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Strengthening Health Information Systems

Strengthening Health Information Systems in NigeriaA series of fact sheets describe and show MEASURE Evaluation works to help strengthen health information systems in Madagascar, the Democratic Republic of the Congo, Nigeria, MaliCôte d’Ivoire, Senegal, and Swaziland.

Methodological Considerations for Use of Routine Health Information System Data to Evaluate Malaria Program Impact in an Era of Declining Malaria Transmission

Methodological Considerations for Use of Routine Health Information System Data to Evaluate Malaria Program Impact in an Era of Declining Malaria TransmissionCoverage of malaria control interventions is increasing dramatically across endemic countries. Evaluating the impact of malaria control programs and specific interventions on health indicators is essential to enable countries to select the most effective and appropriate combination of tools to accelerate progress or proceed toward malaria elimination. When key malaria interventions have been proven effective under controlled settings, further evaluations of the impact of the intervention using randomized approaches may not be appropriate or ethical. Alternatives to randomized controlled trials are therefore required for rigorous evaluation under conditions of routine program delivery. Routine health management information system (HMIS) data are a potentially rich source of data for impact evaluation, but have been underused in impact evaluation due to concerns over internal validity, completeness, and potential bias in estimates of program or intervention impact. A range of methodologies were identified that have been used for impact evaluations with malaria outcome indicators generated from HMIS data. Methods used to maximize internal validity of HMIS data are presented, together with recommendations on reducing bias in impact estimates. Interrupted time series and dose-response analyses are proposed as the strongest quasi-experimental impact evaluation designs for analysis of malaria outcome indicators from routine HMIS data. Interrupted time series analysis compares the outcome trend and level before and after the introduction of an intervention, set of interventions or program. The dose-response national platform approach explores associations between intervention coverage or program intensity and the outcome at a subnational (district or health facility catchment) level.

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Improving Continuity of Care by Strengthening Health Information Systems

Improving Continuity of Care by Strengthening Health Information SystemsHealth information systems (HIS) represent a significant investment for groups that require evidence for accountability and informed decision making. Despite a compelling need for robust evidence of HIS function, these systems have not traditionally been a subject for rigorous study and evaluation. That lack limits learning, sharing, and cultivating best practices that can be shared more widely.

MEASURE Evaluation, funded by the United States Agency for International Development, developed an HIS Learning Agenda, to justify and build an evidence base for which investments in HIS are effective and useful and explore what works to strengthen HIS. For the Learning Agenda, we seek to answer questions such as these: What are the factors and stages of progress in HIS performance and how are they measured? And what are the characteristics of a strong HIS? The project is also implementing activities to build the evidence base on HIS strengthening. We hope our efforts will contribute to evidence-informed global work to strengthen HIS and health outcomes.

One of the many questions that arise in linking improvements to HIS to improved health outcomes is the aspect of coherent client care, or “continuity of care (COC).” COC is the process of providing good-quality healthcare, over time, to a client.

One activity in MEASURE Evaluation’s Learning Agenda is to synthesize what we know so far about how to strengthen HIS and the effects of those efforts. The focus of this synthesis report—which is one of a series—is to document what we are learning about how stronger HIS may improve COC for clients. Here we review what we know now about the effects of HIS strengthening on COC and what areas need research.

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Impact of Insecticide-Treated Net Ownership on All-Cause Under-Five Mortality in Malawi, 2006–2010

Impact of Insecticide-Treated Net Ownership on All-Cause Under-Five Mortality in Malawi, 2006–2010Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis.

To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62–90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60–0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006–2010 in Malawi and represent a novel use of district-level data from nationally representative surveys.

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Easing the Data Collection Burden on Healthcare Providers by Strengthening Health Information Systems

Easing the Data Collection Burden on Healthcare Providers by Strengthening Health Information SystemsHealth information systems (HIS) represent a significant investment for groups that require evidence for accountability and informed decision making. Despite a compelling need for robust evidence of HIS function, these systems have not traditionally been a subject for rigorous study and evaluation. That lack limits learning, sharing, and cultivating best practices that can be shared more widely.

MEASURE Evaluation, funded by the United States Agency for International Development, developed an HIS Learning Agenda, to justify and build an evidence base for which investments in HIS are effective and useful and explore what works to strengthen HIS. For the Learning Agenda, we seek to answer questions such as these: What are the factors and stages of progress in HIS performance and how are they measured? And what are the characteristics of a strong HIS? The project is also implementing activities to build the evidence base on HIS strengthening. We hope our efforts will contribute to evidence-informed global work to strengthen HIS and health outcomes.

This paper—one of a series developed by MEASURE Evaluation—explores how to improve HIS to address the burden of data collection that falls to healthcare providers. The aim is to discover ways to help providers collect good-quality data without compromising the care they give to their clients. This paper reviews what we can discern thus far, through a review of literature and our own experience, and it provides a series of recommendations for data collection and HIS.

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Declines in malaria burden and all cause child mortality following scale up of control interventions in Senegal 2005-2010

Declines in malaria burden and all cause child mortality following scale up of control interventions in Senegal 2005-2010Malaria is endemic in Senegal. The national malaria control strategy focuses on achieving universal coverage for major interventions, with a goal of reaching preelimination status by 2018. Senegal began distribution of insecticide-treated nets (ITNs) and introduced artemisinin-based combination therapy in 2006, then introduced rapid diagnostic tests in 2007. We evaluated the impact of these efforts using a plausibility design based on malaria’s contribution to all-cause under-five mortality (ACCM) and considering other contextual factors which may influence ACCM.

Between 2005 and 2010, household ownership of ITNs increased from 20% to 63%, and the proportion of people sleeping under an ITN the night prior to the survey increased from 6% to 29%. Malaria parasite prevalence declined from 6% to 3% from 2008 to 2010 among children under five. Some nonmalaria indicators of child health improved, for example, increase of complete vaccination coverage from 58% to 64%; however, nutritional indicators deteriorated, with an increase in stunting from 16% to 26%. Although economic indicators improved, environmental conditions favored an increase in malaria transmission. ACCM decreased 40% between 2005 and 2010, from 121 (95% confidence interval [CI] 113–129) to 72 (95% CI 66–77) per 1,000, and declines were greater among age groups, epidemiologic zones, and wealth quintiles most at risk for malaria. After considering coverage of malaria interventions, trends in malaria morbidity, effects of contextual factors, and trends in ACCM, it is plausible that malaria control interventions contributed to a reduction in malaria mortality and to the impressive gains in child survival in Senegal.

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