Health Information Systems

ms in a health care setting, While

gy and syste
Health informatics is the application of bot! h tec
hnolo BY tems cover the records, coding
al th in fo rm at io n sys
health information technology focuses on tools, he
y services.
documentation, and administration of patient and ancill ar y health
ting factors wh
e among the motiva
Concerns about the cost and quality of health care ar industries all over the worl
Z fics d. The
information systems are increasingly implemented across health industries ca efficient ang
system enables the provision 0
combination of elements in a health information
correlate and translated
effective health care services. The components of a health «nformation system are
into harmonious operations.
store, manage, and
The health information systems (HIS) cov er different systems that capture,activities of a health
transmit health-related information that can be source d
from individuals or
disease surveillance systems, dist rict level routine infor
mation systems, hospital
institution, These include
formation systems (HRMIS), and
patient administration systems (PAS), human resource management in
laboratory information systems (LIS).
in p olicymaking and decision-
The information collected from a well-functioning HIS is very useful
making of health institutions and becomes the basis in cre ating program action.
i This translates to efficient
resource allocation at the policy level, and improvement of the quality and effectiveness of health at the
delivery level.
|
sustain able, user-fr iendly, and econom ical. Health care person nel should be educated
HIS should be
of good quality data in
on the use of the routine data collected from the system and the significance
ote
improving health (Pacific Health Information Network, 2016).

Role and Function of Health Information Systems

Sheahan (2017) defines health information systems (HIS) as a mechanism which keeps track of
logs,
all data related to the patient such as patient’s medical history, contact information, medication
appointment schedule, insurance information, and financial account including billing and payment. The
roles that a well-implemented HIS can perform in improving health services are as follows:
1. Easier access to files
The systems have revolutionized the collection and management of patient information.
The need for a hardcopy of the patient’s medical records becomes optional as the systems are
electronic.
2. Better control

Only authorized personnel can have access information on the patient’s health. Doctors
may be given permission to update patient information while a rece tionist may only have the
authority to update a patient’s appointments. P Y

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 3, Easier update

7 fter creation of the record, patient

sont; information can be accessed and reviewed any time and
copies can be printed or released to the patient upon request
4. Improved communications

HIS assists communication among doctors and hospitals, However, medical professionals
must adhere to regulations on patient privacy and security to ensure that information is kept
confidential and safe from unauthorized access.

A good health information system delivers accurate information in a timely manner, enabling
decision-makers to make informed choices about the different aspects of the health institution, from
patient care to annual budgets. It also upholds transparency and accountability due to easier access to
information.

Components of Health Information Systems

The Health Metrics Network (HMN), in its Framework and Standards for Country Health Information
Systems (2008), defines health information systems as consisting of six components:

Ba :

elite
Dissemination Information
and Use RA Ciky
= Resources

Information i
a. Indicators
Products

Data Data Sources

Management AST

Figure 5.1 Six Elements of HIS

1. Health information systems resources

ion, regulation, planning, and the resources required
These include the framework on legislat
l, logistics sup port, financing, ICT, and the
for the system to be fully functional (e.g., personne
ism).
component's coordinating mechan

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 2. Indicators
an d relate
d targets such ag t h
i des ‘adicators
ind outcomes; and the health
The basis of the HIS plan and strategy inclu +s, and
status,
determinants of health; health system inputs, outpurs,
3. Data sources ategories: (1) population-based approaches Such
n ca ‘
Data sources are divided into two “a n surveys and (2) institution-based data such as
as civil registration, censuses, and populatio Occasional health
‘cect surveys, research,
claatifie d ang
ords.
individual records, resource records, and service rec ly under the
ations may not be direct
niza"
information produced by community-based organiz
information.
main categories, but they may provide useful
4. Data management lectio10n and storage a
:
Data management refers to the handling aof data, starting
alysi . ie * mens
flow and quality assurance, processing, compilation, and data analy
5. Information products
Data is transformed into useful information that ser
ves as evidence and provides insight
crucial to shaping a health action.
6. Dissemination and use
to policymakers
HIS enhances the value of health information by making it readily available
and data users.

