Afghanistan Comprehensive Health Information System Strategic Plan

Transcription

1 Afghanistan Comprehensive Health Information System Strategic Plan

2 Foreword Since 2002, considerable investments have been made by the Ministry of Public Health (MoPH) and its donor partners in revamping Afghanistan s health system infrastructure and human resources. Hundreds of health clinics have been established boosting our basic health coverage from 9 percent six years ago to over 85 percent today. Access to diagnostic and curative services has increased and more number of men, women and children are attending health clinics to avail health services. These achievements have only been possible with the continued support from our donors, international community and a strong will of our Afghan staff. At the same time, when much progress has been made, I would like to emphasize that we still have to go a long way in improving the health status of the people of Afghanistan. We continue to face a heavy burden of maternal and child mortality and some of the other poorest health indicators in the world. Numerous factors impede access and effective service delivery: lack of health infrastructure, deficits in health human resource capital, especially female health providers, low literacy and other cultural barriers, poor road access and security conditions. The Ministry has taken a stewardship s role in the health sector. In addition, the Ministry is accountable to the Afghan people, the Government, donors and other development partners. It must report on the progress of the health system within the framework of the Afghanistan National Development Strategy (ANDS) and the Millennium Development Goals (MDGs). In order to fulfill this responsibility, the ministry has to rely on relevant, high quality and accessible data and information on health system performance and the trends in the health status of the population, including the census, routine reporting system, disease surveillance, surveys, information on human and financial management resources and other sources. With increasing emphasis on contracting-out for health service delivery, results-based management and performance-based funding, availability of sound data generated through reliable and transparent systems is in the spotlight. The ministry and its partners are faced with the challenge of getting reliable and timely information which can be used for planning, decision-making and assessing the extent of health service delivery. A variety of data sources are used to capture the information required to manage the health system. The many obstacles to develop such valuable information system, include issues of fragmentation, inadequate use of data, gaps in data from other sectors, gaps in administrative and resource information, need for better survey planning, inadequate data use in provinces and at service level for service management and performance improvement. To meet these challenges, I am pleased to present the Comprehensive Health Information Strategy (CHIS). The strategy has been completed after one year of hard work and extensive consultations with different stakeholders. I am confident that the CHIS will help us in providing the relevant information to policy makers, planners, programme implementers and community members. I consider this document as a roadmap towards achieving the goals defined in the Health & Nutrition Sector Strategy of the ANDS. With this strategy, I ask full support of all our partners in the implementation of the strategy. I am pleased to see the participation of the Afghan people and appreciate the efforts of all those in the international community who have contributed to the development of this strategy. Dr. Sayed Mohammed Amin Fatimie Minister of Public Health Islamic Republic of Afghanistan

3 Acknowledgement I would like to express my appreciation to all the individuals, who worked on the development of the strategy. The MoPH is also grateful to the many Afghan and international organizations and individuals who provided assistance and support in planning, developing, and finalizing this strategy for the Ministry. The Comprehensive Health Information Strategy (CHIS) could not have been developed without the generous contribution of many individuals and organizations. The CHIS was finalized under the guidance of the Steering Committee, appointed by H.E. the minister Dr S. M. Amin Fatimie and chaired by H.E. Deputy Minister Technical Affairs Dr Faizullah Kakar and Dr Ahmad Jan Naem, Director General Policy and Planning. Special thanks to all the core group members and the various individuals who participated in different meetings and provided their valuable inputs. Their contributions, comments and suggestions strengthened the strategies, ensuring their practical implementation. Special thanks go to Dr Ashraf Mashkoor, head of HMIS, for his invaluable contribution and support in the development of the strategy. The efforts of his team, at HMIS, who dedicated themselves tirelessly to completing the strategy in consultation with both national and international partners is specially acknowledged. I would like to extend my best wishes and continued support to the HMIS and M&E departments in the implementation of the current strategy. We would like to sincerely thank the Dr Steve Sapirie for his special contributions providing his continuous support to the group working on the strategy. We are also indebted to the many national and international advisers who supported this effort. In particular, we would like to thank Dr Alishungi, consultant, HMN, Dr Ibne Amin, Director, M&E, Mr Kip Eckroad, MSH-TECH-Serve, Dr Martine Catapano, Advisor GDHSP, Dr Naqibullah Hamdard, MSH-TECH-Serve, Dr Omid Ameli, MSH- TECH-Serve, Dr Peter Hansen, Country Director JHU, Dr Paul Ickx, MSH, Mr Vikas Dwivedi, M&E Advisor (SIDP) for their constant involvement during the various stages of the assessment and strategy formulation. Special thanks to Health Metrix Network (HMN) for supporting the development of the strategy. Finally, I would like to thank all who contributed towards this endeavor in preparation of the Strategy. We look forward to the firm commitment of all our stakeholders throughout the implementation of this strategy. Dr Ahmed Jan Naeem Director General of Policy and Planning

