WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU Rt:GIONAL DU PACIFIQUE OCCIDENTAL
•
ORGANISATION MONDIALE DE LA SANTE
REGIONAL COMMITTEE Thirty-fourth session Manila 5-9 September 1983
WPR/RC34/Technical Discussions/2 6 September 1983 ORIGINAL: ENGLISH
HEALTH MANAGEMENT INFORMATION SYSTEM DEVELOPMENT
1.
INTRODUCTION
The Member States of the World Health Organization decided at the Thirtieth World Health Assembly in 1977 that the main social target of governments and WHO in the coming decades should be the attainment by all citizens of the l4orld by the year 2000 of a level of health that will permit them to lead a socially and economically productive life.l They have been engaged since then in formulating strategies and developing procedures to manage the implementation of those strategies and to achieve the goal within the given time-frame. As organizational and functional modifications to ensure the efficient management and effective achievement of the health development objectives of Member States are introduced, the importance ~f information as an essential ingredient in the decision-making process related to the implementation of policies, strategies and plans of action becpwes obvious. There is thus a need to reorient and develop or strengtherf national health information systems so as to ensure the timely availability of the right kind of reliable information, generated in an efficient way and presented in an understandable format. A national health information system consists of three highly interrelated components: the first is intended to acquire, analyze and provide the information to support the management process within a country, and is generally known as a health management information system (HMIS); the second is intended to collect, store and provide information in the form of technical literature to support the development of new, and the adaptation of existing technologies and methodologies, and is known generally as a biomedical information system (BMIS); and the third is related to the generation or collection and dissemination of information to promote conditions that will help people to "acquire the power to make decisions that have to do with their own health" (IEH). The topic for the technical discussions in conjunctic>n with the thirty-fourth session of the Regional CotlDll.ittee is concerned with health management information system development.
!Resolution WHA30.43. Volume II, 1981, page 1.
WHO
Handbook
of Resolutions
and Decisions,
WPR/RC34/Technical Discussions/2 page 2
2.
DEFINITION AND SCOPE OF HMIS
A management information system is generally defined as the one that collects, processes and communicates data to assist those responsible for the management of resources. As far as the health sector is concerned, a health management information system is aimed at the collection of data and the production and communication of information that can assist health planners and managers in formulating and implementing strategies and monitoring progress in carrying out the measures decided upon; in improving the efficiency with which those measures are carried out; and in facilitating the assessment of their effectiveness and their impact on the health and socioeconomic development of the people.
The scope of the health management information system encompasses information, whether from the health sector or from other related sectors, which is to be used in the management process associated with health programmes and services. It includes the planning, budgeting, monitoring, control, coordination and evaluation aspects of health programme development and management. It provides information for operational management, including information about the use of resources and logistics, as well as information for central planning and policy making. It provides fo.r the use of information by health care workers at the periphery for the maaagement of their own operational units. It does not include technical, professional or clinical information used by health care workers in the care of individual patients. Information about biomedical research and related scientific literature is also excluded as is information specifically for education and training. Conceptually, all information relevant to management, whether the public sector or the private sector, should be included in the health management information system.
3.
OBJECTIVES OF THE HEALTH MANAGEMENT INFORMATION SYSTEM
To support management - planning, programming, budgeting, monitoring, control, coordination and evaluation - of the health system at all levels by: (a) identifying and coordinating all sources of information relevant to the management process and establishing links with other health-related information sources; efficiently acquiring, retrieval), analyzing relevant information; processing (including storage and and ensuring timely provision of
(b)
(c) (d) (e)
promoting training in all aspects of management information system development, especially utilization; working with management to identify changing requirements for health information; contributing to the information system. development of the national health
WPR/RC34/Technical Discussions/2 pa2e 3
4.
PRESENT STATUS OF HEALTH INFORMATION SYSTEMS IN THE REGION!
Based on information available, the regional situation in regard to health information systems can be summarized as follows: 4.1 Organizational aspects
In most countries or areas, there is an identifiable organizational division/unit to provide data and information in support of the planning and management of the health services. Where there is a single identifiable unit/division responsible for health information service functions, two or more units/divi~ions/sections are responsible for one or more components of the health information system2. Because programmes function vertically, so do the health information services. In addition to the units responsible for technical programmes, those responsible for planning, including research, and those responsible for administration/management services, some institutions also provide health information services. The health information service as such appears to be structurally fragmented among different units/sections/divisions of the ministry or department of health in some countries or areas. In most countries or areas, ministries and departments other than health also cater to the needs of the health system. Thus, health data relevant to their functions are analyzed by the ministries and departments dealing with census and statistics, education, labour, environment, family planning, the central statistics system, and national planning and development.
