Strengthening national health information systems

The role of a health information system (HIS) is to ensure the production, analysis, dissemination and use of reliable and timely data by decision makers at all levels of the health system. A well-functioning HIS provides information on which to base programme decisions, to support the development of solid national health policies, strategies and plans, to monitor progress of interventions against national priorities and to contribute to reliable procurement and supply of health products through accurate data on needs and usage. Information is also essential for effective health system governance and regulation, health research, human resources development, health education and training, service delivery and financing.

At the policy level, decisions informed by evidence contribute to more efficient use of resources and, at the delivery level, they provide information about the quality and effectiveness of services. A well-functioning HIS should, among other core functions:

  • generate and compile information from service delivery points to district level routine information systems, disease surveillance systems, laboratory/procurement information systems, hospital patient administration systems and human resource management information systems
  • detect events that threaten public health security
  • analyse, synthesize and communicate information for use in planning and implementation.

The COVID-19 pandemic has further underlined the crucial role of health information systems in enabling countries to effectively respond to disease outbreaks. Weaknesses in surveillance systems and capacities to collect, manage and utilize data, particularly at the community level, undermine the delivery of life-saving health services, most notably in the face of global health threats.

Defining the health information system

A health information system (HIS) is composed of people, tools and methods that interact at different stages of the health information production process. These stages can be defined as a system that integrates data collection, processing and reporting, and uses the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services. It encompasses all health data sources, including health facility and community data, electronic health records for patient care, population-based data, human resources information, financial information, supply chain information and surveillance information, along with the use and communication of this information.

UNDP’s approach

Many countries in which UNDP supports systems for health, particularly through its partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), are low-income countries or are characterized by challenging operating environments. These tend to have young or fragmented health information systems (HIS), sometimes set up in an ad hoc way in response to different donor requirements. UNDP works to assess what is in place and how this can be strengthened to form a sustainable HIS. Working closely with national entities, UNDP’s support includes work to:

  • assess the country requirements based on the national health strategy and priorities
  • support the development of national health information strategies
  • support the integration and harmonization of data management systems, to reduce silos
  • implement electronic patient management systems and/or District Health Information Systems (DHIS) and promote their interoperability with electronic Logistics Management Information Systems (LMIS)
  • support the assessment of where information and communications technology (ICT) can deliver better data and information for decision makers
  • assess needs for other elements of a comprehensive HIS, such as logistics management information systems or human resource management information systems
  • strengthen data literacy of the health workforce
  • strengthen reporting and communication of results at all levels of the health pyramid
  • support the development of study protocols and implementation of related databases and research projects.

When UNDP serves as interim Principal Recipient of the Global Fund programmes in a country, support to health management information systems is often a key area for capacity development, in line with national priorities and the Global Fund guidelines for strengthening data systems. This includes doing so through capacity-building to enable health sector personnel to move beyond a focus on data solely for reporting, to the active use of real-time data in decision-making at all levels, such as in the management and evaluation of programmes and the formulation of budgets. UNDP likewise supports countries with the development of applications to the Global Fund to ensure inclusion of activities to strengthen national HISs, including those to promote enhanced integration across data systems. Examples of focus areas that can be included in the Global Fund funding applications are:

  • routine information systems (the establishment, maintenance and strengthening of national health information systems, district HISs, mobile platforms for community-level data collection and reporting, and support for human resources for data systems)
  • programme and data quality (activities related to assessments of programme and/or data quality, as well as monitoring of quality improvement activities)
  • evaluations, reviews, data analysis and use
  • surveys and studies
  • administration and financing of data systems
  • civil registration and vital statistics systems.

