rapid assessment and Strategic planning Process (RAsPp) · Web viewrapid assessment and Strategic planning Process (RAsPp) Purpose. The following document provides you with a copy

RAPID ASSESSMENT AND STRATEGIC PLANNING PROCESS (RASPP)Purpose

The following document provides you with a copy of two tools that have been developed over a period of time to aid in the assessment of country’s health information systems (HIS) and planning for improvement to the HIS. The tools are modified and simplified versions of the tools developed by the Health Metrics Network for HIS assessment and strategic planning.

It is recommended that prior to using the tools in this document that you also review the more extensive tools to gain an understanding of the context in which the tools were originally developed. It is also important to familiarise yourself with the HMN framework to aid in understanding the importance of each of the components and the extensive interaction across the components.

The HMN tools and other relevant material can be access via the following site:

HMN Framework:

http://www.who.int/healthmetrics/documents/hmn_framework200803.pdf

HMN Assessment tool:

http://www.who.int/healthmetrics/tools/Version_4.00_Assessment_Tool3.pdf

HMN Tool box: http://www.who.int/healthmetrics/tools/en/At this link you will find the list of HMN tools – of particular interest is the Assessment Score Sheet – which is the Excel spreadsheet used for the HMN assessment.

HMN Strategic Planning for HIS Implementation tool:

http://www.who.int/healthmetrics/tools/HISStrategicPlanningProcessGuidance_2009_March_3.pdf

The two tools are a Rapid Assessment Tool (RAT) and a HIS Strategic Planning Tool (HIS SPT). Combined the tools can be known as a Rapid Assessment and Strategic Planning Process(RASPP).

Rapid Assessment and Strategic Planning Process Page 1

http://www.who.int/healthmetrics/tools/HISStrategicPlanningProcessGuidance_2009_March_3.pdf

http://www.who.int/healthmetrics/tools/en/

http://www.who.int/healthmetrics/tools/Version_4.00_Assessment_Tool3.pdf

http://www.who.int/healthmetrics/documents/hmn_framework200803.pdf

The modified tools have been developed to allow smaller countries with less resources an opportunity to undertake a HIS assessment and strategic planning process in a shorter time frame than that required for the more extensive HMN process. In order to ensure the tools are consistent with the original intent of the HMN process the tools maintain core components of the HMN framework and planning processes. The tools also do not necessarily remove the need for a full assessment, but can be a first step in gaining an understanding of immediate key improvement requirements and moving that process forward.

RASPP

The first tool, the RAT, whilst it contains an abbreviated version of the more extensive HMN tool, targets the key questions that need to exist for a basic functioning HIS. That is the key questions from the six components have been identified and included in the RAT. A copy of the RAT can be found as Attachment A.

When undertaking the assessment the assessment team are asked to provide a yes/no response to each of the following:

Present : the criteria is met or has been met in the past Functioning: the statement can be answered positively and evidence is available that this is

happening regularly Adequate: the statement can be answered positively and is meeting most needs Sustainable: the criteria been in place and functioning without external support for some

time

To aid in completing this process an additional table has been provided indicating the type of information/evidence you will need to look for to answer yes or no. This table is provided as Attachment B. You will note that where this assessment differs from the HMN tool is that evidence is required to support the responses.

The second tool, the HIS SPT (Attachment C) provides clear direction to the user on the steps required to develop a strategic plan for the improvement of HIS in a country. The steps outlined in the HIS SPT include: Identifying HIS priorities (based on the assessment and other material gathered); Building consensus of HIS priorities; Developing a vision for the HIS; Identifying goals for the HIS; Identifying strategies to meet the goals; Development of a strategic plan; and Assigning responsibility and timeframes.

Step-by-step instruction and simple templates are provided throughout the HIS SPT to aid the planning process.

Process


Engage key stakeholders

Establish Core Team

Conduct Rapid Assessment

Prepare report

Hold stakeholder workshop

Produce strategic plan

Need for HIS improvement Endorsement

by key stakeholders

The first and most important step in the process for improving the HIS is for key leaders within the relevant areas of the country, such as the Ministry of Health, to recognize the important role that Health Information plays in the planning and management of health at all levels of the health system. There also needs to be an acknowledgement that there are weaknesses in their current HIS and a decision to work towards making the HIS more efficient and effective. Only then are they able to commit to undertaking the RASPP, and the resultant HIS improvement activities that will follow. Figure 3 below provides an outline of the steps to be taken in the RASPP.

Figure 1: Rapid Assessment and Strategic Planning Process

1. Engage key stakeholders

Key stakeholders are likely to include the Ministers and senior officials from the Department of National Planning, Bureau of Statistics, Ministry of Health, Registrar General, etc. For the assessment to be effective, involvement and commitment from these key players is essential. It is also important to identify a “champion” who is committed to the improvement process. Ideally this would be a senior health official, who is well respected and understands the value of information for evidence-based decision making.

2. Establish a Core Team

A Core Team (CT) is established that includes people from key agencies listed above who will undertake and drive the RASPP. Ideally the people involved in the CT will include people who have professional standing and respect, but are also knowledgeable regarding their particular area of expertise, for example, ensuring that a representative from the Bureau of Statistics is experienced in statistical concepts and that their expertise is acknowledged within the information community. They must also have the support of their senior managers to ensure they have the time and resources to commit to the involvement in the CT. Identification of the right people is essential to the effective operation of the Team.

