Routine Data Systems

Data Use for Program Monitoring

Learning Objectives

Differentiate between routine and non-routine data

Understand parameters and influences of HIS via the PRISM framework

Recognize & use tools available to improve RHIS function

Session Overview

General concepts of an RHIS Health information systems PRISM framework for understanding factors that

influence RHIS PRISM Toolset for RHIS1

RHIS Performance Diagnostic Tool RHIS Overview & Facility/Office Checklist Organizational & Behavioral Questionnaire RHIS Management Assessment Tool

Activity – Applying the PRISM Tools

1MEASURE Evaluation, Data demand and information use in the health sector: strategies and tools

Definitions

Health information system

A system providing specific information support to decision-making process at each level of an organization1

Health system

All resources—people, institutions & other—arranged according to established policies to protect, promote and improve the health of the served population2

1Hurtubise R (1984). Managing Information Systems. Kumarian Press, West Hartford.

2 WHO, http://www.euro.who.int/observatory/Glossary/TopPage?phrase=H

Definitions: Routine vs. Non-routine Data

Routine data Are collected continuously at various times

periods (daily, patient by patient, monthly etc.) Come from the HIS and its subsystems that are

collected as part of an ongoing system

Non-routine data Are collected at certain periods of time, or over a

specific period of time Come from special studies or surveys carried out

for specific purposes

Are we talking about this?

Or this?

Or do we mean this?

All of these, but this is where we really want to get

Why do programs need information?

Programs Need Information to

Understand entire context of program status

Enhance program performance through evidence-based decision making

All major functions

service delivery, resource mobilization, financing, stewardship

All levels

Community to national level

Health Information Systems (HIS)

HIS is an integral part of the health system

Just like a health system, an HIS is not static

Health systems in continuous process of change due to pressure from both outside and within the system

HIS must amend itself to these changes

HIS Sub-systems: Frequency of Data Collection Routine or continuous data collection

Health facility-based (pt. info. & service stats) Community based (service statistics) Vital registration Sentinel reporting Program reporting systems

Non-routine or periodic data collection Household or facility-based surveys Population census Rapid assessment procedures (RAP) Research

HIS and HIV Programs

A subset of the comprehensive health system

Data sources can be routine or non-routine

Contribute to data collection of various HIS subsystems

Need harmonization and integration in data collection & utilization within context of national HIS (the Third One)

PRISM* Framework for HIS Performance1

TechnicalDeterminants• system design • data collection forms• Skills/knowledge of personnel

Systemic/Environmental Determinants: leadership, structure, culture, roles/responsibilities, resources

Behavioral determinantsAttitudes, motivation, values

Inputsinformation systemassessment, strategies & interventions

Improved Health Status

Improved Health System

Performance

Desired Outcomes= information system performance• good quality information• appropriate use of information

*Performance of Routine Information System Management1MEASURE Evaluation. 2006. Data demand and information use in the health sector: Strategies and Tools

RHIS Performance Diagnostic Tool

HIS Quality & Use Influences

Standard indicators

Data collection forms

Appropriate IT

Data presentation

Trained people

TechnicalDeterminants

RHIS Overview & Facility/Office Checklist

Technical

Determinants

HIS Quality & Use Influences

Motivation

Attitudes & values

Confidence

Sense of responsibility

Behavioral Determinants

Organizational and Behavioral Questionnaire

Behavioral

Determinants

HIS Quality & Use Influences

Resources

Health sys. structure

Roles & responsibilities

Organizational culture

System &EnvironmentDeterminants

RHIS Management Assessment Tool

System &

Environmental

Determinants

PRISM Tools - Rationale

RHIS often not produce good information for health sector decision-making Data quality may low No processes in place for using data Managers/staff not understand importance of role in

information process & have little incentive

Traditional Assessments of RHIS narrow in focus Answer only part of why RHIS not high quality Typical focus is on data collection or information

technology alone

PRISM Tools - Rationale

Well designed interventions to improve RHIS should address these questions Is the organization committed to information-using

culture? Do people responsible for data collection have

necessary skills? Do they understand & care about importance of

their work? Do managers support them with training,

supervision & needed resources?

Description of PRISM Tools

Systematically provide answers, using an ordered process of gathering information about RHIS

Objectively measure performance & identify factors hindering performance Assess performance of RHIS Identify technical, behavioral & organizational factors affect

RHIS performance Aid in designing/prioritizing interventions to improve

performance Support ongoing efforts for M&E of data quality & use in

decision-making.

PRISM Tools - Implementation

Apply all four Tools for systematic assessment

Implement Tools in this order:

RHIS Performance Diagnostic Tool

RHIS Overview & Facility/Office Checklist

Organizational & Behavioral Questionnaire

RHIS Management Assessment Tool

PRISM Tools:RHIS Performance Diagnostic Tool

Primary component in the set

Determines overall RHIS performance (like MESS for whole M&E system)

Examines data quality & information use to identify gaps

Identifies overall strengths and weaknesses

PRISM Tools:RHIS Overview & Facility/Office Checklist Addresses technical determinants of RHIS such

as

Structure & design of existing information systems

Information flows

Interaction between different information systems

Use to understand availability & status of RHIS resources & practices

PRISM Tools:Organizational & Behavioral Questionnaire Addresses behavioral and organizational

determinants to RHIS, examines

Staff capacity

Knowledge, skills, confidence and motivation

Organizational culture

Promote value of information quality & use?

Compares these factors with RHIS performance to identify related gaps

PRISM Tools:RHIS Management Assessment Tool

Allows a rapid assessment of management and supportive RHIS practices

Results in recommendations for stronger RHIS management

PRISM Tools – Guiding Principles

Holistic approach that recognizes RHIS performance depends on combination of

technical, organizational & behavioral factors

Each of these components contributes to whole system, whole is more than the sum of its parts

Causal influence of all determinants in 3 areas must be understood to improve performance

PRISM Tools Guiding Principles

When data collectors understand importance of their contributions, they will be more committed

When decision-makers believe they have high quality data, more likely to use it for evidence-based decisions

When people empowered to make decisions, become champions for accountability and transparency

PRISM Tools

Tools are administered, based on

Observations, document review, information technology review

Triangulation of multiple data sources increases validity of findings

Self-assessment aspect creates sense of ownership for results & atmosphere of collaboration

Steps to use PRISM Tools Identify a potential opportunity

Determine how Tools would be used for the presenting need

Perform pre-assessment planning Determine organization’s readiness to improve RHIS Assemble core team stakeholders Identify key informants to interview Modify Tool to fit application

Assess & analyze current RHIS performance Use the Tools in order (Diagnostic, overview,

organizational/behavioral, management assessment)

Define plan for reaching desired level of RHIS performance Implement plan and monitor progress

Goal of RHIS Produce meaningful insights about performance of

health system

Is our HIV program working?

Increasing people willing to be counseled & tested

Decreasing HIV incidence

Reaching more pregnant, HIV + women

More effective information systems lead to better health status for more of the population

MEASURE Evaluation is a MEASURE project funded by the

U.S. Agency for International Development and implemented by

the Carolina Population Center at the University of North Carolina

at Chapel Hill in partnership with Futures Group International,

ICF Macro, John Snow, Inc., Management Sciences for Health,

and Tulane University. Views expressed in this presentation do not

necessarily reflect the views of USAID or the U.S. Government.

MEASURE Evaluation is the USAID Global Health Bureau's

primary vehicle for supporting improvements in monitoring and

evaluation in population, health and nutrition worldwide.