These six components of health information systems can be categorized into inputs, processes, and
outputs. ;
Inputs refer to the health information system resources. These resources include health, institutional
coordinations and leadership, health information policies, financial and human resources, and infrastructures.
The indicators, data sources, and data management form.the process in HIS. Core indicators are
needed as bases for program planning, monitoring, and evaluation. Population- and institution-based
sources are also essential for decision-making as they provide guide to health service delivery. Importantly,
these data must be accessible and understandable by users and policymakers. —
Outputs refer to the transformation of data into information that can be used for decision-making
and to the dissemination and use of such information. ‘

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 pifferent Data Sources for Health Information Systems

Demographic Data Administrative Data Health Risk Health Status

Information

Patient Medical Current Medical

History a Management Outcomes Data

Figure 5.2 Sources of Information for HIS

Donaldson and Lohr (1994) explain that a comprehensive database for health information systems
include the following:
1, Demographic data refers to the facts about the patient which include age and birthdate,
gender, marital status, address of residence, race, and ethnic origin. Information on educational
background and employment is also recorded along with information on immediate family
members to be contacted during emergency.
Administrative data includes information on services such as diagnostic tests or out-patient
procedures, kind of practitioner, physician's specialty, nature of institution, and charges and
payments.
or
Health risk information records the lifestyle and behavior (e.g., use of tobacco products
history
engagement in strenuous activities) of a patient and facts about his or her family’s medical
different
and other genetic factors. This information is used to evaluate the patient's propensity for
diseases.
health.
Health status refers to the quality of life that a patient leads which is crucial to his or her
well-
This shows-the domains of health which include physical functioning, mental and emotional
of his or her
being, cognitive functioning, and social functioning. It also shows one’s perception
health in comparison with that of his or her peers.
admissions,
Patient medical history gives information on past medical encounters like hospital
illnesses
pregnancies and live births, surgical procedures, and the like. It also includes previous
and family history (e.g., alcoholism or parental divorce).
diagnoses, allergies
. Current medical management reflects the patient's health screening sessions,
ostic or therapeutic
(especially on medications), current health problems, medications, diagn
problems.
procedures, laboratory test, and counseling on health
various health
7. Outcomes data presents the measures of aftereffects of health care and of
problems. These data usually show the health care events (e.g., readmission to hospital,
unexpected complications or side effects) and measures of satisfaction with care. Outcomes
directly reported by the patient after treatment will be most useful.

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 = Key Points to Remember

ansmit be
store, manage, and tr alth. :
Health information systems (HIS) refer to systems that ¢
apture,

can be sourced from individu als o r act ivi tie s of health institutions,
related information that
. . i ures easi er file access, better control, Casi
HIS improves the delivery of health services because it ens
update, and improved communications.
; systems are health info
inf rmation system resources (inputs
The components of health information tra nsf ormation of data Into);
(processes); and
indicators, data sources, and data management
. information, and its dissemination and use (outputs).

The different data sources are demographic data, administrative data, health risk information, health
status, patient medical history, current medical management, an d outcomes
data.

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 Health Management Information System
managed manually, starting from Patien,
Traditionally, health care administrations have b een wove
registration to consultation. d to be time-consuming and Posed +
The creation of
documents P
tisk of having duplicate records, 4p cuments was also a concern
Improper storage oL ues becans ne
difficulty in retrieval and the high cost of maintaining proper torage. Getting an overview of the nu 7
- ae ms that need immediate act; one
of patients visiting the hospital, or consolidating the nature
Oo P uch as snapshots and dashbosrg : et
_ Providing pertinent reports were very difficult to achieve. Tools alae ich
are necessary in the analysis of the performance of hospitals
were una
Hospitals using the traditional manual process do not have
ued eye me the Teceipy
of data pose a challenge to evidence-based program management. ;
. in probleme in an cords of
equipment and drugs could not be obtained in a timely
manner resulting 3 P ‘ ccountabilj ;
monitoring of expiry dates, stocks, and auto indenting. Inventory of me
tedious task icine and equipment wag a
due to lack of standards in filing names and codes in the institution.
The need to enhance the management of health care
services and to have real-time data to MOnitor
the hospital performance thus calls for a health information mana
gement system that will address these
concerns.
.
As defined by the World Health Organization
(2004), health management informati
(HMIS) is “specially designed to assist on system
in the man: agement and planning of health
opposed to delivery of care” The health compon programmes, as
ent of HMIS refers to clinical studies to unde
medical terminologies, clinical procedures, rstand
and database processes; management refe
that help administer the health care ente rs to the principles
rprise; and information system refers
and implement applications for efficient to the ability to analyze
and effective transfer of patient informat
the six building blocks essential for heal ion. An HMI S is one of
th system strengthening. It is a data
designed to support planning, collecti on system specifically
and organizations.

