HIS

• Health Management Information System (HMIS)


  An information system specially designed to assist in the management and planning of health programs, as opposed to delivery of care

  
• HMIS


  • One of the six building blocks essential for health system strengthening
  • A data collection system specifically designed to support planning, management, and decision-making in health facilities and organizations

  
• Concepts HMIS was developed within

  • The information collected is relevant to the policies and goals of the healthcare institution, and to the responsibilities of the health professionals at the level of collection
  • The information collected is functional; it is to be used immediately for management and should not wait for feedback from higher levels
  • Information collection is integrated; there is one set of forms and no duplication of reporting
  • The information is collected on a routine basis from every health unit
• Major role of HMIS


  To provide quality information to support decision-making at all levels of the health care system in any medical institution
• Characteristics HMIS needs to have

  • Complete
  • Consistent
  • Clear
  • Simple
  • Cost-Effective
  • Accessible
  • Confidential
• Eight elements of the HMIS

  • Data Acquisition
  • Data Verification
  • Data Storage
  • Data Classification
  • Data Computation
  • Data Update
  • Data Retrieval
  • Data Presentation

  
• PRISM Framework

  • Broadens the analysis of routine health information systems to include behavioral, technical, and organizational/environmental determinants

  
• Determinants in the PRISM Framework


  • Behavioral determinants - knowledge, skills, attitudes, values, and motivation of the people who collect and use data
  • Technical determinants - data collection processes, systems, forms, and methods
  • Organizational/environmental determinants - information culture, structure, resources, roles, and responsibilities of the health system and key contributors at each level

  
• Monitoring

  1. Systematic collection

  2. Analysis

  3. Use of information from programs
• Monitoring purposes

  • Learning from experiences acquired
  • Accounting for resources used
  • Accounting for results obtained
  • Taking decisions
• Evaluation


  Assessing an ongoing or completed program or policy as systematically and as objectively as possible
• Evaluation purpose


  To make statements about relevance, effectiveness, efficiency, impact, and sustainability
• M & E Purpose

  The primary aim is to have a strong M & E and review system in place for the national health strategic plan that comprises all major disease programs and health systems

  
• M & E Plan


  1. Address all components of the framework

  2. Lay the foundation for regular reviews during the implementation of the national plan
• Strategies for operationalizing the M&E framework

  • Be primarily country-focused but also offer the basis for global monitoring
  • Address M & E needs for multiple users and purposes, including monitoring program inputs, processes and results, tracking health systems performance and evaluation
  • Facilitate the identification of indicators and data sources, provide tools and guidance for data analysis, and show how the data can be communicated and used for decision-making
  • Bring together the monitoring and evaluation work in disease-specific programs with cross-cutting efforts such as tracking human resources, logistics and procurement, and health service delivery

  
• M&E Framework


  • Builds upon principles derived from the Paris declaration on aid harmonization and effectiveness and the IHP+, putting country health strategies, and the related M & E processes such as annual health sector reviews, at the center

  
• Key Performance Areas

  • Reproductive Health
  • Immunization
  • Disease prevention and control
  • Resource Utilization
• Key Indicators - Reproductive Health


  • Family planning acceptance rate
  • Antenatal care coverage
  • Proportion of deliveries attended by skilled health personnel
  • Proportion of deliveries attended by HEWs
• Key Indicators - Immunization


  • DPR-3 (Pentavalent-3) coverage (>1 children)
  • Measles immunization coverage (>1 children)
• Key Indicators - Disease prevention and control


  • Malaria case fatality rate amongst patients under 5 years of age
  • New malaria cases per 1000 population
  • New pneumonia case amongst under 5 children per 1000 population of < 6 years
  • TB case detection rate
  • TB cure rate
  • Clients receiving VCT services
  • PMTCT treatment completion rate
  • PLWHA currently on ART
• Key Indicators - Resource Utilization


