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Community-based Health Information Systems in the Global Context: A Review of the Literature

cbhisIn developing countries, high disease burden from HIV, malaria, tuberculosis, poor nutrition, and high maternal mortality often intersects with low access to health services (Global Fund, 2014). Community workers (CWs), including community health workers (CHWs), community health extension workers (CHEWs) and community social service providers, have met critical service gaps. Generally, CWs are affiliated with either health facilities or community-based organizations. These providers live in the communities they serve and provide outreach services to people who may otherwise not receive them. The work of community worker providers has helped to improve health, especially maternal, child, and newborn outcomes (Lunsford, 2015; Golding, 2014).

National governments and donors are increasingly emphasizing and supporting the work of CWs to expand health care coverage (de la Torre, 2014). The important role of CWs has been emphasized in recent global health policy, such as USAID’s policy for ending preventable child and maternal deaths (EPCMD) (USAID, 2015) and the President’s Malaria Initiative. Similarly, there is a recognition that decentralized, community-based approaches to HIV care and support will be required to meet UNAIDS’ 90-90-90 target (90% of all people living with HIV will know their status, 90% of people diagnosed with HIV to receive antiretroviral treatment (ART), and 90% of all people receiving ART will be virally suppressed by 2020) (UNAIDS, 2014). Community-based programs implemented by CWs are uniquely suited to help achieve the goals laid out in these policies in the most vulnerable parts of the world. Furthermore, as global health systems move toward universal health coverage, CWs will become even more important to increase health equity (Golding, 2014).

CWs require key health information to do their jobs, and their managers require information to monitor their work. Likewise, Governments and donors require information to better plan community health programs, and to monitor progress against goals. This information, how it is collected, and how it flows, is how we define a community-based health information system(s) (CBHIS). These systems should involve data collection, management, and analysis of health and related services provided to communities outside of facilities (de la Torre, 2014). They should enable information to be shared among community-based services and between community-based services and higher-level health facilities. Moreover, to some extent, they should feed into national health management information system(s) (HMIS). CBHIS have the potential to engage community members, provide them with an avenue to health services, and hold them accountable, contributing to the goals of sustainability (Jeremie, 2014; Sabitu, 2004).

Little is known about how CBHIS are being implemented globally. This literature review seeks to explore the innovations in and different manifestations of CBHIS in developing countries.

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Informing Investments in Health Information Systems

By Heidi Reynolds, PhD, Director for Evaluation, MEASURE Evaluation

The primary function of a health information system in a country is to collect and analyze data in order to help providers and policymakers improve patient care and make decisions about what are the population’s most important health needs and how to address them.

The field is now demanding evidence of progress and accountability for health systems. The Millennium Development Goals, the more recent Sustainable Development Goals, and many health initiatives—including the President’s Emergency Plan for AIDS Relief (PEPFAR)—are driving attention on strengthening health information systems (HIS) to produce that evidence. Country health information systems are key because data from different sources are the best means to fill the large number of information needs to demonstrate progress and accountability.

MEASURE Evaluation works where the focus on data-driven evidence intersects with the capabilities of health information systems in low-resource countries. MEASURE Evaluation is a USAID-funded project with a mandate to strengthen health information systems and, moreover, to share what we are learning as we go.

Our focus is in lower- and middle-income countries where the environments are challenging. Some of these countries don’t have sufficient resources to fund robust routine health information systems or to maintain civil registration and vital statistic registries for generating data. They often rely on donors to fund and carry out population surveys, conduct research, and establish data systems. More often than not, these data systems are implemented to bypass weak government resources and to meet the donors’ needs for reporting on indicators and targets. But these work-arounds have meant slow improvements for a country’s own systems.

