REGIONAL COMMITTEE Fifty-ninth Session Dhaka, Bangladesh
Provisional Agenda item 16 SEA/RC59/18 (Rev.1) 20 July 2006
22-25 August 2006
HEALTH INFORMATION SYSTEM DEVELOPMENT RELATING TO MILLENNIUM DEVELOPMENT GOALS (MDGs) AND HEALTH METRICS NETWORK (HMN)
This paper describes the current situation prevailing in the South-East Asia (SEA) Region with regard to Health Information Systems, as well as efforts being made to strengthen it in Member countries of the Region. It brings out the main issues and challenges which are common to several countries of the Region. A brief summary of the “Conceptual Framework of the SEA Region’s
Strategic Plan for strengthening Health Information Systems” is also presented. The paper is submitted to the Regional Committee for its review and
comments.
Contents Introduction.................................................................................................... 1 Reviewing HIS situation in Member countries of the SEA Region: Issues and challenges...................................................................................................... 2 Resources for HIS .................................................................................................................2 Core indicators .....................................................................................................................2 Data sources .........................................................................................................................2 Data management ................................................................................................................3 Information products ...........................................................................................................3 Dissemination and use .........................................................................................................4
Proposed strategic plan for strengthening health information systems in WHO, South-East Asia Region.................................................................................... 4 Goal ......................................................................................................................................5 Objectives .............................................................................................................................5 Strategies ..............................................................................................................................5
The way forward.............................................................................................. 6
Annex – Matrix of HIS Strategic Framework ........................................................ 8
Introduction 1. development and implementation, and a prerequisite for strategic decisionmaking. Currently, the capacity of countries in the South-East Asia (SEA) Region to specific programme areas. In some countries, there is an “information paradox”, information gaps. They not only have the least information but also limited capacity (skills, systems) to generate, analyse, present and information. The current thrust of regional offices of WHO on health outcomes is therefore being used as an opportunity to strengthen the existing HIS. 2. For the last several years, WHO, together with Member countries of the SEA generate and use health information is often focused exclusively on diseasei.e. countries with the greatest health burden and needs have the biggest disseminate A strong health information system (HIS) is essential for sound programme
Region has undertaken activities to strengthen HIS in countries and has contributed to improving morbidity and mortality statistics. An intercountry consultation on strengthening HIS, held in 2001, finalized the generic protocol for monitoring and country reviews of health information systems were conducted and summarized in
evaluation of HIS in countries. During 2002 and 2003, based on this protocol, a draft regional framework paper. In addition, during 2002, vital registration transformation of data into information for evidence-based decision-making was
reviews were conducted in some countries of the Region. The issue of addressed at a Workshop on Data Management for Evidence-based Decisionmaking, held in 2001. In 2003, the WHO Regional Office for South-East Asia organized a Regional Consultation on Reporting on Data Sets on United Nations Millennium Development Goals and WHO Core Health Indicators, to discuss the process and mechanism at country level for data collection, collating and reporting. In September 2004, the regional progress achieved towards the Meeting. Collaboration with WHO’s Western Pacific Region resulted in the development of a bi-regional framework for strengthening HIS in Asia and the Pacific. The Health Metrics Network (HMN) was launched during the World Health
Millennium Development Goals (MDGs) was discussed at the Health Ministers’
Assembly 2005 and, since then, a debate on how to integrate tools and methods
for health measurement and to build partnership in health information (World Information staff from all WHO regions and headquarters regarding database of
Health Statistics / Health System Metrics) has continued. A meeting of Health core health indicators was held and the basic indicator sets proposed. In December
2005, an Intercountry Consultative Meeting on Strengthening Health Information
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Systems in the South-East Asia Region was held where the Regional Strategy for Strengthening Health Information Systems was finalized.
Reviewing HIS situation in Member countries of the SEA Region: Issues and challenges 3. sound data. The role of HIS is to collect, analyse and disseminate such data. In Public health decision making depends critically on the timely availability of
practice, however, health information systems rarely function systematically. They are often fragmented and unresponsive to user needs. This is largely due to the fact that insufficient attention has been paid to country capacity-building in this needed to monitor progress towards achieveme nt of MDGs. 4. Member countries of the SEA Region. These are as follows:
area. The result is apparent in the inability of most countries to assimilate the data The main issues and challenges in strengthening HIS are common to several
Resources for HIS (a) While Ministries of Health (MoH) in countries of the Region have health information teams to directly or indirectly oversee the operations of health-related data recording and reporting mechanisms established in the country, several countries still lack sufficient capacity, both in terms of human and other resources (i.e. financial support and information and communication technology facilities) for HIS. The existing human resources are not sufficiently trained for applying the latest analytical tools and methods to synthesize information for decision-making; (b) Lack of comprehensive HIS policy, and inadequacy of relevant legislation, regulations and guidelines for HIS, and (c) Inadequate coordination between MoH and different ministries including lack of coordination among donors and international agencies, and between them and MoH.
