This article evaluates social implications of the ""SIGA"" Health Care Information System (HIS) in a public health care organization in the city of Sao Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.
This article evaluates social implications of the "SIGA" Health Care Information System (HIS) in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.
Background: Destruction of health systems in fragile and conflict-affected states increases civilian mortality. Despite the size, scope, scale and political influence of international security forces intervening in fragile states, little attention has been paid to array of ways they may impact health systems beyond their effects on short-term humanitarian health aid delivery. Methods: Using case studies we published on international security forces’ impacts on health systems in Haiti, Kosovo, Afghanistan and Libya, we conducted a comparative analysis that examined three questions: What aspects, or building blocks, of health systems did security forces impact across the cases and what was the nature of these impacts? What forums or mechanisms did international security forces use to interact with health system actors? What policies facilitated or hindered security forces from supporting health systems? Results: We found international security forces impacted health system governance, information systems and indigenous health delivery organizations. Positive impacts included bolstering the authority, transparency and capability of health system leadership. Negative impacts included undermining the impartial nature of indigenous health institutions by using health projects to achieve security objectives. Interactions between security and health actors were primarily ad hoc...
Background: While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. Design: The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. Results: We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4...
The central government s policies,
though well-intentioned, have inadvertently de-emphasized
environmental health and other preventive public health
services in India since the 1950s, when it was decided to
amalgamate the medical and public health services and to
focus public health services largely on single-issue
programs. This paper discusses how successive policy
decisions have diminished the Health Ministry s capacity for
stewardship of the nation s public health. These decisions
have introduced policies and fiscal incentives that have
inadvertently enabled states to prioritize medical services
and single-issue programs over broader public health
services, and diminished the capacity of the public health
workforce to deliver public health services. Diseases
resulting from poor environmental health conditions continue
to impose high costs even among the more affluent, and
hinder development. There are many approaches to
strengthening the public health system, and the authors
suggest one that may require relatively little modification
of existing structures and systems. They suggest
establishing a focal point in the Health Ministry for public
A longstanding debate on health systems
organization relates to benefits of integrating health
programs that emphasize specific interventions into
mainstream health systems to increase access and improve
health outcomes This paper is organized in five chapters.
This introduction is followed by the methodology chapter,
which includes a brief section on the conceptual framework
used to analyze the studies retrieved and the programs
presented within these to map the nature and extent of
integration into critical health system functions. The
results chapter includes: a summary of the outcomes for each
study grouped by the disease area or the clinical problem
the intervention seeks to address, including the reported
success; for each program, analysis and mapping of the
nature and extent of integration into critical health system
functions; and an analysis of how contextual factors either
created opportunities for introducing or integrating a
program or influenced the desirability or feasibility of
program integration. The discussion chapter provides an
overview of the implication of findings for policy makers...
Recently, there has been broad consensus in the global health community on the need for health systems strengthening (HSS) to make further progress toward the Millennium
Development Goals (MDGs) in Sub-Saharan Africa. However, there is still divergence
on how HSS should be framed, what HSS practically entails, and how it should be done.
We set out to clarify HSS for managers of disease control programs (DCPs).
In September 2000, the United Nations
created a new movement in the fight against poverty: 189
countries in the General Assembly expressed their commitment
to the Millennium Development Goals (MDGs) in the Millennium
Declaration (World Health Organization 2004). The
recognition of health as one of the key determinants of
human development is translated in three health-related
MDGs. MDG 4 and 5 focus respectively on children and women
as priority target groups, and MDG 6 focuses on priority
diseases (HIV/AIDS, malaria, and other major diseases),
representing the bulk of the disease burden in low-income
countries. In section two, the author first focuses on how
national health systems can be understood...
Information and communication
technologies (ICT) for health or eHealth solutions hold
great potential for generating systemic efficiencies by
strengthening five critical pillars of a health system:
human resources for health, supply chain management, health
care financing, governance and service delivery, and
infrastructure. This report describes the changing landscape
of eHealth initiatives through these five pillars, with a
geographic focus on Sub-Saharan Africa. This report further
details seven criteria, or prerequisites, that must be
considered and addressed in order to effectively establish
and scale up ICT-based solutions in the health sector. These
criteria include infrastructure, data and interoperability
standards, local capacity, policy and regulatory
environments, an appropriate business model, alignment of
partnerships and priorities, and monitoring and evaluation.