¢ The information collected

is releva
the responsibilities of the health pr goals of the health care instit
ofessionals at th ution, and to
e level of collec
¢ The inf ormation collected is functi ti on .
onal as it is to be used j
not wait for feedback from higher levels. mmed i d shou. Id
Sciately for management an

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Roles of HMIS
role of 7
jor ing at all levels of
me ade quality information to support ngdecision-mak
se at . Si HMIS BieialP tOvins
the he ef a em in ary mes titution. In addition to encouragi the use of health information
els of health service delivery
in hospitals, it also aims to aid in the setting of performance targets ecattor all (R lev i inistry of
and to assist in assessing performance at all levels of the health s
: alth sector (Republic of Uganda Ministry ©
Health Resource Centre, 2010).
An HMIS needs to be complete, consistent, clear, simple, cost-effective, accessible, and confidential
(Janneh, 2002). It should be complete with all information but avoiding duplication and consistent in
assigning definitions to similar information from various sources. It should also be simple to use and clear °
able to use the
as to what is measured by the elements. The eligible users must have access and should be
priority.
system with ease. The confidentiality of patient information and data privacy should always be a top
While providing all these benefits, the system must prove its cost-effectiveness through its operations. ,

Functions of HMIS —
detection,
The information from an HMIS can be used in planning, epidemic prediction and
Ministry of Health
designing interventions, monitoring, and resource allocation (Republic of Uganda
Resource Centre, 2010).
ion of three
Historically, all information systems, including HMIS, are built upon the conceptualizat
and data output. Each phase
fundamental information-processing phases: data input, data management,
comes with elements (Tan, 2010) that perform specific functions.
1. Data input includes data acquisition and data verification. -
through the input of standard ©
a. Data acquisition refers to the generation and collection of data
reading and capturing of data.
coded formats (e.g., bar codes) to assist in the faster mechanical
The authority, validity, and
b. Data verification involves data authentication and validation.
red data.:
reliability of the data sources help ensure quality of gathe
data storage, data classification, data
2. Data management, also called processing phase, includes
update, and data computation.
is advisable that data which are no
a. Data storage includes preservation and archiving of data. It
legislation.
longer actively used should be archived. At times, it is mandatory and part of
sets the efficiency of the system. Key
b. Data clas sification is also called data organization which
ificati on schemes for easier data search.
parameters should be used for data class
manipulation and data transformation
c. Data computation requires various forms of data
stical and probabilistic
ls, linear and nonlinear transformation, stati
(e.g., mathematical mode
function allows data analysis, synthesis,
approaches, and other data analytic processes). This also for other
and evaluation so that data can be used not only for decision-making but
tactical and operational use.
d. Data update facilitates new a nd changing information
and requires constant monitoring.
For HMIS, the mechanism for data maintenanc
e must be in place for updating changes for
manual or automated transactions.
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 3. Data output includes data retrieval and data pre sentation.
data distribution. Th
a. Data retrieval pertains to the processes of data transferane sdti"tvoin the votes transfe,

process considers the duration of transmittal o he needed information is a ée to the

appropriate end-user. The economics of producing the n SNificant
criterion.
b. Data .
presentation .is the ing
reporting of the interp retation of the information prog
ts are expected but the use of visu Uced

by the system. Summary tables and statistical reports @ . als is

encouraged especially for high-level managerial decision-making because they provigg a
better intuitive perspective of the data trend.

