Bulletin of the World Health Organization

Countries need better information to receive development aid

Some donors are now only disbursing funds to countries that provide reliable data on how the money is spent and the outcome. This has led to a need for more reliable health information, but many countries are ill-equipped to provide this.

IN FOCUS - Feature from the Bulletin
1 August 2005

Databases are a vital tool for collating and analysing health information.

In some developing countries health agencies and donors do not know how many people are dying or what the causes of death are. But with increased donor demands for transparency and performance measurement, countries are having to provide reliable health information and efforts are under way to help them.

Countries that do not generate reliable health information or evidence lack the basis for making sound policydecisions. “So you have a weak (health) sector with weak information. Therefore management decisions are often not rational; you don’t provide enough information to get more resources, so it is vicious circle,” said Bernhard Schwartlander, director of strategic information and evaluation at the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Schwartlander said that more than 90% of low-income countries do not have a well-functioning health information system, which is vital for generating basic health data.

A health information system is essentially a collection of health statistics from various sources, used to derive information about health status, health care, provision and use of services, and the impact on a population’s health. Until the 1990s, health information related mainly to clinical data and disease control and surveillance. Since then it has expanded to include population health data to determine major public health problems.

The first aim of a health information system is to identify health issues, said Chris Scott, a development economist at the London School of Economics. It can also be used to inform health programme design and policy choice; it can help to forecast future health scenarios — as in the case of HIV/AIDS in Africa — and to monitor and evaluate the implementation of health policies, Scott said.

For many low-income countries the problem is that even a rudimentary health information system costs too much. “As a result, decision-makers are unable to identify problems and needs and track progress, evaluate the impact of interventions and make evidence-based decisions on health policy, programme design, and resource allocation”, according to a report by WHO’s Health Metrics Network.

This network is a new global partnership, hosted by WHO, that aims to tackle the health information bottleneck in low-income countries and help those countries build or consolidate their fledgling health information systems.

“Health Metrics Network will work with countries to assess the current status, identify gaps, and develop a national plan for improving the health information system,” said interim executive secretary Carla AbouZahr.

The idea is that efforts to strengthen health information systems within countries would be financed by resources in the countries themselves, for example through multilateral development partners such as the World Bank, bilateral donors and global health initiatives such as the Global Fund and the Global Alliance for Vaccines and Immunization (GAVI).

AbouZahr said that the Health Metrics Network hoped to sign agreements by October with a number of low- and middle-income countries to develop health information systems.

Helping countries build and sustain health informations systems is a challenge.

Scott said one way to address this would be for WHO to promote health information systems that are appropriate to the infrastructure, technological capacity and budgets of health ministries. In the poorest countries, it might be helpful to design and implement a simple pencil-and-paper-based health information system which contains data understood by and, therefore, more likely to be used by policy-makers at different levels, he added.

“Launching directly a nationwide, computer-based health information system which is vulnerable to power failures, software crashes and inadequate IT skills of health staff is a high-risk strategy,” Scott said.

There may be a case in large federal states for experimenting with different types of health information systems in different parts of the country to see which one functions best in which set of circumstances, Scott said.

The Global Fund’s Schwartlander agreed: “If solutions are brought in from outside, they tend not be sustainable … we are keen for countries to build their own capacity ... I think sustainability also means that countries have to invest and have to see health information systems as something essential”.

“Today Uganda’s health information system is strong and vibrant.” J.B. Male-Mukasa, Director of Uganda Bureau of Statistics.