4 Table of Contents List of Acronyms... 1 Chapter 1: Introduction Background and Rationale The HIS Assessment & Strategic Planning Process Stakeholders of the Health Information System Stakeholders of the Health Information System within the Ministry Central level Provincial level Stakeholders of the Health Information System outside the Ministry Additional Key Partners Afghanistan HIS Problem & Constraints HIS Resources Indicators Data Sources Data Management Information Products Monitoring, evaluation and use of data... 8 Chapter 2: Afghanistan HIS Vision, Mission and Principles Vision Mission Statement Principles and Desired Characteristics... 9 Chapter 3: Strategy for Strengthening the HIS during the period Objectives and Targets of the Afghanistan HIS Strategic Plan Interventions The Implementation Plan HIS Resource Requirements Critical Assumptions and Risks Mechanisms for coordination Monitoring the Implementation of the Strategy Conclusion Annex A: Members of the Stakeholder Working Group and the Steering Committee Annex B: Glossary of Terms Used in the HMN HIS Strategic Planning Process Annex C: Priority Health Problems and Related Essential Health Services in Afghanistan Annex D: National Core Health Indicators Annex E: Health Information System (HIS) Subsystems and Problems in Afghanistan Annex F: Afghanistan HIS Assessment Scores by HIS component and Health System Building-blocks (Sub-systems) Annex G: Inventory of On-going and Planned HIS Strengthening Efforts Annex H: HIS Strategy Resource Requirements Annex I: Afghanistan HIS Strategy Additional Resource Requirements Annex J: HIS Strategic Objective and Target Monitoring and Evaluation Framework Annex K: The HIS Strategic Planning Process

5 List of Acronyms ANDS I-ANDS ANC ANHRA BPHS BSC CAAC CBHC CHW CSO DEWS DPT DOTS EC EPHS EPI FFSDP FSR GCMU GD HIV/AIDS HMIR HMIS HNS HR HRD HSR IBBS IEC IMCI IIHMR JHU KAP Afghan National Development Strategy Interim-Afghan National Development Strategy Antenatal Care Afghanistan National Health Resources Assessment Basic Package of Health Services Balanced Scorecard Catchment Area Annual Census Community-based Health Care Community Health Worker Central Statistics Office Disease Early Warning System Diphtheria, Pertussis & Tetanus Directly Observed Treatment Short-course (TB) European Commission Essential Package of Hospital Services Expanded Programme on Immunization Fully Functional Service Delivery Point Facility Status Report Grants and Contracts Management Unit General Directorate Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Hospital Monthly Integrated Report Health Management Information System Health and Nutrition Sector Human Resources Human Resource Database Hospital Status Report Integrated Behavioural and Biological Survey Information, Education and Communication Integrated Management of Childhood Illnesses Indian Institute of Health Management Research Johns Hopkins University Knowledge, Attitudes and Practices LQAS MAAR MDGs M&E MIAR MICS MoE MOPH MOPH-SM MSH NACP NGO NHSPA NMLCP NRVA NTP PPH PPHDs PPHO PRR PRO RAMOS RH SARS SBM SGS STD TB TechServ UN USAID WB WHO Lot Quality Assurance Sampling Monthly Aggregated Activity Report Millennium Development Goals Monitoring and Evaluation Monthly Integrated Activity Report Multiple Indicator Cluster Survey Ministry of Education Ministry of Public Health Ministry of Public Health- Strengthening Mechanism Management Sciences for Health National AIDS Control Program Non-governmental organisation National Health Services Performance Assessment National Malaria and Leishmaniasis Control Programme National Risk and Vulnerability Assessment National Tuberculosis Programme Provincial Public Health Provincial Public Health Directorates Provincial Public Health Office Priority Reform and Restructuring Public Relation Office Reproductive Age Mortality Study Reproductive Health Severe Acute Respiratory Syndrome Standards Based Management Second Generation HIV Surveillance Sexually Transmitted Disease Tuberculosis Technical Support to Central and Provincial Ministry of Public Health United Nations United States Agency for International Development World Bank World Health Organization 1