3. Conduct Rapid Assessment

At this stage the CT works through each of the criteria for success set out in the RAT by organizing meetings with the relevant agencies to assist in answering the questions. An important element of this work is to collect evidence to substantiate the Team’s responses. Where policy documents and legislation, etc exist, the team will be asked to collect them. Where no written evidence is available, the CT will be required to interview people to build up information and have a clear picture of the situation.


4. Prepare report

The CT will then write a draft report on their findings from undertaking the Rapid Assessment and disseminate it to the key stakeholders for review. This will provide an opportunity to validate the results obtained during the assessment, and will form the basis for discussion at the workshop.

5. Stakeholder workshop

This workshop is an opportunity for the key stakeholders and CT to come together to discuss the draft report and to plan the way forward. The key purpose of the workshop is to:

Validate the findings in the Rapid Assessment report and, if necessary, to amend the report; Articulate the visions and goal for the HIS; Prioritise the issues to be addressed, with consideration of the local political climate, funding

streams, other initiatives underway that could be leveraged; Reach a consensus on the “what's” and the “how’s” to achieving the HIS vision.

It is envisaged that this workshop will be held over two days. The outputs from the workshop (i.e. the completed templates) will form the basis of the material for the strategic plan. The purpose of the above planning processes at the workshop is to ensure robust discussion has been undertaken with all the key stakeholders when setting a vision and goals for the future HIS. It also ensures that everyone involved in the HIS is aware of their own role in achieving this vision.

6. Produce strategic plan

The CT will produce the draft HIS Strategic Plan, which maps the way forward using the information and ideas captured at the Workshop. It will include details of each of the activities to be undertaken and the person(s) responsible, a detailed budget, a vision and a process for monitoring of the plan. Once the plan is completed, it will be sent to the key stakeholders.

7. Plan endorsed by key stakeholders

The HIS Strategic Plan will be circulated to all key stakeholders to seek endorsement of the document. A cycle of amendments may need to be factored into the endorsement process. However, the overall endorsement process should be completed within 1-2 months of the workshop to ensure the engagement of the key stakeholders obtained at the workshop is not lost. The sign-off process should also include a final endorsement from the Minister of Health. This endorsement indicates to all involved in the planning and implementation process that activities identified within the HIS Strategic Plan have the support of senior personnel.

At this stage it might be useful for a HIS governance committee to be established to ensure that the plan is implemented. This committee can then commence the process of seeking funding (if required) and undertaking the activities outlined in the plan.


ATTACHMENT A – HIS RAPID ASSESSMENT TOOLNumber

Criteria for Success Present* Functioning* Adequate* Sustainable* Comments/Evidence

HIS RESOURCESCoordination, Planning and Policies

1 Is there a national cross-sectoral HIS committee?

2 Is there a written national HIS policy?

3 Is there HIS related legislation to measure:

Vital StatisticsService Delivery Notifiable Disease Reporting

456

Financial and Human Resources7 Are there human resources uniquely

identified as HIS?8 Are there clear lines of responsible for

HIS?9 Is there an allocated budget line within

the MOH for HIS activities?Infrastructure

10 Is there sufficient hardware available for HIS use?

11 Is there sufficient software available for HIS use?

12 Is there sufficient networking infrastructure to support HIS use?


Number


INDICATORS13 Are there national core indicators to

measure:Health determinantsHealth system inputs and outputsHealth outcomes and status

141516

17 Is there a national strategy for collection of health indicators?

DATA SOURCESPopulation Based

18 Is there a complete population census undertaken at least every 10 years?

19 Is there a Civil Registration process in place for all births and deaths?

20 Are periodic surveys undertaken to capture information for key health issues?

Institution Based21 Are individual health records maintained

for recording the ongoing treatment of patients?

22 Are there appropriate health service records collected?

23 Are there appropriate resource records collected, including finance and human resources?

DATA MANAGEMENTData Storage, Management and Transmission

24 Are there written procedures for data


Number


storage, including security and destruction?

25 Is there a centralised database or data warehouse that combines all health data collections?

26 Are there defined, locally appropriate mechanisms in place for data transmission?

INFORMATION PRODUCTS27 Are staff appropriately skilled to

transform data into information?- At national level- At divisional/provincial/local level

28

29

30 Are there tools and procedures available to assess the quality of data?

31 Is there a set of national health data standards and definitions that are used across all health data collections?

DISSEMINATION AND USEDemand, Analysis, Policy and Advocacy

32 Are managers and clinicians using information for policy and advocacy?

Planning, Priority Setting and Resource Allocation, Implementation and Action33 Is an annual health report submitted to

Parliament each year?34 Are health managers using information

for planning, priority setting or resource allocation and action?

35 Are clinicians using information for


Number


planning, priority setting or resource allocation and action?

36 Is data readily available to internal and external users, e.g. on the internet or intranet?

*KeyPresent – the criteria is met or has been met in the past Functioning – the statement can be answered positively and evidence is available that this is happening regularlyAdequate – the statement can be answered positively and is meeting most needsSustainable –the criteria been in place and functioning without external support for some time


ATTACHMENT B: PUTTING THE RAPID ASSESSMENT INTO PRACTICE

The following tables provides the assessment team with examples of alternative ways of asking the questions and examples of what can be considered to be present, functioning, adequate and sustainable. The alternative questions column provides you with the opportunity to gather the evidence required to support the yes/no responses in the remaining columns.