!Based on the Report of the Regional Workshop on National Health Information Systems, World Health Organization Regional Office for the Western Pacific, Kuala Lumpur, Malaysia, 16-25 June 1980, Sec. 2, pp. 3-5. 2tnformation system refers to the methods, materials, media, producers and recipients involved in an organized way to effect information transfer within a specific field, activity or organization and hence consists of a complex collection of information, persons who produce and use it, institutions which process it and a set of behaviour patterns, customs and traditions by which these persons and institutions interrelate. Information service is a service for the regular and ad hoc provision of information. This may take the form of dissemination or-information or information transfer, including a query/answer service. An information service must be backed by at least one information system, and an information system may back several information services.
WPR/RC34/Technical Discussions/2 page 4
4.2
Technical and procedural aspects
Problems associated with data collection, analysis and utilization can be categorized as follows: (a) Problems of data collection There are many gaps in the collection of data, especially on finance and from the private sector. Delays occur in transmitting and collating data due to geographical constraints, organizational limitations and processing. There is a lack of common definition in data collection with associated problems of validity and comparability. Motivation of health workers to provide accurate data is also a problem in spite of the judicious use of legislation to make collection mandatory. In some countries, reliance upon legislation alone is found to be ineffective but some believe it valuable to legitimate requests for data. Data collection there is duplication in an ad hoc way. data. The-y;ck of a basic problem. (b) is not always coordinated. As a consequence and redundancy. Requests for data often arise Together these lead to excessive demands for statistical coordinating agency is seen as a
Problems of analysis Reliance on manual processing limits the potential for analysis. On the other hand, in some countries or areas the introduction of automatic data processing systems has created problems. Information is not always classified in a way which permits analysis in relation to health policy objectives. An example is the need to identify expenditure on urban and rural health services, when it is policy to increase spending in rural areas. Health indicators need to be developed for the analysis of such information.
(c)
Problems of utilization There is general acceptance that a serious problem is the lack of utilization of available information. In addition, in the absence of procedures for compilation and reporting, data although available are not properly used. Lack of analytical capability inhibits the utilization of inform?tion in many cases. It is also possible that tbe utilization of information is directly related to the level of development of the managerial process. This is due to a lack of awareness of the value of information by managers and others involved in decision making. Available information tends to be unrelated to the priorities of managers. There is a lack of coordination of information requirements. Information on services and programmes is often unrelated to financial information.
WPR/RC34/Technical Discussions/2 page 5
(d)
General problems There are also some general problems. Lack of trained staff is a very connnon problem in all aspects of information systems. Another problem is resources devoted to research which does not address high priority health problems or result in information useful for management. Information should satisfy the requirements for comparison over time. In a number of cases, lack of precise definitions, inadequate coverage by the health services, and insufficient intersectoral coordination in data collection has led to unreliability. Efficient procedures taking into account frequency in utilization of these indicators can provide reliable data.
4.3
Health information system development
In seven countries or areas, activities have been initiated to further develop health information systems/services, such as computerized hospital discharge/vital statistics information systems, standard health statistics systems, health reporting systems, use of computer technology to strengthen the health information system, private sector service information, manpower information, centralized management information system development. It seems that the major area for development has been the management information system to provide relevant information for the management of health progrannnes. Ministries and departments of health themselves have been responsible for initiating development activities in this area though the actual scope of these activities covers specific components only. It seems that different units/divisions take the initiative in developing an information system to cater for their progrannne requirements. 4.4 Conclusions
There are health information systems problems in all countries or areas relating to data collection, processing and utilization. There is an important gap between available and needed information on the one hand and available and used information on the other. In some countries, national vital and health statistics committees exist. Through feedback mechanisms, problems are being identified and efforts are being made to solve these problems. However, these efforts are isolated and uncoordinated and lead to duplication and inefficiency. An environment favourable to the development of a more comprehensive health information system exists in many countries. The time seems to be ripe to initiate more systematic approaches to the provision of information for programme development and management.