Health Information Systems In Countries Research Articles

Methodological challenges in collecting and analysing data on child unintentional injuries: Insights from the CHILD Vigilance project (CHIVI) on parents’ attitudes and practices

Abstract Injuries are among the top ten conditions affecting children according to WHO's latest evidence on years lived with disability. Despite this fact, EU countries are still missing strong information systems for enabling efficient response to the problem. Data on child unintentional injuries are still inconsistently collected in Europe due to substantial deficiencies in injury surveillance data as well as differences in coding systems and legal policies on reporting requirements. Apart from specific countries (e.g. Norway) there is no population-based monitoring of child unintentional injuries in Europe, while initiatives to collect EU-wide information on child unintentional injuries such as the Eurosafe study, seems to be scarce. Improving data availability will require greater investments in country health information systems, vital statistics systems, and household survey programmes. Technical advisory groups indicate the need to develop standard data collection procedures and ensure that indicators are harmonised across global initiatives. Building country capacity in collecting, analysing and increasing the use of child injury data for decision making at global, regional, and national levels, is important. The current presentation will discuss the methodological challenges identified in collecting and analysing data on child unintentional injuries based on the CHILD Vigilance project (CHIVI), which is being conducted in two countries (Portugal, Greece) under the umbrella of EUPHA INJ and aims at assessing parenting attitudes and supervision practices in children aged 0-14 years. Based on 577 valid responses, involving 890 children (53.1% male; 46.8% female) the study revealed major challenges in defining child unintentional injuries, identifying validated tools to accurately measure injuries and their impact on children as well as the challenges in defining the most appropriate determinants of child unintentional injuries.

The Gap Between Technology and Ethics, Especially in Low- and Middle-Income Country Health Information Systems: A Bibliometric Study.

Digital health information systems are quickly replacing paper systems worldwide. This study examined scholarly work reflecting how ethical considerations for health information systems (HISs) have evolved over time, with particular interest in the contributions from low- and middle-income country (LMIC) institutions. We systematically searched four research databases for terms related to HISs, ethics, and LMICs; and identified 601 relevant articles published from 1975 through 2019. The included publications were produced by 1,000 authors from more than 700 institutions. However, only 30 publications were co-authored by researchers from both an LMIC and a high-income country (HIC). Most publications pertained to data security. There is an acute need to address a wider array of HIS ethics topics, including those that may be unique to LMIC resource constraints. We recommend more collaborations between LMIC and HIC institutions to address the full range of HIS ethical concerns in LMICs.

CHALLENGES TO THE HEALTHCARE SYSTEM IN BULGARIA AFTER THE OCCURRENCE OF THE CORONAVIRUS

At the end of 2019, humanity was facing one of the most serious challenges that had a negative impact on the entire world economy. The new coronavirus (COVID-19) has been declared a pandemic by the World Health Organization (WHO). It is appearance led to widespread fear, which in turn affected everyone's daily life. As if the international community was suddenly paralyzed, life began to move at a slow pace and people wondered if they too would be affected by a disaster called the coronavirus. The current study aims to analyze the changes and provocations that occurred with the onset of the pandemic. The results show that there are significant gaps in the country's health information systems and that the Coronavirus Disease (COVID-19) has had serious consequences for the country's health, social security and economic growth. The main research methods used in the development are analysis, method of analysis and synthesis, intuitive and systematic approach.

National nodes: a tool to enable efficient work of Distributed Infrastructure on Population Health

