Introduction to Routine Health Information System was created for undergraduate and postgraduate health science students to introduce them to the concepts and methods of routine health information systems. The learning objectives are to help users explain the roles of routine health information systems (RHIS) in health service management; examine strategies used to improve routine health information systems; acquaint with skills to carry out the process of improving RHIS performance; discuss three categories of determinants that influence RHIS.

1. Introduction to Routine
Health Information Systems
DESALEGN TEGABU ZEGEYE (MD,MPH)
DEPARTMENT OF HEALTH INFORMATICS
UNIVERSITY OF GONDAR
FEBRUARY 2011
HIBBs is a program of the Global
Health Informatics Partnership

2. Objectives
 Explain the roles of routine health information
systems (RHIS) in health service
management
 Examine strategies used to improve routine
health information systems
 Acquaint with skills to carry out the process of
improving RHIS performance
 Discuss three categories of determinants that
influence RHIS

3. Outline
 Definitions
 RHIS concepts
 Strategies used to improve routine health
information systems
 Analytical Framework for Understanding RHIS
Performance –The Prism Concept

4. Definitions
 Health System - is defined as the system of all
actors, institutions, and resources that undertake
“health actions” – i.e. actions whose primary purpose
is to promote, restore, or maintain health (WHO
2000).
 Information System - System that provide specific
information support to the decision-making process
at each level of an organization
 Health Information System - “A system that provides
specific information support to the decision-making
process at each level of an organization.” (Hurtubise,
1984)

5. Why Health Information System?
 Good management is a prerequisite for increasing
the efficiency of health services
 Improved health information system is clearly linked
to good management
 Information is crucial at all management levels of
the health services from periphery to the centre. It
is required by policymakers, managers, health care
providers, community health workers

6. Routine Health
Information System (RHIS)
Definition:
 Ongoing data collection of health status, health
interventions, and health resources
 Examples: facility-based service statistics, health
administration statistics and community-based
information systems

7. RHIS includes…
 Health service statistics for routine service
and special program reporting
 Administrative data (revenue and costs,
drugs, personnel, training, research and
documentation)
 Epidemiological and surveillance data
 Data on community-based health actions

8. Types of Routine Data
Collection Methods
 Health unit data collection
 Community data collection
 to monitor activities performed in the community by
health unit staff or by community health workers
 to obtain more representative data on the health
status and living environment of the communities
served, including data on births and deaths in the
community, agricultural and meteorological data, data
on education, etc.
 to assist in planning for health services that are more
accessible to community

9. Data Collection Instruments
Data collection instruments in RHIS:
Curative Preventive
• Medical records • Growth cards
• Laboratory forms • MCH cards
• Referral forms • School health card
• Family registration
records

10. Data Collection Instruments for
Health Unit Management
 Service delivery records
 Registers
 Tally sheets
 Population charts
 Resource Management records

11. Ise wh ot e a Clc n
s s it R uin D t oet
u a l io
Is u et
nt mns
r
• Content (comprehensive)
• Record filing (patient-retained vs. health unit-
retained)
• Layout (self-explanatory)
• Production form
• Electronic patient record

12. Guiding Principles of RHIS
 Data for decision making
 Collection of only essential health data used for
decision making
 Data collection for local analysis and use by the
health worker
 Data collected by all health workers as they
perform their day to day duties
 Data processing and analysis are done starting from
the point of collection
 Integration of all routine information systems
 Simple to operate and maintain

13. What is Wrong with Current RHIS?
 Irrelevance of the information gathered
 Poor quality of data
 Duplication and waste among parallel health
information system
 Lack of timely reporting and feedback
 Poor use of information
 The difference in culture between data people and
decision makers: Planning and management staff
rely primarily on “gut feeling” to formulate ad hoc
decisions rather seek pertinent data

14. Steps Involved in
RHIS Restructuring
Step 1: Carrying out service and information system
assessments
Step 2: Developing new sets of essential health
indicators
Step 3: Defining data sources and developing data
collection instruments for each of the indicators
selected
Step 4: Developing a data transmission and
processing system
Step 5: Ensuring use of the information generated
Step 6: Planning for RHIS resources

15. STEP 1: Assessment of the
Existing System
 Rapid Assessment of the current use and
performance of the existing system.
 Find out how and how well the current system
works, to describe the various components of the
system and the organizational environment

16. STEP 2: Develop Essential Indicators
Select essential indicators for management
functions at each level of the health system:
• Health status (and disease surveillance)
indicators
• Health services (and national program)
indicators
• Resource indicators (human, physical, financial)

17. What Data Elements Should be
Collected?
 Can provide useful information (affecting the
management decisions)
 Cannot be obtained elsewhere
 Are easy to collect
 Do not require much work or time
 Can be collected relatively accurately
 ESSENTIAL DATA SET based on indicators
reflecting the health status of the community

18. Essential Data Set
(From Shaw,2005)
MUST
KNOW

19. Essential Dataset (continued)
WHAT?
The minimum amount of data that needs to be
collected
WHY?
For the effective management of services which
allows them to make the greatest impact on the
health needs of the community which they serve
(improving coverage & quality)
HOW?
Through routine data collection

