نظام المعلومات الصحية وإدارة الخدمات الصحية

Health Information Management

• Health information management is a prerequisite for increasing the efficiency of health services.
• An improved health information system is clearly linked to good management.
• Information is crucial at all management levels of health services, from the periphery to the center.
• This information is needed by policymakers, managers, healthcare providers, and community health workers.
• Changing the way information is gathered, processed, and used for decision-making implies changing the way an organization operates.

Definitions

• System: Any collection of components that work together to achieve a common objective.
• Health System: All the activities whose primary purpose is to promote, restore, or maintain health.
• Information: A meaningful collection of facts or data.
• Information System: Systems that provide specific information support to the decision-making process in an organization.
• Health Information System: A set of components and procedures organized to generate information that will improve healthcare management decisions at all levels of the health system.
• The ultimate objective of a health information system is not to gain information, but to improve action.

What is wrong with current H IS

• Irrelevance of the information gathered.
• Poor quality of data.
• Duplication and waste among parallel health information systems.
• Lack of timely reporting and feedback.
• Poor use of information.
• Difference in culture between data people and decision-makers; planning and management staff often rely primarily on "gut feeling" to formulate decisions rather than seeking pertinent data.

Challenges

• Health Financing
• Performance of human resources for health
• Usage of health information for decision-making
• Access to medicines and technology
• Service delivery
• Existing strategies for addressing these challenges in Yemen’s health system
• Progress of the Yemen health sector

Weaknesses

• Most countries around the world, and in developing countries, have weaknesses in their health systems.
• This module seeks to provide participants with a comprehensive approach to health system strengthening.

Definition of Concepts

• System: A group of interacting, interrelated, interdependent elements/parts forming a complex whole, that work towards a common goal. The malfunctioning of one of the parts of the system affects the other parts.

What is a Health System?

• Health systems encompass all levels: central, regional, district, community, and household.
• A health care system is a means of organized social response to the health conditions of the population.
• It is narrower than a health system and is often described in terms of the levels of healthcare and organizational structure of the Ministry responsible for health in most countries.

Investments in Health

• Investment and efforts in countries like Yemen, whether they involve disease control, health care delivery, health promotion or policy-making, will fail if the health system itself is weak or ineffective.
• Most health interventions in countries like Yemen depend upon an existing infrastructure and use of services that are themselves very weak.
• Health systems are now seen as fundamental to global health and their strengthening as vital by the global health community.

State of Health Systems

• The poor state of health systems in many parts of the developing world is one of the greatest barriers to increasing access to essential healthcare.
• Some richer countries have larger populations without access to care because of inequitable arrangements for social protection.
• Others are struggling with escalating costs because of inefficient use of resources.

Principles of a Health System

• People-centered: Equity and fairness
• Results-oriented: Quality management system for continual quality improvement
• Evidence-based: Technocrats, academicians, politicians, community use of information for decision-making
• Community-driven: Leadership, governance, accountability, transparency, and sustainability
• Systems thinking: Holistic view of the health system is adopted

Context of the Health System in Yemen

• Organizational arrangements
• Economic context
• Socio-cultural and political context
• Legislative context
• Main actors in the health system
  • Government
  • Private/NGOs (Not for profit -e.g. faith-based-, Private for profit)

Main Actors in the Health System

• Civil society organizations
• Development partners (International/Bilateral/Foundations)
• Media

Types/Models of Health Systems

• Public Health Systems
• Social security health systems: where workers and their families are insured by the state.
• Publicly funded health systems: where the residents of the country are insured by the state.
• Social health systems: where the whole population or most of the population is a member of a sickness insurance company.
• Private Health Systems: Health services are offered by purely private health enterprises

Health System Goals

• Improving health and health equity in ways that are responsive, financially fair, making the best or most efficient use of available resources.
• Achieving greater access to and coverage for effective health interventions without compromising efforts to ensure provider quality and safety.