Abstract The European framework of health information (HI) consists - besides the supra-national framework - of national frameworks of health infrastructures. It is therefore essential to strengthening capacities to provide HI and carry out research in countries. Nowadays, one can experience lack of coordination, communication and cooperation between stakeholders in a country, leading to overlap or duplication of research and field-work. InfAct proposes a tool to overcome a majority of these difficulties by encouraging MSs to establish national nodes (NN) as a national focal point for DIPoH. A NN is a building block of DIPoH often coordinated by a national institution or governmental unit that functions as a NN and brings together relevant national stakeholders in an organised way. Researchers from public health institutes and research groups constitute the NN to share expertise and updated knowledge on HI with each other. Currently, there are some active NN in the EU, with differences in scope, scale and initial purpose, due to different organisation of HI systems in countries. Such heterogeneity can also be found in national eHealth strategies. Diverse organizational arrangements exist which has proven to influence collaborative activities. At the same time new needs are arising, such as to better bridge the digital HI between research and health care, so that our health care systems can faster contribute to integrated data driven insights. This also relates to the debate on the Health Data Space, which creation is stated in the mission letter to the new European Commissioner for Health. For example, the eHealth Network has been discussing policy documents targeted at national level policy with regard to the organization of National eHealth Networks. In this pitch presentation, an overview of different practices will be presented with proposals for future work in this area, including the role of NN in DIPoH and proposals for their sustainability. Panelists: H Van Oyen Epidemiology and Public Health, Sciensano, Brussels, Belgium Department of Public Health, Ghent University, Ghent, Belgium Contact: herman.vanoyen@sciensano.be S Montante Brussels Liaison Office, National Institute of Health of Italy (ISS), Brussels, Belgium Contact: sabrina.montante@iss.it E Bacry Health Data Hub, Santś publique France, Paris, France E Bernal-Delgado Health Services and Policy Research Group, Institute for Health Sciences in Aragon, Zaragoza, Spain Contact: ebernal.iacs@aragon.es C Sousa Pinto Advanced Analytics and Intelligence, Shared Services In Ministry Of Health, Lisbon, Portugal Contact: catiasousapinto@gmail.com

A learning agenda to build the evidence base for strengthening global health information systems.

Evidence-based interventions are necessary for planning and investing in health information systems (HIS) and for strengthening those systems to collect, manage, sort and analyse health data to support informed decision-making. However, evidence and guidance on HIS strengthening in low- and middle-income countries have been historically lacking. This article describes the approach, methods, lessons learned and recommendations from 5 years of applying our learning agenda to strengthen the evidence base for effective HIS interventions. The first step was to define key questions about characteristics, stages of progression, and factors and conditions of HIS performance progress. We established a team and larger advisory group to guide the implementation of activities to build the evidence base to answer questions. We strengthened learning networks to share information. The process of applying the learning agenda provided a unique opportunity to learn by doing, strategically collecting information about monitoring and evaluating HIS strengthening interventions and building a body of evidence. There are now models and tools to strengthen HIS, improved indicators and measures, country HIS profiles, documentation of interventions, a searchable database of HIS assessment tools and evidence generated through syntheses and evaluation results. The systematic application of learning agenda processes and activities resulted in increased evidence, information, guidance and tools for HIS strengthening and a resource centre, making that information accessible and available globally. We describe the inputs, processes and lessons learned, so that others interested in designing a successful learning agenda have access to evidence of how to do so.

Evaluating EHR and Health Care in Jordan According to the International Health Metrics Network (HMN) Framework and Standards: A Case Study of Hakeem

Hakeem is one of the e-health systems that were implemented in Jordan to support the health care and services of medical sectors by connecting public health hospitals all around Jordan. This paper was carried out as a unique and first study to investigate the effectiveness of Hakeem health system according to the international health information systems standards. The health metrics network (HMN) framework and standards for country health information systems are used to measure the Hakeem system from different perspectives to ensure that it meets its objectives to maintain the required level of medical services in Jordan compared to international systems. The study was conducted on 522 respondents of Hakeem system users from four hospitals and ten health centers in Jordan. Data were collected by a valid and reliable questionnaire and interviews and analyzed by SPSS software. The study results indicated that the conformity extent of Hakeem system's components with HMN framework and standards are in different agreements percentages. Some components are with acceptable percentages such as the integration polices and data processing while other components are with moderate, low, and very lower percentages that needed improvements. In light of the results, the study introduces some recommendations to improve Hakeem systems such as improving the technical support of the entire system and the services used in the pharmacy unit.

The Nigerian health information system policy review of 2014 : the need, content, expectations and progress.

Nigeria's national health information system (HIS) data sources are grouped into institutional and population based data that traverse many government institutions. Communication and collaboration between these institutions are limited, fraught with fragmentation and challenges national HIS functionality. The objective of this paper was to share insights from and the implications of a recent review of Nigeria's HIS policy in 2014 that resulted in its substantial revision. We also highlight some subsequent enactments. In 2013, Nigeria's Federal Ministry of Health launched an inter-ministerial and multi-departmental review of the National Health Management Information System policy of 2006. The review was guided by World Health Organization's 'Framework and Standards for Country Health Information Systems'. The key finding was a lack of governance mechanisms in the execution of the policy, including an absent data management governance process. The review also found a multiplicity of duplicative, parallel reporting tools and platforms. Recommendations for HIS Policy revisions were proposed to and implemented by the Federal Government of Nigeria. The revised HIS policy now provides for a strong framework for the leadership and governance of the HIS with early results.

