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.
Although Health Metrics Network was aimed at “oiling the wheels” of health information systems development, AbouZahr said it was developing a framework that countries and partners could use to guide the development of such systems.
The framework development would be informed by experiences among partners and with countries, in particular Ghana, Mexico and Thailand — which are at different stages of health information systems development — that are working with Health Metrics Network. The framework includes a health information systems quality assessment tool based on the work done by the International Monetary Fund (IMF) and the World Bank to improve the quality of financial data.
Health Metrics Network’s partners include the World Bank and the Global Fund, which has allocated 5–7% of its grants to building country health information systems.
Schwartlander said the Global Fund was also working with WHO to develop an assessment tool that would identify the strengths and weaknesses of a health information system. The self assessment checklist breaks down the major components that need to be included in a decent health information system, he said.
“We are about to finalize the first draft and field test it with WHO”, Schwartlander said.
Susan Stott, a manager from the World Bank’s Operations Policy and Country Services Division, agreed that low-income countries need to develop health information systems — particularly vital registration (or sample registration) — to measure results.
“We are highly committed to improving our focus on ‘results’ and increasingly recognize that we’re not going to be able to be more effective if our countries cannot [focus on results], and that country willingness and capacity to manage for results is fundamental to the entire development enterprise,” Stott said.
Experts like Scott and Stott agree that for health expenditure to have the greatest impact on reducing mortality and disability, information is required on the diseases that have the greatest impact and on how health spending is allocated.
In the mid-1990s in the United Republic of Tanzania most people died at home rather than in clinics or hospitals, so were excluded from the official morbidity data, while district health budgets had more than 1000 expenditure items that made it difficult to identify spending patterns.
Scott cited the successful use of a health information system in rural districts in the United Republic of Tanzania that lacked disease burden and expenditure mapping information as an example.
As a result there was often a mismatch between the burden of disease and the allocation of health expenditure, Scott said. In one district, malaria accounted for 30% of years of life lost but received only 5% of health spending in 1996.
As part of an innovative pilot scheme in two districts — Morogoro and Rufiji — the Tanzania Essential Health Interventions Project (TEHIP) did a sample survey which asked whether anyone had died or fallen sick recently in the household, and if so, with what symptoms.
The results were used to construct a burden of disease profile for the local population and a profile of local health spending.
Comparison of the two profiles revealed the extent of the misallocation of health resources and the pattern of health spending was altered to provide a closer match with the disease burden.
“The results of this change were remarkable,” Scott said. In a four-year period — 1997–98 to 2001–02 — the under-five mortality rate in Morogoro fell by 43%, while in Rufiji it fell by 46% between 1999–2000 and 2002–03, said Scott.
Meanwhile the director of Uganda’s Bureau of Statistics J.B. Male-Mukasa told a similar success story. Uganda’s health information system was developed in the 1960s, stagnated in the 1970s and 1980s, and was revitalized in the 1990s.
Uganda’s Central Ministry of Health was set up to monitor epidemics of major communicable infectious diseases and had recent success in managing Ebola fever and HIV/AIDS.
“Today Uganda’s health information system is strong and vibrant”, said Male-Mukasa who is also a member of WHO’s Health Metrics Network board.
However, one of the problems Uganda and other countries with established health information systems face is the ability to respond to new information needs, he said.
Information gathering widened from data on diseases to general information on resources for health personnel, infrastructure and financial resources for health, he added.
Information has also been collected on the main causes of disease from several national household surveys conducted by Uganda Bureau of Statistics (UBOS) since the 1990s. All of these have been used by the network to track major causes of morbidity including HIV, tuberculosis and malaria.
A key lesson was that Uganda improved its health information system by working with other national agencies, Male-Mukasa said.
Haroon Ashraf, London.