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Health Information Systems: Challenges and Perspectives
How to learn from and share experience?
Michel ODIKA
The difficultylies not so much in developing new ideas as in escaping from old ones
(John KEYNES, economist).
Political will forstrengthening governance capacity…
Contemporary health systems tend to become increasingly complex, in the sense that multiplestakeholders are interconnected, with constantly shifting boundaries. In many points, thecredibility and legitimacy of health policy choices depend less on total consensus (unrealistic)than on procedural fairness and transparency. Importantly, policy-makers today are more opento lessons from abroad than they may have been in the past, and are using them to feednational policies with innovative approaches and better evidence of what works and what doesnot. In this specific context, creating the political alignment and commitment to improvehealth information systems is only a first step. Why? Insufficient preparation for newbehaviors and practices is often the weak point. Of particular importance, therefore,is a betterunderstanding of resistance to change. So, the biggest problem, according to John KEYNES,is not to let people accept new ideas, but to let them forget the old ones. For instance, theinstitutional capacities to enable effective health information systems are not a given. Theyare typically weak in countries where, by choice or by default, deep-seated bureaucratictraditions remain the rule…As things now stand, there is growingneed for making information systems instrumental tohealth policies. How to do that depends much on context and background. Nevertheless, bybuilding on networks of organizations and institutions from interdependent and indissociableareas of expertise and interest, relevant and transparent health information systems canproduce consensus-based and validated benchmarks for assessing progress in addressing thechallenges and changes facing health systems.
Comprehensiveness to improve decision-making process and policy-making…
Health authorities to be effective need, not only basic data, but equally strategic informationobtained through a departure from traditional views on the
architecture
, the
clients
and the
scope
of health information systems.Why? Experience across many, if not most, countries(“rich” and “poor” included) shows that health information systems, primarily dedicated toguiding decision-making process, can be described as “closed administrative structures”.Mainly due to a strong top-down and public-sector-only flavour, there is limited flow of limited data on health status, resource allocation and services delivery. Additionally, in manycountries around the world, limited information is almost
exclusively
used to a limited extentby a limited number of established officials when formulating policy reforms, while limiteduse is made of highly critical information from other tools and sources –e.g. NGO’s,household expenditure, opinion polls, university institutions, research centers, etc -,many of whichare often located outside the public sector and even outside the health sector.
Greater emphasis on responsiveness…
In many respects, routine data from traditional healthinformation systems often failinresponding to the rising demand forhealth-associated information from a multitude of
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