Question Alternative questions Present Functioning Adequate Sustainable

Is there a national cross-sectoral HIS committee?

Could you show us the terms of reference for any cross- sectoral committee that you have that looks after HIS? NOTE: the terms of reference are an indication that they have taken the time to at least think about what it is the committee should do, or be involved in. You will want to ask this question of at least the Ministry of Health (MOH) people as well as the Civil Registration (CR) and Bureau of Statistics (BOS) people.

This response will be a yes if they at least have a TOR for the committee.

This response will be a yes if they have met in the last twelve months.

This response will be yes if they have met at least 4 times in the last twelve months.

This response will be yes if they are meeting at least every 4-6 weeks.

Is there a written national HIS policy?

Could we see a copy of the latest national policy for HIS? NOTE: If they are not able to produce a single HIS document then they may have information policies for other departments/sections that provide some indication of HI related interest. (e.g. ICT policies may mention HI). You will want to ask this question of at least the MOH, CR and BOS people.

This response will be a yes if they are able to produce a policy for HIS – a single document on HIS – not documents across other areas.

This response will be a yes if the document has recently been drafted or reviewed and updated (i.e. in the last couple of years).

This response will be a yes if it covers all aspects of HIS (i.e. HMN components).

This response will be a yes if the policy can carry the country through technological, administrative and political changes.

Is there HIS related legislation to measure:

Vital Statistics Could we see a copy of the legislation that supports the collection of births and deaths registration? You will want to ask this

This response will be yes if they can produce the

This response will be a yes if it has been reviewed in the last

This response will be a yes, if it provides

This response will be a yes, if the legislation can be


question of the CR people. legislation or refer you to a web site with the legislation available.

couple of years and that they can provide examples of when and how often they look at the legislation. If they know it exists but can’t provide a copy then it is not functioning.

definitions and guidelines to aid the collection of vital statistics. E.g. definitions exist in the document for live birth 0- and they meet WHO definitions.

changed to allow for easy adoption of definition changes or changes in technology that impact on data collection.

Service Delivery Could we see a copy of the legislation that supports the collection of data on how your health system functions (e.g. licensing of facilities, a Health Act). You will want to ask this question of the MOH people.

This response will be yes if they can produce the legislation or refer you to a web site with the legislation available.

This response will be a yes if it has been reviewed in the last couple of years and that they can provide examples of when and how often they look at the legislation. If they know it exists but can’t provide a copy then it is not functioning.

This response will be a yes if it covers all aspects of service delivery.

This response will be a yes if it can carry the country through technological, administrative and political changes.

Notifiable Disease Reporting

Could we see a copy of the legislation that makes sure that doctors and other clinicians report notifiable diseases? You will want to ask this question of the MOH people.

This response will be yes if they can produce the legislation or refer you to a web site with the legislation available.

This response will be a yes if it has been reviewed in the last couple of years and that they can provide examples of when and how often they look at the legislation. If they know it exists but can’t provide a copy then it is not functioning.

This response will be a yes if it covers all relevant notifiable diseases and methods for collection and reporting for the country.

This response will be a yes, if the legislation can be changed to allow for easy adoption of definition changes or changes in technology, politics or administrative processes that impact on data collection.


Are there human resources uniquely identified as HIS?

You may want to ask if you can view organisational charts for the MOH, BOS, and CR. The organisational charts should be detailed enough to identify specific people and sections that are responsible solely for HIS. You will also want to ask if they have position descriptions or role statements for people to see if their roles are actually HIS related.

This will be a yes response if they are able to produce the organisation charts or position descriptions.

This will be a yes if the documents are current or have been reviewed in the last couple of years.

This will be a yes if it is clear from the position descriptions that the roles are only HIS and not many other tasks.

This will be a yes if it is clear that the role statements will allow for changes in technology, administration and politics.

Are there clear lines of responsibility for HIS?

Using the documents above you will want to see if the position descriptions or organisational charts clearly indicate a line of responsibility.

This will be a yes if the organisational chart has lines that indicate reporting lines. The position descriptions should clearly indicate what the person is responsible for and who they report to.

This will be a yes if the documents are current or have been reviewed in the last couple of years.

This will be a yes if there is an indication from the people you are talking to that they believe that the documents reflect what it is they are responsible for and their reporting lines.

This will be a yes if it is clear that the role statements will allow for changes in technology, administration and politics.

Is there an allocated budget line within the MOH for HIS activities?

There are several documents that you may need to look at including budget proposals and end of year financial reports for proposals for HI units as well as ICT (and potentially other areas). Some countries may provide you with actual budget documents that have not only been presented to parliament but also passed by parliament to indicate the allocation to HIS activities.

This will be yes if there is a clear indication from any of the documents that there is allocation in the budget for HIS activities.

This will be a yes if the money is actually provided and then used for HIS activities.

This will be a yes if they indicate that they received all of the money they had asked for in budget proposals.

This will be a yes, if there is indication that the over several years there has been a gradual increase in the amount allocated and that this will continue.