Core indicators 5. There is a need to revisit the core health indicators, particularly the defined dataset at all levels.
Data sources
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(a) Data collection systems are overloaded with details which may not be required for policy formulation or decision-making; (b) Disaggregated dat a are often not available in the form required by programme managers for day-to-day decision-making at the point of delivery of health services; (c) Health information systems are not well equipped for emergency preparedness and vulnerability reduction. Therefore, these are not responsive enough to help contain natural disasters and emergencies; (d) Member countries need to improve or to strengthen Vital Registration, and (e) Other challenges include inadequate HIS coverage of public and private sectors - resulting fro m inability to access data from the private sector,
and Non-governmental Organizations (NGOs) - and weak coordination and linkage between different information sources and systems, e.g., service statistics and survey based data.
Data management 6. management. These are: Several countries have listed problems being faced by them in data (a) Weak linkage in data transmission from one level to the next. Some countries still use a manual system which suffers from a lack of standardization in record–keeping; this causes problems in data transmission and analysis;
(b) Weak feedback mechanisms; (c) Appropriate tools for transforming data into information for decisionmaking are not always applied properly; (d) Inadequate data processing capacity at all levels, and (e) Lack of policy/guideline on data storage and non availability of a data dictionary.
Information products (a) Data are often unreliable, incomplete or not available on time; (b) Poor data quality especially that relates to the cause of death, and misclassification of causes of mortality inadequate data quality control mechanisms; and morbidity, including
(c) Inadequacy of specific information, such as on poor population, gender and marginalized groups and on other disaggregated data.
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Dissemination and use 7. Countries have not been able to use HIS data effectively for policy debate and decision-making due to: (a) Required data are not available timely. Often, these are incomplete and thus not usable for evidence-based action; analytical thinking; (b) Absence of an organizational culture which values and encourages (c) National HIS are often found to be inadequately equipped with regard to appropriate tools and techniques of data analysis; (d) Very limited extent of data utilization at lower levels, especially less
utilization of data from external sources, and their weak dissemination, and
(e) Inadequate capacity for data analysis, synthesis and use at the local level.
Proposed strategic plan for strengthening health information systems in WHO, South-East Asia Region 8. The Conceptual Framework of strengthening HIS is mentioned below. the SEA Region’s Strategic Plan for
Conceptual Framework of the SEA Region’s Strategic Plan for HIS STRENGTHEN DATA COLLECTION AND UTILIZATION IN DECENTRALIZED SYSTEMS POLICY DEVELOPMENT, REGULATION AND LEGISLATION ON HIS RELATED AREAS
ENHANCED COMMUNICATION, COOPERATION AND COORDINATION
DATA DISSEMINATION
DATA ELEMENTS SYSTEM ANALYSIS ( DESIGN AND MAINTENANCE )
CAPACITY BUILDING FOR DATA SHARING AND UTILIZATION
DATA UTILIZATION
HEALTH INFORMATION HEALTH SYSTEMS DATA SOURCE
HEALTH DATA ANALYSIS EFFECTIVE MARKETING OF HIS PRODUCTS
DATA QUALITY DEVELOPMENT AND ALLOCATION OF RESOURCES (HUMAN, PHYSICAL, FINANCIAL)
DATA PROCESSIING
DATA FLOW
PROMOTION OF DATA QUALITY
APPROPRIATE APPLICATION OF ICT
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9.
The matrix of HIS Strategic Framework in the South-East Asia Region is
provided in the A nnex. It consists of actions and initiatives proposed for each monitoring the implementation of the Strategic Framework at the regional level.
strategic area, possible areas of WHO and donor assistance and indicators for
Goal 10. To improve the availability, quality and use of health information for improved efficiency and effectiveness of health programmes.
