Collecting health information at a local level

Target 35 of the ‘Health for All’ strategy statesthat "member states should have health information systems capableof supporting their national strategies for Health for All". in Rorterdam a local health information system has been developedwhich aims to:

• Monitor the health situation and related factors in the cityof Rotterdam at district and neighbourhood level;
• Contributeto the development of a local health policy for reducingthenoted differences in the health situation of the population.

information is collected from various sources including:

• data on mortality and morbidity and statistics concerning healthrelated areas like housing, employment, traffic, environment,etc.;
• data collected from the population itself;
• ideas andviews of key informants;
• documentary information.

The article outlines the design of the system, gives a reviewof the information stored and presents some of the results.     

Perspectives on Health Reporting for the European Community

The steps towards more integration of the European Communitywill affect health systems and health care in a number of ways.To support policy development and decision-making, health andhealth system information is needed on Community level. We discussthe role.of the Community in health and health care. We examinethe state of health-related information for health policiesand the relevant dimensions of a reporting system. At present,wide gaps exist between information needs and availability.Information on ongoing health-related activities is not co-ordinated.Comparative data can only be drawn from differing national sourcesor non-Community international compilations. For a future reportingsystem, the political decisions on the role of health in theCommunity and its administrative implementation are a majordeterminant. The development of a health reporting system isa comprehensive management task that requires significant inputof resources, including research.     

Linkages between public and non-government sectors in healthcare: A case study from Uttar Pradesh,India

Effective utilisation of collaborative non-governmental organisation (NGO)-public health system linkages in pluralistic health systems of developing countries can substantially improve equity and quality of services. This study explores level and types of linkages between public health sector and NGOs in Uttar Pradesh (UP), an underprivileged state of India, using a social science model for the first time. It also identifies gaps and challenges for effective linkage. Two NGOs were selected as case studies. Data collection included semi-structured in-depth interviews with senior staff and review of records and reporting formats. Formal linkages of NGOs with the public health system related to registration, participation in district level meetings, workforce linkages and sharing information on government-supported programmes. Challenges included limited data sharing, participation in planning and limited monitoring of regulatory compliances. Linkage between public health system and NGOs in UP was moderate, marked by frequent interaction and some reciprocity in information and resource flows, but weak participation in policy and planning. The type of linkage could be described as ‘complementarity’, entailing information and resource sharing but not joint action. Stronger linkage is required for sustained and systematic collaboration, with joint planning, implementation and evaluation.     

浅论三级甲等医院信息安全等级保护管理体系建设

为贯彻落实国家信息安全等级保护制度,2009年卫生部印发了《卫生行业信息安全等级保护工作的指导意见》,规范和指导全国卫生行业信息安全等级保护工作。根据此意见要求,全国三级甲等医院的核心业务信息系统均需要进行等级保护建设整改与测评。本文就曙光医院核心业务信息系统等级保护整改中的管理体系建设提供一些基本的思路、方法和步骤。     

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Integration of electronic health records (EHRs) in the national health care systems of low‐ and middle‐income countries (LMICs) is vital for achieving the United Nations Sustainable Development Goal of ensuring healthy lives and promoting well‐being for all people of all ages. National EHR systems are increasing, but mostly in developed countries. Besides, there is limited research evidence on successful strategies for ensuring integration of national EHRs in the health care systems of LMICs. To fill this evidence gap, a comprehensive survey of literature was conducted using scientific electronic databases—PubMed, SCOPUS, Web of Science, and Global Health—and consultations with international experts. The review highlights the lack of evidence on strategies for integrating EHR systems, although there was ample evidence on implementation challenges and relevance of EHRs to vertical disease programs such as HIV. The findings describe the narrow focus of EHR implementation, the prominence of vertical disease programs in EHR adoption, testing of theoretical and conceptual models for EHR implementation and success, and strategies for EHR implementation. The review findings are further amplified through examples of EHR implementation in Sierra Leone, Malawi, and India. Unless evidence‐based strategies are identified and applied, integration of national EHRs in the health care systems of LMICs is difficult.     