Is there sufficient hardware With all of the departments that you talk to This will be a yes if This will be yes if it is this will be a yes this will be a yes if


available for HIS use? ask for a tour around the department and ask them to provide you with a summary of the number of computers that they use. Also ask about whether they have enough desks, shelves, paper, and forms to do their job. You may also want to ask if all of the hardware is functioning. E.g. are all of the computers working? Are there enough shelves to stores files? Is there a shortage or paper, pens etc?

from your tour it is clear that the hardware is available.

clear that all of the equipment is being used for its intended purposes and is operating. e.g all computers are operating; forms are being used for collection of data, not for children to draw on.

if they indicate that they can always do their job because they always have equipment available. E.g. they don’t have to line up to use computers or that forms are always available, or they always have a desk available when needed.

they believe that with technology changes the existing situation can carry them through. E.g. do they have enough computers to move to an electronic health record?

Is there sufficient software available for HIS use?

You will want to ask them to list the software that is available for staff to do their jobs. At a minimum they should be listing software such as Word and Excel. If they collect any data using off the shelf or developed products ask them to list these products as well. You will want o ask this question of all departments.

This will be a yes if they can provide you with a list of all software used across all departments.

This will be a yes if the software has been used in the last month and that people know how to use it. i.e. are they using it to perform their jobs such as using Excel or access to manipulate data

This will be a yes if they do not identify other software that they would also like to have available to perform their job.

This will be yes if they have the people skilled to keep collecting and analysing the data using the existing tools.

Is there sufficient networking infrastructure to support HIS use?

Ask if there is a network drive that allows for the storage of all relevant work related data and information and if everyone who should have access does have access. You will need to ask this question of all departments.

This will be a yes if a network exists.

this will be a yes if everyone who should have access does have access and that they are using the network to collect and store data.

This will be a yes if it is available at all times without outages.

This will be yes if the network is able to cope with the introduction of an electronic health record.

Are there national core indicators to measure:


Health determinants

Ask if there is a national minimum data set (MDS) that outlines the indicators that measure health determinants.

This will be yes if a MDS exists.

This will be a yes if the MDS is used to determine the types of data that is collected.

This will be a yes if all relevant reporting requirements are met.

This will be a yes if the MDS can be adapted to include additional data items as required in the future.

Health system inputs and outputs

Ask if there is a national minimum data set that outlines the indicators that measure health system inputs and outputs.





Health outcomes and status

Ask if there is a national minimum data set that outlines the indicators that measure health outcomes and status





Is there a national strategy for collection of health indicators?

Ask to see the national strategy health indicator collection or the document that outlines how the national indicators are collected.

this will be a yes if they can produce the document.

This will be a yes, if it has been used to assist in the development of the MDS or has been developed or reviewed in the last 12 months.


This will be a yes if it can be adapted to include additional data items as required in the future.

Is there a complete population census undertaken at least every 10 years?

Ask to see the report from the last population census. If no formal reports are available then ask when the last Census was conducted and when the next one will be.

This will be a yes they indicate that a Census has been undertaken in the last 10 years.

This will be a yes if the entire population was surveyed – even remote areas.

This will be a yes if key items were collected.

This will be a yes if they have begun planning for the next census.

Is there a Civil Registration process in place for all births and deaths?

Ask the CR people to describe the process for the registration of a birth and a death. i.e. is there a formal process in place for registering these events.

This will be a yes if there is a formal process that operationalises the legislation.

This will be a yes, if everyone who needs to register a birth or death has access to do so.

This will be a yes if they can provide an indication that they have complete or

This will be yes if the registration process is able to react to changes to legislation in the future.


near complete coverage of births and deaths.

Are periodic surveys undertaken to capture information for key health issues?

Ask the MOH and BOS people for reports or a listing of the surveys that they undertake to capture key health information. It is also useful to obtain the timeframe in which the survey’s were last conducted, along with sample size and whether they were population based or a subset of the population

This will be a yes if reports or a listing of key health surveys can be provided.

This will be a yes if the surveys were conducted for the population and in the last 5 years.

This will be a yes if at least the DHS or the Steps programs have been run.

This will be a yes if there are plans to continue to conduct the surveys or there is a 5 year plan or strategy to conduct further surveys.

Are individual health records maintained for recording the ongoing treatment of patients?

When visiting with the hospital and MOH staff ask to look through a number of health records/medical records for the patients. If the records are paper based, ask to have a tour of the filing area as well in the hospital. In the health clinics ask if you can look at what tools they use to record information about the patient’s visit (e.g. a register book, patient cards or an actual medical record).

This will be a yes if they have a health record for each patient that attends the facility/hospital/clinic.

This will be a yes if the records have completed entries in them. (e.g. for a hospital admission, there are progress notes, a discharge summary etc).

this will be a yes if the records can be accessed when required by clinical staff (i.e. the paper records are in the clinic or in the ward when needed or the electronic record is available when required by the clinician).

This will be a yes if the records are in a medium which can survive the rigors of a lot of handling. (e.g. a paper record is stored in a thick cardboard folder with the papers secured in a manner that makes it easy for the clinician to access the relevant pages. Or an electronic health record is stored on a platform that allows for long term retrieval).

Are there appropriate health service records collected?