In order to bring specific examples of these criteria to
light, this report concludes with 12 specific case studies
of potentially scalable ICT-based health care solutions
currently being implemented across the globe at community...
The health systems of Japan and the Asian Tigers--Hong Kong (China), the Republic of Korea, Singapore, and Taiwan (China)--and the recent reforms to them provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend too on the design features of the system-the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals-rapid cost and price inflation, a race for the best technology, and so on-shows the difficulties of corporatization. Korea's experience with a narrow benefit package shows the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan...
Health system strengthening and reform
are often necessary actions to achieve better outcomes. The
World Bank's 2007 strategy for health, nutrition, and
population emphasizes the importance of health system
strengthening for results. This paper proposes 'health
systems analysis' as a distinct methodology that should
be developed and practiced in the design of policies and
programs for health system strengthening. It identifies key
elements of health systems analysis and situates them in a
logical framework supported by a wide range of data and
methods and a sizable global literature. Health systems
analysis includes evidence on health system inputs,
processes, and outputs and the analysis of how these combine
to produce the outcomes. It considers politics, history, and
institutional arrangements. Health systems analysis proposes
causes of poor health system performance and suggests how
reform policies and strengthening strategies can improve
performance. It contributes to implementation and
evaluation. Examples from Mexico...
The World Bank often carries out
in-depth analysis of the conditions and challenges facing
different sectors in our client countries as a contribution
to developing the analytical and information base for
lending, policy dialogue, and more in-depth analytical work.
In the health sector, we have identified a substantial body
of this type of work focusing on analyzing the performance
of health systems, its causes, and potential strategies for
performance improvement. The Bank's 2007 Health,
Nutrition and Population (HNP) strategy emphasizes the
importance of our work on health system strengthening. HSA
is often the analytical foundation of this work in
countries. This paper reviews a sample of HSAs, 12 major
studies carried out since 2000 across all Bank regions.
Using the health systems framework of the flagship program
on health sector reform and sustainable financing, a
comparable synopsis of each study has been prepared in a
simple two page chart which traces the analysis from
measures of health system performance to its causes and then
from policy 'control knobs' to proposals for
reform which are intended to improve that performance.
Several key questions about the conceptual basis...
This paper begins with the premise that
it is not possible to implement an efficient, modern RAP
strategy today without the effective use of information
technology. The paper then leads the architect through the
functionality of the systems components and environment
needed to support RAP, pausing to justify them at each step.
The paper can be used as a long-term guide through the
systems development process as it is not necessary (and
likely not possible) to implement all functions at once. The
paper's intended audience is those members of a
planning and strategy body, working in conjunction with
technical experts, who are charged with designing and
implementing a RAP strategy in a developing country.
The delivery of health services in
Russia is a federal, regional and municipal responsibility.
Reform of the regional health systems, which suffer from
over-reliance on curative and inpatient care, deteriorating
infrastructure and equipment, and poor quality of services,
is a major challenge for the country. From 2003-2008, the
World Bank helped strengthen the stewardship capacity of
Russia's Federal Ministry of Health and Social
Development (MOHSD) and restructure health systems in two
pilot regions: the Chuvash Republic and Voronezh oblast. In
both regions, hospital bed numbers were reduced while
simultaneously increasing service delivery capacity at the
primary care, specialized ambulatory, and long-term care
facility levels through the introduction of new
technologies, clinical protocols, and resource allocation
mechanisms that link payments to performance.
Public health observatories proactively
investigate health issues to provide robust analytical
evidence to policy makers. This type of organization has
different characteristics from other public health
institutions, such as information-gathering bodies, academic
public health departments, or state employed public health
practitioners. Governments in Latin America have also begun
establishing regional, national, and provincial
observatories. Some of the regional observatories provide
comparisons of countries in the region in areas such as
public health, human resources, food security, and
nutrition. Regional and national health observatories have
become important tools for governments and health ministries
to support national strategic partnerships and to empower
civil society, health sector stakeholders, and health sector
authorities seeking to develop more effective and efficient
health systems. Health observatories are therefore a key
instrument for health systems to generate information, data,
and intelligence on people's health status and the type
and quality of health care delivery. By making all this
information available to health providers and policy makers
in a timely manner...