Objectives (a) To validate, analyse and disseminate information on the regional health situation and trends; (b) To support countries in their efforts to enhance national capacity and capability in health planning and management by strengthening country health information systems, and effective health policies based on sound evidence.
(c) To provide support to countries for the development of efficient and
Strategies 11. In order to achieve the goal and objectives, the Regional HIS Strategic Plan consists of nine strategic areas as follows: (a) Policy development, regulation and legislation on HIS - related issues (Advocacy for policies and regulatory mechanisms for different HIS-related activities viz. data collection from the private health sector, vital registration, release of public information, and use of electronic medical records, etc.); (b) Health information design/set-up and maintenance (Periodic assessment of HIS sub-systems and linkages, review of minimum essential datasets for core and other indicators); (c) Development and allocation of HIS resources (Advocacy for adequate financial and human resources, capacity building, and opportunities and incentives for career development for HIS staff); (d) Appropriate application of ICT
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(Provision of adequate hardware, software and other ICT infrastructure); (e) Promotion of data quality (Data quality standards, control mechanisms, instruction manuals, trainings and incentives); (f) Effective marketing of HIS products (Analysis of changing needs of data users, regular publication of annual health bulletins and health system profiles, and developing and keeping the MoH website updated); (g) Strengthening of data sharing, analysis and utilization at all levels (Develop/strengthen mechanisms to facilitate vertical and horizontal transmission of data/information within the MoH, establish/enhance an
integrated health database/data warehouse, strengthen analytical capability of HIS staff to synthesize and produce data-based evidence, conduct training on utilization of the evidence for programme planning, management, policy debate and decisions); (h) Enhancement of mechanisms for effective communication, cooperation and coordination (Advocacy for develo pment and implementation of mechanisms for partnership with stakeholders, and develop/enhance strategies for effective communication between data providers and data users at all levels, including the provision of feedback mechanisms), and (i) Strengthen data collection and utilization in decentralized systems (District-level data, their management, and complete and timely transmission to provincial and national levels under a decentralized system). 12. For details of strategic areas and required actions, please see the Annex.
The way forward 13. The Regional Strategy for Strengthening Health Information Systems in countries of the SEA Region, 2006-2015, was formulated and discussed with HIS focal points and National Statistical Offices in December 2005 and will be printed and distributed shortly. It gives the countries generic guidance in drawing up their action plans for further strengthening country health information systems. This is
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the first consolidated strategy which has replaced fragmented approaches taken by countries and their partners in health development in the area of HIS. 14. Since the HMN as a partnership platform was launched in 2005, this strategic approach has facilitated harmonization of all efforts related to strengthening countries' health information. Many Member countries indicated their interest in seeking HMN support for a comprehensive review of their national assessment of HIS to five countries in the region, namely Bangladesh, Bhutan, Indonesia, Myanmar and Timor-Leste. 15. A brochure on Datasets on Core Health Indicators, by country, was published. It covered the years 2000, 2002, 2004 and 2005. Similarly, Datasets on UN MDGs, by country, have been published covering the years 2002, 2004 and 2005 along with baseline data for 1990. 16. Since the Regional Consultation held in 2003 on Datasets on MDGs and the discussion at the Health Ministers’ Meeting (HMM) 2004 on progress made in achieving the MDGs, the Regional Office has been working closely with country offices and UN country teams in each country, providing operational definitions of MDG indicators/sub-indicators, and in facilitating collection of disaggregated data national / sub-national levels. to help in tracking progress and measuring achievements with regard to MDGs at HIS. This year, HMN has provided catalytic support for a comprehensive
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Annex
Matrix of HIS Strategic Framework Strategic area Actions and initiatives Possible areas of WHO/donor assistance Advocacy with governments in general, and health ministries in particular for greater political will and resource allocation for HIS development and strengthening. 1.2 Develop policies on HIS-related Technical support in the issues (IT policy, release of development of HISpublic information, confidentiality of medical records, electronic exchange of information, etc.). related policies. Number of countries which have developed and implemented policies on important HIS-related issues. Indicator Number of countries which have increased resource allocation for activities related to HIS development and strengthening.
1. Policy 1.1 Advocate for HIS to be given development, higher global and national regulation priority. and legislation on HIS-related issues.
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Strategic area
Actions and initiatives 1.3 Provide/ strengthen the legal basis and define regulatory mechanisms for different HISrelated activities (example, data collection from the private health sector, vital registration system, release of public information, and use of electronic medical records, etc.).