Ask to review the most recent reports on health facility (clinics, hospitals, nurses station) activity such as number of patients admitted to hospital, number of patients

This is a yes if they are able to produce these reports.

This is a yes if the reports are current (i.e. available for the previous calendar

This is a yes if the reports are for types of services

This is a yes if the reports can still be produced if there is a restructure to the


attending outpatient clinic etc. year (or financial year).

(inpatient, outpatient, outstations).

MOH or a new facility is added.

Are there appropriate resource records collected, including finance and human resources?

Ask to review the most recent reports on resource usage. At a minimum there should be financial and human resources reports. The human resources reports should outline the number of health care professionals (see the CHIPs report as a guide to the types of reports available).

This is a yes if they are able to produce these reports.

This is a yes if the reports are current (i.e. available for the previous calendar year (or financial year).

This is a yes if the information contained in the reports can be broken down further by facility, time period, gender (for human resources) etc.

This is a yes if the reports can still be produced if there is a restructure to the MOH or a new facility is added.

Are there written procedures for data storage, including security and destruction?

Ask to see the procedures that outline how data should be stored, secured and destroyed. Likewise you may want to ask if there are policies to support the procedures.

This is a yes if the procedures exist.

This is a yes if they have been developed or reviewed in the last 2 years.

This is a yes if they cover all three components (storage, security and destruction).

This is ayes if the procedures can easily be adapted to deal with changes in technology.

Is there a centralised database or data warehouse that combines all health data collections?

Ask if there is a single point or place where all health related data is stored. i.e. is there a database that a user or decision maker can access to retrieve data to answer their questions. If there isn’t a database is there a mechanism in place so that there is awareness of where all health related data is stored and can be retrieved?

This is a yes if a warehouse exists (or the alternative mechanism exists).

This is a yes if the most recent data that is available is for the last calendar year or reference period and that there is more than one year available.

This is a yes if data for all health related collections is in this facility.

This is a yes if the six of the warehouse can accommodate many years of data and is on a platform/format that allows for retrieval at a later date.

Are there defined, locally appropriate mechanisms in place for data transmission?

Ask to see the written policies or procedures for transfer of data. The policy or procedure should cover all aspects of data transfer – both paper and electronic. You will need to ask this question of MOH, CR and BOS.

This is a yes if a policy or procedure exists.

This is a yes if it has been developed or reviewed in the last two years.

This is a yes if it covers both paper and electronic transmission.

This is ayes if the procedures can easily be adapted to deal with changes in technology or


processes.Are staff appropriately skilled to transform data into information?- At national level- At divisional/provincial/local level

Ask to see copies of reports that have been produced from MOH, CR and BOS using data that is available to each of these agencies. You will also want to ask these questions of the hospital and nursing station level staff as well. Ask who was responsible for completing the reports which will provide an indication if it was done in country or whether there are staff that can turn data into information.

This is a yes if reports can be produced and by in-country staff and not consultants.

This is a yes if the reports have been produced in the last two years.

This is a yes if the reports are available at all levels (national, provincial, local etc).

This is a yes there is evidence that the reports have been produced for a number of years – this is an indication that they have been doing the work for some time and have kept skilled staff to do the work.

Are there tools and procedures available to assess the quality of data?

Ideally you would like to ask if they have a quality plan or strategy – and ask this of all agencies that collect and transform data. However, if a quality plan is not available, then ask to see the types of basic edits (e.g. males with female codes, all fields complete)that they apply to the data and then the more detailed quality checks (e.g. trend analysis) that are applied to the data during the data cleaning process. They may also have summary reports of quality checks that have been undertaken.

This is a yes if a quality plan exists or they can show you the quality checks that are applied to the data.

This is a yes if in an electronic environment the quality checks are automated and auctioned. This is a yes in a paper based environment if they can demonstrate examples of quality checks on data. Alternatively, review the various reports that you have accessed previously and identify any data anomalies.

This is a yes if quality checks are applied at all levels – from data entry through to finalisation of figures for reports.

This is a yes if the quality checks can be adapted to deal with new data collections or changes in existing collections. e.g. can a new edit be applied to the system.

Is there a set of national health data standards and definitions that are used across all health data collections?

Ask if they have a national health data dictionary (NHDD) and can you have a look at it. If they don’t have a data dictionary, ask if all of the data items that they collect across all collections are defined and that everyone uses those definitions in collecting

This is a yes if a NHDD exists or that all data items are defined.

This is a yes if the NHDD has been developed or reviewed in the last 2 years.

This is a yes if all health collections are using the definitions in the NHDD and

This is a yes if the NHDD can be adapted to deal with new data collections or changes in existing


their data. know of its existence.

collections and if there is an agency that has responsibility for the NHDD.

Are managers and clinicians using information for policy and advocacy?

Ask to see examples of reports or circumstances where a doctor/ has used data/ information to develop a policy that is supported by the data. Likewise ask to see examples where data/information has been used to advocate for the introduction of a health program or change to existing programs – supported by the data.

this is a yes if examples exist.

This is a yes if the examples are recent (i.e. the last 12 months-2 years)

This is a yes both clinicians and managers are using the information for policy and advocacy.

This is a yes if there is ongoing evidence that the information has been used (in the correct manner) for a number of years – that it isn’t just a single case that has happened in the last year.

