LESSON ONE

INTRODUCTION TO HEALTH MANAGEMENT

INFORMATION SYSTEMS

The concept of information Data that have been processed and is read for use by the recipient. Data that have been interpreted and understood by the recipient of the message and provides a basis for decision making. It is data which have been analysed, summarized and processed in some other fashion to produce a message. In its widest sense it covers all kinds of facts and understanding having a bearing on organizational management.

The Concept of Information count

It is knowledge and understanding that is usable by the recipient It must tell the recipient something not already known which could not be predicted It reduces uncertainty Has surprise value It includes numerical data, factual knowledge, narrative accounts, opinions and evaluations Information is raw material for the mind, which uses it to develop skills, knowledge and, ultimately perhaps wisdom

The Functions Performed by Information

The reduction of uncertainty As an aid to monitoring and control As means of communication As a memory supplement As an aid for simplification

VALUE OF INFORMATION
Information is vital for decision making Improves decision making Enhances efficiency Provides a competitive edge to the organization

THE CONCEPT OF DATA

Facts, ideas, or concepts that can be collected and be represented electronically in digital form. Data are facts obtained by reading, observation, counting, measuring, and weighing etc which are then recorded. It is raw or basic data and are often records of the day to day transactions of the organization. For example, the data , amount and other details of an invoice or cheque, payroll details of pay, National Insurance and tax for a person, the output for a machine or shift, the number of vehicles passing a road monitoring point and so on. Data are derived from both external and internal sources. Most external data are in readily usable and concrete forms e.g. bank statements, purchase invoices.

DISTINCTION BETWEEN DATA AND INFORMATION

Data requires capturing, handling, recording and processing- by whatever means incurs costs. It is only when data are communicated and understood by the recipient, and are thus transformed into information. That the value may arise, provided that the information is used to improve decision making.

HEALTH MANAGEMENT INFORMATION SYSTEM System A collection of components that work together to achieve common objective. Information System A system that provides information support to the decision making process at each level of the organization.

Health Information System:

A system that integrates data collection processing, reporting, and use of the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services. A comprehensive and integrated structure that collects, collates, analyses, evaluates, stores, disseminates, health and health related data and information for use by all. It is an integral part of a health system, the operational boundaries of which include all resources, organizations and actors that are involved in the regulation, financing, and provision of actions whose primary intent is to protect, promote or improve health. HIS is an integrated effort to collect, process, report and use health information and knowledge to influence policy making, programme action and research.

GOAL OF HISS
Data have no value in themselves. Value and relevance come only when they are analysed, transformed into meaningful information , and used. Therefore, the ultimate objective of a health information system is to produce information for taking action in the health sector. Performance of such a system should therefore be measured not only on the basis of the quality of data produced, but on evidence of the continued use of these data for improving health systems operations and health status. These applies at all; levels at the level of patients care, at the health facility, and at the community, district, national and globe levels.

GOAL OF HISS COUNT

A health information system is not static entity but a process through which health related data are gathered, shared, analysed, and used for decision making information is transformed into knowledge action. There is a strong interdependence between health information systems and information systems in other sectors e.g. female literacy is associated with improved sanitation etc.

DOMAINS OF HEALTH INFORMATION

Health determinants Health system inputs HEALTH SYSTEM Outputs Health system out comes

HEALTH INFORMATION SUBSYSTEMS

1. Disease surveillance and outbreak notification 2. Data generated through household surveys 3. Registration of vital events and consensus( e.g. birth, death and causes of death). 4. Data collection based on patient and service records and reporting from community health workers, health workers and health facilities. 5. Programme specific monitoring and evaluation for example for TB, HIV/AIDS etc. 6. Administration and resource management ( including finance/budget, personnel and supplies.