Possible areas of WHO/donor assistance
Indicator
• Advocacy with countries • Number of countries in the development of important HIS-related legislation, like those related to vital registration systems, collection of private health sector data, etc. • Technical support in the formulation/ development of legislation, regulatory mechanisms and operational guidelines for HIS-related issues. • Financial support for regulatory mechanisms and operational guidelines for HISrelated activities (example, reproduction of manuals, etc.). which have passed legislation related to HIS. • Number of countries which have developed and disseminated operational guidelines for different HISrelated legislation and policies.
1.4 Develop and implement operational guidelines for HISrelated policies, regulations and legislation.
• Technical support in the • Number of countries development of which have developed operational guidelines. operational guidelines for HIS-related policies, regulations and legislation.
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Strategic area
Actions and initiatives 1.5 Advocate for more rigid/stricter implementation of HIS-related legislation and policies.
Possible areas of WHO/donor assistance Financial support for the conduct of meetings and seminars for heightening
Indicator Number of countries which showed improvements in HIS
awareness on the need for performance as a result strict and rigid of stricter implementation implementation of HISrelated legislation and policies. of HIS-related legislation and policies (example, increase in the percentage completeness of birth and death registration; increase in the percentage coverage of reporting notifiable diseases by private physicians, etc.
2. System analysis (Health information system design/setup and maintenance)
2.1 Conduct periodic, in-depth and Technical support for the comprehensive assessment of HIS and its sub-systems. 2.2 Develop and implement systematic plans for HIS development and strengthening (HIS masterplan for the country; IT masterplan; short-term HIS action plans; HIS strategic plans etc.), including well-defined resource allocation. 2.3 Identification/periodic review of minimum essential datasets and core health indicators to be used and shared by different programmes within and outside of the MoH, and to meet international reporting requirements (example, MDG). Financial support for the conduct of national workshops to identify/review minimum essential datasets and core health indicators. conduct of HIS assessment studies.
Number of countries conducting periodic, comprehensive and indepth HIS assessment.
Provision of technical Number of countries support in the preparation which have developed HIS of HIS masterplans/ strategic plans. strategic plans.
Number of countries which have systematically identified and collected minimum essential datasets, and are regularly generating core health indicators, including those needed for international reporting requirements (example, MDGs).
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Strategic area
Actions and initiatives 2.4 Link and harmonize different information systems and subsystems among programmes and other units within the MoH. • •
Possible areas of WHO/donor assistance Technical support for the development/ strengthening of HIS sub-systems. Technical support for the development/ strengthening of a harmonized HIS. • Financial and technical support for the conduct of training activities on harmonized HIS. • Financial and technical support for the pilottesting, evaluation, modification and finalization of design of the harmonized HIS, prior to nationwide implementation.
Indicator Number of countries with the following HIS subsystems in place: vital registration system; hospital information system; disease surveillance systems (for both communicable and noncommunicable diseases); finance, health facilities and equipment, and human resource information systems. Number of countries which have developed/ designed, pilot-tested, evaluated, and implemented a harmonized HIS.
2.5 Develop linkage with/access to routinely produced healthrelated database collected/
Advocate for the establishment of intersectoral linkages to
Number of countries in which the MoH have established linkages with other agencies like the National Statistics Office, and Ministry of Finance, etc. for the sharing of health and health-related information.
generated by agencies/ entities facilitate access to and outside of the MoH (vital sharing of information registration system, population with external agencies data from the Census Office, collecting health and private health sector, national health accounts, health insurance, socio-economic data, etc.). health-related data.
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Strategic area
Actions and initiatives
Possible areas of WHO/donor assistance support for staff training on research methodologies (example, sampling designs, and development of data collection tools, etc.). • Financial and technical support for the conduct of research and special studies. • Technical support in the development of maintenance plans. • Financial support for the improvement of physical facilities; upgrading and replacement of computer software and hardware. •
Indicator Number of countries which have institutionalized the conduct of research and special studies to supplement routine data collection (example, number of countries which conduct a national health survey every 5/10 years, etc).
2.6 Develop/strengthen capacity to • Financial and technical conduct on a periodic basis, research and special studies to supplement routine data collection systems (example, National Health Survey, Demographic and Health Survey, Sample Registration System, and Collection of Biomarkers, etc.).