How Do Countries' Health Information Systems Perform in Assessing Asylum Seekers' Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries.

Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods: Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson’s rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0–97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results: In the independent rating, Pearson’s rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health, socio-economic status and health behaviour. The relative gap in the HIATUS component “data sources and availability” was much higher in Germany (92%) than in NL (28%). Conclusions: The standardised tool (HIATUS) proved useful for assessment of country HIS performance in two countries by consensus-based rating. HIATUS revealed substantial limitations in HIS capacity to assess the health situation of asylum seekers in both countries. The tool allowed for between-country comparisons, revealing that capacities were lower in DE relative to NL. Monitoring and benchmarking gaps in HIS capacity in further European countries can help to strengthen HIS in the future.

Countering the “dam effect”: the case for architecture and governance in developing country health information systems

ABSTRACTThis paper presents a case for enterprise architecture (EA) and IT governance for driving techno-organizational change and coordination of health information systems (HISs) in developing countries. We support our claim with analyses of a large-scale electronic HIS in Ethiopia by tracing the logic of actors’ decisions and conduct within and beyond the organizational boundaries of the Ethiopian Federal Ministry of Health to understand how the information system innovation process is designed, legitimized and imposed by internal and external organizational forces. In the absence of formalized institutional arrangements throughout the HIS development and implementation, an international development agency fills a key gap forming an obligatory passage point which we conceptualize as “the dam effect.” Drawing on actor-network theory, we identify three important implications of EA and IT governance: (1) to help achieve an alignment of interests within the enterprise; (2) to serve as a tool for protecting the interests of the enterprise in external negotiations; and (3) to serve as a pragmatic approach to carrying out techno-organizational change.

Strengthening health information systems for disability-related rehabilitation in LMICs.

The purpose of this study was to describe the state of rehabilitation health information systems (HIS) in different settings, and identify key processes and actions which contribute to the development of HIS which can effectively support low- and middle-income countries (LMICs) allocate resources to health-related rehabilitation to people with disabilities. Nine case studies were conducted across different disability and developmental settings using documentary review and semi-structured key informant interviews (N = 41). Results were analysed against the six building blocks of a HIS, based on the Health Metrics Network Framework and Standards for Country Health Information Systems and existing HIS capacity. Key barriers or enablers to good disability data collection and use, were documented for each HIS component. Research results suggest there is no gold standard HIS for rehabilitation. There was broad consensus however, that effective health related disability planning requires reliable data on disability prevalence, functional status, access to rehabilitation services and functional outcomes of rehabilitation. For low-resource settings, and where routine HIS are already challenged, planning to include disability and rehabilitation foci starting with a minimum dataset on functioning, and progressively improving the system for increased utility and harmonization, is likely to be most effective and minimize the potential for overburdening fragile systems. The recommendations from this study are based on the successes and challenges of countries with established information systems, and will assist LMICs to prioritize strategic measures to strengthen the collection and use of data for rehabilitation, and progressively realize the rights of people with disabilities.

Potential use cases for the development of an electronic health facility registry in Nigeria: Key informant's perspectives.

Background: Master facility lists (MFL) maintain an important standard (unique identifier) in country health information systems that will aid integration and interoperability of multiple health facility based data sources. However, this standard is not readily available in several low and middle income countries where reliable data is most needed for efficient planning. The World Health Organization in 2012 drew up guidelines for the creation of MFLs in countries but this guideline still requires domestication and process modeling for each country adopting it. Nigeria in 2013 published a paper-based MFL directory which it hopes to migrate to an electronic MFL registry for use across the country. Objective: To identify the use cases of importance in the development of an electronic health facility registry to manage the MFL compiled in Nigeria. Methods: Potential use cases for the health facility registry were identified through consultations with key informants at the Federal Ministry of Health. These will serve as input into an electronic MFL registry development effort. Results: The use cases identified include: new health facility is created, update of status of health facility, close-out, relocation, new information available, delete and management of multi-branch health facility. Conclusion: Development of an application for the management of MFLs requires proper architectural analysis of the manifestations that can befall a health facility through its lifecycle. A MFL electronic registry will be invaluable to manage health facility data and will aid the integration and interoperability of health facility information systems.