Functions of a Health System

• Service provision
• Resource generation
• Financing
• Stewardship

The WHO Health System Framework

• Service delivery
• Health workforce
• Information
• Medical products, vaccines & technologies
• Financing
• Leadership/Governance
• Access coverage
• Improved health (level and equity)
• Responsiveness
• Social and financial risk protection
• Improved efficiency

Service delivery pillar

• Includes delivery of effective, safe, and quality personal and non-personal health interventions to those who need them when and where needed, with minimal waste of resources.
• Demand for care and integrated packages; leadership and management; and infrastructure and logistics.

Health workforce pillar

• Refers to human resource for health (HRH) that is responsive, fair, and efficient in order to achieve the best possible health outcomes, given available resources and circumstances.
• Need norms/standards that govern the production of sufficient staff and ensure fair distribution.
• HRH must be competent, responsive, and productive.
• HRH observatories are essential for facilitating HRH management.

Health information system pillar

• Ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status by decision-makers at all levels of the health system
• Standardized and integrated systems and tools; linkages- local, national, regional, global.
• This is a key building block that cuts across all the other building blocks.

Medical products and technologies pillar

• Ensures equitable access to essential medical products and technologies that provide scientifically sound, quality, safe, efficacious and cost-effective interventions.
• The medical products include medicine, reagents etc.
• Technologies include health infrastructure (e.g. X-ray, lab, vaccines, etc.)
• There is need for norms/standards and policy options on products and technologies.
• Procurement processes, monitoring, innovation and patenting of new products are essential.

Health Financing pillar

• Raising adequate funds for health
• Ensuring that people can use needed services
• Protection from financial catastrophe or impoverishment associated with having to pay for health services.
• Providing incentives for providers and users to be efficient
• Policies that support sustainable options/social protection

Leadership and Governance

• Stewardship that involves ensuring that strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system design, transparency and accountability.
• A health system may be understood through the arrangement and interaction of its parts, and how they enable the system to achieve the purpose for which it was designed.
• How one building block affects and influences the others, and is in turn affected by them.

Common Systems Characteristics

• Self-organizing: Weak stewardship structures (the leadership and governance building block) often disregard or ignore valuable communication and feedback (the health information building block), leading to policies and practices that do not adequately respond to the latest information or evidence. The internal structure and organization –marked in this case by a weak or malfunctioning link between the governance and information blocks- influences to a great degree the functions and abilities of the system itself.
• Constantly changing: Systems adjust and readjust at many interactive time scales.
• Tightly-linked: The high degree of connectivity means that change in one sub-system affects the others.
• Governed by feedback: Systems are controlled by "feedback loops" that provide information flows on the state of the system, moderating behaviour as elements react and back-react on each other.

Characteristics of a Functional Health System

• Access to services (availability, affordability, acceptability, physical accessibility, and adequacy of supply).
• Quality of care and service delivery
• Safety
• Coverage
• Equity
• Efficiency
• Effectiveness of health care delivery
• Ethics, and rights-based approach in delivery of services
• Sustainability of services
• Health system responsiveness

The Eight Domains of Responsiveness

• Autonomy (respect for patient's views of what is appropriate and allowing informed choices.)
• Choice (an individual's right or opportunity to choose a healthcare institution and health provider and to secure a second opinion and access specialist services when required.)
• Clarity of communication (clear explanation to patients and family the nature of the illness, details of treatment and available options.)
• Confidentiality of Personal Information (privacy in the environment in which consultations are conducted and the concept of privileged communication and confidentiality of medical records.)
• Dignity (the ability of patients to receiving care in a respectful, caring, and non-discriminatory setting.)
• Prompt attention (the ability to access care rapidly in the case of emergencies, or readily with short waiting times for non-emergencies.)
• Quality of basic amenities (the physical environment and services often referred to as "hotel facilities", including clean surroundings, regular maintenance, adequate furniture, sufficient ventilation, enough space in waiting rooms etc.)
• Access to family and community support (the extent to which patients have access to their family and friends when receiving care and the maintenance of regular activities.)

Group Assignment:

• Based on the knowledge of health system building blocks, identify the current health system problems in Yemen and discuss how "systems thinking" can contribute to the improvement of the existing Health System Strengthening in Yemen.