2.7 Develop/strengthen/implement maintenance plan for HISrelated resources (improvement and maintenance of physical facilities; upgrading and replacement of computer hardware and software, etc.).
•
Number of countries which have developed, documented and disseminated maintenance plans for HIS-related resources. Number of countries which have regular budgetary allocation for the implementtation of the maintenance plan for HIS resources.
•
Number of countries which have implemented activities in accordance with the maintenance plan (example, number of computers upgraded/ replaced using country maintenance budget, etc.).
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Strategic area
Actions and initiatives 2.8 Develop/enhance mechanisms for active involvement of different stakeholders in undertaking management functions for HIS (provide general directions; standardization of system inputs and outputs; clearinghouse for data collection forms; periodic and regular review of data requirements, and periodic HIS performance assessment, etc.). 2.9 Develop and disseminate User’s Manuals for HIS and its sub-systems.
Possible areas of WHO/donor assistance in eliciting active stakeholder involvement in HIS management. • Technical support in developing effective mechanisms and defining management functions for HIS.
Indicator
• Advocacy with countries Number of countries which have developed functional mechanisms for stakeholder involvement in HIS management (example, number of countries with a functional multisectoral national HIS Committee).
• Technical support in the Number of countries preparation of the HIS which have developed, User’s Manual. • Financial support for the production/publication of the HIS User’s Manual. reproduced and disseminated their HIS User’s Manual.
3 Development 3.1 Advocate for stronger and allocation development and greater of HIS allocation of HIS resources: resources (I) Strengthening of the HIS (human, work- force; physical, (II) Greater budgetary financial). allocation for HIS-related activities and needs, and (III) Improvement of HIS-related facilities, including ICT. 3.2 Assess/review HIS human resource requirements at different levels in both public and private sectors (number and type of staff needed; job descriptions, staff qualifications, etc.) and implement corrective measures as needed.
Advocacy with governments for greater allocation of resources for HIS-related activities.
Number of countries which have increased their resource allocation for HIS-related activities.
Technical and financial support for the conduct of HIS human resource assessment at different levels.
Number of countries which have conducted an assessment of their HIS human resource requirements at different levels.
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Strategic area
Actions and initiatives 3.3 Develop/enhance and implement career development plan for HIS workforce (development of career path; provision of benefits and incentives, etc.).
Possible areas of WHO/donor assistance Advocacy for countries to develop career development plans for the HIS workforce.
Indicator Number of countries which have developed and implemented career development plans for the HIS work- force (example, number of HIS positions created; number of countries which have developed and allocated budget for the implementtation of incentive schemes for HIS staff, etc.). • Number of fellows trained on health information sciences and related fields, by type of training and country. • Number of in-country short-term non-degree training courses on health information sciences and related areas conducted, by country.
3.4 Develop and implement training • Financial support for programme on health long/short-term fellowinformation sciences and ships (both degree and related fields (Biostatistics, non-degree, local and Epidemiology, Demography, abroad) for training on etc.) and other forms of health information specialized training for data sciences. providers and data users at all • Financial and technical levels. support for the development of training materials to be used for local training on health information sciences. • Financial and technical support for the conduct of in-country short-term non-degree training on health information sciences and related fields. 3.5 Assess/improve HIS-related physical facilities (example, storage space for medical records, computer room, etc.). 3.6 Allocate funds for HIS-related activities, including the conduct of special studies and sampler surveys. Financial support for improvement of HISrelated physical facilities.
Number of countries which have implemented improvement projects for HIS-related physical facilities. Number of countries which have regular allocations in their country health budgets for HIS-related activities.
Advocacy for regular allocation of funds from the country health budget, for HIS-related activities.
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Strategic area
Actions and initiatives 3.7 Resource sharing for HIS development, strengthening and maintenance by units within the MoH, donor agencies, private organizations and NGOs.
Possible areas of WHO/donor assistance Advocacy with countries and donor agencies for the adoption of resourcesharing mechanism for HIS development and maintenance.
Indicator Number of countries which have implemented a resource-sharing mechanism among units within the MoH and among donors, for HIS development and maintenance. Number of countries which have strengthened communication facilities for the rapid transmission and access of data from the peripheral to higher levels. Number of countries with computerized HIS at national and sub-national levels.
