Using Health Information for Health System Improvement

Using Health Information for Health System Improvement – Syllabus (2016)

Using Health Information for Health System Improvement

for Brandeis University

HS327f, Fall 2016, Module II

Syllabus

Dates: November 1 – December 13, 2016

Time: 9:00 – 11:50 on Tuesdays

Location: Heller G-3

Course Instructors: Theo Lippeveld, Deirdre Rogers, Herman Willems

COURSE GOALS AND OBJECTIVES

To achieve delivery of quality health services and subsequently sustainable health of the target populations, the World Health Organization (WHO) promotes strengthening the six major building blocks of the health system: (1) governance and management; (2) service delivery; (3) human resources; (4) health commodities; (5) health financing; and (6) health information systems (HIS). Health Information Systems (HIS) remain the backbone for providing information to track progress for improving the different health system components and monitor the achievement of the health related Sustainable Development Goals (SDGs).

Strong health information systems that produce reliable, timely, and quality data are one of several factors enabling health program managers to monitor and evaluate and improve health system performance by making evidenced-based decisions. Since the 1990s, knowledge and understanding of the role of HIS development and health information on global health systems have improved. Despite this, use of information for evidence based decision making is still very weak in most developing countries. Ill-defined information needs, data quality issues, as well as centralization and fragmentation of health information systems are some of the root causes. This is particularly the case for the routine institution based health information systems.

Two key frameworks have been developed to measure the performance of health information systems and plan for their improvement: (1) the Health Metrics Network (HMN) developed a Framework for Country Health Information Systems (WHO, 2008), which were intended to define standards guiding the production, the harmonization, and the use of quality health information by all countries and global agencies; and (2) the Performance of Routine Information System Management (PRISM) framework (Aqil et al., 2009) was developed around the same time, and focuses more particularly on routine service delivery oriented health information systems. Both frameworks as well as various assessment tools can help countries to focus investment and technical assistance on the development of a standardized health information system; to provide a roadmap for strengthening health information systems and putting in place ongoing monitoring and evaluation mechanisms; and, ultimately, to increase access to – and better use of – improved health information for health system improvement at the local, country and global levels.

This course will follow the concepts promoted by both the HMN and the PRISM frameworks to review and better understand the health information systems that guide decision-making, leading to better health. The focus of the course will be on the routine health information systems (RHIS). 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 instructor is Dr. Theo Lippeveld, Adjunct Lecturer at Brandeis University, and Senior Health Information System Advisor at John Snow Inc. (JSI). Ms. Deirdre Rogers and/or Dr. Herman Willems, both Senior Technical and Monitoring & Evaluation Advisors at JSI, will co-teach and facilitate all sessions. 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 health information systems and why you believe it is important to improve the country’s health information system (either basing this on the reality of some country or making it up)

b)  propose conducting an assessment and describe 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 22. 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.

Module 1: Introduction to Health Information Systems (HIS)
(November 1)

Lecturer: Theo Lippeveld

Learning Objectives:

By the end of this module, student will be able to:

• Understand the essential link between the health system and the health information system (i.e. can explain who needs health information for what, and what data is needed)
• Describe the health data sources and give examples of each data source and their categories
• Describe the six components of a health information system (according to the HMN framework)
• Describe what they will learn in this RHIS Course

Topics Covered:

·  Health system and health system building blocks; health systems challenges

·  Functions of health systems by levels: national, regional/district; health facility; community; individual patient/client

·  Information needs for each type of health systems’ functions

·  Sources of health information and their categorization

·  Components of health information system (according to the HMN Framework)

·  Introduction to RHIS Course Objectives and Sessions

●  Explanation of Assignments

Reading

How can routine health information systems improve health systems functioning in low-resource settings? Assessing the evidence base. MEASURE Evaluation Special Report. February 2012.

WHO. 2008. Framework and Standards for Country Health Information Systems. Second Edition. http://www.who.int/healthmetrics/documents/hmn_framework200803.pdf

van Olmen et al. Health systems frameworks in their political context: framing divergent agendas. BMC Public Health 2012, 12:774

http://www.biomedcentral.com/1471-2458/12/774

Marcelo, A.B. Health Information Systems: a Survey of Frameworks for Developing Countries. IMIA Yearbook of Medical Informatics. 2010; 25-29.

