Health Information Systems: Challenges And Perspectives

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Health Information Systems: Challenges and Perspectives How to learn from and share experience? Michel ODIKA The difficulty lies not so much in developing new ideas as in escaping from old ones (John KEYNES, economist). Political will for strengthening governance capacity… Contemporary health systems tend to become increasingly complex, in the sense that multiple stakeholders are interconnected, with constantly shifting boundaries. In many points, the credibility and legitimacy of health policy choices depend less on total consensus (unrealistic) than on procedural fairness and transparency. Importantly, policy-makers today are more open to lessons from abroad than they may have been in the past, and are using them to feed national policies with innovative approaches and better evidence of what works and what does not. In this specific context, creating the political alignment and commitment to improve health information systems is only a first step. Why? Insufficient preparation for new behaviors and practices is often the weak point. Of particular importance, therefore, is a better understanding of resistance to change. So, the biggest problem, according to John KEYNES, is not to let people accept new ideas, but to let them forget the old ones. For instance, the institutional capacities to enable effective health information systems are not a given. They are typically weak in countries where, by choice or by default, deep-seated bureaucratic traditions remain the rule… As things now stand, there is growing need for making information systems instrumental to health policies. How to do that depends much on context and background. Nevertheless, by building on networks of organizations and institutions from interdependent and indissociable areas of expertise and interest, relevant and transparent health information systems can produce consensus-based and validated benchmarks for assessing progress in addressing the challenges and changes facing health systems.

Comprehensiveness to improve decision-making process and policymaking… Health authorities to be effective need, not only basic data, but equally strategic information obtained through a departure from traditional views on the architecture, the clients and the scope of health information systems. Why? Experience across many, if not most, countries (“rich” and “poor” included) shows that health information systems, primarily dedicated to guiding decision-making process, can be described as “closed administrative structures”. Mainly due to a strong top-down and public-sector-only flavour, there is limited flow of limited data on health status, resource allocation and services delivery. Additionally, in many countries around the world, limited information is almost exclusively used to a limited extent by a limited number of established officials when formulating policy reforms, while limited use is made of highly critical information from other tools and sources – e.g. NGO’s, household expenditure, opinion polls, university institutions, research centers, etc -, many of which are often located outside the public sector and even outside the health sector.

Greater emphasis on responsiveness… In many respects, routine data from traditional health information systems often fail in responding to the rising demand for health-associated information from a multitude of

2 constituencies. For example, citizens need easier access to their own health records, which should inform them about the progress being made in their treatment plans, and allow them to take part in decisions regarding their own health and that of their families and communities. Similarly, communities and civil society organizations need better information to protect their members’ health, reduce exclusion and promote equity. As for health professionals, they also need information to improve the quality of their work as well as to improve integration and coordination of services. Especially noteworthy, ultimately, is the fact that political leaders need crucial information on how well the health system is meeting society’s goals and on how public money is being spent… Information that can be used to steer health policies is quite different from the data that most conventional health information systems currently produce (2009). Now more than ever, the widespread need to monitor what such health policy is achieving across the range of basic values1 and directing principles2. That basically means asking key questions that go well beyond what can be answered by tracking health outcome indicators, resource use, and services output, which is what conventional health information systems usually focus on…

Premium on transparency… The ceaseless multiplication of information users, producers and stakeholders implies that the way information is generated, shared and used also has to evolve. In practical terms, this demand calls for open, collaborative and flexible models to ensure that the most relevant sources of basic data are tapped, and strategic information flows (quickly and easily) to all those who can translate it in appropriate decision and action. Better identification of priority issues and trends is important and vital to anticipate the future in terms of challenges and changes. So, from a policy point of view, the crucial information is that which allows identification of the systemic and operational constraints where planning is predominantly structured along epidemiological considerations, thus providing a new and dynamic basis for progress…. However, this virtuous circle critically depends on transparency, for instance, by making available health-related information readily accessible via the Internet – as is the case in Mali3, where effective and productive communication is considered both an outcome and a motor of what can be labelled as “regime of Explicit Health Guarantees. So, in the specific case of Mali, accessibility and availability of information are essential to transparency…

In summary: commitment to quality and safety… Like comprehensiveness and responsiveness contribute to relevance, so accessibility and availability of information improve transparency, which in turn strengthens the credibility and legitimacy of health authorities. At the same time, safety relates to anything protective and promotive for health. As a key component of governance capacity and global safety, therefore, the quality of such information in terms of relevance and transparency is a condition for modernization and development. Where open and collaborative structures function properly, basic data provide strategic information for guiding priority setting and decision-making process. Conversely, no progress in the way information is processed stands as an obstacle to the design and implementation of all ambitious reform. Ultimately, the first wealth is health mostly because the main source of wealth is the mastery of information…

1. Individual freedoms, citizens’ responsibility, social justice, and collective solidarity. 2. Equity and continuity in access to care, quality and safety of health services, comprehensiveness and personcentrednes, cost-effectiveness and efficiency, among others… 3 . Republic of Mali. Ministry of Health: National Health Information System (http://www.sante.gov.ml/msante/index.php?option=com_content&task=view&id=858&Itemid=120).

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References 1. Grindle MS. The good government imperative: human resources, organizations, and institutions. In: Grindle MS, ed. Getting good government: capacity building in the public sector of developing countries. Boston MA, Harvard University Press, 1997 (Harvard Studies in International development:3-28). 2. Hildebrand ME, Grindle MS. Building sustainable capacity in the public sector: what can be done? In: Grindle MS, ed. Getting good government: capacity building in the public sector of developing countries. Boston MA, Harvard University Press, 1997 (Harvard Studies in International development:31-61). 3. Inglehart R, Welzel C. Modernization, cultural change and democracy: the human development sequence. Cambridge, Cambridge University Press, 2005. 4. Maiga Z, Traore Nafo F, El Abassi A. Health sector reform in Mali, 1989-1996, Antwerp, ITG Press, 2003. Doctor Michel ODIKA – Copyright, 2009.