Using Health Information for Health System Improvement – Syllabus (2017)
Using Health Information for Health System Improvement
for Brandeis University
HS327f, Fall 2017, Module II
Syllabus
Dates: October 31 – December 12, 2017
Time: 9:00 – 11:50 on Tuesdays
Location: Heller TBD
Course Instructors: Theo Lippeveld, Deirdre Rogers, Herman Willems
COURSE GOALS AND OBJECTIVES
To ensure the delivery of quality health services to the people who need them, the World Health Organization (WHO) promotes strengthening the six building blocks of a health system: (1) governance and policy, (2) service delivery, (3) human resources, (4) health commodities, (5) health financing, and (6) health information systems (HIS). A strong HIS makes it possible to track progress on improving the other five health system building blocks and, ultimately, to monitor the achievement of the health-related Sustainable Development Goals (SDGs).
Strong health information systems that produce reliable, timely, and quality data are among several factors enabling health program managers to monitor, evaluate, and improve health system performance and make evidence-informed decisions. Since the 1990s, knowledge and understanding of the role of HIS development in global health systems have improved. Despite this, use of information for evidence-informed decision making—particularly data produced by routine health information systems (RHIS)—is still very weak in most low- and middle-income countries (LMICs). RHIS generate data collected at public and private health facilities and institutions, as well as at community-level healthcare posts and clinics. These data—generated at regular intervals of a year or less—cover health status, health services, and health resources. Some of the root causes of poor RHIS performance are ill-defined information needs; poor data quality; issues surrounding the use of information; limited human resource capacity; and the centralization and fragmentation of HIS.
At the Measurement for Accountability for Results in Health (MA4Health) Summit, in June 2015, the U.S. Agency for International Development (USAID), WHO, and the World Bank called for action “to improve health facility and community information systems including disease and risk surveillance and financial and health workforce accounts, empowering decision makers at all levels with real-time access to information.”[1] Achieving this goal in 15 years—the deadline set by the global health agency leaders who attended the MA4Health Summit—will require building the capacity of developing countries to collect, manage, and interpret health data. And this, in turn, will require training on an unprecedented scale.
This course is an introduction to the routine health facility-based and community-based information system, which is the most common source of information on health services management and programs. Using practical case studies, lectures and in class discussions, students will learn how to improve the performance of RHIS, by producing reliable data to inform decisions at all levels of the health system. They will also come to understand the important contribution of information and communication technology (ICT).
By the end of the course, participants will be able to:
– Articulate the importance of assessing HIS and the rationale for strengthening HIS
– Describe the components and standards of a national HIS that must be considered and assessed
– Understand the importance of Routine Health Information System (RHIS) for improving service delivery
– Describe how to assess RHIS performance and its determinants, and to develop a RHIS strengthening plan
– Consider the appropriate use of Information and Communication Technology (ICT) for RHIS data management, data transmission, and data presentation
– Identify and analyze constraints and opportunities for use of RHIS information at all levels of the health system and formulate an action plan to better use information for health services planning and health facility management
COURSE DESCRIPTION
After an initial presentation of the health system, HMN framework and PRISM framework and tools, participants will use the PRISM tools to make a diagnosis of the strengths and weaknesses of the routine health facility based (and community based) information system (RHIS) and to plan for RHIS strengthening. In subsequent modules the students will study the RHIS as the most common data source for generation of real time data on planning and management the health services in low and middle income countries (LMICs). Based on practical case studies, they will learn how to improve the performance of RHIS in terms of the production of quality information and use of information at all levels of the health system, and what the contribution is of ICT.
TEACHING METHODS
The course will use a variety of teaching methods such as lectures, demonstrations, discussions, analyses of case studies.
READINGS
All required readings can be accessed online using the links provided in the syllabus.
FACULTY
The lead instructors are Dr. Deirdre Rogers and Dr. Herman Willems, both Adjunct Lecturers at Brandeis University, and Senior Technical and Monitoring & Evaluation Advisors at John Snow Inc. (JSI). Dr. Theo Lippeveld, Senior Health Information System Advisor at JSI, will provide an introduction to the course and teach the first session. Other staff from JSI’s Center for Health Information and Monitoring and Evaluation (CHIME) will be brought in as guest speakers.