Tools and guidance

To support comprehensive improvements to HIS, UNDP aligns its focus with international standards and recommendations developed by the World Health Organization (WHO). The WHO UHC Technical Brief: Strengthening Health Information Systems, for instance, details seven strategic areas for actions that are required to strengthen national HIS:

  • Improve governance. HIS strengthening requires an enabling environment and robust collaboration between health and other sectors, including the information and communications technology (ICT) sector.
  • Invest in data sources and capacities. These investments strengthen health information, workforce skills and capacities for using health statistics and data.
  • Align stakeholders in support of HIS. Development partners and national institutions should make sure that their investments are complementary. Data, monitoring and accountability should be integrated into one plan and one budget for the health sector, and should be aligned with the health Sustainable Development Goals.
  • Use the digital revolution. The power of ICT innovation can help improve the availability, completeness, timeliness, quality and use of data for decision-making in health. Minimizing the burden of data collection, analysis and reporting through eHealth strategies can improve health service delivery and management.
  • Strengthen the capacity for systems and applications to be reusable. The use of scalable, affordable and open access software systems should be promoted and common health information architecture, standards, guides, tools and solutions to data management and analysis should be developed.
  • Use data to improve policy and service delivery. With a focus on equity, disaggregated data and access to needs-based, goodquality services, health information should be provided to decision makers at all levels for improving health policy, systems and services.
  • Strengthen accountability and reporting of results. There should be national oversight mechanisms for key indicators of national health targets and goals and mechanisms for regular transparent reviews to assess progress against national health sector targets.

A number of tools are also available to strengthen monitoring and evaluation (M&E) systems for health programmes and systems, as a distinct but interconnected component of broader HIS strengthening. Most notably, in the context of the Global Fund programmes, stakeholders should refer to the guidance and tools made available on the Global Fund website, which includes information related to national M&E system assessments, data systems for HIV surveillance and DHIS-2 strengthening.

Health information system versus monitoring and evaluation system

The health information system (HIS) is sometimes equated with national monitoring and evaluation (M&E) systems, but this is an oversimplification. In addition to being essential for M&E, the HIS also serves broader objectives, such as providing alert and early warning capability, supporting patient and health facility management, enabling planning, stimulating research, permitting health situation and trends analyses, and reinforcing communication of health challenges to different groups.

Information is of little value if it is not available in formats that meet the needs of different groups, i.e. policymakers, planners, managers, health-care providers, communities and individuals. The way information is collated and presented, and its dissemination and communication, are therefore essential attributes of the system. The HIS supports strategic and management decisions for the entire health sector and so the HIS is the responsibility of multiple stakeholders (e.g. ministries of health as well as national statistics offices). The national M&E system needs to contribute to and draw on existing data from the HIS. As such, the performance of the M&E system is directly linked to the capacity of the HIS. For example, health workers who report and manage HIV-specific data are often also responsible for collecting and managing data about other health services.

For additional guidance related to UNDP’s support to strengthen electronic logistics management information systems and their interoperability within HISs, visit the Logistic management information systems (LMIS) page. Further details on digital solutions that UNDP has employed to strengthen systems for health information, M&E and logistics data can be found on the Real-time data solutions page.

Strengthening systems with District Health Information System 2

UNDP has amassed experience providing technical assistance to national entities in diverse country contexts for the roll-out, scale-up and integration of national health information systems (HISs), particularly through District Health Information System 2 (DHIS-2). UNDP personnel in country offices and at the global level play an important role in the international DHIS-2 community, including facilitating DHIS-2 academies and sharing best practices and experiences with colleagues in other countries about strategic approaches to strengthening HISs in both fragile and relatively stable contexts. In Sudan, for example, UNDP has helped the country to achieve considerable progress since 2015, for example by launching a web-based DHIS-2 database to implement one national routine HIS. To facilitate the sustainable uptake of the system, UNDP supported the training of 900 staff on the use of the HIS at national and subnational levels. This was complemented by support to revise, print and distribute guidance and reporting tools for the use of the system at health facilities. In Angola, further to providing implementation support for the deployment of DHIS-2, UNDP supported the development and integration of new HIV data collection tools into the system, which allowed the government to collect key information for understanding HIV/tuberculosis co-infection and the impact on key populations.