Essential evidence for guiding health system priorities and policies: anticipating epidemiological transition in Africa

BackgroundDespite indications that infection-related mortality in sub-Saharan Africa may be decreasing and the burden of non-communicable diseases increasing, the overwhelming reality is that health information systems across most of sub-Saharan Africa remain too weak to track epidemiological transition in a meaningful and effective way.ProposalsWe propose a minimum dataset as the basis of a functional health information system in countries where health information is lacking. This would involve continuous monitoring of cause-specific mortality through routine civil registration, regular documentation of exposure to leading risk factors, and monitoring effective coverage of key preventive and curative interventions in the health sector. Consideration must be given as to how these minimum data requirements can be effectively integrated within national health information systems, what methods and tools are needed, and ensuring that ethical and political issues are addressed. A more strategic approach to health information systems in sub-Saharan African countries, along these lines, is essential if epidemiological changes are to be tracked effectively for the benefit of local health planners and policy makers.ConclusionAfrican countries have a unique opportunity to capitalize on modern information and communications technology in order to achieve this. Methodological standards need to be established and political momentum fostered so that the African continent's health status can be reliably tracked. This will greatly strengthen the evidence base for health policies and facilitate the effective delivery of services.

Developing decentralised health information systems in developing countries –cases from Sierra Leone and Kenya

Health service provision is a public concern that mostly takes place at community level, through primary health care. Using cases from Sierra Leone and Kenya, this study shows how country health information systems, producing simple information products such as quarterly bulletins and league tables being distributed widely, have enabled the communities to be engaged in improving the health status of the population. The community based information systems were part of a national system and the usefulness of comparing local data with data from other communities and from across the country in pursuing equity in health services provision is demonstrated. A community based information system is thus benefiting from being part of and integrated with the larger national system. The article presents and discusses community based participatory approaches to developing information systems which are enabling the community to take ownership and ‘cultivate’ culturally appropriate systems. Illustrated by the cases, the article argues that modern ICT and Internet based technologies, and even ‘cloud’ based infrastructures, are indeed appropriate technologies even at community level in rural Africa.

Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies

Recent substantial increases in international attention to health have been accompanied by demands for statistics that accurately track health progress and performance, evaluate the impact of health programs and policies, and increase accountability at country and global levels. The use of results-based financing mechanisms by major global donors has created further demand for timely and reliable data for decision-making. In addition, there is increasing country demand for data in the context of health sector strategic plans, including in countries that have established International Health Partnership (IHP+) compacts [1]. In spite of recognized efforts by programs and countries, the ability to respond to this demand is constrained by limited data availability, quality, and use. Many developing countries have limitations that hamper the production of data of sufficient quality and timeliness to permit regular tracking of progress made in scaling up and strengthening health systems. Data gaps span across the range of input, output, outcome, and impact indicators. New ways of working and a more systematic approach by all partners are needed to better monitor and evaluate progress and performance. We believe that this global public good is a necessary foundation to improve health investments and programs and accelerate progress towards the Millennium Development Goals (MDGs) and other major international health goals. Monitoring and evaluation (M&E) in health requires different types of data, including levels and distribution of health financing, health workforce, service access and quality, intervention coverage, risk factors, and health status, which are derived from multiple sources. Table 1 summarizes the current situation and required actions in developing countries for the main data sources: household surveys, birth and death registration, census, health facility reporting systems including surveillance systems, and administrative data. To improve data availability, quality, and use, each of these data sources need to be strengthened according to international principles and standards, including the Health Metrics Network framework for country health information systems [2],[3]. In this process, strengthening country capacity in collecting, processing, analyzing, and using health data is essential. There are many initiatives to support capacity building, but the current situation tends to be fragmented, often driven by the needs of single-disease programs. Long-term systematic efforts to build the capacities of country institutions are few and far between. Such an approach should promote quasi-autonomous or independent country institutions, which work very closely with ministries of health and national statistical offices. Adherence to the Fundamental Principles of Official Statistics is critical to increase accountability, transparency, and adherence to quality standards [4]. Table 1 Health data sources: Situation in countries and required actions. The eight agencies working in global health (Box 1) agree that it is critical to strengthen the five key data sources (Table 1) and capacity for analysis, synthesis, validation, and use of health data in countries. This should enable countries to better monitor and evaluate their own progress and performance and, secondarily, allow them to respond to the increased emphasis on results and accountability [5]. The eight agencies propose four global actions to support these country goals. Box 1. Eight Agencies Working in Global Health Bill & Melinda Gates Foundation GAVI Global Fund to Fight AIDS, Tuberculosis & Malaria UNAIDS UNFPA UNICEF World Bank World Health Organization