预防接种信息管理系统的实施及应用进展

预防接种信息管理系统（Immunization Information Management Systems,IIMSs）是公共卫生信息系统的重要组成部分。它的应用一定程度上提高了工作效率,促进预防接种工作的深入开展。IIMSs自建设以来,覆盖率逐年提高,然大多数国家仅限于日常预防接种管理,对数据的应用除少数发达国家和国内部分省外,较少见报道。现通过检索国内外发表的有关文献,对IIMSs的实施及应用进展进行综述。     

The data for decision making project: assessment of surveillance systems in developing countries to improve access to public health information

OBJECTIVE: By using timely, high-quality information, ministries of health can identify and address priority health problems in their populations more effectively and efficiently. The Data for Decision Making (DDM) project developed a conceptual model for a data-driven health system. This model included a systematic methodology for assessing access to information to be used as a basis for improvement in national health surveillance systems. STUDY DESIGN AND METHODS: The DDM surveillance assessment methodology was applied to six systems in five countries by staff from the US Centers for Disease Control and Prevention (CDC). Ministry of health personnel at national, regional, district and local levels were interviewed using either informal conversation or an interview guide approach, and their methods for collecting and using data were reviewed. Attributes of timeliness, accuracy, simplicity, flexibility, acceptability and usefulness were examined. Problems and their underlying causes were identified. RESULTS: The problems preventing decision makers from having access to information are many and complex. The assessments identified no fewer than eight problem areas that impeded decision makers' access to information. The most common deficiencies were concerning the design of the system, ongoing training of personnel and dissemination of data from the system. CONCLUSIONS: To improve the availability of information to public health decision makers, it is recommended that: (a) surveillance system improvement begins with a thorough evaluation of existing systems using approaches outlined by the CDC and the Health Metric Network of the World Health Organization; (b) evaluations be designed to identify specific causes of these deficiencies; (c) interventions for improving systems be directly linked to results of the evaluations; and (d) efforts to improve surveillance systems include sustained attention to underlying issues of training and staff support. The assessment tool presented in this report can be used to facilitate this process.     

健康影响评估制度的理论演进、评价方法与实现路径

健康影响评估是判断政策、规划、计划和项目对人群健康潜在影响及其影响分布的程序、方法和工具.许多国家将其作为推动"健康融入所有政策"的有效治理工具.新型冠状病毒肺炎(COVID-19)疫情对我国政府治理体系和治理能力提出巨大挑战,突显卫生健康对国民经济的重要影响,突显构建健康优先治理体系的紧迫要求.我国《基本医疗卫生与健...     

Analysing health care systems performance: the story behind the statistics

This commentary paper argues that the Asia-Pacific region would benefit from a home-grown version of the European Observatory on Health Care Systems to inform health sector policy: an Asia-Pacific Observatory. The countries in this diverse region, ranging from highly developed to very poor countries, are undergoing dramatic and diverse health sector changes, often on the basis of little evidence and with little information on successes and failures in neighbouring countries. The international community also is interested in knowing more about the many distinctive models of Asia-Pacific health care. While statistical comparisons are important, health policymakers and researchers need to understand the story behind the statistics in order to interpret the numbers and to formulate policies and strategies. Health system profiles therefore are useful instruments that describe how a complex health sector works, offer a comparative framework for cross-national comparisons, identify trends in health system design, and with standardised measures and regular updates measure progress against benchmarks. These reports and expanded analyses have influenced both national and Europe-wide debates on health policy. In the Asia-Pacific region, health systems research has built up a critical mass of studies and people with strong links across countries. The next ambitious steps are to identify sponsors able to support an enterprise that transcends national boundaries and to begin a project of comparative studies of national health systems.     

Rebuilding health systems in post-conflict countries: estimating the costs of basic services

After the fall of the Taliban in 2001, the Afghan transitional government and international donors found the health system near collapse. Afghanistan had some of the worst health indicators ever recorded. To begin activities that would quickly improve the health situation, the Ministry of Health (MOH) needed both a national package of health services and reliable data on the costs of providing those services. This study details the process of determining national health priorities, creating a basic package of services, and estimating per capita and unit costs for providing those services, with an emphasis on the costing exercise. Strategies for obtaining a rapid yet reasonably accurate estimate of health service costs nationwide are discussed. In 2002 this costing exercise indicated that the basic package of services could be provided for US dollars 4.55 per person. In 2006, the findings were validated: the four major donors who contracted with non-governmental organizations (NGOs) to provide basic health services for nearly 80% of the population found per capita costs ranging from dollars 4.30 to dollars 5.12. This study is relevant for other post-conflict countries that are re-establishing health services and seeking to develop cost-effective and equitable health systems.     