20. EDS - Choosing a Type
Data - led
 Focuses on the need to collect data which is required, is of
interest, or may be useful
 Is usually vague on what information output can be
obtained from data
Action - led
 Focuses on the need to collect data that reflect identified
priority health needs & are required by pre-determined
indicators
 Indicator driven – national & local
 Usually directly linked to specific objectives and targets
 Action-led systems are the most practical way to go

21. EDS at Each Level:
The Information Filter (From Shaw 2005)
Indicators,
• Standardised
Procedures,
• Usefulness datasets & use of
• Address the International IS info for ACTION:
needs of all
stakeholders National Inf. Systems Community
• User-friendly District
• Dynamic Zonal Information Systems
Province
National
District Information Systems
International
Community Information Systems

22. Step 3: Data Sources and Data
Collection Tools
Defining data sources and developing data
collection instruments for each of the indicators
selected.
Data collection
 start small - as data quality improves & systems
are streamlined - add slowly
 collect data – linked to objectives - that can be
used to calculate indicators

23. Data Sources and Data
Collection Tools (continued)
 Collect only data that is easily available -
determine easiest site for recording of data - do
not duplicate points of data collection
 Use clear & standardised definitions
 Train & provide ongoing support to data collectors
– improve data quality
 Data collection tools
 Use a minimum number of tools - user friendly,
familiar & acceptable

24. Step 4:
Developing a Data Transmission
and Processing System
 Information flows (including referral systems):
 Horizontal data transmission
 Vertical data transmission
 Use appropriate communication technology:
 Paper-based
 Electronic: Telephones, diskettes

25. Data Processing and Analysis
• Paper-based systems:
• Error-prone
• Computerized systems:
• Off-the-shelve versus customized
• Decision support systems
• Use of appropriate technology
• Capacity-building

26. Step 5: Ensuring Use of the
Information Generated
How can we improve information use?
2.Ownership and relevance of the information must
be felt among all potential users of the information,
through active participation in the system design
3.Data need to be of appropriate quality, aggregated
at the right level, and produced in a timely manner

27. Ensuring Use of the Information
Generated (continued)
1. Performance-based management systems tend to
increase use of information for decision making.
2. Cultural differences between data people and
action people can be decreased through
consensus building, teamwork, and training.
3. Data presentation and communication (feedback)
should be customized for users at all levels.

28. Step 6: Planning for RHIS Resources
• Adequate staffing
• Adequate logistic system for printed supplies
• Computer hardware/software and maintenance
• Communications equipment
• HIS line-item in MOH recurrent budget

29. Analytical Framework for
Understanding Performance of
Routine Health Information
Systems in Developing Countries

30. The Prism Framework
 The Prism, or three-point framework, is predicated
on the assumption that improving capacity in RHIS
(and subsequently performance) requires
interventions that address
 the environmental
 behavioral determinants of performance, and
 the technical determinants
 It broadens analysis of routine health information
systems to include the behavior of the collectors
and users of data and the context in which these
professionals work

31. PRISM framework
(From Aqui,2009)

32. RHIS Performance Diagnostic Tool
1. Data Quality Assessment at District or
Higher Level
2. Use of Information Assessment at District
or Higher Level
3. Data Quality Assessment at Facility Level
4. Use of Information Assessment at Facility
Level

33. Prism tools (Aqil,2007)

34. Sources
 Aqil A, Hozumi D, Lippeveld T. 2005. PRISM tools. MEASURE Evaluation, JSI.
Available online at: http://www.measure.com.
 Aqil A, Lippeveld T. 2007. Training manual on continuous improvement of
HMIS performance: quality and information use; focus on HIV/AIDS services.
MEASURE Evaluation, Guangxi and Yunnan CDC.
 Aqil, A, Lippeveld, T & Hozumi, D 2009, PRISM framework: a paradigm shift
for designing, strengthening and evaluating routine health information
systems. Health Policy and Planning, vol. 24, no. 3, pp. 217-228.
 Aqil, A., Lippeveld, T 2010, Improving RHIS Performance For Better Health
System Management, Routine Health Information System Course Trainer
Guide.
 Lippeveld T, Sauerborn R and Bodart C (eds.). Design and Implementation of
Health Information Systems. Geneva: World Health Organization, 2000
 Helfenbein, S. et al. (1987) Technologies for Management Information
Systems in Primary Health Care. Geneva: World Federation of Public Health
Associations


35. Sources (continued)
 MEASURE Evaluation http://www.cpc.unc.edu/measure
RHINONet:http://rhinonet.org
 Shaw, V 2005, Health information system reform in South Africa: developing
an essential data set. Bulletin of the World Health Organization, vol. 83, no. 8,
pp. 632-636.
 Health Metrics Network: http://www.who.int/healthmetrics
 WHO,2000. World Health Report 2000: Health Systems: Improving Health
Systems Performance; World Health Organization: Geneva.

36. HIBBs is a program of the Global Health
Informatics Partnership
www.ghip.net
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