List of Functions of HMIS

Listed below are the possible functions in an HMIS with the corresponding type of information that
can be captured and tracked in the system (Behavioral Health Collaboration Solutions, 2006).
1. Client data relates to all the information of the client which is related to his or-her transactions,
reports, and other information such as client billing data, clinical data, and other client data.
- Scheduling is observed to distribute resources to areas that need them. An example is linking the
schedule to the billing of the entity. .
- Authorization tracking focuses on monitoring of the authorized personnel and their use of the
-authorized units.
. Billing refers to the notification of the charges for the patient and other related documents such as
the compliant electronic claim.
- Accounts receivable (A/R) management ensures that customers are properly notified about their
bill and will settle it accordingly. Data for A/R management include. tracking aging of unpaid
services, tracking reasons for denials, and aged receivable report by payer source.
. Reporting refers to reports issued by the entity which could be basic reports or report writer.
. Medical record, also called an electronic health record (EHR), is a collection of digital
information about a patient. Aside from patient registration, the data could include assessment,
treatment plan, and progress/encounter notes.
Compliance refers to procedure that should be followed for the improvement of the condition of
the patient or the service provided such as treatment plan and progress note.
Financial data refers to information relating to the performance of the entity collected for
administering purposes. These include financial reports, general ledger, payroll, and accounts
payable.

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 Determinants of HMIS Performance Area
The determinants affecting the performance of an HMIS may be behavioral, organizational, and technical.

Behavioral determinants
The data collector and users of the HMIS need to have confidence, motivation, and competence to
perform HMIS tasks in order to improve the routine health information system (RHIS) process. The
chance of the task being performed is affected by the individual perceptions on the outcome and the
complexity of the task (Aqil, Lippeveld, & Hozumi, 2009). Lack of motivation and enough knowledge on
the use of data has been found to be a major drawback in the data quality and information use. Changing
people's attitude towards data collection and analysis is necessary in order to maximize the performance of
" the RHIS process (Routine Health Information Network, 2003).

Organizational determinants
The important factors that affect the development of the RHIS process are the structure of the
health institution, resources, procedures, support services, and the culture within the organization (Aqil,
Lippeveld, & Hozumi, 2009). However, other factors which include lack of funds, human resources, and
management support contribute to the determinant of the RHIS process. | ,
Having a system in place which supports data collection and analysis and transforms it into useful
information will help in promoting evidence-based decision-making. Thus, all components within the
system are ideal in making the RHIS perform better. An improved RHIS performance means an effective
organizational culture that promotes information use by collecting, analyzing, and using information to
accomplish the organization's goals and mission (Sanga, 2015).

Technical determinants

Technical factors involve the overall design used in the collection of information. It comprises the
complexity of the reporting forms, the procedure set forward in the collection of data, and the overall
design of the computer software used in the collection of information (Sanga, 2015).

PRISM Framework
The Performance of Routine Information Systems Management (PRISM) is a conceptual framework
that broadens the analysis of HMIS or RHIS by including the three determinants of HMIS performance,
namely:
* Behavioral determinants — knowledge, skills, attitudes, values, and motivation of the people who
collect and use data,
. Organizational/environmental determinants — information culture, structure, resources, roles, and
responsibilities of the health system and key contributors at each level, and
© Technical determinants - data collection processes, systems, forms, and methods.

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 ses in cer tai n are as, as well as the COnrelay
This framework identifies the strengths and weaknes i

interventions to improy, mae

.
e
ji

tizing
.

among these areas. This assessment aids in designing an d priori

ee

tysyatert
system. |
performance, which in turn improves the performance of the health
The PRISM framework, founded on performance improvement principles, defines the Vatig
components of the routine health information system an’ d their linkages tone produce better qualit ae,
and continuous use of information, leading to better health system perform nce and, conseq
uently bets a
» er

health outcomes (Aqil, Lippeveld, & Hozumi, 2009).

c (3 Key Points to Remember

+ A health management information system (HMIS) is “specially designed toassist in the Management
and planning of health programs, as opposed to delivery of care (WHO, 2004):
* The major role of HMIS is to provide quality information to support decision-making at all levels of
the health care system in any medical institution.
+ Historically, all information systems, including HMIS, are built upon the conceptualization of three
fundamental information-processing phases: data input, , data management, and data output. Each
phase comes with elements that perform specific functions. The eight elements are data acquisition,
data verification, data storage, data classification, data computation, data update, data retrieval, and
data presentation. - “uP “Sot Roa as
¢ The determinants affecting HMIS performance are behavioral, organizational, and technical.
* The PRISM (Performance of Routine Information Systems Management): framework defines the
various components of the routine health information system (RHIS) and their linkages to produce
better quality data and continuous use of information, leading to better health system performance
and, consequently, better health outcomes.