Is an annual health report submitted to Parliament each year?

Ask to see the latest copy of the health report submitted to Parliament. Review the document to determine if the data contained in the document is for the reference year. E.g. if it is a 2010 report, is the data for 2010. Also ask to see previous year’s reports as well.

This is a yes if a report exists.

This is a yes if the report is for the most recent year.

This is a yes if the data is for the most recent year.

This is a yes if they are able to produce reports for a number of years.

Are health managers using information for planning, priority setting or resource allocation and action?

Ask to see examples of reports or proposals that have been developed using current data to aid in decision making about planning, priority setting, resource allocation and action. For example, if a new ward or health clinic has been opened or has had approval for development, was the decision based on real data in proposals?

This is a yes if the proposals exist.

This is a yes if data was used to support the proposals.

This is a yes if the data can be identified as valid and appropriate for the argument being presented.

This is a yes if there are a number of examples of where data has been used in proposals.

Are clinicians using information for planning, priority setting or resource allocation and action?

Ask to see examples of reports or proposals that have been developed using current data to aid in decision making about planning, priority setting, resource allocation and action. For example, if a new

This is a yes if the proposals exist.

This is a yes if data was used to support the proposals.

This is a yes if the data can be identified as valid and appropriate for

This is a yes if there are a number of examples of where data has been used in proposals.


ward or health clinic has been opened or has had approval for development, was the decision based on real data in proposals?

the argument being presented.

Is data readily available to internal and external users, e.g. on the internet or intranet?

Ask to see the websites for each of the departments and ask that they show you where data is available for users on these sites. Likewise ask to see where data is stored on the intranet and whether all staff or relevant staff have access to the data.

this is a yes if there is data on the website or intranet.

This is a yes if the data is the most recent release of the data.

This is a yes if the data is for the previous year and for more than one collection.

This is a yes if the websites and intranet can be accessed when and wherever necessary(e.g. server failures do not frequently occur).


ATTACHMENT B – SUMMARISED HIS STRATEGIC PLANNING PROCESSThe following is adapted from the more detailed document produced by the Health Metrics Network – Guidance for the Health Information Systems (HIS) Strategic Planning Process1.

PurposeThe purpose of this document is to provide those involved in the strategic planning process (SSP) a step-by-step guide to develop a strategic plan for the Health Information System (HIS) for their country. Prior to undertaking the SSP an assessment of the HIS should have been completed (either using the full HMN Assessment Tool or the Rapid Assessment Tool developed by the Health Information Systems Knowledge Hub (HIS Hub)). The Strategic Planning Process (SPP) is the next stage in the process of planning for the improvement of the (HIS). The core activity in the SPP will be a workshop to be conducted in country with key stakeholder involvement. It will also be necessary to factor time into the schedule for stakeholder meetings before and after the workshop.

INTRODUCTION

Preparatory work:Prior to undertaking the SPP a Core Team (CT) should be established (if you have not already done so through the rapid assessment process) to manage the whole HIS SPP, and potentially many of the strengthening activities that result from the planning process. The role of the CT is described on page 7 of Guidance for the Health Information Systems (HIS) Strategic Planning Process. It is suggested that the CT contain 3-4 members including 2-3 from Ministry of Health (MOH) and 1 from the Bureau of Statistics. Of the MOH participants, it may be important to include a member of the Public Health staff, as well as those working in the Acute Care areas. You may also need to consider including people from Planning and the Registry of Births, Deaths and Marriages (or the organisation responsible for civil registration).

Before the SPP Workshop, the CT should: Read Guidance for the Health Information Systems (HIS) Strategic Planning Process.

It will be important for the CT to have a good understanding of the planning process and the required background information.

Read the reports prepared by the assessment team and also any relevant documents gathered/compiled during this process.

1 Health Metrics Network (March 2009) Guidance for the Health Information Systems (HIS) Strategic Planning Process: Steps, Tools and Templates for HIS Systems Design and Strategic Planning, Version 6.


Determine the relevant participants for the SSP workshop with reference to page 8 of Guidance for the Health Information Systems (HIS) Strategic Planning Process, and the provision of relevant pre-reading to the group.

Undertake to gather the following material together that will help all participants involved in the planning process to gain a good understanding of not just the HIS for the country, but also strategic priorities for health specifically, and the country in general.

o Government strategic and corporate plans.o Ministry of Health strategic and corporate plans.o Bureau of Statistics strategic and corporate plans.o Any indicators that are used for reporting against these, as well as any

indicators used for monitoring and evaluating any of the specific donor funding, etc.

o Listing of the national priority health problems and related essential services.o Listing of the types of data collected, where it is stored and who has

responsibility for the data.o Listing of the routine reports that are produced, when they are produced and

who has responsibility for their production.o Listing of who has been trained in what areas of the health information

system environment.o Any other reports that you think would provide useful background

information.

STRATEGIC PLANNING PROCESS

Module 1

1.1 Identifying HIS prioritiesThe first step in this process will be to identify and prioritise HIS issues/concerns – using the HIS assessment undertaken previously. The document should be reviewed to determine if the recommendations cover all of the current issues/concerns with the HIS. That is, the CT should ask the following questions:

Are the recommendations comprehensive? Are there other issues or concerns with the HIS that have not been identified

through the assessment?

