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?
At 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.