So the question becomes, what interventions work to strengthen a country’s health information systems so they improve the functioning of the country’s overall health system and, at the same time, provide data that satisfy the need for donors to report on international goals?

la-graphicAt MEASURE Evaluation, we have articulated three questions to answer that big one: (1) What are the factors and conditions that indicate progress to improve health information systems? (2) What are the stages of that progression to a strong HIS, and how are they measured? (3) What are the characteristics of a strong health information system?

As we answer those questions, we are engaging other interested parties to share insights and information. With input from many quarters, we expect to learn more, faster. Here’s how we’re working and how you might help:

  • We are working to create resources to facilitate learning exchange. I hope you’ll check out the HIS Strengthening Resource Center at http://www.measureevaluation.org/his-strengthening-resource-center.
  • We are working to break out of our specialized “silos” and, in an iterative fashion, share what we are learning and critically assess the gaps we can identify.
  • We support rigorous evaluation of HIS strengthening activities (such as an evaluation of an electronic health record implementation in Swaziland) and syntheses of literature and case studies of investments in HIS strengthening.
  • The HIS Strengthening Resource Center also is a hub for that hoped-for learning exchange. It shows the current status of health information systems in lower- and middle-income countries; it has a model for HIS strengthening to facilitate a shared vision and lexicon; and it features tools and resources to improve measurement—including performance indicators and methods. This is a work in progress, and the more others use it and provide feedback, the stronger it will become.
  • We have an inter-partner technical advisory group that provides input to documents and the strategic direction for our learning and for the HIS Strengthening Resource Center.

How can you take advantage now of what we’re learning? You can access the HIS Strengthening Resource Center for its changing compilation of country profiles, HIS resources, indicators, tools, a bibliography of relevant materials, and a model of HIS strengthening. There, you’ll also find a place to leave comments and questions. And, please check back as we will continue to update this resource center.

Reading: Africa and the Millennium Development Goals

Africa and the Millennium Development Goals: Progress, problems, and prospects
Mutasa, Charles and Mark Paterson, editors.  Lanham, MD: Rowman & Littlefield, 2015.

Authors critically assess the progress that Africa has made toward the achievement of the MDGs; explore possibilities for accelerating that progress; and offer alternatives and recommendations in support of institutions in Africa engaged in promoting the achievement of sustainable development. In doing so the book examines the role of various actors including the African Union (AU), Africa’s regional economic communities (RECs) such as ECOWAS, the United Nations and other development partners.

Evaluation des besoins pour la mise en oeuvre de la surveillance sentinelle de VIH/SIDA à travers les activités de consultations prénatales au Burundi

Evaluation des besoins pour la mise en oeuvre de la surveillance sentinelle de VIH/SIDA à travers les activités de consultations prénatales au BurundiIn 2010 in Burundi, sentinel surveillance of HIV and AIDS was interrupted in 2010 due to issues such as irregular availability of commodity supplies, lack of equipment, and low levels of relevant skills among staff. A needs assessment was conducted to revitalize the sentinel surveillance system in Burundi; it focused on antenatal care visits.

The needs assessment was conducted with the participation of many stakeholders supporting the National AIDS Control Program (NACP). The USAID-funded MEASURE Evaluation project led the study design and helped with development of the assessment protocol, training of survey staff, and supervision of data collection in the field. The assessment involved qualitative interviews with health providers and a literature review. Study activities were carried out under the coordination of a steering committee set up by the Ministry of Public Health and AIDS Control. MEASURE Evaluation Burundi provided support to the Monitoring and Evaluation Unit staff of the NACP for data analysis and report writing.

A technical group reviewed and validated the tools and the assessment report. The assessment provided recommendations for key actions to be taken at each level of the health system to support and sustain the sentinel surveillance system. Findings were shared with major stakeholders and a joint plan of action was developed, highlighting the potential role of all partners in strengthening sentinel surveillance.

Access the report in French.

Reading: Qualitative Research for Development

Qualitative Research for Development: A guide for practitioners
Skovdal, Morten and Flora Cornish. Warwickshire, UK: Practical Action, 2015.