6 Chapter 1: Introduction 1.1 Background and Rationale The Government of Afghanistan considers health a fundamental human right indispensable for the exercise of the human rights of its people. The Health and Nutrition Sector has been identified in the Afghanistan National Development Strategy (ANDS). The ANDS strategic objective for this sector is to improve the health and nutrition of the people of Afghanistan through quality health care and the promotion of healthy life styles. Afghanistan ranks close to the bottom on global measures of health and nutrition. Improving health and nutrition is vital to improving the livelihood and well- being of the Afghan people and to achieving the goals of the MDGs. The Ministry of Public Health (MoPH) has pursued their realization through the formulation of a Health and Nutrition Sector Strategy. However, following the fall of the Taliban the government has faced an immense task to bring about changes to enable millions of its people to enjoy their health rights due to formidable structural and other obstacles, many that are beyond the control of the Ministry of Public health. Therefore, disparities continue to exist in varying magnitude influenced by geography, socioeconomic status and gender affecting all dimensions of health care including prevention, curative and service to individuals with disabilities. Afghanistan has been able to receive considerable donor assistance and various NGOs have come forward to assist through contracting arrangements to provide health services, mainly to the rural areas that have lagged considerably behind in accessing health services. The MoPH has adopted a Stewardship role in the health sector. The Ministry is committed to enhancing evidence-based, bottom-up and participatory strategic planning in all levels of the National Health Care System (NHCS). As part of its strategic planning, the HIS will ensure the availability, coordination, distribution and use of accurate, reliable, and user-friendly health information in health service and program design, implementation, Monitoring and Evaluation (M&E) and related activities. The MoPH uses a variety of sources from which to gather information useful for health system management. Until now there was no overall planning for a Comprehensive Health Information System (CHIS) for Afghanistan, as each information component and sub-system was designed primarily in response to the funding and advice provided by partner agencies. Therefore, the Ministry welcomed the opportunity to undertake the Health Metrics Network (HMN) assessment process, which began in The tabulation of the assessment results and definition of priority HIS problems took place in September and October, In addition, there were recent expressions of concern from senior MoPH leaders about the existing information systems and their use for monitoring and evaluation, with specific attention to information gaps, the long-term directions and sustainability of the system, the need to validate findings, and the need to disseminate and use information at all levels. Afghanistan s Health Information System (HIS) is primarily comprised of the following components: the HMIS service reporting system, the reporting systems of special programs, the Disease Early Warning System (DEWS), the data support for administrative system including human resources, financial management and supply management, population census, health facility assessments and various household surveys capturing information on various indicators in the health and nutrition sector. These systems have arisen with support of various partner agencies during the recovery and reconstruction period, including WHO, the World Bank, the EC and USAID. 2

7 1.2 The HIS Assessment & Strategic Planning Process The HIS Strategic Planning Process was comprised of the three modules of Phase II as devised by the Health Metrics Network. A Core Team (CT) was created under the coordination of the Director of the Health Management Information System within the General Directorate of Policy and Planning. The Core Team was supported with short and long term Technical Advisors provided by USAID (TechServe), the World Bank and the European Commission (EPOS & AEDES). A Stakeholder Working Group (SWG) was created with wide participation from all MoPH programs and departments, as well as the Ministry of Interior and the Central Statistical Organization (CSO). This group varied in size and organization as the process moved from Module 2 through Module 3 as depicted in Annex K, the HIS Strategic Planning Process Diagram. Each of four sub-groups reviewed the priority problem statements defined within their assigned HIS Components and decided which problems were important enough to carry over into the intervention design, and determined an appropriate measure of the problem that could be defined as an indicator for setting improvement objectives and monitoring progress. The sub-groups set objectives for those problems that appeared to be most important by defining a desired amount of improvement (reduction in the problem indicator) and the year by which such improvement was to be achieved. They then identified possible strategic interventions for addressing each priority problem and objective. Presentation and discussion between sub-groups helped confirm which interventions seemed to be most effective and feasible and such interventions were recorded. The progress of the strategic planning process was reported to and monitored by a Steering Committee (SC) chaired by the Deputy Minister for Technical Matters and the DG for Policy and Planning. Its members were DGs and Directors from all relevant departments, and from interested partner organizations. The SC met on different occasions during the process and provided support and guidance in response to the presentation of the problems, objectives, interventions, implementation plan and resource estimation. Altogether more than 45 persons participated in the HIS SP process during Phase 2. The objective of the HIS SP was defined as the generation of the principle products of the HMN SP process, leading to the approval of the plan, mobilization of necessary resources, and early commencement of implementation. The assessment of the Afghan health information system was conducted according to the framework defined by the HMN using the components of an information system and their interaction with the Health System Building Blocks. The various components include the resources required for the information system, the data sources, management, information products and their use across the various functions of the Ministry such as stewardship, financing, health workforce, medicine and supplies, technology and various aspects of service delivery. Specifications for the HIS Strategic Planning and Implementation Process a. Insure consensus on current priority gaps, HIS improvement objectives and selected interventions. b. Attention to all levels community, facility, district, provincial, MoPH program and long-term strategy c. M & E should be annually planned and routinely conducted at several levels d. Service Performance Improvement and Quality Assurance to be a priority, along with Data quality. e. Define and pursue a medium-term HIS Vision. f. Address registration and monitoring of private providers; 3