Overcoming migrants’ barriers to health

Climate change, global conflict and economic necessity are driving the highest levels of migration in history. According to the International Organization for Migration (IOM) some 192 million people are living outside their place of birth, representing about 3% of the world's population. The sheer scale of human displacement has turned migrant health into a priority global public-health issue, an issue rendered more complex by the diversity of the populations involved--from people in search of work or education to more vulnerable groups like asylum seekers and refugees. Apart from the increased potential for the spread of infectious disease that a more mobile global population brings, there is also rising concern that migrants' health needs are not always adequately met. Many countries restrict access to health care for certain migrant groups--including irregular migrants and asylum seekers. For example, until a recent court ruling, the United Kingdom restricted access to free health care to some migrants--including irregular migrants--to counter any possibility that they were entering the country primarily for free medical treatment. Dr Daniel Lopez-Acuna, director of WHO's Health Action in Crises Recovery and Transition Programmes, says migrant health issues are coming to a head in some countries, which is why they have been raised at the highest levels within the public-health agenda at national and international health levels. [ILLUSTRATION OMITTED] For Lopez-Acuna, the threat of communicable diseases spreading is only one aspect of the issue: With ever-increasing migrant populations in many countries, more strain is being put on government systems that provide health services to the public, he says. This strain is even greater when the flow of humanity is between lower-income countries, says Dr Eric Laroche, assistant director-general of the Health Action in Crises cluster of departments at the World Health Organization (WHO). Providing health care for new flows of migrants can place extra burdens on the receiving country, he says, and cites poverty, marginality and the stress of displacement among the factors affecting the health of populations on the move. At the World Health Assembly in May, WHO agreed on four strategies to address the vulnerabilities and healthcare needs of migrants. Advocacy and policy development is crucial to ensure migrants have equitable access to health services, says Lopez-Acuna. There is also a need to assess trends in migrants' health by improving country health information systems, which can help identify and fill gaps in service delivery. Lopez-Acuna also believes it is essential to train policy-makers and health stakeholders on migrant health issues, and to improve service delivery to reinforce migrant-friendly public-health services and establish minimum health-care standards for all vulnerable migrant groups. Between 1960 and 2005 the number of international migrants in the world more than doubled, from an estimated 75 million in 1960 to almost 191 million in 2005, according to a United Nations report, Trends in total migrant stock, 2005 revision. Migration is now running at about 3% annually, according to the IOM. Undocumented migration is harder to track but the International Labour Organization estimates that there are 15-30 million irregular immigrants internationally. Refugees represent 9.7% of global migrants, according to the Worm refugee survey in 2005, which estimated that there were 17 million global refugees, most of whom were hosted by African countries. Family reunification and the allure of a better life, including enhanced prospects for work or education are driving migration to countries belonging to the Organisation for Economic Co-operation and Development (OECD). From 2004 to 2005 immigration to OECD countries increased by four million people. This labour-driven trend is expected to continue as high-income countries with low fertility see their populations decline and age. …

Tracking progress on child mortality

The increased attention to tracking progress towards the Millennium Development Goals (MDG), including Goal 4 of reducing child mortality, has drawn attention to a number of interrelated technical, operational and political challenges and to the underlying weaknesses of country health information systems upon which reliable monitoring depends. Assessments of child mortality published in 2005, for almost all low-income countries, are based on an extrapolation of the trends observed during the 1990s, rather than on the empirical data for more recent years. The validity of the extrapolation depends on the quality and quantity of the data used, and many countries lack suitable data. In the long run, it is hoped that vital registration or sample registration systems will be established to monitor vital events in a sustainable way. However, in the short run, tracking child mortality in high-mortality countries will continue to rely on household surveys and extrapolations of historical trends. This will require more collaborative efforts both to collect data through initiatives to strengthen health information systems at the country level, and to harmonize the estimation process. The latter objective requires the continued activity of a coordinating group of international agencies and academics that aims to produce transparent estimates -- through the consistent application of an agreed-upon methodology --for monitoring at the international level.