Scaling up integrated management of childhood illness to the national level: achievements and challenges in Peru

This paper presents the first published report of a national-level effort to implement the Integrated Management of Childhood Illness (IMCI) strategy at scale. IMCI was introduced in Peru in late 1996, the early implementation phase started in 1997, with the expansion phase starting in 1998. Here we report on a retrospective evaluation designed to describe and analyze the process of taking IMCI to scale in Peru, conducted as one of five studies within the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE) coordinated by the World Health Organization. Trained surveyors visited each of Peru's 34 districts, interviewed district health staff and reviewed district records. Findings show that IMCI was not institutionalized in Peru: it was implemented parallel to existing programmes to address acute respiratory infections and diarrhoea, sharing budget lines and management staff. The number of health workers trained in IMCI case management increased until 1999 and then decreased in 2000 and 2001, with overall coverage levels among doctors and nurses calculated to be 10.3%. Efforts to implement the community component of IMCI began with the training of community health workers in 2000, but expected synergies between health facility and community interventions were not realized because districts where clinical training was most intense were not those where community IMCI training was strongest. We summarize the constraints to scaling up IMCI, and examine both the methodological and policy implications of the findings. Few monitoring data were available to document IMCI implementation in Peru, limiting the potential of retrospective evaluations to contribute to programme improvement. Even basic indicators recommended for national monitoring could not be calculated at either district or national levels. The findings document weaknesses in the policy and programme supports for IMCI that would cripple any intervention delivered through the health service delivery system. The Ministry of Health in Peru is now working to address these weaknesses; other countries working to achieve high and equitable coverage with essential child survival interventions can learn from their experience.     

The impact of integrating the elimination programme for lymphatic filariasis into primary health care in the Dominican Republic

Integration of disease-specific programmes into existing health care delivery systems is a challenge for many countries, made more salient as the scope and scale of disease-specific programmes increases. This paper reports on the programmatic outcomes of 2 years of integrating the lymphatic filariasis (LF) elimination programme into primary health care (PHC) in the Dominican Republic during a period of national health care reform and decentralization. Data were collected retrospectively from community volunteers, PHC staff and LF programme staff using a mix of quantitative and qualitative methods. Benefits of integration for LF elimination included increasing the extent of the geographic coverage of mass drug administration (MDA) and a 21% increase in municipalities achieving the MDA target coverage rate of 80%. Benefits which accrued to PHC included improved information systems and strengthened relationships between the health services and the community. This study also identified challenges to implementing integration and the solutions found. These include the importance of focusing on the professional development of disease-specific program staff as their roles change, strengthening specific weakness in the general health system and finding alternative solutions where these are not easily solved, actively engaging senior management at an early stage, continually evaluating the impact of integration and not pushing integration for the sake of integration.     

Beginn der Routinephase Gesundheitsberichterstattung des Bundes

The federal German health reporting system, financed by the Federal Ministry of Health, is monitoring the status of health, health behaviour, risk factors, health care utilisation, costs and resources of the health care system on the national level. The health reports offer action-oriented information on health related topics and provide a scientific basis for health policy decisions. This paper gives an overview on upcoming topics of the health report and briefly describes how the health reporting system is organised by the Robert Koch-Institute. Beside the health monitoring on national level the federal health reporting system co-operates with other health reporting systems on sub- and international level.     

'Health transformation programme' in Turkey: an assessment

The aim of this study is to assess the 'Health Transformation Programme' (HTP) in Turkey announced in 2003. This assessment has been made according to the ultimate performance goals of a health care system, such as improvement in health status, financial risk protection and satisfaction with health care. This study provides a brief history of health policy since 1980, when the Turkish health care system began to transform with the introduction of both structural adjustment and market-oriented reform policy. The main aim of these reforms was increasing efficiency. Reform proposals of the 1990s focused on the introduction of a general health insurance (GHI) system, decentralization, introduction of a family medicine scheme, purchaser-provider split, contracting-out, quasi-markets and improvement of management information systems. Like the reform proposals of the 1990s, HTP has eight components, the major ones being a new role for the Ministry of Health (MoH), introduction of a GHI system, reorganization of health service delivery and human resources development. No component of HTP has yet been sufficiently realized. Therefore, despite some improvements, Turkish people continue to face low health status and a low level of financial risk protection. More research needs to be done for the determination of satisfaction with health services.     