8 1.3 Stakeholders of the Health Information System Stakeholders of the Health Information System within the Ministry The stakeholders for the HIS within the Ministry can be broadly divided into two groups. Stakeholders at the central level form one group and the provincial level forms the second. The central level includes the various General Directorates, Departments and programs which are directly involved in implementation or overseeing the implementation of planned strategies and plans. The provincial level includes the Provincial Public Health Officers, District Health Officers and Health Facility Staff Central level General Directorate of Policy and Planning (GDPP) The GDPP is responsible for coordinating the development of health policies to meet current and future challenges; review current health strategies and design future plans; monitor and evaluate performance; formulate laws and regulations, and draft budgeted strategic and action plans. The directorate, in collaboration with different stakeholders, will have a prime responsibility in developing the HIS for the ministry and its partners. Two of the major departments involved in data collection and ensuring timely availability of information for planning within the GD are the Monitoring and Evaluation Directorate and the Health Management Information System Department. The main aim of the Monitoring and Evaluation Directorate (M&E-QA) is to coordinate, guide and harmonize monitoring and evaluation activities among various departments within the central Ministry of Public Health, Provincial Public Health Directorates and NGOs. In addition to its full time staff, the Monitoring and Evaluation Department is advised by a consultative group, the Monitoring and Evaluation Advisory Board, which is comprised of representatives from the MOPH, international technical agencies and donor agencies. The Board advises the Ministry of Public Health in the development of guidelines, monitoring tools and related procedures. The Health Management Information System (HMIS) Department is responsible for collecting routine information on key health services performance indicators from all health facilities and hospitals in the country. Approximately 90% of BPHS facilities report into the HMIS. The HMIS works closely with other key departments, including the Monitoring and Evaluation Department, to provide the stakeholders with relevant information. The HMIS Department hosts an HMIS Task Force, a body whose function is to provide overall guidance, oversight and technical support. General Directorate of the Afghan Public Health Institute (APHI) APHI functions as a think-tank for the Ministry. It coordinates all new research, manages surveillance of communicable diseases and coordinates training on public health subjects within and outside the ministry. The APHI has six departments: Research and Informatics, Information, Education and Communication (IEC) and Publication, Surveillance and Detection of Disease (Disease Early Warning System (DEWS), Food and Drug Quality Control, Training Management and Public Health Laboratories. General Directorate of Human Resources (GDHR) GDHR is responsible for policy development, operational and financial planning, implementation, performance appraisal and review, relating to human resources development and management, and overall management reform, in the Ministry. This General Directorate is also responsible for building a skilled, adaptable and responsive workforce to meet current and future challenges and managing 4

9 collaboration relating to many reform projects, with the Civil Service Commission (CSC) and key areas of the MoPH, especially the GDPP and GDA. These efforts especially relate to reform management, capacity building, transparency and integrity management, and dispute and conflict resolution. General Directorate of Health Care Services Provision (GDHCSP) This Directorate is responsible for policy development, operational and financial planning, implementation, monitoring, evaluation and review, ensuring equitable, sustainable and quality health care covering all issues relating to curative and diagnostic services in clinical facilities l such as hospitals and polyclinics; issues relating to reproductive health, child and adolescent health; and implementation of various preventive basic health care and communicable disease programs. Within this General Directorate the other key partners in monitoring and evaluation of various programs include the departments of HIV/AIDS, Tuberculosis, Nutrition, Expanded Program of Immunization, Reproductive Health, Mental Health, Disability and Child and Adolescent Health. Each of these departments and programs have, to some degree, data gathering, analysis and reporting activities. General Directorate of Pharmaceutical Affairs (GDPA) This GD is responsible for policy development, operational and financial planning, implementation, monitoring, evaluation and review of the pharmaceutical sector. This general directorate aims to provide all required medicines, whether domestic or foreign, and to insure they are effective, safe, of good quality, and are fairly priced. In additions they strive to insure that medicines are properly used,and are appropriate to the needs of the patient; are accessible to patients at all times in all parts of the country; and that patients are not deprived of medications due to financial barriers. It oversees the development and enactment of required policy, and draft Legislation and regulation of the pharmaceutical market; establishment of the National Medicines Agency/Drug Regulatory Authority, which will evaluate the safety, efficacy and quality of pharmaceutical products, and control their import, export and distribution; establish a Medicines Information Centre; and, promote fair competition in supply so as to ensure quality at an affordable price. General Directorate of Administration (GDA) This General Directorate is responsible for providing quality support services to other entities within MoPH. It oversees management and operational structures required to implement required strategies and services. This includes drafting specifications, processing tenders, conducting negotiations and documenting agreements, contracts and grants with service providers in accordance with MoPH policy Provincial level Provincial Public Health Directorates (PPHDs) The Provincial Public Health Directorates are now staffed with nine Provincial Public Health Officers (PPHOs), among them one technical officer for HMIS. The Provincial Public Health Coordination Committee (PPHCC) that involves key partners in health, as outlined in its terms of reference, provides support to monitoring and evaluation activities of the PPHD. There remains, however, an urgent need to build the capacity of the PPHOs at the provincial level in order to ensure the fulfillment MOPH s stewardship responsibilities vis-à-vis the implementing NGOs at the provincial level. The health system at the provincial level has an important role to play in collecting, processing and analyzing data on health system performance and human health status 5