Module 2: Definition Assessment of Routine Health Information Systems (RHIS): Performance, Quality and Use
(November 8)

Lecturer: Theo Lippeveld

Learning Objectives:

By the end of this module, student will be able to:

• Define RHIS performance (production, management and use of quality data)
• Identify and analyze possible constraints for successful implementation of a RHIS
• Demonstrate understanding of the PRISM framework and tools
• Explain the three categories of determinants of RHIS performance
• Diagnose RHIS performance (to measure production, management, and use of high-quality data)
• Apply the PRISM tools to identify and analyze possible constraints on successful implementation of an RHIS

Topics Covered:

●  Definition and role of RHIS

●  RHIS problems in low and middle income countries

●  Introduction to framework for assessing RHIS performance

○  PRISM conceptual framework

○  Definition of RHIS performance

○  Determinants of RHIS performance

●  Overview of PRISM tools to assess RHIS performance

●  Translating assessment results into action plan

○  Designing/prioritizing interventions to improve RHIS performance

○  Advocacy solutions

○  Developing action plans for improving RHIS

●  RHIS Monitoring and Evaluation

○  Monitoring: supportive supervision

○  Evaluation: repeated PRISM assessments

Readings:

Aqil, A., Lippeveld, T., Hozumi, D. PRISM Framework: A Paradigm Shift for Designing, Strengthening and Evaluating Routine Health Information Systems. Health Policy and Planning 2009 24(3):217-228; doi:10.1093/heapol/czp010, Oxford University Press. 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.

http://www.cpc.unc.edu/measure/publications/ms-12-51

Belay, H. and Lippeveld, T. 2013. Inventory of PRISM Framework and Tools: Application of PRISM Tools and Interventions for Strengthening Routine Health Information System Performance

http://www.cpc.unc.edu/measure/publications/wp-13-138?searchterm=PRISM+invent

Hotchkiss, D., Aqil, A., Lippeveld, T., Mukooyo, E. Evaluation of the Performance of Routine Information System Management (PRISM) Framework: Evidence from Uganda. BMC Health Services Research 2010, 10:188.

http://www.biomedcentral.com/1472-6963/10/188

Belay H. 2016. PRISM Tools: revison

Module 3: RHIS data management standards: flow, quality, integration and interoperability

(November 15)

Guest speaker: David Boone

Learning Objectives:

By the end of this module, student will be able to:

• Select indicators for RHIS
• Design RHIS formats of data collection instruments and feedback reports to facilitate use of the information by health managers
• Describe basic approaches to data quality assurance
• Ensure RHIS integration and interoperability

Topics Covered:

§  Overview of RHIS Data Management Standards

-  Description of the data collection process and tools

-  Paper vs. electronic data collection (EMR)

-  Challenges of data collection and management in resource poor settings

§  Basics of data quality assurance

§  HIS data management standards validation tool

Readings:

Heywood, Arthur; Boone, David. Guidelines for Data Management Standards in Routine Health Information Systems. February 2015. MEASURE Evaluation

www.cpc.unc.edu/measure/publications/ms-15-99

MEASURE Evaluation, “Data Quality Assurance” suite of tools (the Data Quality Audit Tool (DQA) and the Routine Data Quality Assessment Tool (RDQA))

http://www.cpc.unc.edu/measure/tools/monitoring-evaluation-systems/data-quality-assurance-tools

Module 4: RHIS Data Analysis
(November 22)

Lecturer: Deirdre Rogers

Assignments/submissions:

Consultant Report (Assignment 1) due.

Learning Objectives:

By the end of this module, student will be able to:

• Analyze routine data to produce information products: tables, graphs and maps
• Understand how these information products can show how the value of an indicator varies between geographic regions, age groups, sexes and diseases as well as how the value of an indicator varies over time (trends)
• Understand which types of analysis and which types of information products are most appropriate for various types of indicators
• Label and write appropriate interpretations of information products

Topics Covered:

§  Data flow exercise

§  How to use data visualization techniques to compare different groups or show trends

§  Choosing which type of analysis to use for various types of indicators

§  Comparison of findings from routine data with findings from other data sources

§  Elements of a good communication strategy (exercise write a paragraph summarizing data, highlighting a need for action and asking for action)

§  Communication methods that are appropriate for different audiences

§  Common dissemination vehicles

Readings:

Analysis of health facility data: Guidance for managers and analysts DRAFT. WHO, 2015.

Global Reference List of 100 Core Health Indicators

For the Excel-based course: online tutorial for using Excel to create charts: http://excelcentral.com/excel2007/essential/lessons/05010-create-a-simple-chart-with-two-clicks.html Presenting data effectively: Communicating your findings for maximum impact. Stephanie Evergreen, 2014.

Making Research Findings Actionable: A quick reference to communicating health information for decision-makers. MEASURE Evaluation, 2013. http://www.cpc.unc.edu/measure/publications/ms-09-39/at_download/document

Chart suggestions: a thought starter http://extremepresentation.typepad.com/files/choosing-a-good-chart-09.pdf

Module 5: RHIS Data Use to Improve Quality of Care at the Health Facility Level
(November 29)

Guest speakers: Sabrina Eagan and Herman Willems, JSI HIV/AIDS Advisors