FUNCTION OF HEALTH INFORMATION SYSTEM

1. 2. Bring together data from all different subsystems To share and disseminate data to the many different audiences for health information 3. To ensure that health information is used rationally, effectively and efficiently to improve health action. Therefore a strong health information system is an essential component of sound programme development and implementation, and is a prerequisite for strategy decision-making. It provides the basis upon which improved health outcomes depend In theory, a health information system consists of a process of gathering, sharing, analysing, and using health related data for decision making information transformed into knowledge for action

WHO ARE THE MAIN ACTORS IN THE HEALTH INFORMATION SYSTEM?

A health information system should generate information for different uses by different health system actors: 1. Presentation of data 2. Data interpretation 3. Uses of health information

Health Management Information System:

It is an information System specially designed to assist in the Management and planning of health programmes, as opposed to delivery of care. It is an efficient collection, collation, Analysis, Evaluation strategy, Dissemination and use of Information about individual patients, population, resources used and health outcomes of intervention and the state and nature of systems through which the intervention are applied. The HIS, like any other system, consists of parts which are interrelated, interdependent and work towards a common goal.

Health Management Information System Count

The functionality of an HIS may differ from organization to organization. The System is a combination of Health Information and Management Information The system collects information on health ( morbidity and mortality statistics, service statistics) and on management (human resources, financial, fixed assts and infrastructure, drugs, and supplies logistics) and performs comparative analysis with population based data from various surveys. The HIS is a POWERFUL TOOL FOR MAKING HEALTH CARE DELIVERY MORE EFFECTIVE AND EFFICIENT

PURPOSE OF HIS
To support informed strategic decision making by providing quality data which help managers and health workers at all levels of the health system in planning and managing the services; monitoring disease trends and control epidemics, and providing periodic evaluation
towards agreed targets.

SPECIFIC OBJECTIVE
To increase the quality of management of the health system hence the need to develop a strategic plan.

COMPONENTS OF HEALTH INFORMATION SYSTEM

Ministry of Health Kenya National Bureau of Statistics (KNBS) Vital Registration Private Health Institutions Research Institutions Faith Based Organization (FBO), etc

THE VALUE AND IMPORTANCE OF

HIS
It supports the management of the health system whose ultimate goal is to improve and maintain the health of an individuals families and communities. HIS is considered as a system that provide health and health related information to facilitate evidence based decision making processes at all levels of health pyramid.

THE CURRENT LEVELS OF CARE IN THE HEALTH SECTOR ARE:

Level 1 Community Level 2 Dispensary and Clinics Level 3 - Health Centre including Maternity and Nursing Level 4 - Sub District and District Hospitals (Primary hospitals) Level 5 - Provincial and general Hospitals (Secondary Hospitals) Level 6 - National Referral Hospitals ( tertiary

PRIMARY OBJECTIVE OF HIS To provide the right information to the right user at the right time HIS is a prerequisite for the effective and efficient management of health services. The successful use of its information resources by producing information products that are aligned with needs of the user in forefront. HIS should be developed with a careful assessment of the levels the information generation, feedback mechanisms and use by all.

THE BROAD OBJECTIVES OF HIS

To determine end user information needs at various levels of the health system To facilitate data collection, analysis, information generation storage To facilitate information dissemination, feedback (horizontal and vertical) and use of information for evidence based decision making.

BENEFITS OF HIS
Helping decision makers to detect and control emerging and endemic health problems, monitor progress towards health goals, and promote equity. Empowering individuals and communities with timely and understandable health related information, and drive improvements in quality of services. Strengthening the evidence based decision making for effective health policies, permitting evaluation of scale up efforts, and enabling innovation through research Improving governance, mobilizing new resources, and ensuring accountability in the way they are used. Since a properly organized HIS is needed to produce information for taking action, the development of HIS strategic plan will provide clear road map for implementation of planned activities.

CURRENT HIS SUBSYSTEMS

There are various subsystems in HIS and are summarized in the three categories namely: Health services information Population based data Management information

HEALTH INFORMATION SYSTEM DATA SOURCES

Data collection based on patient and services

records and reporting from community health workers and health facilities. Data generated through household surveys Registration of vital events (births, death and causes of death) Disease surveillance and outbreak notification Programme specific monitoring and evaluation Administration and resource management ( including finance /budget, personnel and supplies).

