Bulletin of the World Health Organization

Building health information systems in the context of national strategies for the development of statistics

Tony Williams

The focus of this issue of the Bulletin is a most welcome indication of renewed attention on health information systems (HISs) and on information systems generally. Recent work by Chris Scott highlights the need, both in countries and globally, to develop the culture of evidence-based policy-making: to help identify issues; inform the design and choice of policies; forecast the future; monitor policy implementation; and evaluate policy impact (1). Scott also considers alternative criteria for policymaking and concludes that none of them is consistent with transparent and accountable democratic political processes, nor is likely to lead to equitable, efficient and effective policy outcomes. Good statistical systems are essential for good governance and are part of the enabling environment for development.

In this issue, Carla AbouZahr & Ties Boerma (pp. 578–583) and Sarah Macfarlane (590–596) note the increasing emphasis on the need for a wide range of statistics to inform sound decision-making on health policy and its execution. These needs go far beyond information from, and on, the health system itself, including information on the socioeconomic, demographic, environmental and behavioural determinants of health outcomes, taken for instance from vital registration systems, household surveys and population and housing censuses. Health policies and outcomes are also linked to policies and outcomes in other sectors, such as education, and to more general development frameworks such as poverty reduction strategies and the monitoring of the Millennium Development Goals (MDGs). This is highlighted in the case of information needed to understand, prevent and cure diseases. For example, heightened concern about HIV/AIDS is bringing agencies and sectors together to implement, monitor and evaluate interventions to prevent and control the epidemic. This focuses attention on the need to look across national statistical systems, which are generally not well equipped to meet these increased policy requirements; and the countries that need good statistics most are those with the weakest information systems.

The importance of strategic approaches to statistical development was recognized by the Second International Roundtable on Managing for Development Results, held in Marrakech, Morocco, in February 2004. The Marrakech Action Plan for Statistics (2) set a target for all low-income countries (where appropriate) to have national strategies for the development of statistics (NSDSs) by 2006 and to have started to implement them by the following year in order to have high-quality, locally produced data for the next major review of the MDGs in 2010. To be effective, NSDSs should be integrated into national policy processes and included in the policy dialogue between developing countries and donors.

PARIS21 (Partnership in statistics for development in the 21st century) has developed guidelines (3) that envisage NSDSs as a dynamic and consultative approach that draws on existing best practice in statistical planning and improvement, covering the whole national statistical system, building on the United Nations’ fundamental principles for official statistics (4), good practice in technical cooperation (5), and existing statistical improvement processes such as the International Monetary Fund’s general data dissemination system (6). At the same time, this approach incorporates lessons learnt about inclusive, participatory development processes used for instance in the development of poverty reduction strategies, and follows best practice in organizational development and management.

The added value of the NSDS approach is that it looks at statistical capacity building through a development and management lens and at development policy and optimal management practices through a statistical lens — all in pursuit of better development outcomes. It promises to do for statistical planning what the poverty reduction process has done for national development planning. A good strategy, adequately funded and successfully implemented, can help countries to break free from the vicious cycle of under-funding and under-performance.

The Health Metrics Network (HMN) has been established to increase the availability and use of timely and accurate health information in countries and globally through shared agreement on goals and coordinated investments in core HISs. Clearly, HISs are a priority in all countries, but they are not the only priority and they need to be set within the context of other national statistics and information systems. Decisions on investing in statistical capacity building in an efficient, coherent and sustainable way should be informed by a comprehensive review of national information systems: what is needed, what is available and of what quality, what are the gaps, what the priorities are and how much they will cost. Making the transition to evidence-based policymaking can best be achieved through formulating an NSDS, incorporating health information needs, which is fully integrated into the system of national policy-making. PARIS21 and HMN are working closely together to achieve these shared goals.

Ref. No. 05-024679


  • Scott C. Measuring up to the measurement problem: the role of statistics in evidence-based policy-making. Paris: PARIS21, Organisation for Economic Co-operation and Development. Available from: www.paris21.org
  • Marrakech Action Plan for Statistics. Better data for better results. An action plan for improving development statistics. The Second International Roundtable on Managing for Development Results, organized by the Multilateral Development Banks in Marrakech, Morocco, 4–5 February 2004. Available from: http://www.managingfordevelopmentresults.org/2ndRoundtable.html
  • Guide to designing a national strategy for the development of statistics. Paris: PARIS21, Organisation for Economic Co-operation and Development; 2004. Available from: www.paris21.org
  • United Nations Statistical Commission. Fundamental principles of official statistics. New York: United Nations; 1994.
  • United Nations Statistical Commission. Some guiding principles for good practices in technical cooperation for statistics. New York: United Nations; 1999.
  • Guide to the General Data Dissemination System (GDDS) manual. Washington: International Monetary Fund, Statistics Department; 2001.

Senior Policy Adviser, PARIS21, Development Co-operation Directorate, Organisation for Economic Co-operation and Development, 2 rue André Pascal, 75775 Paris Cedex 16, France (email: tony-williams@oecd.org).

(2) PARIS21 is a partnership of statisticians, policy-makers, development professionals and other data users in both developing and developed countries, which aims to promote a culture of evidence-based decision-making and well-managed national statistical systems, especially in low-income countries.