This volume grows out of an initiative in the World Bank on resource allocation and purchasing ('RAP'), which started in 2000, and continues to publish articles and books related to strategic purchasing. The initiative emerged from such questions in developing economies as: why do individuals need help in purchasing health services from providers? Is the 'middleman' really necessary? Can people not just buy health services in the same way they would go to the local market to buy bread, milk, or fruit, especially since, throughout most of history that is what most people did? When sick, they contacted local healers directly. Public policy historically was limited largely to protecting the sick against charlatans and was enforced through ethical codes such as the Hippocratic Oath. There was no expensive technology, and most serious conditions led to death. Loss of employment and burial costs were the most expensive parts of illness. With industrialization and the scientific revolution, all this changed. As understanding about the causes, prevention, and treatment of illness expanded, interventions become more complex and expensive. Health care was no longer the exclusive domain of traditional healers. Partly because of the complexities involved...
In 2003, the Government of Turkey
launched an Health Systems Strengthening (HSS) reform called
the 'Health Transformation Program' (HTP). The HTP
was designed to address these health system challenges. It
was recognized at the outset that without system-wide
reforms, significant and sustainable changes in health
system performance could not take place. The overall
objective of the HTP was to make the health system more
effective by improving governance, efficiency, user and
provider satisfaction, and long-term sustainability. The
main elements of the HTP are: (i) establishment of a single
purchaser in the health system; (ii) focusing the Ministry
of Health (MoH) on stewardship functions; (iii) making the
public sector health services delivery network autonomous;
and (iv) strengthening human resources management and
information systems in the health system. In its technical
focus and paradigm, the HTP represents a classic
'textbook' approach to HSS which many Bank clients
are trying to implement.
Background: Health data can be useful for effective service delivery, decision making, and evaluating existing programs in order to maintain high quality of healthcare. Studies have shown variability in data quality from national health management information systems (HMISs) in sub-Saharan Africa which threatens utility of these data as a tool to improve health systems. The purpose of this study is to assess the quality of Rwanda's HMIS data over a 5-year period. Methods: The World Health Organization (WHO) data quality report card framework was used to assess the quality of HMIS data captured from 2008 to 2012 and is a census of all 495 publicly funded health facilities in Rwanda. Factors assessed included completeness and internal consistency of 10 indicators selected based on WHO recommendations and priority areas for the Rwanda national health sector. Completeness was measured as percentage of non-missing reports. Consistency was measured as the absence of extreme outliers, internal consistency between related indicators, and consistency of indicators over time. These assessments were done at the district and national level. Results: Nationally, the average monthly district reporting completeness rate was 98% across 10 key indicators from 2008 to 2012. Completeness of indicator data increased over time: 2008...
This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable...
This paper describes (i) how a national health information System was designed, tested and implemented in Papua New Guinea, (ii) how the system was integrated with other management information systems, and (iii) how information has been used to support decision-making. It concludes that central coordination of systems design is essential to make sure that information systems are aligned with government priorities and can deliver the information required by managers. While there is often scope for improving the performance of existing information systems, too much emphasis can be placed on revising data collection procedures and creating the perfect information system. Data analysis, even from imperfect systems, can stimulate greater interest in information, which can improve the quality and completeness of reporting and encourage a more methodical approach to planning and monitoring services. Our experience suggests that senior decision-makers and political leaders can play an important role in creating a culture of information use. By demanding health information, using it to formulate policy, and disseminating it through the channels open to them, they can exert greater influence in negotiations with donors and other government departments...
INTRODUCTION: Health systems and services research by nursing personnel could inform decisionmaking and nursing care, providing evidence concerning quality of and patient satisfaction. Such studies are rather uncommon in Cuban research institutes, where clinical research predominates. OBJECTIVE: Assess the results of a strategy implemented between 2008 and 2011 to develop nursing capacity for health systems and services research in 14 national research institutes based in Havana. METHODS: The study comprised four stages: description of approaches to health systems and services research by nurses worldwide and in Cuba; analysis of current capacities for such research in Cuba; intervention design and implementation; and evaluation. Various techniques were used including: literature review, bibliometric analysis, questionnaire survey, consultation with experts, focus groups, and workshops for participant orientation and design and followup of research projects. Qualitative information reduction and quantitative information summary methods were used. Initially, 32 nursing managers participated; a further 105 nurses from the institutes were involved in research teams formed during intervention implementation. RESULTS: Of all published nursing research articles retrieved...