4 Appropriate
4.1 Strengthen capacity to transmit, access and share application of information at different levels information as well as between MoH and and other public health and healthcommunicati related institutions. on 4.1.1 Conduct needs technology assessment. (ICT). 4.1.2 Provide computer hardware, software and other information infrastructure (email and internet access, networking, eHealth, etc.) at appropriate levels.
• Financial support for procurement/installatio n of communication equipment/ infrastructure necessary for the rapid transmission and access of data from the peripheral to higher levels (radios, fax machines, modems, etc.). • Technical support for the assessment and design of ICT inputs appropriate for the country. • Financial support for the procurement/ provision of computer hardware, software and other information infrastructure.
4.2 Expand IT application (Geographic Information System (GIS), Service Availability Mapping (SAM), etc.).
• Technical and financial Number of countries support for staff training applying GIS, SAM, etc. as on expanded IT applica- part of their HIS. tion (GIS, SAM, etc.). • Financial support for the procurement of software and equipment necessary for expanded IT application (example, GIS software, PDAs, etc.).
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Strategic area
Actions and initiatives 4.3 Develop and implement training programme on IT for HIS staff at different levels.
Possible areas of WHO/donor assistance Financial and technical support for the development and conduct of training programme on IT for HIS staff at different levels.
Indicator Number of countries which have developed and conducted training programme on IT for HIS staff at different levels. Number of countries which have coordinated donor requirements, especially in relation to specialized software. Number of countries which have developed/strengthened their policies and legal framework for the vital registration system. Number of countries which have developed, documented and disseminated data quality standards and data quality control mechanisms.
4.4 Coordinate donor requirements, especially in relation to the use of specialized softwares. 5 Promotion of data quality. 5.1 Strengthen policy and legal framework for vital registration systems.
Establish mechanisms for the coordination of donor requirements.
Advocacy with countries for the development of policies/legislation for the establishment/ strengthening of the vital registration system.
5.2 Develop, document, disseminate and implement data quality standards and data quality control mechanisms (example, completeness of medical records, and use of ICD).
• Technical support for the development of data quality standards and data quality control mechanisms. • Financial support for the documentation, reproduction and dissemination of data quality standards and data quality control mechanisms.
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Strategic area
Actions and initiatives 5.3 Produce and disseminate documents (Instruction Manuals, ICD Manual, Data Dictionary, etc.) which can be used as reference materials by staff in accomplishing data collection and reporting requirements.
Possible areas of WHO/donor assistance • Technical support for the development of reference materials (Instruction Manuals, Data Dictionary, etc.), including translation services if necessary. • Financial support for the reproduction/purchase and dissemination/ distribution of reference materials (example, ICD10 Manual).
Indicator Number of countries which have developed, reproduced and disseminated reference materials (Data Dictionary, Instruction Manuals, etc.) for HIS staff in accomplishing data collection and data reporting requirements.
5.4 Develop/strengthen capacity of • Technical support for surveillance and early warning systems to produce real-time data, especially during disease outbreaks, epidemics and disasters. the design and development of early warning and rapid surveillance systems. • Financial support for the installation of communication and other facilities needed for the rapid transmission and easy access to data. • Technical and financial support for staff training on early warning/ surveillance systems.
Number of countries with functional surveillance and early warning systems in place.
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Strategic area
Actions and initiatives 5.5 Provide staff training on data quality, including the use of ICD and other international classification systems, the vital registration system and
Possible areas of WHO/donor assistance • Financial and technical support for the conduct of training on data quality, including ICD training.
Indicator Number of ICD trainings conducted, by country and type of staff trained.
international health regulations • Financial support for (IHR). the purchase and distribution of ICD Manuals. 5.6 Design and implement a regular and institutionalized system for the monitoring and evaluation of data quality at all levels. • Technical support for the design and development of an institutionalized system for monitoring and evaluation of data quality at all levels, including the development and documentation of operational guidelines for such a system. • Financial and technical support for training on the implementation of institutionalized system for monitoring and evaluation of data quality at all levels. 5.7 Conduct special studies in situations where data collection and data quality are big problems (e.g. sentinel surveillance system, sample vital registration system, etc.). • Technical and financial support for the conduct of special studies. • Number of countries conducting special studies to determine data quality. • Number of countries which have developed an institutionalized system for the monitoring and evaluation of data quality at all levels. • Number of countries which have allocated budget for activities related to the monitoring and evaluation of data quality control at all levels.
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Strategic area
Actions and initiatives
Possible areas of WHO/donor assistance the planning and design of linkages with other institutions to improve the coverage and timely transmission of data.