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HMIS Monitoring and Evaluation
A health management information system aims primarily
at Sey ane ion
Planni
management of a national health strategy plans; thus, continuous ee is ne ng
Cesarand
for it to be effective. By definition and function, monitoring and eve ned fk are compliment,
Monitoring refers to the collection, analysis, and use of information gathere sede ae for the
purpose of learning from the acquired experiences, accounting the resources use oth interna] and
external, and obtaining results and making decisions. These purposes correspon to three functions.
learning, monitoring, and steering. Meanwhile, evaluation is the systematic assessment of completeg
Programs or policies. The objective is to gauge the effectiveness of the program 7 that adjustments ¢
be made in areas that need improvement. An evaluation has both a learning
function in which the lessong
learned need to be incorporated into future proposals, and a monitoring functi
on which means that the
concerned parties review the implementation of policy based on the objectives and resources,

Purpose of M&E
A robust monitoring and evaluation (M&E) system is required to assess the effect of an
integrated
service delivery. Appropriate indicators, data collection systems, and data analysis to support
decision-
making help guide the successful implementation of integrated services and measure the effect
on both
service delivery and use of services (FP/Immunization Integration ‘Working Group, n.d.).

-M&E Framework
A general framework of M&E of health system strengthening (HSS) was developed
by various global
partners and countries. Derived from the Paris Declaration on aid harmonization
and effectiveness and
the International Health Partnership (IHP+), this framework places health
strategy and related M&E
processes of each country at the center. The strengthening of a conimon country platform for the M&E of
HSS is the core of the framework. In doing so, there is better alignment and the monitori
ng of fundings for
health systems is easy.
There are four components of the framework as provided by WHO, namely, the indicator doniains,
data collection, analysis and synthesis, and communication use, intended for achieving greater
health impact. For monitoring medical services, indicators should be tracked to assess processes and
results associated with the various indicator domains. In this way, the strengths and weaknesses of
implementation are provided and can be used for troubleshooting in the system. In terms of outcomes and
impact indicators, the changes may not be directly caused by service delivery efforts for there are other |
factors to consider. However, these data are still useful in understanding the current health status and
context within a country (FP/Immunization Integration Working Group, n.d.).
It should be noted that shifts in outcome and impact indicators may not be directly attributable to
integrated service delivery efforts, as there are many other factors which influence these indicator |
However, where possible, it can be useful to collect these data in order to understand the broader health
context within a country, and the ways in which packages of interventions can lead to impact over time
(FP/Immunization Integration Working Group, n.d.).

Science
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M&E Plan
Aa An M&E plan addresses the components of the framework and establ establiishes the foundation for regular
veviews during the implementation of th
— on the
gah health
SLsector w proces
reviemien aa ses whichOR aT
are consi dered
ec
infor matio n sta Guli
for Sing
global tie
monit pto
oring based
are
ted and evaluated through 2 and performance of the entire system. Medical institutions
assessment of reports, surveys, HMIS, and other evaluation studies.
Nat i * ogi of India identifies strategies which help in the successful
- Se cif lly , the
tstion af ne Rae
ica ee ep ee
needs for
(3) f - € fr am ew or k sho uld (1) be localized, (2) address the
ie Ie users and purposes, ide ntification of indicators and data sources, and
(4) be able
multiple S aci lit ate the
e-specific programs.
to use the M&EE in diseas

M&E and HMIS Indicators

ch mea sur es the valu e of the ch ange in units that can be compared
An indicator is a variablé whi among
. The focu s is on a sing le aspe ct of a program such as input, output,
to past and future"units tor key aspects of health system performance.
The United
ous indi cato rs to moni
others. HMIS uses vari classifies: these indicators (Table
7-1) into five
l: Dev elo pme nt (US AID )
States Agency for Internationa zat ion , disease prevention and control,
resource
uct ive hea lth , imm uni
broad categories, namely, reprod woe
Pe

utilization, and data quality.