Use Table 1.1 to record the priorities (see Appendix B). Consider the indicator documents and other listings that have been gathered and identify any further issues/concerns that are not already listed on Table 1.1. For example, are their concerns/issues that have been identified in the government’s Strategic Plan that have not been identified in the assessment. If so, add them to Table 1.1. Where possible, also enter in the “impact” column the consequences of the current issue. This helps to explain why it is an issue and will also help in future steps to determine the priority for corrective action.


1.2 Understanding the information flow and responsibilitiesIt is important that everyone involved in the SPP understand where and how all of the health information is collected, analysed and disseminated within the country. To aid this process it helps to develop a flow diagram. You may want to start with a top level diagram that shows the overall information flow. From there you can build sub-diagrams that break the processes down further. The purpose of putting together a flow diagram is to summarise the information flows and to ensure that everyone involved in the planning process is working from the same base of understanding. It is also useful (where possible) within the diagram to indicate which agency is responsible for the collection of the data/information. See Appendix A for an example of the flow diagram.

All steps in this module can be completed by the CT leading into the SPP Workshop. The CT should aim to have all of the material collated at least a week prior to the workshop. This will allow for distribution of the documents to the workshop participants before the planning sessions, allowing them sufficient time to read through and consider the content of the documents.

Module 2 – Conducting the Workshop

2.1 Preparation for the workshop

Prior to the workshop the CT should identify potential participants or agencies who should attend the workshop. The following list may help in determining the appropriate people to attend. Ministry of Health Representatives:

Secretary for Health Medical Records Staff Health Planners Medical Staff DON and Senior Nursing Staff Paramedical Officers in Charge Administrative Staff

representative Director Public Health Public Health OICs Statistics

Other Department Representatives: Planning Information Communication

Technology Registrar Births and Deaths Education Sport Border Control Government Information Office Human Resources Aid Management Unit

A draft agenda should also be provided to the workshop participants to provide them with an understanding of the topics that will be covered. The letter of invitation should provide the participants with an understanding of why the workshop is being conducted. An example of the invitation and agenda is provided in appendix C.

The CT may find that during the activities in section 1.1 that they wish to explore information further with specific stakeholders. Likewise, if external facilitators are providing


assistance for the workshop, they may wish to explore information further with key stakeholders. Therefore, prior to the workshop the CT should ensure they allocate at least a day to hold discussions with key stakeholders. For example, meeting with the Registrar of Births, Deaths and Marriages or planning or aid agency representatives.

2.2 Introduction and Understanding HIS concepts

It is important that all of the participants have an understanding of what is meant by HIS. As such, following introductions and other necessary formalities the CT (or facilitators) should do a brief presentation of the concepts.

During this presentation the CT will also provide a brief summary of the process that has been undertaken to date to draw together the various documents.

2.3 Building consensus in HIS priorities

The purpose of this step is to ensure that you have identified all of the existing issues with the current HIS. The workshop participants should begin by discussing the contents of Table 1.1 and consensus needs to be reached on the priorities listed on this document. If further issues/priorities are identified during this discussion then they should be added to Table 1.1.For each issue, the group should provide a criticality level. That is, they should determine “how serious” the issue is. The group should categorise the issues as either High, Medium or Low importance in the appropriate column on Table 1. This process will assist in later steps to determine the sequence of activities in the strategic plan.

2.4 Developing a vision

This step involves developing a vision for the HIS for the country. It is important to ensure that the vision for the HIS aligns with the vision for the MOH and the country as a whole.A vision statement is a declaration of a shared sense of purpose. It expresses your ideas about what your HIS will be like in two years time, or in ten years time … or any time in the future.

A shared vision is an important element within your whole of country approach to HIS. It will have implications for how your HIS is organised and the roles that are played by people within the health sector.

In developing the vision you need to consider the following question to help drive the discussion:

What would you like the HIS to become or develop into over the next three to five years?

To develop a vision statement:1. The first step, is to brainstorm a series of words that describe where you want the

HIS to be in the next three to five years. Don’t try and over think the exercise – just brainstorm ideas – no idea/thought is right or wrong.

2. If time permits, break up into groups and each group should then attempt to develop a vision statement using the summary list as a starting point.


3. Bring the groups back together to present their statement. From there the group should attempt to draw together the key concepts of a vision statement based on what has been produced by the individual groups.

Vision statements are generally not developed in a short period of time. If time is an issue and the workshop is only being conducted for one day, then you may only be able to achieve step 1 above. As such, the words can be agreed to and a draft statement can be developed in coming weeks.

Example statements:To assist in developing the statements, you may want to refer to page 89 Appendix II.A1 of Guidance for the Health Information Systems (HIS) Strategic Planning Process. This appendix contains example vision statements.

2.5 Identifying goals

The purpose of this step is to take the gaps or issues identified in section 2.3 and begin to think about how to progress to the new environment. In this step the group will be thinking about what it is they want to achieve in 3-5 years with the new environment. That is, what are the goals they want to reach with the new HIS.

The first step is to review Table 1.1 which outlines the existing HIS. To assist this process you may want to consider the following examples:

Example 1: In the current system there is “inaccurate counting” of patient episodes. In the new system you would want to have easily retrievable accurate statistics on patient episodes. Example 2: Currently, medical record staff have minimal skills in the use of technology (e.g. computers). In the new environment you want medical record staff competent in data entry, editing, analysis and reporting, using the available technology.