10 In addition to the PPHOs at the province level, the Ministry intends to place District Health Officers (DHOs) at the district level, to assist in supervising health facilities and Community Health Workers (CHWs) at the grassroots level. The CHWs and health facility staff are the prime generators and users of data Stakeholders of the Health Information System outside the Ministry Some of the other ministries involved in health-relevant data collection and information management include the Central Statistical Organization (CSO) which has been identified as the nodal agency to produce statistical estimates at the national level. The Ministry of Finance and Ministry of Economy have the responsibility of monitoring progress on the ANDS-HNSS. The Ministry of Interior (MoI) is setting up a vital registration system to register all births and deaths across the country. Other ministries like the Ministry of Women s Affairs, Ministry of Rural Rehabilitation and Development, Ministry of Higher Education and the Civil Services Commission are entities which take part in collection as well as usage of data generated for the health sector Additional Key Partners All donor organizations providing technical and financial support to the Ministry of Health are additional stakeholders for data generation and information use. The major donors in the health and nutrition sector include the World Bank, USAID and the European Commission. Major international and national implementing partner organizations include EPOS, AEDES, MSH/TechServe, JHU, IIHMR, CDC, UNICEF, WHO and the Global Fund provide assistance in various parts of the health system and require information for effective planning and management. The HMN supported the process of developing the strategy, both technically and financially, and is known to be interested following the implementation of the strategy and development of the information system in Afghanistan. 1.4 Afghanistan HIS Problem & Constraints The Afghanistan Health Information System was assessed using the HMN HIS assessment framework. The core group reviewed approximately 300 questions related to various components of the health and health information system. The table, Annex F, summarizes the findings of the assessment. The table identifies the HIS components that are performing least well. Based on the assessment the components that were identified as most needing improvement are: generation and use of vital statistics information, morbidity and mortality indicators, risk factor data, census data and use, administrative data and records, policy and planning support to HIS and data use for policy formulation, resource allocation, implementation and action planning. The health sub-systems most affected by low HIS performance appear to be Financial management, Medicine and Supply management and Stewardship (leadership and management). In addition to analyzing the scores from the HIS Assessment, an attempt made to clearly define the HIS problems. Following is the list of the major problems statements all of which have been addressed in the strategic interventions HIS Resources Health Legislation There is little relevant legislation (such as Statistics Law 1385), and it does not provide a framework for the HIS as it does not adequately cover aspects of vital registration, notifiable diseases, private sector data, confidentiality and fundamental principles of official statistics. 6

11 HMIS Human Resources Capacity building of PPHO, DHO and health facility staff on the use of data for monitoring and evaluation and service performance improvement is lacking. There are inadequate human resources at all levels who are proficient in core health information sciences including information. In-service training aimed at HIS strengthening are neither adequate (structured and well-designed) nor well targeted Indicators A number of indicators are not harmonized and stratified by different levels of health system. No meta-dictionary is available with standard definition of indicators at the national and sub-national levels Data Sources Census There is low capacity at CSO for data collection, processing and analysis of the census and the census tools do not include appropriately designed questions on mortality. There are inconsistencies with population denominators including geographic and age breakdown of population by the CSO and other sources. Vital Registration Vital registration including births and deaths by the Ministry of Interior is practically nonexistent and cannot produce key estimates frequently required by public health programs Surveys There is a lack of clear direction and a mechanism to support a multi-year planning for surveys of all types, including their funding, timing, choice of methodology, key variables measured, and adequate disaggregation and representativeness. Surveillance There is inadequate surveillance of obstetric complications and maternal deaths, including notification, death audits or verbal autopsy and response. Every maternal death is an important health event that must be reported and responded to, as an essential public health service function. There is inadequate retrospective analysis of DEWS/surveillance data for identification of epidemics of common infectious diseases, particularly those with impact on child mortality. Health services Monitoring and evaluation of community-based services is less developed compared to facility-based services, either through routine data collection or sample surveys. HMIS, DEWS and reporting systems of vertical programs including EPI and TB are not adequately integrated at the service delivery level and during data transmission. This creates some duplication in data collection and inconsistencies in reported figures from various sources. Compilation and use of heath service records, as generated through the HMIS for monitoring coverage is not consistently done at the health facility level, with hospitals being the weakest in this regard. There is no plan for capturing health service data from the private health care sector. There is lack of clear direction on the monitoring of the quality of services provided by the private sector. 7

