Judge Business School Information for Action in Public Health Systems in Developing Countries Geoff Walsham
Judge Business School Information for Action in Public Health Systems in Developing Countries Geoff Walsham.
Dec 18, 2015
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Judge Business SchoolInformation for Action
in Public Health Systems
in Developing Countries
Geoff Walsham
Page 2
Information for action - definition
• The regular and widespread use of information as an input to processes such as planning, management, monitoring and evaluation of health activities and systems with a view to enabling more effective action in the field and improved health outcomes
Page 3
ANM ANM Register
PHC MOICPHC
Sector LevelHealth Supervisor
Block MOIC
CHC
District Head Quarter (DPMU)
STATE HEAD QUARTER
District TB Department
District Malaria Department
District Leprosy Department
District Blindness Control Program
Others
Sub-Centre Level
PHC Level
CHC Level
District Level
State Level
Health System Information
FlowData Given
Feed Back
Information for action – some examples
Using information at the national level to develop plans to meet the MDGs
Using information at state level to prioritise particular programmes in that state and develop action plans to achieve these
Using information at district level to monitor the achievement or underachievement of district health goals and to generate future plans to respond to this
Using information at the PHC level to better understand local health problems and issues in order to target resource use more effectively
Using information on particular villages and sub-centres to develop ANM activity plans which maximise the use of her capabilities
Page 5
Information for action needs good data
Accurate
Complete
Timely
Relevant
Available where and when needed
Page 6
Why is data in public health systems often poor quality?
Misreporting due to unintended mistakes, arithmetic calculations etc
Deliberate misreporting to present a distorted picture of achievements
Under-reporting or no reporting due to time pressures, lack of motivation to report or excessive number of forms, data elements etc.
Lack of understanding of the importance of data or its role in improving health outcomes – no ‘information culture’
Page 7
What information and communication technologies (ICTs) can do
Provide the capability to capture data more effectively at local level e.g. through mobile phones
Provide resources for the processing of data more quickly and accurately
Provide capabilities for the generation and display of information in a user-friendly and adaptable way
Provide the capability to integrate information across all levels of analysis from the global to the local
Page 8
What ICTs cannot do
Produce motivated and knowledgeable health workers at all levels
Produce an information culture which places high value on the use of information for action
Eliminate ‘perverse incentives’ in the health system to misrepresent data or distort information
Provide the levels of resources and long-term commitment needed to raise the quality of health care to widely acceptable levels
Page 9
Developing the software – HISP/DHIS
Health Information Systems Programme (HISP) started in South Africa in the mid-1990s
Provides a computer-based district health information system (DHIS) for health planning and management
Approach extended to a range of other countries in Africa and Asia
Based on open-source software, the latest version being DHIS2
Page 10
Developing the people
Ashas
ANMs
Medical officers in PHCs
Block and district personnel
State and central health staff
Page 11
Developing the institutional support
Health is known globally to operate in vertical silos
This is often mirrored in vertical institutions who place less emphasis on horizontal communications
Need for a change of culture to one of cooperation, horizontal communication and the development of shared goals
This matches the spirit of the original HISP approach
Page 12
Conclusions
• Health management information systems (HMIS) need to be viewed as only one part of heterogeneous networks composed of people, technology, standards, institutions, processes etc.
• Change programmes need to address all of these elements holistically and over extended time periods
Page 13
Thank You
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