POPULATION BASED DATA

Population based data include census, vital registration and surveys MANAGEMENT INFORMATION
Covers administrative records, health services, and disease records.

USERS OF HEALTH INFORMATION

At each of the health system, users of health information have different needs and use information in different ways. At the most basic level of client health worker interaction, patient records are a vital of information at the individuals level, for reviews of care and norms, confidential inquiries and facility based audit reviews of provider practices. At the facility, managers need information on patient profiles, patterns of admissions and discharges, length of hospital stay, use of medicines and equipment, deployment of different categories of health care workers and ancillary staff, costs and income At district, provincial and national level, policy makers, planners, managers and other stakeholders use this information and data on locally relevant population profiles and risk factors in decision making regarding allocation of resources to different facilities Within the public health sector, such information is transmitted upwards through district and provincial levels to the national level where basic resource allocation decisions are made.

INSTITUTIONAL REVIEW OF HIS

Health Information System in Kenya has been reviewed severally with a view of putting in place sound systems that provides quantitative and qualitative data which is essential for identifying major health problems.

CHARACTRISTICS OF GOOD
INFORMATION
Good information is that which is used and which creates value. Good information is:
Relevant for its purposerelevant to the problem being considered. Sufficiently accurate for its purpose - Accurate for the purpose it is intended Complete enough for the problem. Complete in respect of the key elements of the problem. From a source in which the user has confidence- when the source has been reliable in the past and when there is good communication between the information producer and the manager. Communicated to the right person information directed exactly where it is required. Communicated in time for its purpose. In time to be used That which contains the right level of detail Detailed in consistent with effective decision making.

Characteristics of good Info Cont

Communicated by an appropriate channel of communication- Communicate through proper channel e.g. with regard to the nature and purpose of the information, the speed required, and the requirements of the user That which is understandable by the user - 1. Information preferred by the user e.g. in the form of pictures, narrative, statistical and facts 2. Remembered knowledge, environmental factors, e.g. group pressures, the time available, and trust in the information system 3. Language

THE IMPORTANCE OF INFORMATION

AND MANAGEMENT
Managers in organizations make decisions, prepare plans control activities by using information from formal sources, e,g from organizations management information systems or from informal means, such as face to face conversations, telephone calls, through social contacts and so on. Managers are faced with Accelerating rate of change More complex environment Considerable uncertainty.

 Therefore the manager should be able to define the type of information he requires and MIS should be able to supply it. In practice, of course, it does not happen like this and managers have to use whatever information is a available, from whatever source. As Peter Drucker has said the manager will never be able to get all the facts he should have. Most decisions have to be based on incomplete knowledge either because the information is not available or it would cost too much in time and money to get it. There is nothing more treacherous, more common than the attempt to make precise decisions on the basis of course and incomplete information. In spite of the difficulties of producing it, managers need relevant information to assist them to plan, to control, and to make decisions.

 Relevant information is information which: - Increase knowledge - Reduces uncertainty - Is usable for the intended purpose Management get things done through people by using relevant information. Although all managers need information, they do not need the same type of information. The type of information is dependent on many factors including; - the level of management - the task in hand - Confidentiality - Urgency

MANAGEMENT OF INFORMATION SYSTEMS: It is a system using formalised procedures to provide management at all levels in all functions with appropriate information, based on data from both internal and external sources To enable them to make timely and effective decisions for planning, directing and controlling the activities for which they are responsible. Emphasis is on the uses to which the information is put and not how the information is processed. An MIS is usually efficient at providing regular formal information from routine transaction data, e.g relating to stock movements, sales, production etc. MIS can be rigid and unable to deal with unpredictable especially from outside the organization or that required by strategic management. Also formal systems are poor at providing the behaviour context of information, e.g the less tangible characteristics.