12 Administration There is inadequate and inconsistent tracking of health system finances including program budgets and expenditures at the central MOPH and provincial levels There is inadequate tracking of procured and distributed health system commodities including pharmaceuticals o The tracking system of health work force (HR database) has certain shortcomings:it is not integrated with (linked to) MOPH human resource management processes.the private sector health providers are not systematically inventoried and tracked.community health workers are not systematically inventoried and tracked Data Management Central storage of key health data is incomplete, not integrated, not routinely maintained and not readily available for routine and ad hoc monitoring and evaluation Information Products Mortality Recent estimates of child mortality do not include insecure areas and migratory population. There are no estimates of adult mortality rates. Maternal mortality estimates are outdated and there is lack of a consensus and decisive plan on the most cost-effective methodology and frequency of measurements of maternal mortality. Morbidity Provincial and local level estimates and monitoring of malnutrition prevalence are not available Monitoring, evaluation and use of data Sharing and Use of M&E and HIS data - There is fragmentation of HIS and M&E functions at MOPH and sub-optimal sharing and use of generated information. Monitoring, evaluation and use of data There is inadequate, nonsystematic and poorly standardized use of data for performance assessment and improvement at central, provincial, district and facility levels. There are inadequate measures to improve the quality of data reported through HMIS. Summary health information updates covering a minimum set of core indicators such as ANDS progress reports and other key reports are poorly distributed among MOPH, PPHOs, and service delivery sites. There is inadequate human resource capacity for pooling data and developing analytic reports. Use of data for resource allocation is centralized. Provincial planning uses information to some extent, but this is not equivalent to evidence-based resource allocation. The full list of priority HIS problems by HIS Component and Health Subsystem appear in Annex E. 8

13 Chapter 2: Afghanistan HIS Vision, Mission and Principles The mission of the Health and Nutrition Sector as defined in the Health and Nutrition Sector Strategy (HNSS) is to improve the health and nutritional status of the people of Afghanistan through quality health care service provision and the promotion of healthy life styles in an equitable and sustainable manner. The vision, mission, principles and desired characteristics for the Afghanistan Comprehensive Health Information System Strategic Plan has been formulated keeping in mind the mission of the HNSS. 2.1 Vision In 2013, the health sector in Afghanistan is served by a reliable and sustainable health information system producing timely, comprehensive, standardized, high quality, accurate and easily accessible information in accordance with updated health legislation. 2.2 Mission Statement The MoPH through its Health Information System (HIS) is dedicated to providing information of use to health policy-makers and service managers at all levels of the health system to enable them to take evidence-based decisions for providing optimal health services and promoting the physical, social and mental well-being of the Afghan population. 2.3 Principles and Desired Characteristics In 2013, the Afghanistan Comprehensive Health Information System Strategic Plan will display the following characteristics: The scope of the HIS is comprehensive enough to provide necessary information for decision-making to policy-makers and other health managers at all levels of the system, with attention focused on priority strategies and programs in the Health and Nutrition Sector Strategy and its constituent priority health strategies. The HIS functions, organization, scope, products, processes and tools will have been defined and implemented with contributions from all stakeholders involved in health data collection, analysis, interpretation and dissemination (directorates, departments and programs of MoPH, NGOs, CSO, MoI and others) and are in compliance with updated health legislation. A high performance system of standardized and user-friendly Information Technology (IT) is fully functioning at central and provincial level. The components of the HMIS (routine service data collection, analysis and management) are being maintained without donor funding. Full functionality and sustainability of the HIS is ensured through adequate resource availability (HR, facilities, technology and finance). High quality and accurate data is being provided in a timely manner, and is being made easily available on a regular basis through a system of broad dissemination for routine use by its defined users. Use of health data is systematic and routine at all levels of the system facilitating users to properly analyse and interpret data for improving monitoring and performance (coverage and quality) of the health services for which they are responsible. Decentralization of the management and use of the HIS is achieved through appropriate stratification of health indicators (national, central, provincial, contractors, partners and 9

14 facility) plus the empowerment of Provincial and NGO service managers and periodic capacity-building. The system has been designed and procedures developed to minimize the burden of data collection, maintenance and reporting, while maximizing its use. 10

