Health Metrics Network (HMN)• HIS School of Population Health, University of Queensland• International Development Research Center (IDRC CRDI) • Japan International Cooperation Agency (JICA)• Norwegian Agency for Development Cooperation (Norad)

Introduction of Sponsors and Donors

• The Rockefeller Foundation• Secretariat of the Pacific Community (SPC)• UK Department for International Development (DFID)• UN Economic and Social Commission for Asia and the Pacific

(ESCAP)• UN International Telecommunication Union (ITU)• United States Agency for International Development (USAID)• United States Department of Defense (DOD)• United States President’s Emergency Plan for AIDS Relief (PEPFAR)• World Health Organization (WHO)

Other Introductions and Appreciations

• Country Delegate Points of Contact• Donor Points of Contact• WPRO Staff• Conference Support• Management Sciences for Health• Futures Group• Training Resources Group• Small Group Facilitators• Rapporteurs

Pre-forum HIS Survey Results

Health Policy Project, Futures GroupAnita Datar Garten

• Why was it important to gather this information?

• What methodology was used?

• What were the limitations?

• What were the findings?

• What are the implications for the forum?

Overview

• To inform the design of the forum

• To understand importance of HIS strengthening

• To produce a snapshot of HIS in each country

• To identify cross-border promising practices

Why was it important?

• Semi-structured interview guide posed questions: o Who is currently coordinating, contributing, and using HIS data?o What are some challenges to strengthening HIS? o What steps have been taken to strengthen HIS?

• Interviewee profileo Technical experts in health, finance, statistics,

telecommunications

• n = 27 (February – June 2011)

What methodology was used?

• Technology and scheduling challenges

• Language limitation

• Not representative of all sectors in each country

• Resulted in broad, thematic summaries

What were the limitations?

• Common Challenges across all countries

• Promising Practices by countryo Actions Takeno Barriers Broken

• Reflections from sectors

What were the findings?

Governance and Multisectoral Engagement• Secure political leadership for HIS• Reduce siloed activities and increase multisector coordination• Enforce private sector reporting

Strategic Planning and Financing • Ensure evidence-based decision-making in planning• Increase donor coordination and harmonization of systems

Information Use• Increase data quality and confidence • Strengthen data analysis skills• Encourage health information sharing and use • Build strong data culture at all levels

Common Challenges

Human Capital Development• Build stable health care workers trained in HIS• Train medical professionals in management

System and Data Interoperability• Address fragmentation of HIS sub-systems• Increase interoperability across HIS sub-systems

Common Challenges (cont’d)

Capacity-building

“ We cannot deal with HIS as a technology issue alone…80% of strengthening HIS is about building the capacity of people and strengthening organizational development.”

In your words…

Governance

"Money is required for systems development, but for governance you need a shared vision and a willingness to engage to ensure consensus building.”

In your words…

Information Use

“I had no idea that our health information was so vital to other Ministries.”

In your words…

• Actions Takeno Draft Health Sector Development Plan (2011-2016) emphasizes

development and strengthening of routine HIS;o All public health hospitals connected to DHIS 2.0, which allows for

interoperability in reporting from the field to central level;o Priority Communicable Disease Surveillance data also updated

weekly through web-based software from 64 districts and 6 divisional headquarters.

• Barriers Broken• Challenges in data reporting are being addressed to improve

timeliness and produce a clearer health information picture.

Promising Practices: Bangladesh

• Actions Takeno In 2009 MOH redesigned and rolled-out web-based national HIS;o Ongoing, regular meetings between MOH and URC programmers

ensures capacity transfer and ownership of web-based HIS;o Result: 100% reporting from all public facilities across provinces; o Next steps include expanding roll-out to NGO hospitals and private

clinics.

• Barriers Brokeno Reliance on external expertise decreasing, while simultaneously

building in-country capacity to manage national HIS.

Promising Practices: Cambodia

• Actions Takeno Health sector issues fall under social sector within MOF;o MOH and MOF work in close collaboration, meeting regularly to

discuss health sector needs and funding priorities;o When MOH comes up with new policies, they work directly with

MOF to understand budgetary implications and determine priority needs.

• Barriers Brokeno Siloed agency activities giving way to coordinated strategic

planning that ensures stakeholder engagement and buy-in.

Promising Practices: Fiji

• Actions Takeno MOH currently developing HIS strategic plan (2011-2015) ; o Led by MoH with strong engagement from educational

institutions, the Agency for Population and Family Planning, the Central Bureau of Statistics, and the Ministries of Communication and Information, and Home Affairs.

• Barriers Brokeno Isolated planning replaced with MOH leadership of a multisectoral

and coordinated process.

Promising Practices: Indonesia

• Actions Takeno In 2010, adopted LaosInfo, which serves as a national database

intended to improve coordination and sharing of information;o First piloted at the MOH , including training for health workers to

understand data needs for M&E and reporting on MDGs;o By 2011, expanded roll-out to five Ministries including Agriculture,

Forestry, Education, Finance, and Commerce.

