An Opportune Time to Strengthen Health Information Systems

July 3, 2015

Ensuring health information systems are standardized and well-coordinated is essential to improving health outcomes across a range of countries and realizing many of the health goals laid out by the international community. Indeed, timely and accurate data is required to build political will for domestic investments into health systems; make evidence-based decisions to respond to inequities in health; measure progress in achieving national and subnational goals; identify and prepare for potential health threats; and progressively realize universal health coverage and global health security. In the lead up to the Third International Conference on Financing for Development in July and the United Nations Summit to adopt the post-2015 development agenda in September, participants at a three day conference held at the World Bank in June pushed for common measurement and accountability systems.

The Measurement and Accountability for Results in Health Summit placed a concentrated focus on the current state of health information systems. There was agreement that while progress has been achieved during the Millennium Development Goal (MDG) era, important challenges remain. Development partners and representatives from a wide range of countries—Bangladesh, Burundi, Ghana, Indonesia, Laos, Malawi, Mali, Mozambique, Nigeria, South Africa, Tanzania, Ukraine, and Vietnam—reflected on current constraints and limitations and raised the following interconnected issues:

• The lack of coordination among development partners places an undue burden on countries by requiring them to report data on an unwieldy number of indicators. This is particularly taxing because indicator definitions can vary and reporting periods are not aligned. Moreover, this leads to the production of fragmented data that can be conflicting and is not comparable across districts or countries.
• Data tends to be used by implementing partners and Ministries of Health solely to satisfy donor reporting requirements. Therefore, data is not sufficiently seen as a tool to make effective and efficient funding decisions to fill health gaps. This means that overworked frontline health practitioners take time to collect and share data, but do not see the data used to directly address health challenges. This diminishes their incentives to collect timely and accurate data.
• There is inadequate national and international financing for health information systems. Further, when budgets are tight, monitoring and evaluation and the information system infrastructure they depend on are among the first items to be cut. While this may create budgetary relief in the short-term, it prevents decision makers from having the necessary data to make smart investments in future appropriation cycles.
• Development partners do not sufficiently focus on strengthening existing national systems. Instead, they establish a multitude of parallel health information systems that do not interact. As a result, national public health surveillance systems and registration and statistics systems remain weak or even absent.
• The institutional and human resources capacity among Ministry of Health officials and managers in data collection, analysis, and use is weak and there are insufficient training and employment opportunities.

Similar challenges were discussed at CSIS on June 23 at the launch of the Institute for Health Metrics and Evaluation (IHME)’s new Financing Global Health 2014 report: Shifts in Funding as the MDG Era Closes. IHME’s report revealed stagnation in total donor funding for health. Additionally, funding levels are not expected to return to the levels seen at the start of the MDG era. In this environment, better health outcomes will need to be achieved through a more effective use of resources. The need for disaggregated, accurate, and timely data at all levels of the health system to better assess the effectiveness of aid was therefore a theme that ran through the launch event. Dr. Christopher Murray, Director of IHME, noted that we are currently not able to track dollars down to the geography where they are spent. He stated: “I think eventually we are going to want to know where money goes within countries […] If you track financial flows, you could see who is being left out and where dollars are not going and not making progress. This requires an entire change in how lows are recorded.” 

While these challenges are familiar and have been raised many times before, there is recognition that as the international community readies itself to set the post-2015 development agenda, there is a unique opportunity to put a spotlight on the need to invest at higher levels in better data. To this end, at the World Bank Summit, participants widely endorsed the Roadmap for Health Measurement and Accountability and the 5-Point Call to Action. The strategic priority actions laid out in these plans include increasing domestic and international financing for health information systems,  improving country capacity, maximizing the use of new data tools, increasing coordination among donors, and promoting community participation in monitoring activities.

Operationalizing these plans will be challenging for a variety of reasons including the significant differences in country circumstances, as well as the many changes needed to be undertaken by all actors at all levels of the health system. While the process of improving national health information systems should be country-led, close coordination among development partners both within and across countries is also required to ensure the past’s fragmented approach is not repeated. Development partners will need to agree to measure fewer things better and to carefully manage the inherent tension between the demand for more disaggregated and more frequent data with the need for accurate measurement. In a context of tight financial resources and intensified competition for worthy goals, it is important to take advantage of this unique moment to highlight the importance of making sustainable investments in better data.