  • Trace drug availability (in stock)
  • OPD attendance per capita
  • Inpatient admission rate
  • Average length of stay (inpatient)
• Key Performance Areas and Indicators: Inputs

  • Vaccine stockouts in a single month (YES/NO, by type of vaccine)
  • Number of services providers trained in provision of EPI/FP integrated services
• Key Performance Areas and Indicators: Outputs


  • Number of service delivery points offering integrated FP and immunization services
  • Number of days per month when both immunization and family planning services are offered at the same site
  • Number/percent of women attending routine child immunization services who received information on family planning from a vaccinator
  • Number/percent of women (with children <12 months) going for family planning who receive information on immunization from the family planning provider
  • Number/percent of women attending routine child immunization services who accept a referral to family planning services
  • Number/percent of women attending routine immunization services who follow through on a FP referral from a vaccinator
  • Number/percent of women attending family planning services who follow through on referral to immunization services from a family planning provider
• Key Performance Areas and Indicators: Outcomes and Impact


  • Number of children receiving DTP1, DTP3, measles1, and DTP 1–3 dropout
  • Immunization coverage for DTP1, DTP3, measles1, and DTP 1–3 dropout
  • Number of new family planning acceptors by method type and demographic/age group
  • Contraceptive prevalence rate
  • Total financial cost of inputs required to integrate FP and immunization services (per facility, per client exposed, per new FP acceptor)
  • Maternal, infant, and child mortality rates
• Health Systems Monitoring Indicators and Data Sources: Inputs and Processes

  • Total health expenditure as % of DGP
  • Total health expenditure per capita
  • % general government expenditure on health
  • Doctors per 10,000 population
  • Nurse/midwives per 10,000 population
  • Graduates of health training institutions per 10,000 population
  • Hospital beds per 10,000 population
  • Doctors using electronic health records
  • Tracer medicines availability
  • Median drug price ratio for tracer drugs
• Health Systems Monitoring Indicators and Data Sources: Outputs

  • Index of service readiness
  • Service accessibility (distance to facility)
  • General practitioner utilization rate
  • Outpatient department utilization rate
  • TB treatment success rate (DOTS)
  • 30-day hospital case fatality rate AMI and stroke
  • Waiting time to elective surgeries: cataract, PTCA, hip replacement
  • Surgical wound infections (% of all surgical operations)
  • Cancer treatment delay (time between first GP visit and first treatment, for breast and colon cancer)
• Health System Indicators and Data Sources: Outcomes: Coverage of Interventions

  • Antenatal care coverage (4+)
  • Antenatal care coverage (1)
  • Skilled birth attendance
  • DPT3 Immunization coverage
  • HiB, Hep3, measles, OPV
  • ART coverage
  • Contraceptive prevalence
• Health system indicators and data sources

  • Outcomes: Coverage of Interventions
  • Outcomes: Risk Factors and Behaviors
  • Impact
  • Financial Risk Protection

  
• Subnational


  Referring to a region or locality within a country, rather than the country as a whole
• Facility assessment


  Evaluation of a healthcare facility
• General practitioner utilization rate


  Measure of how often people visit their general practitioner
• Outpatient department utilization rate


  Measure of how often people visit the outpatient department of a healthcare facility
• Clinic data


  Data collected from healthcare clinics
• Survey


  Data collected through a survey of people
• Service Quality and Safety


  Measures of the quality and safety of healthcare services
• TB treatment success rate (DOTS)


  Measure of the success rate of tuberculosis treatment using the DOTS (Directly Observed Treatment, Short-course) approach
• Clinical data


  Data collected from clinical records
• 30-day hospital case fatality rate AMI and stroke


  Measure of the mortality rate within 30 days of being admitted to hospital for acute myocardial infarction (heart attack) and stroke
• Hospital records


  Data collected from hospital records
• Waiting time to elective surgeries: cataract, PTCA, hip replacement


  Measure of how long people have to wait for certain elective (non-emergency) surgeries