THE INFORMAL SYSTEM

There is another information system in every organization which helps to overcome the above mentioned problems Informal communication takes place at all levels from discussions, telephone calls, meetings, observation and so on also known as the grapevine verbal communication. Informal networks are flexible, speedier, can cater for local problems than MIS. Thus, the formal and informal channels are not competitors but as complementary facets of the total information networks in the organization. INFORMATION IN ORGANIZATIONS Information gives power to people. It must be distributed Must not be restricted or filtered not to cause bias and distortion. From a specialist Benefits the organization

TRANSFORMATION OF DATA INTO INFORMATION

All systems are composed of the same basic elements; input; processes and outputs Inputs The inputs to a productive system include raw materials, labour equipment and plant facilities, job specifications, standards of all types, maintenance facilities. Power supplies etc The usual procedures when analyzing a system is : - To choose those outputs with which we are concerned- these are unusually those outputs most relevant to the system objectives - To choose inputs for examination and control which are considered to have significant effects on the outputs considered important. In all system other than physical ones, the transformation process is controlled by information In the simplest case, information on the output of the system is used a basis for control of the output of the system This is known as feedback or information feedback.

TYPES OF HEALTH MANAGEMENT INFORMATION SYSTEMS

Management Information Systems Database Managent Systems Decision Support Systems Question Answer Systems Information Retrieval Systems The Internet SUMMARY Information increases knowledge, reduces uncertainty, adds value when used. Data are facts which have been recorded Information is processed data which is understood by the user. The value of information comes from its user

SUMMARY COUNT
Good information is: relevant, accurate, in time to be used, sent to the right person, and is understandable. Communication systems include a source, a message and the destination Perception is the understanding a person receives from a message Unexplained jargon is a barrier to understanding A Management information systems (MIS) provides managers at all levels with appropriate information for planning, control and decision making. Both formal and informal source of are important and should complement one another.

HEALTH MANAGEMENT INFORMATION SYSTEM

Health management information incorporates all the data needed by policy makers, clinicians and health services users to improve and protect population health. Investing in health management information system has the following benefits: Help decision makers to detect and control emerging and endemic health problems Empower individuals and communication with timely and understandable information health related information and drive improvements in quality of service. Strengthen the evidence based for effective health policies, permitting evaluation of scale- up efforts, and enabling innovation through research Improve governance, mobilise new resources, and ensure accountability in the way they are used.

Objectives of Health Management Information Systems. The primary purpose of the organization is to satisfy the needs of its clients. The system approach is objective oriented. The approach is a top down one where what comes before how. The purpose of the organization is expressed in its objectives. Objectives express the direction and level of achievement expected from the organization as a whole and, at lower levels, from the individual parts, sections and departments which make up the organization.

Types of Objectives
1. Personal and Organizational objectives -Helps to achieve individual and health organizational objectives. 2. Multiple objectives Series of objectives to cope with the various responsibilities of a health survive organization e.g. 3. Conflicting objectives
Objectives are often in conflict and some compromise is usually necessary Management have to overcome constrains which hinder the fulfilment of objectives Hard issues are measurable, clearly defined with known solution techniques

LESSON TWO

THE ORGANIZATION OF HEALTH INFORMATION SYSTEMS IN THE MINISTRY OF HEALTH

The Historical Development that led to the establishment if HIS in MOH
Kenyas Health Information System was established in 1972, when a committee including representatives from the ministry of Health, World Health Organization, Central Bureau Of Statistics and the Attorney General Chambers was formed to initiate the process. Task of this committee was to design a Health Information System (HIS) in Kenya. This was a result of an evaluation of the MoH on the available data which indicated very little data available in the form of useful data. The Committee studied the problems associated with inadequate reports and data and established the following. The forms used by hospitals (Med,21 and Med, 22, and Med, 23) could not be used outside the hospital because they were both bulky and complicated. The number of qualified staff were minimal and could not fill out the forms completely.