Indicator • Number of countries wherein the MoH have established linkages with other institutions to improve the coverage and timely transmission of information for vital registration and disease surveillance systems.
5.8 Establish linkages with relevant • Technical support for institutions to improve the coverage and timely transmission of information for the vital registration and disease surveillance systems.
5.9 Conduct activities to heighten community awareness on the need for birth and death registration.
• Technical and financial support for the implementation of activities to heighten public awareness on birth and death registration.
• Number of countries which have conducted activities to heighten public awareness on the need for birth and death registration. • Number of countries providing incentives for the collection and reporting of good quality health information.
5.10
Provide incentives for the
• Financial support for the provision of incentives.
collection and reporting of good quality data.
6 Effective marketing of HIS products.
6.1 Conduct needs assessment and Technical and financial situational analysis for the marketing of HIS products.
Number of countries
support for the conduct of which have conducted needs assessment and needs assessment and situational analysis for the situational analysis for marketing of HIS the marketing of HIS products. products. Number of countries implementing marketing strategies for HIS products. Financial support for the implementation of activities aimed to create awareness of HIS products.
6.2 Increase awareness of data users (both within and outside of MoH) on HIS products (types of health information available, how they can be accessed, etc.), using the services of a professional for the marketing of such products, as needed.
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Strategic area
Actions and initiatives 6.3 Regularly publish integrated HIS summary reports covering the core health indicators, including the MDGs (example, Annual Health Bulletins, Health System Profiles, etc.). 6.4 Improve the quality and content of HIS-related reports and publications.
Possible areas of WHO/donor assistance Technical and financial support for the preparation, publication and distribution of integrated HIS summary reports. • Technical support in improving the quality and content of HIS reports (undertaking comparative analysis, inclusion of analytic write-ups, including data and analysis on topics of current interest, etc.). • Financial support for the publication and distribution of analytic reports.
Indicator Number of countries which regularly publish integrated HIS summary reports.
Number of countries with regular HIS publications which include not only presentations (graphs and tables) but also critical analysis of data.
6.5 Increase the types/modes, coverage and frequency of dissemination of HIS products for all types of audience, from the general public to policymakers and national government officials (Members of the Cabinet, Parliament, etc.), and the international community.
• technical and financial support for the design and development of different modes of dissemination of HIS products appropriate for different types of audience and users. • Financial support for the reproduction and distribution/ conduct of different kinds of dissemination materials/ activities.
Number and types of dissemination materials/ activities for HIS products developed/ implemented by countries.
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Strategic area
Actions and initiatives 6.6 Develop, maintain and market the MoH website.
Possible areas of WHO/donor assistance Technical and financial support for the development, maintenance and marketing of the MoH website.
Indicator • Number of countries which have developed, maintained and marketed the MoH website. • Number of countries posting updated health information on the MoH website.
7 Strengthening 7.1 Develop/strengthen of data sharing, analysis and utilization at all levels. mechanisms to facilitate vertical and horizontal transmission of information within the MoH.
Technical and financial
Number of countries
support for the design and which have developed installation of mechanisms and implemented to facilitate easy mechanisms to facilitate access/sharing/interfacing easy access/sharing/ of databases among interfacing of database different information sub- among different systems within the MoH (example, LAN for computerized systems). information sub-systems within the MoH. Number of countries where the MoH has established linkages with local and international institutions for the exchange and sharing of health and health-related data.
7.2 Provide/facilitate access to relevant external data sources, both local and international (Memorandum of Agreement with other agencies for the exchange and sharing of data; creation of/membership in multi-sectoral technical working groups; membership in local and international health information networks, etc.). 7.3 Establish/enhance an integrated health database or “data warehouse” at national and sub-national (region, province, district, sub-district) levels.
Advocacy for the establishment of linkages between the MoH and other local and international institutions for the exchange and sharing of health and health-related data.
Technical and financial
Number of countries
support for the design and which have development/ established/enhanced a enhancement of a health “data warehouse” at national and sub-national levels. health “data warehouse” at national and subnational levels.
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Strategic area
Actions and initiatives 7.4 Develop country-level capability for data analysis and the application of methodologies to address data problems (example, use of census data to estimate mortality levels; derivation of country-level estimates for important parameters and indicators like the prevalence and incidence of diseases, etc.).