Key lndicators —
Table 7.1 Categories of HMIS
GALL ce ee
YONA aU Area
e rate
1, Family planning acceptanc .
Reproductive Health - _—
rage
2. Antenatal care cove hati!
rie s at te nd ed by Sxi lle d-h ealth personnel oat
‘T”'3. Proportion of delive gD WISe OSIBTE
,e
byd
s atten HE dWS
4 : Proportion 0 f deliverie ~ ro *

Se
) coverage (>1.child)’ inte
Immunization
5. DPT-3 (Pentavalent-3
coverage (> Thi. Aree ssh stele
- 6, Measlés Immunization
7 . Malaria case fatali
ty rate among pa tients under 5 yearsof ages TOSI 1 |
Disease Prevention and Waar Tey ve!S
evR
8 _ New malaria cases
per 1,000 population
Control
per 4,000 population, of.
cas es among children under. 5-
9 ~ New pneumonia 1 2 ~

<5 yrs Re caw

FO ee FOW
n rate =
40, TB case detectio
11. TB cure rate
g VCT-services:'. «
42. Clients receivin
letion rate.
_ PMTCT treatment comp
y on ART
44. PLWHA currentl

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 Key Performance Area
Resource Utilization
Data Quality
CN ans here Soe
15. Trace drug availability (in stock)
16. OPD attendance per capita
17. In-patient admission rate
18. Average length of stay (in-patient)
19. Bed occupancy rate
20. Reporting completeness rate
21. Reporting timeliness rate

Source: HMIS Information Use Training Manual (USAID, 2013)

Table 7.2 provides specific indicators, data sourc
es, and purposes for tracking each indicatoy for
monitoring family planning and immunization service delivery
and assessing the integration of services
This table includes a variety. of quantitative indicators coupled
with qualitative techniques in order tg
better understand the basics of the integration processes and solici
t feedback on the approach,
Table 7.2 Quantitative indicators for monitoring family plann
ing/immunization integration
Indicator Data Source Purpose
INPUTS
Vaccine stockouts in a single HMIS, Service statistics
month (YES/NO, by type of Monitor vaccine stockouts.
vaccine)
Contraceptive stockouts in a HMIS, Service statistics
single month (YES/NO, by type of Monitor contraceptive stockouts.
contraceptive)

Number of service providers

trained
in provision of EPI/FP
integrated services
Number of service delivery
points offering integrated FP and
immunization services
Number of days per month when | Service Statis
both immunization and family
planning services are offered at
the same site
Number/percent
of women
‘| attending routine child
immunization services who
;
received information ;
on family
planning from a vaccinator
Training records Monitor reach of EPI/FP integration
;
training as an input for effective
_.| integrated service delivery.
Service Statistics and Supervision
Coverage of integrated service
delive .
tics and Supervision Availability of co-located FP/
Observation + Intervi immunization services
( erviews)
_—
Supplemental tracking column Quality/continuity of
that can be added to existing implementation of integrated
immunization register
service delivery
[Monitored for demonstration/p
ilot
programs only]
_