15 Chapter 3: Strategy for Strengthening the HIS during the period Objectives and Targets of the Afghanistan HIS Strategic Plan Based on the problems identified, the core group along with members from the SWG developed the following 20 objectives and targets. Strategic Interventions are the principle means to describe what is proposed by the different Stakeholder Working sub-groups for addressing and reducing the priority HIS problems and the defined HIS improvement objectives and thence become the subject of activity design for implementation and costing purposes. The following table presents the objectives which were developed following the definition of priority problems, as listed in the previous chapter. Table 1: Objectives and Targets # Objectives Target (AS = HMN Assessment Score) 1 Ensure legislation that supports improved reporting of essential health data AS from 0.7 to 2.5 by To increase the proportion of HIS and service staff with capacity in managing and performing HIS responsibilities from <20% to 80% by 2013 and functions 3 To improve the completeness and data quality of the HMIS including harmonization of indicators at various levels of the health system Revised HMIS implemented by Dec 2011 List of indicators stratified by health system available by Dec To develop Data Warehouse functionality AS from 1.5 to 2.5 by To strengthen Health/statistical constituencies and coordination AS from 1 to 3 by To support the census in 2010 and 2020 AS scores for use of census and VR data To enhance the use of population and vital statistics raised to 3.0 by 2013 information for planning and monitoring 7 To develop a comprehensive, multi-year survey plan, Plan developed and shared with all updated biannually stakeholders by To integrate multi-level health M&E activities, including an M&E Plan for Community-based health care by facilities and communities To improve tracking of health sector inputs including health financing, human resources and commodities To improve reporting of maternal deaths and increase investigations of reported deaths All facilities and 40% of communities by 2013 AS 1.0 to 3.0 by % of facilities by To scale-up implementation of CAAC 80% by To strengthen DEWS at the provincial and central level AS from 1.0 to 3.0 by To ensure all reports and surveys provide gender-specific All reports and surveys provide genderspecific data as appropriate by 2013 data as appropriate % of private facilities registered and To ensure proper registration of private facilities (qualified 50 % of those sending regular reports by practitioners) and regularly reporting through HMIS To establish a quality measurement and assurance system for all levels of health care, public and private (indicators, tools and procedures) To ensure estimates of priority indicators are provided for stewardship in a timely manner 80 % of public health facilities follow measures to improve quality Increase AS from 0 to 3.0 by To ensure all central Directorates and PPHOs produce AS rises from 2 to 3 11

16 # Objectives annual reports including a minimal list of key indicators To ensure all thirty-four PPHOs give evidence of data use for provincial planning, resource allocation and service performance improvement To support a robust performance measurement system for Results-Based Financing (RBF) To support development of information systems for new strategies and services within the health sector like blood screening, etc Target (AS = HMN Assessment Score) 75% of HF have periodic data use sessions by 2013 By January 2010 By 2013 the HIS system will be ready to adapt rapid changes and inclusion of new needs 3.2 Interventions A set of strategic interventions were developed to address the problems identified during the assessment phase. The interventions were developed in small working groups of different stakeholders from within and outside the ministry. While developing the interventions the following principles were followed: a. Decision-making should be evidence-based. b. HNSS policies and priorities should be pursued. c. Need for integration of reporting systems and data from multiple sources at all levels. d. Focus on information needs across the Ministry. e. Avoid disrupting current HIS developments (annex G). f. Focus on what is feasible and affordable in the long run. g. Stress data quality from all sources. h. Maximize integration and efficiency in data assembly, analysis and information dissemination, reinforcing the ability for departments to increasingly work together. Strategic interventions range across the Components of HIS Development Plan as listed in Table 2, along with the responsible departments. Table 3 presents the full list of Strategic Interventions by the Objective which they address. Improvement of the information system is not the responsibility of one department or unit within the ministry. It requires the collaboration and coordination of different program units and departments in order to develop and improve systems and procedures. The interventions have been grouped into six HIS Components (A through F) to assign responsibilities to a group of departments to work together and be responsible. The grouping has been done keeping in mind to cluster similar or linked interventions together and assign the responsibility of implementation to small management teams comprised of the concerned programs and units. Table 2: Intervention components and responsible departments Groups Component Responsible Departments A Legislation, Coordination and Data Sharing Laws & Regs, Policy and Planning, HMIS, M&E B Surveillance and Data Use HMIS, DEWS with service programs C Data Quality and Monitoring and Evaluation M&E, HMIS, APHI Research Dept with service programs D HIS Capacity Development APHI with HMIS and M&E E Administrative Data Support HF, Pharmaceuticals and HR F Quality of Care and Hospital Service Monitoring M&E, QA, Curative Services, with HMIS 12