An analysis of the Priority and Criticality columns in table 1.1 will assist in determining significant areas of focus.

Once all of the goals have been identified by the group and consensus has been reached, the goals can be recorded in Table 2.1 in the “Goals” column.

2.6 Identification of strategies

The next step is to determine what strategies need to be put in place to achieve the goals determined by the group. In this context, strategies should not just be monetary, it is people, resources, personal and professional commitment.

The process for this step will be to think about the goals you have identified in the previous step. What types of activities do you need to undertake to meet those goals. Essentially, you are identifying a series of components or functions (e.g. a training program for medical record staff – current and future staff) that need to be implemented to meet the


vision for the HIS. What do you need to have in place in order to achieve the desired outcomes? It is essential that you cover all aspects of the HIS – HIS resources, indicators, data sources, data management, information products, dissemination and use. Whilst undertaking this step, you will need to think about how each of the tasks helps achieve the vision.

Use Table 2.1 (see Appendix B) to summarise the thoughts of the group in the “Strategy” column.

Example tasks/activities:To assist in identifying the tasks/activities, you may want to refer to page 79 Table 7.3 (particularly column 1) of Guidance for the Health Information Systems (HIS) Strategic Planning Process.

2.7 Assigning responsibility and timeframes

As with all types of planning, it is important that responsibilities and timeframes be assigned. This helps ensure ownership of the tasks, progression of the task, clarity amongst the group and accountability. The group now need to assign responsibility and realistic completion dates to the appropriate columns in Table 2.1.

It is essential that any tasks that are dependent on another task or consequent to another task are clearly identified. What may assist this planning process is to develop a detailed GANNT chart after the workshop which will allow you to graphically display the dependencies and obtain a clearer picture of what needs to be completed first.

Module 3

3.1 Developing a Strategic Plan

The purpose of the above planning processes is to ensure robust discussion has been undertaken when considering the vision for the future HIS in your country. It also ensures that everyone involved in the HIS is aware of their role in moving forward to achieve the vision for the HIS. The process will also assist in compiling a relevant, realistic strategic plan.Prior to the CT completing the strategic plan, final tasks that need to be undertaken by the group include:

Finalising the vision statement Providing costings for each of the strategies Who has overall responsibility for the strategic plan? How will the plan be monitored?

The CT can now progress with completing the strategic plan using Appendix III.E of Guidance for the Health Information Systems (HIS) Strategic Planning Process as a guide to the content that should be included in the final document. Table 2.1 should be included as an appendix to the final strategic plan. Ensure you have included information in the document on the background to the development of the plan including the process undertaken to develop the plan.


Once this document is finalised, it should be sent to all key stakeholders for comment and endorsement.


APPENDIX A – DATA FLOW FOR HIS OF COUNTRY XSource: Developing Health Management Information Systems: A practical guide for developing countries (WHO, 2004)


Departments

Institutes/Centres Central Hospitals

Dispensaries/Village Health Centres

Units/Programmes of the Provincial Health

Service

Units/Programmes of the District Health Service District Health Service

Statistical Unit

Provincial Health Service

Central Health Statistical Unit

Minister of Health 1

1

1

1

1

1

1 2

2

2

2

2Basic health indicators; demographic; morbidity and mortality data; data from multipurpose surveys

1Health services data; epidemiologic surveillance; manpower and finance; other services

Reports

Feedback

APPENDIX B - PLANNING TABLESTable 1.1 HIS priorities and issues of concernNo. Issue Impact Criticality2

Table 2.1 Goals and Strategies

2 Rank each Issue as either High, Medium or Low criticality


No. Goal Strategy Responsibility TimeframeOfficer Office Start

(mth/yr)Complete (mth/yr)


APPENDIX C - EXAMPLE AGENDA AND INVITATION LETTER

Sample Invitation LetterDear XXXX, The Department /Ministry of Health invites you or your representatives to attend a workshop to assist in planning a Health Information System for [INSERT COUNTRY NAME]. The Workshop will be conducted by [INSERT NAME OF FIRST FACILITATOR] and [INSERT NAME OF FIRST FACILITATOR] from the [INSERT NAME OF ORGANISATION THEY ARE REPRESENTING], who have been invited by the Government of [INSERT COUNTRY NAME] to provide guidance in the design and implementation of a Health Information System for [INSERT COUNTRY NAME]. They have asked that the broadest representation of Health Professionals; Government Departments with any relationship to health information and community leaders be present at this Workshop. The Workshop will be held on [INSERT DAY DATE] at the [INSERT LOCATION] from 8.30am to 4.00pm. Lunch will be provided on Wednesday. It would be appreciated if you could advise how many people from your Department will be attending. Regards,

[INSERT NAME OF CT CHAIRMAN]


Appendix D: Sample Workshop Agenda

Planning Workshop 1 Introductions and Purpose 2 Review of work to date3 Building consensus4 Developing a vision5 Bridge Building6 Investment identification 7 Wrap up and where to from here


rapid assessment and Strategic planning Process (RAsPp) · Web viewrapid assessment and Strategic planning Process (RAsPp) Purpose. The following document provides you with a copy

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