ORGANIZATION OF HEALTH INFORMATION COUNT

The number of qualified staff were minimal and could not fill out the forms completely The district hospital was overloaded with the responsibility of collecting, compiling and reporting all medical cases that occurred within the district. The workload at the district level was so much that they were private, mission hospitals and other smaller health units. The review suggested that an overhaul of the existing system was necessary including a decentralization of reporting by the district hospitals. The responsibility to report was therefore placed on each health facility irrespective of the controlling agencies. The existing forms were reviewed and revised based on priority preventive and curative health areas.

 The trial was meant to rust for one year and the results of the trial were to form the basis of the final forms. Unfortunately, it was not possible to finish the study after one year but the pilot project was completed in 1976 and the suggestion and recommendations were adopted as policy. Thus HIS was born. In September 1976, Kilifi was added to the system. In December 1976, it was decided that whole Kenya should be introduced to the system. A number of documents such as Antenatal cards, environmental sanitation, medical personnel and medical inventory reports etc.were tried during the pilot study but were not included as part of the HIS because those responsible for studying and recommending the documents did not submit their findings to the committee in time for their approval. This and other important data collection instruments however, could be introduced in the future as the MOH saw fit.

 The Committee approved the following documents for use by all units. 1.Med 800 - Out patient Register 2. Med 801 - Out Patient card 3. Med 8002 - Out Patient Tally sheet 4. Med 803 - Immunization tally list 5. Med 804 - Monthly Laboratory report 6. Med 901 - Discharge sheet 7 . Med 902 - Out of patient Monthly Activity Report 8. Med 903 - Immunization summary.

 In 1982, another committee of professional was formed to investigate on the accuracy and efficiency of all health data collection forms. The Committee was satisfied that on the application tools and recommended minor changes. In 1984, in response to the national policy on District for Rural Development, the ministry of Health decentralized its reporting activities by establishing Health Information Systems (HIS) offices in all districts where all health data from m all health facilities would be processed. In order to support the policy making role of the MoH in Management, planning and budgeting as well as strengthening the coordination function with NGOs and the private sector in health care delivery, a proper design and implementation of integrated health information and management system will be critical taking into consideration the achievement and constrains encountered during the review period.

 Health Information and Management System are critical as stated in the National Policy Framework paper 1994 2010, National Health Sector Strategic Plan 1 and 11 1999 2004, 2005 -2010 and the Performance Monitoring and Evaluation (PME) Framework 2005 to 2010 respectively. To meet this greatest challenge the health sector under the coordination of Ministry of Health Management Information Systems division initiated the process to review and integrate data collection (Registers) and reporting tools (summary forms) in April 2006 to meet the current challenges and demand for data. The process took over one year to agree on indicators and variables to be included in the data sets or what should be collected by the registers and reporting summaries. The revised data collection (registers) tools in 2006/2007 are as follows.

INTERGRATED MINSTRY OF HEALTH DATA COLLECTION AND REPORTING TOOLS

DATA COLLECTION TOOLS (REGISTERS) 1. MOH 204A OUT PATIENT REGISTER (UNDER FIVE YEARS) 2. MOH 200B OUT PATIENT REGISTER (OVER FIVE YEARS) 3. MOH511 CHILD WELFARE CLINIC (CWC) REGISTER 4. MOH 510 IMMUNIZATION REGISTER FOR CHILDREN 5. MOH 333 MATERNITY DELIVERY REGISTER 6. MOH 406 POSTNATAL REGISTER 7. MOH 512 DAILY ACTIVITY (FAMILY PLANNING) REGISTER 8. MOH 30 IN PATIENT REGISTER 9. MOH 209 RADIOLOGY REGISTER 10. MOH 204 RADIOLOGY REGISTER 11. MOH 268 DIAGNOSTIC INDEX CARD 12. MOH 405 ANTERNATAL CLINIC (ANC) REGISTER