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 Indicator
Number/percent of women (with
children <12 months) going for
family planning who receive
information on immunization
from the family planning provider
trom—
Number/percent of women
attending routine child
immunization services who .
accept a referral to family
planning services
pare
Number/percent of women
attending routine immunization
services who follow through ona
FP referral from a vaccinator
Number/percent of women
attending family planning services
who follow through on referral
to immunization services from a
family planning provider
Number of children receiving DTP
14, DTP 3, measles’, and DTP 1-3
dropout
HMIS and population-based
Immunization coverage for DTP1,
| Survey Data
DTP3, and measles?
Number of new family planning
acceptors by method type and .
demographic/age group
Contraceptive prevalence rate
Total financial cost of inputs
required to integrate FP and
immunization services (per
facility, per client exposed, per ©
new FP acceptor) .
Maternal, infant, and child
mortality rates
-
1
In many countries measles coverag e
interpretation of findings for measles coverage should be d one within
__ Source: Key Con
uni zat ion Int egr ati on Act ivi tie s (FP /Im mun ization Integration Working Group, n.d.)
and Imm
Data Source Purpose
Supplemental tracki
ckin g column Qual ity/continuity of
added to FP Ledger implementation of integrated
[Monitored for de monstrat . ; service delivery i
programs only] pe plo
Supplemental trackin g column Acceptance of FP referrals
added to Immunization Ledger provided by the vaccinator
[Monitored for demonstration/pilot
programs only]
Comparison of supplemental Follow through on FP referrals
tracking column added to provided by the vaccinator
immunization ledger, and
supplemental tracking column
added to FP ledger
[Monitored for demonstration/pilot
programs only]
Comparison of supplemental -| Follow through on immunization
tracking column added to FP referrals provided by the family
ledger, and supplemental tracking planning provider
column added to immunization
ledger r
[Monitored for demonstration/pilot
programs only] . :
Immunization ledger/HMIS, and Use of immunization services, |
population-based survey data dropout
.,,| Percentage of children <12
months in a given population who
have received DTP1 and DTP3
Family Planning ledger/HMIS . | Uptake of family planning
services
Population Survey Data Contraceptive use within a given
population
Cost of inputs required for
Program data/Special costing integration. This may be helpful
studies. are
in planning for decisions related
; - | to sustainability and scale-up of
integrated services.
infant Measure improvement in health
Studies on maternal and status.
mortality
3 coverag e, even though measles is suppo
sed to be given later. Analysis and
is higher than DTP mstances.
the contex t of individual country circu
and Evaluating Family Planning
siderations for Monitoring
HMIS Monitoring and Evaluation
r
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 HMIS Indicators and Health Programs
Ut ght
HMIS j . sary for monitoring different aspec
asp ts of ts
various health Prop;
is a source of routine data necessary d be carefully selected to meet the es Blam,
implemented in a country. The HMIS indicators show Sentigl
rious health programs and services
information necessary for monitoring the performance 0 va. : and to

present an overview of available health resources.

This section explains the relationship of HMIS indicator s and some of the health Programs ,
communicable and non-communicable diseases. These disease data: provide an in-depth understangin
of how HMIS can be used for monitoring program performance d how it encourages similar in-dep
an intervention, child .
analysis for all health programs and services such as maternal survival inter ? Mortality ang
child survival intervention, and Stop TB program.

Maternal Survival Interventions

The fifth millennium development goal targets to reduce the maternal mortality ratio by 75 Percent _
and to achieve universal access to reproductive health. Despite this set goal, none of the
maternal survival
intervention alone can reduce the maternal mortality rate. As Campbell and Graham (2006) explained, ©
the complexity of the country contexts and maternal health determinants makes it complicated
to choose |
the best strategies in achieving this goal. However, they found that packaging of health facility-orient
ed
interventions is highly effective and has high coverage of the intended target group.
In order to routinely monitor the progress towards implementation of a highly effective package of
maternal survival interventions, HMIS is designed to provide some of the core input, process,
and output
indicators. ,
The HMIS indicators are related to the following:
1. pregnancy care interventions .
+ 1st antenatal care attendances
¢ 4th antenatal care attendances

¢ Cases of abnormal pregnancies attended at out-patient departments (OPD)

of health facilities
¢ Institutional cases of maternal morbidity and mortality due to
antepartum hemorrhage
(APH), hypertension and edema reported by in-patient departments (IPD)
of health facilities
« Cases of abortion attended at health facilities
|
+ Cases of medical (safe) abortions conducte
d at health facilities
2. intrapartum care
+ Deliveries by skilled attendants (at health facilities)
¢ Deliveries by health extension wor
kers (HEW) (at home of health post
s)
¢ Institutional cases of maternal morbidity and mortality due
to obstructed labor

72 Health Information System for Medical Laboratory Science

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 3, postpartum care

e 1st postnatal care attendance

. Institutional cases of maternal morbidity and mortality due to postpartum hemorrhage (PP H)
and puerperal sepsis

4, interpartum period
» Family planning method acceptors (new and repeat)
« Family planning methods issued by type of method

These indicators, although not complete to monitor all aspects of maternal survival strategies, capture
data related to pregnancy, such as intrapartum and postpartum care, and are sufficient to give a broad
tions. More so, using these
indication of the performance of the package of maternal survival interven
indicators help prompt further investigations when problems on issues arise.

Child Mortality and Child Survival Interventions

The leading cause of under-5 child mortality in the Philippines in 2012, as reported by the Department
reported
of Health (DOH) in its top 10 leading causes of child mortality report, was pneumonia with 2,051
cases. Figure 7.1 shows data on other causes of child mortality, such as diarrhea and gastroenteritis,
congenital anomalies, septicemia, other diseases of the nervous system, accidental drowning and
submersion, dengue fever and dengue-hemorrhagic fever, chronic lower respiratory diseases, meningitis,
and leukemia.