• Barriers Brokeno Efforts underway to build awareness of data needs and

understanding of relationship to better health outcomes.

Promising Practices: Lao PDR

• Actions Takeno Currently drafting five-year HMIS strategic plan, which aligns with

e-health strategy;o Established HIS steering committee (led by Vice Minister of Health)

to coordinate and harmonize HIS activities among partners, donors, and other key agencies including the Ministry of Finance.

• Barriers Brokeno Emphasis on leadership, political commitment, and multisectoral

engagement.

Promising Practices: Mongolia

• Actions Takeno 2007, establishment of Philippines Health Information Network; o PHIN built linkages between stakeholders, assessed the state of

HIS, and formulated the strategy for HIS development;o Drafted plan outlining need to implement standards and improve

access to and dissemination of health information.

• Barriers Brokeno Fragmented HIS giving rise to improvements in sub-system data

flow, interoperability, and a clearer health information picture.

Promising Practices: Philippines

• Actions Takeno Assessed status of eHealth to understand ICT uptake and identify

and areas for improvement;o Strength: Thailand is leading with respect to use of ICT;o Challenge: Need to strengthen eHealth foundation with emphasis

on establishment of governing body;o Efforts underway to establish national level, multisectoral

authority to support e-Health.

• Barriers Brokeno Expanding definition of HIS strengthening to go beyond the

technology challenge and focus on leadership.

Promising Practices: Thailand

• Actions Takeno In 2010, revised National Statistical Indicator System;o Government Statistical Office collects data on over 350 indicators

including 20 health indicators from the MOH;o Established central repository, which serves as the source for

annual statistical publication.

• Barriers Brokeno Transparency and increased access to information leading to

emerging information picture.

Promising Practices: Vietnam

Improve communication

“We recognize the need to have a multisectoral approach. The forum will help us create dialogue in- country.”

Reflections from Health

Strengthen data culture

“We hope to increase access to health data and encourage data use to improve health outcomes.”

Reflections from Statistics

Evidence-based decision-making

“We really need to have reliable information in place to ensure proper financing.”

Reflections from Finance

Community of practice

“There is a growing demand to apply ICT to solve health challenges…[the forum] will help [us]

establish a community of practice for the region and strengthen South-to-South collaboration.”

Reflections from Telecommunications

• Common challenges across countries provide a starting point for developing an action plan and a roadmap for strengthening HIS.

• Promising practices highlight country-owned, country-derived solutions and encourage sharing of information and lessons learned within and across country delegations.

• Reflections from each sector reinforce the importance of this work and the critical role that each of you will play for the next four days and beyond.

What are the implications for the forum?

Thank You!

AgendaM

onda

y, 1

3 Ju

ne

8:30 Introduction to the Forum HIS Impact Story - Thailand Technical Overview of HIS Overview of the Country Leadership & Ownership Framework Lunch Working Group Session #1 - HIS Ownership and Leadership Closing Plenary 5:30 Session EndsTu

esda

y, 1

4 Ju

ne

8:30 A Collective Vision for HIS Impact Story #2 Creating an Information Culture in HIS Working Group Session #2 – MultiSectoral Engagement and Coordination/Demand for DataLunch Working Group Session #3 – HIS Strengths and Gaps Analysis Closing Plenary5:00 Session Ends

AgendaM

onda

y, 1

3 Ju

ne

8:30 Introduction to the Forum HIS Impact Story - Thailand Technical Overview of HIS Overview of the Country Leadership & Ownership Framework Lunch Working Group Session #1 - HIS Ownership and Leadership Closing Plenary 5:00 Session EndsTu

esda

y, 1

4 Ju

ne

8:30 A Collective Vision for HIS Impact Story #2 Creating an Information Culture in HIS Working Group Session #2 – MultiSectoral Engagement and Coordination/Demand for DataLunch Working Group Session #3 – HIS Strengths and Gaps Analysis Closing Plenary5:00 Session Ends

AgendaW

edne

sday

, 15

June

8:30 Effective MultiSectoral Collaboration Working Group - Synthesis and Preparation for Report-Outs Inter-Team Reporting and NetworkingStructured Networking Lunch Highlights from Inter-Team Networking Donor Panel – Resources to Support HIS Strengthening Overview of Action Plans Working Group Session #4 – Action Planning5:00 Session Ends

Thur

sday

, 16

June

8:30 Impact Story #3 Working Group Session #5 – Action Planning Continued Working Group - Synthesis and Preparation for Report-OutsLunch Inter-Team Reporting and Networking Highlights of Country Priority Actions Overview of VLDP Evaluations Closing Remarks5:00 Session Ends

AgendaW

edne

sday

, 15

June

8:30 Effective MultiSectoral Collaboration Working Group - Synthesis and Preparation for Report-Outs Inter-Team Reporting and NetworkingStructured Networking Lunch Highlights from Inter-Team Networking Donor Panel – Resources to Support HIS Strengthening Overview of Action Plans Working Group Session #4 – Action Planning5:00 Session Ends

