The Time is Now for Improving Routine Institution-based Health Information Systems

By Theo Lippeveld, MD, MPH. Robust routine institution-based health information systems generate the relevant data that district managers and care providers need to make decisions that ultimately will lead to sustainable health outcomes in the communities they serve.

By Theo Lippeveld, MD, MPH, MEASURE Evaluation, and Vice President and Senior Health Information Systems Advisor, John Snow International

The crucial role of routine health information systems in improving health service delivery cannot be overstated. As we look to new era of the sustainable development goals, having reliable, routine data will be critical to understanding where gaps in coverage, access, or equity exist and can be improved with the right investments.

Across low and middle income countries, reliable information systems generate the essential data for making evidence-based programming, resource allocation, and policy-making decisions. Robust, routine, institution-based health information systems (RIBHIS) not only report quality data to national and international policy makers, but most importantly generate the relevant data that district managers and care providers need to make decisions that ultimately will lead to sustainable health outcomes in the communities they serve.

RIBHIS are the main source of information on health services and resources. Facility and community level data collected through these systems are available on a continuing basis and for the lowest service delivery levels. These data are a critical source of information for local decision making, community outreach, monitoring quality of care, of management of services, programs, and clients; reporting progress towards health plan targets and goals, equity, performance-based financing.

At the Measurement and Accountability for Results in Health (MA4Health) Summit last week, I moderated a panel on the various dimensions of RIBHIS strengthening. The Summit Call to Action and Roadmap call for strengthening sustainable health facility and community information systems. In order to achieve these goals, our community of RHIS advocates will need to leverage the experiences and learning from countries who have successfully strengthened these systems. The panel included speakers on experiences from Cambodia, Ghana, Rwanda, Ethiopia, Kenya, Uganda, and Senegal. A MEASURE Evaluation and JSI colleague, Tariq Azim, with his colleague Noah Elias from the Federal Ministry of Health of Ethiopia, used a hand illustrated presentation to demonstrate how community-based information systems in Ethiopia can greatly contribute to ensure continuity of care for chronic preventive episodes (e.g., pregnancy) and for chronic diseases (e.g., tuberculosis and HIV/AIDS), as well as diabetes and hypertension. The system allowed health extension workers in Ethiopia to connect with the facility-based providers in ensuring quality of care for the communities in their catchment area. They are now researching how to use information and communications technology (ICT) to make the paper-based systems more efficient.

Other panelists covered additional key topics of RHIS that need particular attention, including:

  • Production of quality data through institutionalized systems of Data Quality Assurance (DQA)
  • Use of information for decision making with the help of dashboards produced by web-based data management systems
  • How to create interoperable systems to interlink service delivery statistics, population-based statistics, and resources for health
  • The need for community-based health information systems
  • Use of health facility data for improving the quality and efficiency of care.

After hearing from the panelists, I shared two key reflections on RIBHIS looking forward. First, the expansion of ICTs in HIS is unstoppable and has a tremendous potential in increasing the performance of the systems. But countries and development partners need to make the necessary investments for improving connectivity and bandwidth of ICT as well as for maintenance and troubleshooting in order to make ICT functional and sustainable.

Second, as ICT and other measures for strengthening systems move forward, we must not lose focus on promoting the use of information for evidence-based decision making at all levels. The ultimate goal of any health information system is to produce information that can improve the functionality of the health system. Using information does not stop with problem identification; it involves problem solving and action. That is part of creating an information culture, and creating a new culture in complex systems such as health takes time. That is why we still need a lot of advocacy to convince country governments and developing partners that RIBHIS can become the pillar of their national HIS.

Time has come to stop the stereotypical way of saying: “routine HIS produce low-quality data that are not used, so let us do population or facility surveys.” We need to work together to improve and invest in sustainable routine RIBHIS in support of quality health service delivery!

For more information, visit: and the Routine Health Information Network (RHINO), supported by MEASURE Evaluation and USAID.

Reprinted with permission from JSI.

Filed under: Health Information Systems , Public Health
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