This book guides development practitioners through the process of planning, conducting and reporting on a qualitative study, while simultaneously highlighting the role of qualitative research in improving the impact, quality and accountability of development programs. Chapters cover a number of data collection methods, including participatory learning and action, Photovoice, individual interviews, and focus group discussions and observations. Case studies from Save the Children and other international organizations are included.

OVC Outcomes Monitoring: Training for Data Collectors on PEPFAR OVC Monitoring, Evaluation, and Reporting Essential Survey Indicators

ovc-mer

From early childhood through adolescence, life events have far-reaching consequences. Lack of nutrition in early life can stunt growth and lead to health issues. Lack of education through adolescence can limit opportunities for stable livelihoods and lead to risky behavior, which can increase risk for HIV transmission. Providing a suite of integrated services for orphans and vulnerable children (OVC) and adolescents is a means to improve nutrition, access to education, and household economic security.

As part of its monitoring, evaluation, and reporting (MER) guidance, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has launched a set of essential indicators for measuring the effectiveness of these OVC programs that address holistic well-being for children and their families over time.

PEPFAR’s standards and expectations are high for collecting and measuring these indicators. It states that “indicators (which measure the results) are essential to assessing whether programs are measurably improving child well-being,” and that they form the evidence base to “create knowledge for decision making.” The complexity of both OVC programs and of the evolving MER environment demand sophisticated skill levels.

MEASURE Evaluation has developed a new training manual to meet the need for skilled data collectors who can gather required information to track the ways OVC programs contribute to the broader HIV and child protection response. This training tool, “Training for Data Collectors on PEPFAR Monitoring, Evaluation, and Reporting Essential Survey Indicators,” aims to train data collectors in collecting essential data that can support improved, evidence-informed, strategic portfolio development and programming, and resource allocation at all levels. The training manual is designed specifically for outcomes monitoring, which is a rapid survey approach to collect the nine PEPFAR OVC MER essential survey indicators.

This manual also serves to meet longer-term PEPFAR expectations for capacity building for MER data collection skills, data quality assessments, data feedback loops, and data use for decision making that ultimately will reside within local institutions and organizations.

“Data collectors are vital to ensuring successful OVC outcomes monitoring,” says Lisa Parker, PhD, MEASURE Evaluation lead for the project’s OVC monitoring and evaluation portfolio. “This training manual serves as an important step in gathering trustworthy data that will contribute to better programs to address children’s needs through family strengthening OVC interventions and to design the next generation of evidence-informed programs.”

For more information
Data is important to determine “what works” and to keep OVC programming on track, ensuring positive impacts on children and families, reaching targets laid out in the PEPFAR initiatives—Accelerating Children on Treatment (ACT) and Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS)—and ultimately achieving the goal of an AIDS-free generation. For more information on MEASURE Evaluation’s work on OVC issues, visit http://www.measureevaluation.org/measure/our-work/ovc.

Guidelines for Integrating Gender into an M&E Framework and System Assessment

Guidelines for Integrating Gender into an M&E Framework and System AssessmentThis document offers concrete guidance on how organizations can comprehensively and explicitly integrate gender in their monitoring and evaluation (M&E) systems. It describes how to make each component of a functioning M&E system gender-sensitive and provides guidance on how to assess an M&E system to ensure that gender is fully integrated throughout the system for appropriate collection, compilation, analysis, dissemination, and use of gender data for decision making.

This document outlines why it is important to apply a gender lens to M&E processes and structures and contextualizes gender in an M&E system. It then walks you through how to think about gender and address it in each of the components of an M&E system. This guide includes examples of gender-specific assessment questions that can be integrated in an M&E system assessment and provides guidance on how to plan and conduct an M&E system assessment.

This guidance document is intended for national health program and M&E managers, subnational health program staff with M&E responsibilities, M&E officers from different agencies or organizations, and development partners who provide M&E support to national and subnational M&E systems.

Access the resource.