paris 21 meeting ghana 27-28 july 2005. challenges in health information health metrics network hmn...
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PARIS 21 Meeting
Ghana
27-28 July 2005
• Challenges in health information
• Health Metrics Network
• HMN Framework and profiling tool
An Information Paradox: Reporting of Mortality in the WorldAn Information Paradox: Reporting of Mortality in the World
GHS report
Maternal health survey
SPA
CWIQ
Data Collection in Ghana 1991-2008 (non-routine only)Data Collection in Ghana 1991-2008 (non-routine only)
CWIQ
DHS 2 DHS 3
Living Standards Survey 3
Living Standards Survey 4
Living Standards Survey 5
DHS 4 DHS 5
MICS 3 Census
WHS
The Vicious Cycle The Vicious Cycle
HealthWeak
InformationSystem
Limited capacity to generate or analyse data.
DecisionMaking
Sectional interests, donor demand, inertia etc.
Donorsfocus on
theirsown
dataneeds
Little investment inhealth information systems.
WeakDemand
Data not trusted or used for policy-making at country level.
HMN Goal, Principles, ObjectivesHMN Goal, Principles, Objectives
Goal:Goal: Increase the availability and use of timely and reliable health information in countries and globally through shared agreement on goals and coordinated investments in health information systems
Principles: Principles: Country ownership; Stakeholder involvement
Objectives: Objectives: – Develop framework and standards for health
information systems – Support countries to implement plans adherent
to the HMN framework– Develop incentives for enhanced dissemination
and use of sound health information
HMN FrameworkHMN Framework
Description and standards for core data elements, data collection methods, data management, resources, data analysis and use.
Diagnostic tool; standardized self-assessment and learning tool DQAF for health Principles and processes for strengthening country health information systems
Health Information System Comprehensive ApproachHealth Information System Comprehensive Approach
Facility-based datadisease surveillancepatient & facility recordsfacility surveyshealth system data (infrastructure, supplies,human, financial resources)
Population-based datacensus vital statisticshousehold surveysdemographic surveillance
Ministry of Health National Statistics OfficeHMN
Health Information System ProfileHealth Information System Profile
1. Context, processes & resources
2. Data platforms
4. Data synthesis, analysis and use
3. Outputs/results for selected indicators
CountryHealth
InformationSystemProfile
Rating Context, Resources and Processes; Thailand & Ghana 2005Rating Context, Resources and Processes; Thailand & Ghana 2005
• Legal framework, coordination and planning
• Human resources availability and skills
• Infrastructure, equipment, information technology
• Data flow and management, feedback
% rating
0 20 40 60 80 100
Ghana
Inadequate Satisfactory
Rating Context, Resources and Processes; Thailand & Ghana 2005Rating Context, Resources and Processes; Thailand & Ghana 2005
% rating
Thailand Ghana
Inadequate Satisfactory
• Legal framework, coordination and planning
• Human resources availability and skills
• Infrastructure, equipment, information technology
• Data flow and management, feedback
Assessment of Data Sources & Data Collection MethodsAssessment of Data Sources & Data Collection Methods
Criteria for assessment
• Contents
• Capacity
• Practices
• Dissemination
• Integration
Data collection methods
• Census
• Vital statistics
• Population surveys
• Surveillance (acute & chronic)
• Services data (health facilities)
• System (administrative, financial)
Census
Vital registration
HH Surveys
Surveillance (acute)
Surveillance(chronic)
Service statistics
Health system infoGhana
Rating Data Collection Platforms: Thailand & Ghana, 2005 Rating Data Collection Platforms: Thailand & Ghana, 2005
Inadequate Satisfactory
Census
Vital registration
HH Surveys
Surveillance (acute)
Surveillance(chronic)
Service statistics
Health system infoThailand Ghana
Rating Data Collection Methods: Thailand & Ghana, 2005 Rating Data Collection Methods: Thailand & Ghana, 2005
Inadequate Satisfactory
Assessment of Outputs % IndicatorsAssessment of Outputs % Indicators
Criteria for assessment
• Data collection method
• Timeliness• Periodicity• Consistency• Representativeness• Disaggregration• Estimation method
Core indicators
• Child mortality• Maternal & adult
mortality• HIV/AIDS, TB,
malaria• Smoking,
hypertension• Immunization • Service utilization• Water & sanitation
Under five mortality per 1,000 live births, Ghana, 1985-2004
0
20
40
60
80
100
120
140
160
180
200
1985 1988 1991 1994 1997 2000 2003
Estimate 2003(WHO/UNICEF)
DHS 1988
DHS 1993
DHS 1998
DHS 2003
Reconciling Data SourcesReconciling Data Sources
Reconciling Data SourcesReconciling Data Sources
Measles coverage among children aged 1 year, Ghana, 1995-2004
0
20
40
60
80
100
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Estimates (WHO/UNICEF) Reported Survey
Improved water supply, urban and rural households, Ghana, 1995-2004
0
20
40
60
80
100
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Estimate-urban Estimate-ruralSurvey-urban Survey-rural
Reconciling Data SourcesReconciling Data Sources
South Africa
Ghana
Eritrea
Uganda
Senegal
Central African Republic
Niger
Rating Outputs/Indicators: Selected Countries, 2005Rating Outputs/Indicators: Selected Countries, 2005
Inadequate Satisfactory
South Africa
Ghana
Eritrea
Uganda
Senegal
Central African Republic
Niger
Rating Outputs/Indicators: Selected Countries, 2005Rating Outputs/Indicators: Selected Countries, 2005
Inadequate Satisfactory
Data synthesis, analysis and useData synthesis, analysis and use
• Indicators in national data set linked to planning
• Data available and compared across public, voluntary and private sectors
• Summary reports covering key indicators produced at all levels
• Summary reports targeted to different audiences, including policy-makers, parliamentarians, media, civil society
• Evaluation of data and indicators documented
• Ghana score: Inadequate Satisfactory
From Diagnosis to ActionFrom Diagnosis to Action
• Establish national coordinating mechanism - MOH, Bureau of Statistics, research & academic bodies, disease-specific programmes
• Select essential indicators and develop integrated database – Data warehouse
• Develop national health information system plan; better planning and coordination of household surveys
• Develop health information system components; sample registration that includes causes of death; avoid less cost-effective methods such as maternal mortality surveys
• Enhance synthesis and use of data for decision-making (linking inputs and outcomes) by combining data from all sources and linking to budgets and expenditure.
• Support Health Statistics Resource Centre (software library, PDF electronic library).
HMN Support to Countries HMN Support to Countries
• Low and lower-middle income countries: technical and financial support up to $500,000 in a given year. Highest priority for HMN action.
• All countries except high income countries: technical assistance plus limited financial support up to $100,000 in a given year
• All countries except high income countries: technical assistance if they generate their own in-country financial resources. These countries can serve as regional centres of excellence and facilitate sharing of experiences.