Thur

sday

, 16

June

8:30 Impact Story #3 Working Group Session #5 – Action Planning Continued Working Group - Synthesis and Preparation for Report-OutsLunch Inter-Team Reporting and Networking Highlights of Country Priority Actions Overview of VLDP Evaluations Closing Remarks5:00 Session Ends

• Keynote Speaker

– Assistant Secretary Bayugo

• Technical Overview of HIS

– After Keynote Address– Presented by Dr. Ramesh Krishnamurthy, WHO

Adjustments

• Design based on two prior forums, extensive interviews with delegates

• Facilitated working groups/brief plenary reports • Maximum interaction among delegates within and across

countries and sectors• Rigorous documentation of working group findings that will

be disseminated to all delegates• Follow up by forum organizers to enable knowledge sharing,

exchange of lessons learned, and continued progress

Adjustments

• Be Curious • Be Fully Present • Be Courteous • Be Prompt • Be Engaged • Be Open

Orientation Norms

• Obsession with a belief limits your ideas.

• Think before you do, not after you’re done.

Orientation Norms

HIS Impact Story Development and Status of Health Information

Standard in Thailand

Presenter: Dr. Boonchai Kijsanayotin

• Principle: Health data standards are essential for Interoperability

• Reality: Health Information systems are often fragmented, with limited health data standards and operability

• Goal: To establish national health information standards to facilitate information sharing and exchange

• Key Players: MoPH, MOI, NSO, NESDB, National insurance schemes, Hospitals, HSRI, Universities, TMI, vendors, Research institutes

HIS Challenge

• 2008: Initiated collaboration via Thai Health Information Network (THINK); meets every two months to share information

• 2010: Developed 10-year Strategic Plan for National Health Information Systems with inputs from key stakeholders and support from the National Health Commission (Chaired by Prime Minister)

• 2011: Established National Health Information Committee (NHIC) and selected 4 priority areas of focus: – 1) National health information standards – 2) National health indicators– 3) Community based HIS – 4) Health information security

Actions Taken

• Developing health data standards to serve health financing central mechanism (e.g. case mix information system) in collaboration with National Healthcare Financing Development Office.

• With support from MoPH, NECTEC, and NHIC, developing national standard data set for chronic disease registry, referral system, and public health reporting systems.

• Plans to establish Thai Health Data Standards Maintenance Office (TH-DSMO):– Study and select health data standards from international and national

standard development organization (SDOs) – Advocate the use and maintenance selected standards

Actions Taken (cont’d)

• Establishment of working groups with strong engagement from multiple government agencies and academia.

• Increased awareness of on going HIS projects across agencies as well as enhanced information exchange and better collaboration.

Impact

• Realization of the central mechanism for national health insurance reimbursement with collaboration from the National Healthcare Financing Development Office

– Thai Casemix Center– Thai Health Data Standards Maintenance Office– Central health claim data clearing house– National health financing data repository – Central Information auditing mechanism

• Realization of the Thailand Health Data Standards Maintenance Office (TH-DSMO).

• Implementation of health data standards gaps employing well established international standards e.g. LOINC, HL7, HIE, SDMX-HD etc.

• Increase health information human resources : Health information management personnel, health IT professionals, health informaticians.

Next Steps

• Involvement of all stakeholders

• Create awareness among high level executives

• Don’t reinvent the wheel

• Stepwise versus Big Bang approach

Key Messages

Country Ownership Strategies:Asia Pacific Leadership Forum on

Health Information SystemsWHO WPRO Conference Center

13-16 June, 2011

Technical Overview of HIS

Dr. Ramesh Krishnamurthy, WHO

Overview of the Country Leadership and Ownership

Continuum

Mark Landry, WHO

Country Ownership Strategies:Asia Pacific Leadership Forum on

Health Information SystemsWHO WPRO Conference Center

13-16 June, 2011

• It is never too late to offer anything that is good.

• Union is the source of success.

Orientation Norms

Country Ownership Strategies:Asia Pacific Leadership Forum on

Health Information SystemsWHO WPRO Conference Center

13-16 June, 2011

• Heavy we carry together, light we carry together.

• Many hands make light work.

• Don’t ride an elephant to catch a grasshopper.

Orientation Norms

Country Ownership Strategies:Asia Pacific Leadership Forum on

Health Information SystemsWHO WPRO Conference Center

13-16 June, 2011

• XXX

– XXXXX

Changes to Agenda

Technical Overview of HIS

Ramesh Krishnamurthy

• Bangladesh, WG-D• Cambodia, WG-A• Fiji, WG-I• Indonesia, WG-H• Laos, WG-G

Working Group Meeting Rooms

• Mongolia, WG-C• Philippines, WG-F• Thailand, WG-B• Vietnam, WG-E