Research gaps in routine health information system design barriers to data quality and use in low‐ and middle‐income countries: A literature review

Despite the potential impact of health information system (HIS) design barriers on health data quality and use and, ultimately, health outcomes in low‐ and middle‐income countries (LMICs), no comprehensive literature review has been conducted to study them in this context. We therefore conducted a formal literature review to understand system design barriers to data quality and use in LMICs and to identify any major research gaps related understanding how system design affects data use. We conducted an electronic search across 4 scientific databases—PubMed, Web of Science, Embase, and Global Health—and consulted a data use expert. Following a systematic inclusion and exclusion process, 316 publications (316 abstracts and 18 full papers) were included in the review. We found a paucity of scientific publications that explicitly describe system design factors that hamper data quality or data use for decision making. Although user involvement, work flow, human‐computer interactions, and user experience are critical aspects of system design, our findings suggest that these issues are not discussed or conceptualized in the literature. Findings also showed that individual training efforts focus primarily on imparting data analysis skills. The adverse impact of HIS design barriers on data integrity and health system performance may be even bigger in LMICs than elsewhere, leading to errors in population health management and clinical care. We argue for integrating systems thinking into HIS strengthening efforts to reduce the HIS design‐user reality gap.     

Supporting the Development of Evidence-Informed Policy Options: An Economic Evaluation of Hypertension Management in Ghana

ObjectivesUniversal healthcare coverage in low- and middle-income countries requires challenging resource allocation decisions. Health technology assessment is one important tool to support such decision making. The International Decision Support Initiative worked with the Ghanaian Ministry of Health to strengthen health technology assessment capacity building, identifying hypertension as a priority topic area for a relevant case study.MethodsBased on guidance from a national technical working group of researchers and policy makers, an economic evaluation and budget impact analysis were undertaken for the main antihypertensive medicines used for uncomplicated, essential hypertension. The analysis aimed to address specific policy questions relevant to the National Health Insurance Scheme.ResultsThe evaluation found that first-line management of essential hypertension with diuretics has an incremental cost per disability-adjusted life-year avoided of GH¢ 276 ($179 in 2017, 4% of gross national income per capita) compared with no treatment. Calcium channel blockers were more effective than diuretics but at a higher incremental cost: GH¢ 11 061 per disability-adjusted life-year avoided ($7189 in 2017; 160% of gross national income per capita). Diuretics provide better health outcomes at a lower cost than angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers. Budget impact analysis highlighted the potential for cost saving through enhanced price negotiation and increased use of better-value drugs. We also illustrate how savings could be reinvested to improve population health.ConclusionsEconomic evaluation enabled decision makers to assess hypertension medicines in a Ghanaian context and estimate the impact of using such evidence to change policy. This study contributes to addressing challenges associated with the drive for universal healthcare coverage in the context of constrained budgets.     

National health information systems in the Pacific islands: in search of a future

Health information is essential for proper management and deployment of limited resources in the health services of the Pacific Islands. There have been numerous efforts to establish and strengthen sustainable information systems but the common feature of these attempts has been the very limited achievement. Subsequently, the use of information as a management tool has been abandoned in favour of 'gut feeling', hearsay and adhocry. In the last decade health planning and primary health care activities have necessitated the re-emphasis of monitoring and surveillance of health and health service indicators. Therefore a revival of interest in health information systems is taking place. A review of national health information systems in the Pacific showed that routinely collected data remained largely untouched by human thought. The contributing factors to the current inertia are examined with suggestions on how to elevate health information from its current lowly status to its rightful place as an essential tool for management. The special problems of small island states, like limited resources, geographical isolation, natural barriers to technology, and diverse cultural milieu, will be examined in relation to an appropriate health information system for Pacific Island countries in the twenty-first century.