Possible areas of WHO/donor assistance • Study fellowships for training on data analysis (example, Degree and short-term training programmes on biostatistics, demography, etc.). • Financial and technical support for the conduct of short-term nondegree training on quantitative methods in the Region and in countries. Technical support for the application of appropriate data analysis techniques to address specific areas of interest to data users.
Indicator • Number of study fellowships awarded to countries. • Number of training programmes on quantitative methods conducted in the Region and in countries.
7.5 Develop/apply appropriate data analysis techniques to address specific areas of interest to data users (example, generation of specific morbidity and mortality rates according to geographic (by region, province, etc.) and demographic variables (by age, sex, cause), time series analysis for determination of trends, risk factors; gender sensitivity; equity; poverty reduction etc.).
Number of countries producing data or maintaining database in a form amenable to further analysis to address specific areas of interest (example, disaggregated data; time series data, risk factor data etc.).
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Actions and initiatives 7.6 Develop and implement training programmes on data utilization for programme planning, management, monitoring, evaluation, and policy formulation for MoH staff at different levels.
Possible areas of WHO/donor assistance • Technical and financial support for the development and
Indicator Number of countries which have conducted training programmes on
reproduction of training data utilization for materials on data different types of data utilization. • Technical and financial support for the conduct of training programmes on data utilization for different types of data users at different levels. users at different levels.
7.7 Develop mechanisms to facilitate the transmission of essential health information/evidence to policy and law makers, and its transformation into policy and action (example, creation of Technical Working Group, conduct of regular briefings with policy-makers, etc.).
Technical support for the design and development of mechanisms to facilitate transformation of health information/evidence into policy and action.
• Number of countries which have developed mechanisms for the transformation of health information/ evidence into policy and action. • Number of legislations enacted/policies developed/important decisions made based on data from the HIS.
7.8 Provide incentives to government units, organizations, etc. for good performance in utilization of health information for action.
Technical support for the development of operational guidelines for the provision of incentives for good performance in utilizing health information for action. Conduct of activities for the development and implementation of a
• Number of countries which provide incentives for good performance in utilizing health information for action. Development and existence of a harmonization
8 Enhancement of mechanisms for effective communicatio n, cooperation
8.1 Advocate for the development and implementation of a harmonization mechanism among donors at the international level.
harmonization mechanism mechanism among among donors at donors at international international levels. levels.
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Strategic area and coordination.
Actions and initiatives 8.2 Develop and implement a strong country policy on HIS coordination/partnerships among countries, donors, agencies and other stakeholders of the HIS. 8.3 Involve donors and other stakeholders in designing the HIS.
Possible areas of WHO/donor assistance Technical support for the
Indicator Number of countries
development and which have developed implementation of policies and implemented policies on HIS on HIS coordination/partnerships coordination/partnerships among countries, donors and other stakeholders. Financial support for the conduct of activities involving donors and other stakeholders in designing the HIS. among countries, donors and other stakeholders. Number of countries where donors and stakeholders are involved in designing the HIS. Number of countries with operational and effective communication strategies between data users and data providers, including feedback mechanisms. Number of countries with decentralized systems, which have improved data quality at the district level. Number of countries with decentralized systems which have developed mechanisms for complete and timely transmission of data from the district to provincial and national levels.
8.4 Develop/enhance strategies for Technical support in the effective communication between data providers and data users at all levels, including the provision of feedback mechanisms. 9 Strengthen data collection and utilization in decentralized systems. 9.1 Develop and implement mechanisms to improve the quality of district-level data and their complete and timely transmission from the district to provincial and national levels, under a decentralized system. development of strategies for effective communication between data users and data providers, including feedback mechanisms. Technical and financial support for the development and implementation of mechanisms to improve data quality at the district level, and ensure the timely transmission of data from the district to provincial and national levels.
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Strategic area
Actions and initiatives 9.2 Train district-level staff on
Possible areas of WHO/donor assistance Technical and financial
Indicator Number of countries
data analysis and utilization for support for the training of which have trained programme planning, district-level staff on data district-level staff on data monitoring, management and evaluation. analysis and utilization for analysis and utilization. programme planning, monitoring, management and evaluation. 9.3 Develop and implement mechanisms for the proper dissemination of integrated district-level data. Technical and financial support for development and implementation of mechanisms for the proper dissemination of integrated district-level data. Number of countries with decentralized systems which have disseminated integrated district-level data widely.