2,000

1,800

1,600

1,400

1200

1,000

800

600

400

200

Diarrhea and Congenital Other diseases Septicemia Accidental Chronic tower Dengue Fever Meningitis Pulmonary and
Pneumonia Heart disease
drowning and respiratory and Dengue-
Gastroenteritis Anomalies of the nervous
submersion diseases hemorrhagic
system
fever
® Female
168 215 184 | 140 |
* 469 211 231
Male 298 228 | 141 | 161°
i 400 348 302 240

Philippines
Figure 7.1 Leading cause of under-five child mortality in the
(The 2012 Philippine Health Statistics, 2012) —

luation 73
iMMIS!Monitoring and Eva

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 The Philippine government through DO H launched various strategies to help ensure goog health
Filipino children by 2025. of
1. Chi he Philippine Nation al Strategic Framework for Plan Deye| ;
~ Chi
* Chaat she ‘ SiR ott as A acevo Tentf
. for poli cyma king sr
and prog ram plann
f Filipino children. jn nd
and. ”
roadmap for interventions aimed at safeguarding the veer Ty;.. “8a
onthe Rights of mis 'S Part of
the Philippines’ commitment to the United Nations Con © Child (Uy
CRC).
2. Children’s Health 2025 — This is a subdocum
ent of Child 2) er in an ol OPment of
Filipino children and the protection of their rights by utilizing the yore approach,
3. Integrated Management of Childhood Illness (IMCI) - IMCT is a strategy that aims to
lower
child mortality caused by common illnesses.
4. Enhanced Child Growth - This is an intervention aimed to
improve the health and nutri tion of
Filipino children by operating community-based health and nutrition
posts all through Out the
country.

Stop TB Program
_ Envisioning a tuberculosis-free world, the goal of the Stop TB
Program (STP) is to dramatically reduce
the global burden of tuberculosis (TB) by 2015. This is
in line with the WHO’s millennium development
goals and the Stop TB Partnership which aims to push
TB up the world political agenda. One of the main
objectives of the program is to achieve universal access
to high-quality care (i.e., universal access to high
quality diagnosis and patient-cent
ered treatment) for all people with TB (including
HIV and those with drug-resistant TB). those co-infected with

TB case detection and successful completi

on of the treatment/cure of TB remain at
TB Strategy. Thus, by 2050, one of the targe the core of the Stop
ts of the strategy is to reduce the prevalence
to TB by 50 percent compared with the 1990 of and deaths due
baseline.
The HMIS indicators to monitor Stop
TB Program are
* TB patients on DOTS (Number of
new smear
¢ TB case detection (Number of
new smear- Positi
smear-negative pulmonary TB cases ve pulmonary TB cases detected, number of new
detect ed, number of new
extra-pulmonary TB cases
* HIV-TB co-infection (Proportio of detected)
n newl y diagnosed TB ca
ses test
ed for HIV)
+ HIV+ new TB patients enrolled in DO
TS " B
TB treatment outcome (Treatment completed PTB+
, Cured PTB+, Defaulted PTB+ Deaths PTB*)

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[ {wud
Key Points to Remember

y Monitoring and evaluation (M&E) i

better
up for system
‘health. Global partners and a core
ee)ries ishave component
developed of current
a general framework for toM&Escaleof health
efforts
strengthening (HSS).
I pr : ng M&E and review y em in Pp ai i

strategic plan that compr 1Ses all major disease programs and heath cyte i. ° : :

indi . lth
ere are different HMIS
can be use d in mo ni to ri ng the key aspects of the health
h
from whic g the five broad categories, namely, reproductive hea ,
. vet en performance ar Te trom amon
sy nization disease ation, and data quality.
mm , prevention and control, resources utiliz
s health programs
V HMIS isa source of routine data necessary for monitoring different aspe cts of variou
to meet the essential
implemented in a country. The HMIS indicators should be carefully s elected and to
programs and se rvices
information necessary for monitoring the performance of various health
present an overview of the available health resources.

HMIS Monitoring and Evaluation | 75

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