Suggested capacity development indicators

  • National health information strategy in place
  • Comprehensiveness of health data capturing prevalence, incidence and qualitative social and behavioural data, disaggregated by age and gender
  • The percentage of districts that submit timely, complete and accurate reports at the national level
  • Level of use of data collection systems for studies and evaluations
  • Level of integration of health data into management and forecasting reports and processes the percentage of evaluations completed per plan
  • Availability and transparency of data for management and partner review
  • Availability and use of policies and procedures

Key resources

Global Fund resources:

Strengthening monitoring & evaluation
The Global Fund
[su_button url=”https://www.theglobalfund.org/en/me-systems-strengthening/” target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: html5″ text_shadow=”0px 0px 0px #000000″]Website[/su_button]

Global Fund Strategic Framework for Data Use for Action and Improvement at Country Level
The Global Fund
[su_button url=”https://www.theglobalfund.org/media/8362/me_datauseforactionandimprovement_framework_en.pdf” target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: html5″ text_shadow=”0px 0px 0px #000000″]PDF[/su_button]

Building Resilient and Sustainable Systems for Health: Information Note
The Global Fund
[su_button url=”https://www.theglobalfund.org/media/4759/core_resilientsustainablesystemsforhealth_infonote_en.pdf” target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: file-pdf-o” text_shadow=”0px 0px 0px #000000″]PDF[/su_button]

National health information system strengthening: principles and approaches:

WHO UHC Technical Brief: Strengthening Health Information Systems
World Health Organization
[su_button url=”https://apps.who.int/iris/bitstream/handle/10665/259716/UHC_tech_brief.pdf?sequence=1&isAllowed=y” target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: file-pdf-o” text_shadow=”0px 0px 0px #000000″]PDF[/su_button]

Health Metrics Network HIS Assessment Tool
The tool helps to enhance entire health information and statistical systems, and to concentrate efforts on strengthening country leadership for health information production and use.
[su_button url=”http://www.afro.who.int/sites/default/files/2017-06/AHO_HealthMetricsNetwork_Assessment_Tool_version4.00.pdf” target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: file-pdf-o” text_shadow=”0px 0px 0px #000000″]PDF[/su_button]

MEASURE Evaluation’s Health Information System Strengthening Model
[su_button url=”https://www.measureevaluation.org/resources/publications/tr-17-156″ target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: file-pdf-o” text_shadow=”0px 0px 0px #000000″]PDF[/su_button]

Health Data Collaborative: Building Country Capacity for Data Analysis and Use
[su_button url=”https://www.healthdatacollaborative.org/meetings-events/building-country-capacity-for-data-analysis-and-use/” target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: html5″ text_shadow=”0px 0px 0px #000000″]Website[/su_button]

Framework and Standards for Country Health Information Systems
World Health Organization
This resource is intended to be the universally accepted standard for guiding the collection, reporting and use of health information by all developing countries and global agencies.
[su_button url=”https://apps.who.int/iris/bitstream/handle/10665/43872/9789241595940_eng.pdf?sequence=1″ target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: file-pdf-o” text_shadow=”0px 0px 0px #000000″]PDF[/su_button]

UNAIDS M&E Assessment Tool
The tool provides information on the preparation for and implementation of an assessment of the national HIV monitoring and evaluation (M&E) system.
[su_button url=”http://www.unaids.org/sites/default/files/sub_landing/files/1_MERG_Assessment_12_Components_ME_System.pdf” target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: file-pdf-o” text_shadow=”0px 0px 0px #000000″]PDF[/su_button]

Monitoring the Building Blocks of Health Systems
World Health Organization
This is a handbook of indicators and their measurement strategies
[su_button url=”https://apps.who.int/iris/bitstream/handle/10665/258734/9789241564052-eng.pdf” target=”blank” background=”#0468b1″ color=”#1f0101″ icon=”icon: file-pdf-o” text_shadow=”0px 0px 0px #000000″]PDF[/su_button]

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