Imagine: Ensuring No System Is Left Behind

By Brittany Iskarpatyoti, MPH, Technical Specialist in M&E

LIVERPOOL, ENGLAND—One of the subthemes for this year’s Health Systems Research (HSR) conference is “Leaving no one behind: Health systems that deliver for all.” There’s been a global discussion on ensuring access to health for marginalized populations, universal health coverage, gender equity, and the need for an intersectional approach in health systems strengthening. As the thematic description put it, making sure people don’t “slip through the health system safety net.”  

But what if the safety net is worn down, tattered or nonexistent? An emerging topic among presenters and participants here has been addressing health systems in fragile and conflict-affected states. Conflict and forced displacement are disruptive and have complex consequences on health systems. Presenters have discussed the conflict-related challenges in a siloed and disconnected health system, in coordinating resources, and in ensuring coverage during disruption. But one thing I have yet to hear is discussion of the issues regarding health information systems in these contexts.

Health information systems (HIS) are the foundation of a health system. They house the data necessary to inform decision making; they should ensure that data are of high quality and timely. In fragile states where health systems are strained, HIS are also likely to suffer. Entire components of a strong HIS can be compromised or missing. (See the Health Information Systems Strengthening Model: https://www.measureevaluation.org/his-strengthening-resource-center/his-strengthening-model)

Even though the sessions here have not investigated these challenges within HIS, while I’ve been staffing the MEASURE Evaluation information booth at HSR I’ve had the opportunity to talk about HIS strengthening with delegates from various countries. One delegate from South Sudan commented: “Strengthening is great—but there’s an assumption that we have something to strengthen.”

He continued that because of the ongoing civil war in his country, health services are disconnected and health information is spotty, at best. It’s hard to discuss health for all when the systems needed to identify inequities and monitor and evaluate progress towards this goal don’t even exist.

Some available evidence argues that health information can be strongest during system shocks, such as during the Ebola outbreak in West Africa—when funding flowed in to monitor the progression of the epidemic. But vertical systems that are specific to a disease or issue may not be interoperable with existing systems (if other systems exist). Additionally, sustaining systems once global media and development attention has moved on requires shared attention and concerted efforts by both funders and governments. Health information systems aren’t built quickly; they require long-term commitments and a level of self-reliance that some countries may not be able to achieve. But does that mean we shouldn’t try?

Imagine if we worked toward equity of the systems that provide and monitor health, just as we want equity among those who use it.

Can you imagine yourself being part of the dialogue on health information system strengthening? Visit the MEASURE Evaluation HIS Resource Center: https://www.measureevaluation.org/his-strengthening-resource-center; or join the Linked-In group, Improving Health Information Systems at https://www.linkedin.com/groups/13586972/.

We’re talking there, and your voice is welcome.

Brittany Iskarpatyoti talks with delegates about the Health Information Systems Strengthening Resource Center at MEASURE Evaluation’s booth at HSR 2018