COURSE EVALUATION
Grading will be as follows:
· Class Participation (40%)
Each student is expected to engage in general class discussions and in discussions of assigned cases by posing questions and responding to questions posed by the Professor and other students.
· Consultant Report (30%)
As a health consultant, you have been asked to advise the Ministry of Health of a low or middle income country (LMIC) about strengthening its routine health information system (RHIS).
a) explain the value of a high functioning health information system, and why you believe it is important to improve Country X’s health information system (Country X can be a real country or a fictitious one that you make up)
b) propose conducting an assessment in Country X and describe broadly how it will be done, who will be involved, and potential outcomes.
The Memo should be no more than 3 pages (single spaced) with references cited appropriately throughout the text (references not included in page limit).
The Consultant Report is due at beginning of class four, 9:00am on November 21. NO LATE PAPERS!
· Final Assignment (30%)
In-class group assignment. A scenario will be presented, and then each group will take one aspect to analyze, summarize and present. Aspect will be randomly assigned to each group.
· Team One: Resources
· Team two: Indicators and Data Management
· Team Three: Data Sources
· Team Four: Data Quality
· Team Five: Dissemination
Each group will have about 2 hours for the assignment, followed by group presentations. The 10-15 minute summary presentations should include:
1) Primary problems (3-5) in your assigned areas of the HIS assessment
2) Underlying causes of those problems (e.g., resources, coordination, capacity, guidance, supervision)
3) Solutions in the short and medium term for the client (government, etc.) to consider
4) Risks of doing nothing and the benefits of the solutions proposed
Note: We recognize that there are advantages and disadvantages to group projects. In this case, we feel that the advantages outweigh the disadvantages. Group projects can spread the work and instill teamwork skills, which are important elements of HIS as well as project/program design, management, implementation, monitoring and evaluation. More importantly, chances are that students who will undertake HIS-related work in the future, either as project staff, external evaluators, or consultants offering technical assistance, will do so in a collaborative fashion. It is thus vital that they become accustomed to working through these processes in conjunction with other people.
COURSE MODULES
The course will be taught in seven modules of three hours (in fact 2h 50min) each.
Session 1: Introduction to RHIS: Health Systems and Health Information Systems
(October 31)
Lecturer: Theo Lippeveld
Learning Objectives
By the end of this Session, participants will be able to:
q Understand the essential link between the health system and the health information system
q Explain who needs health data, what type of data is needed, and how data could be used
q Describe the health data sources and give examples of each data source and its categories
q Describe the six components of a health information system, according to the Health Metrics Network (HMN) framework
q Describe what they will learn in this RHIS course
Topics Covered
q Health system and health-system building blocks
q Health-system challenges
q Functions of a health system by levels: national, regional/district, health facility, community, and individual patient/client
q Information needs for each type of health system’s function, and for managing, monitoring, and evaluating health-system inputs and processes, outputs, outcomes, and impact
q Sources of health information and their categorization
q Components of a health-information system, according to the HMN framework
q Introduction to RHIS course objectives, sessions, and assignments
Reading
· Health Metrics Network. Framework and standards for country health information system, 2nd edition. (2012). Geneva, Switzerland: World Health Organization (WHO). Retrieved from http://www.hrhresourcecenter.org/node/746
· International Health Partnership + Related Initiatives (IPH+) and WHO. (2011). Monitoring, evaluation and review of national health strategies: a country-led platform for information and accountability. Geneva, Switzerland: WHO. Retrieved from http://www.who.int/healthinfo/country_monitoring_evaluation/documentation/en/.
· WHO. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. (2007). Geneva: WHO. Retrieved from http://www.who.int/healthsystems/strategy/en/.
· WHO, United States Agency for International Development, & University of Oslo. Health facility information system resource kit. (Draft; February 2015).
