The Health Metrics Network, and the case of Health Information Strengthening in Sierra Leone

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The Health Metrics Network, and the case of
Health Information Strengthening in Sierra Leone

• WITFOR, August 26 2009,Hanoi
• Johan Ivar Saebo

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HMN A global partnership focused on
strengthening country health information systems

• Country support and tools for
• HIS assessment
• HIS strategic planning
• HIS implementation in a few selected countries
  (to learn from the field)
• Framework and guidelines for HIS implementation
• The HMN Framework
• HIS implementation guidelines
• Buyer's guide to HIS software and services
• Guidelines for ICT procurement policies/resolution
  s
• Guidelines for establishing an ICT infrastructure
  for HIS
• Communicate tools, activities and results
• www.healthmetricsnetwork.org
• HMN newsletter
• Hosted by WHO

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HMN and Sierra Leone
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Challenges of Sierra Leone Degradation of the
health system

• 10 years of civil war 1991 to 2001
• Loss of half of health facilities
• Death or emigration of half of health workers
• Weakening of the culture of information use
• De-motivated ME staff at district and national
  levels
• Almost no data reported by hospitals
• No annual statistical report for more than 15
  years
• National "Annual Review" is used for planning but
  hardly used for discussion of results

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A vicious cycle, how to break it?
Decisions not evidence-based
Donors get their own
Data not trusted
Weak demand
Using evidence not perceived as a winning strategy
Poor data quality
Limited investment in HIS
Weak HIS
Fragmentation
limited capacity to manage or analyse data
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Sierra Leone projectSome challenges towards
sustainable HIS

• Thinking about IT to counter
• Poor electricity supply, and lots of virus
• Fragmentation of HIS, and little awareness among
  the fragmented actors on the scale and
  implications of this
• Poor data quality, and hence lack of interest in
  HIS investment
• Little information transparency, and poor culture
  of analysis, feedback, and accountability
• Poor sense of what information is important, and
  how to analyse it, how to present it, interpret
  it, and act upon it

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Trying new solutions
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Integration Data entered in one form...
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show up in other forms. Used to highlight
duplication
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Improving quality
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Transparency Accountability and peer pressure
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Seeing is believing
People living closer to Freetown have greater
access to clinical workers
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What has this led to?

• District managers are competing to have the best
  scores!
• Western Area District Medical Officer placed ad
  in newspaper reminding about free maternal health
  services, since he was very upset about the low
  institutional delivery rates ("We want to be
  best")
• Donors are impressed with data quality and
  completeness, and request their data now from the
  integrated data repository (UNICEF, DFID, IRC,
  WHO, etc)
• Revision of forms, from more than 10 to 4. No
  overlap between data entry forms. A simpler, more
  streamlined system of collection.

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Challenges still to be addressed

• Capacity building, capacity building, and more
  capacity building! At all levels, for IT, health
  information management, information use.
• Expanding the scope No hospital data in the
  system.
• Link with Financial IS, Humar Resource IS, Drug
  logistics IS etc
• MoH is broke. There is no exit-strategy when it
  comes to funding.
• Scores of people "living off the land", working
  for free but selling "free" commodities to make a
  living. Ghost workers system and other types of
  corruption thrive on lack of information.

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Thank you!

• Health Metrics Network
• www.healthmetricsnetwork.org
• The Global Health Information Network
• www.tghin.org