Session 2: RHIS Performance Assessment: Performance of Routine System Management (PRISM)
(November 7)
Lecturer: Herman Willems
Learning Objectives
By the end of this session, participants will be able to:
q Demonstrate understanding of the three categories of determinants of RHIS performance
q Diagnose RHIS performance (to measure production, management, and use of high-quality data)
q Apply Performance of Routine Information System Management (PRISM) tools to identify and analyze possible constraints for successful implementation of an RHIS
q Develop recommendations /interventions to strengthen the area needing improvement
Topics Covered
q Introduction to the framework for assessing RHIS performance
o PRISM conceptual framework
o Determinants of RHIS performance
q Overview of PRISM tools to assess and improve RHIS performance
· RHIS overview tool
· RHIS performance diagnostic tool
· Facility/office checklist
· Management assessment tool
· Organizational and behavioral assessment tool
q RHIS assessment process
· Steps to conduct a PRISM assessment
· Analysis and presentation of PRISM data
· Examples of the application of PRISM tools in various countries
q Translate an assessment result into an action plan:
· Design and prioritize interventions to improve RHIS performance
· Learn how the assessment results can be developed into possible solutions to address RHIS-related issues.
· Advocate for solutions
· Develop action plans for improving RHIS
Reading — SCAN each; make sure you understand PRISM!
· Aqil, A., Lippeveld, T., & Hozumi, D. (2009). PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health Policy and Planning, 24(3):217-228. Retrieved from http://www.cpc.unc.edu/measure/publications/ja-09-99.
· Aqil, A., Lippeveld, T., Moussa, T., & Barry, A. (2012). Performance of Routine Information Systems Management (PRISM) tools user guide. Chapel Hill, NC: MEASURE Evaluation, University of North Carolina. Retrieved from http://www.cpc.unc.edu/measure/publications/ms-12-51.
· Belay, H. & Lippeveld, T. (2013). Inventory of PRISM framework and tools: application of PRISM tools and interventions for strengthening routine health information system performance. Chapel Hill, NC: MEASURE Evaluation, University of North Carolina. Retrieved fromhttp://www.cpc.unc.edu/measure/publications/wp-13-138?searchterm=PRISM+invent.
· Heywood, A. & Boone, D. (2015). Guidelines for data management standards in routine health information systems. Chapel Hill, NC: MEASURE Evaluation, University of North Carolina. Retrieved from www.cpc.unc.edu/measure/publications/ms-15-99.
· Hotchkiss, D., Aqil, A., Lippeveld, T., & Mukooyo, E. (2010). Evaluation of the Performance of Routine Information System Management (PRISM) framework: evidence from Uganda. BMC Health Services Research, 10:188. Retrieved from http://www.biomedcentral.com/1472-6963/10/188.
· MEASURE Evaluation. Data quality assurance tools (Website). Retrieved from http://www.cpc.unc.edu/measure/tools/monitoring-evaluation-systems/data-quality-assurance-tools.
· MEASURE Evaluation. PRISM: Performance of Routing Information System Management Framework [Website]. Retrieved from http://www.cpc.unc.edu/measure/resources/tools/monitoring-evaluation-systems/prism.
Session 3: RHIS data management standards: flow, quality, integration and interoperability
(November 14)
Lecturer: David Boone
Learning Objectives
By the end of this session, participants will be able to:
q Appreciate the importance of good RHIS data-management practices
q Describe data-management needs for the three health-system management levels
q Understand what structures and processes allow for good data management
q Understand when and how data-management standards are to be applied to local systems
q Be familiar with the harmonized standards for health facility-based and community-based information systems and their different domains and subdomains
q Understand how the harmonized standards can improve data quality and use
q Be familiar with the RHIS Rapid Assessment Tool
q Understand the causes of RHIS data fragmentation
q Understand the key principles of RHIS data integration/interoperability
Topics Covered
q Introduction to RHIS data management
q Data-management needs of the different RHIS management levels
q Overview of data-management standards, themes, and guidelines
q Domains and subdomains used to organize data-management standards
q Harmonized standards for health facility-based and community-based information systems
q RHIS Rapid Assessment Tool
q Implementation, including workshop preparation, selecting participants, and outlining the process
q Scoring, analysis, and interpretation of results
q Action planning using the tool's results
q Data fragmentation, integration, and interoperability
q Principles of RHIS data integration
q Country examples of data interoperability
Reading:
Heywood, A. & Boone, D. (2015). Guidelines for data management standards in routine health information systems. Chapel Hill, NC: MEASURE Evaluation, University of North Carolina. Retrieved from www.cpc.unc.edu/measure/publications/ms-15-99