17 Detail activities proposed under each intervention are listed in a separate document. The following table presents the summary of the objectives and proposed interventions to address the priority problems. Table 3: Objectives and related interventions No. Objectives Int. No. Interventions Groups Ensure legislation that supports Legislation is drafted and enacted to support improved 1 improved reporting of essential 1 A reporting from public and private sector facilities health data To increase the proportion of HIS and service staff with capacity in managing and performing HIS responsibilities and functions To improve completeness and quality of the HMIS data including harmonization of indicators at various levels of the health system To develop Data Warehouse functionality To strengthen Health/statistical constituencies and coordination To support census in 2010 and 2020 To enhance use of population and vital statistics information for planning and monitoring To develop a comprehensive, multi-year survey plan, updated biannually To integrate, multi-level health M&E activities, including an M&E Plan for Communitybased health care carried out by all facilities and communities To improve tracking of health sector inputs including health financing, human resources and commodities To improve reporting of maternal deaths and investigations To scale-up implementation of CAAC Include training on the health information system in inservice training (additional program-specific training are bolded w/in other interventions) Include training on the health information system in pre-service training of health workers Develop and implement a range of improvements to the HMIS, review of indicators and stratification, integration of data from special programs, enhancement of data quality and scaling-up NMC at provincial level Develop resources, procedures and responsibilities for data warehouses at central and PPHO levels Establishment of inter-ministerial (health and statistical constituencies) coordinating body for HIS, and liaison offices for coordination and sharing of health, population and social information Promote availability and use of CSO pre-census population figures and annual population updates in planning at all levels of health service delivery Support the development, availability and use of vital registration data by the MoPH and its partners Prepare and implement a multi-year plan for health surveys that insures timely, efficient availability of priority qualitative and quantitative indicators (reducing survey overlaps and gaps) Strengthen coordinated monitoring of all health activities integrating data from vertical programs, HMIS and DEWS, along with relevant survey data Develop and pilot a new innovative approach to monitoring of health service by involvement of the community Support improved tracking of health system finances including program budgets and expenditures at the central and provincial levels, and establish a system of National Health Accounts Establish a drug management information system (DMIS) as an enhanced tracking system for pharmaceuticals procurement, importation, storage, distribution and rational use of medicine Further develop data management for Human Resources, including training, private providers and CHWs Develop procedures for improving maternal and neonatal death notification from health facilities and for investigation of causes Strengthen implementation of Catchment Area Annual Census at the facility level 13 D D C C A A A C E B B

18 No. Objectives Int. No. Interventions Groups To support development of DEWS including mapping, To strengthen DEWS at the diagnosis, analysis and response, HW knowledge of provincial and central level standard case definitions and outbreaks supported with B lab results To ensure all reports and surveys provide gender-specific data as appropriate To ensure private facilities (qualified practitioners) are registered and are regularly reporting through HMIS To establish a quality measurement and assurance system for all levels health care, public and private (indicators, tools and procedures) To ensure estimates of priority indicators are provided for stewardship in a timely manner To ensure all central Directorates and PPHOs produce annual reports including a minimal list of key indicators To ensure all thirty-four PPHOs give evidence of data use for provincial planning, resource allocation and performance improvement To support a robust performance measurement system for Results-Based Financing (RBF) To develop data support for new strategies and services Enhance the generation of gender-specific data and 13 indicators (within routine registers, records reports and surveys) Establish, supported by legislation, private health provider registration and reporting procedures 14 (including qualified practitioners, pharmacies, private clinics & hospitals, diagnostic centers and laboratories) Establish a quality measurement and assurance system 15.1 for all levels health care, public and private (indicators, tools and procedures) Standardize hospital patient records and develop 15.2 hospital service(quality) monitoring procedures Design and implement procedures for monitoring 15.3 quality of hospital services 16.1 Develop a methodology and plan for measuring MMR Design coordinated interventions for assessing child 16.2 mortality including Demographic Surveillance System (DSS) and MICS Devise an approach for assembling and integrating morbidity data from various sources (DEWS, HMIS, 16.3 prevalence and household surveys) for 12 key communicable diseases Devise cost-effective method for estimating prevalence 16.4 of NCDs, including diabetes, hypertension, disability and mental health problems Devise cost-effective methodology for measuring and 16.5 monitoring <5 severe malnutrition at the provincial level, including tools development Streamline and enhance the quality of and broaden targeted distribution of health and service reporting at central and provincial level, including results conferences and PR events. Develop guidance for and implement team approaches in using routine and survey data at central, PPHO, NGO and facility levels, including the weekly watch of health events, performance monitoring, annual provincial planning and resource allocation and Service Performance Improvement planning Review existing, design improved, and assess pilot applications of service measurement methods in support of the RBF initiative Develop procedures for collecting data on gender-based 20.1 violence through appropriate mechanisms Facilitate development and maintenance of recording 20.2 and reporting of services related to HIV/AIDS including drug users Develop recording and reporting of blood screening 20.3 services 20.4 Develop and maintain recording and reporting system 14 C A F B C B E C

19 No. Objectives Int. No. Interventions Groups for emergency preparedness and for monitoring the effects of disasters, and the services delivered for the affected populations 3.3 The Implementation Plan Most activities were planned to generate a specific product, often a plan, curricula, new procedures, database or similar HIS-related development. The duration of each activity is shown by indicative start and completion dates, along with the responsible unit or program. Finally, types of additional resources required by the activity are indicated, and whether they are one-time development costs or are likely to be an increase in the operational budget on a continuing basis (such as salaries for new positions). The objectives and interventions have been grouped into six HIS Components (table 2). It is expected that these sub-groups of the Stakeholder Working Group will continue to meet and function as a team during implementation in order to maintain the needed linkages between these six important subjects. The interventions are phased by year of implementation as shown in the Gantt chart in table 4. After considerable discussion and adjustment the proposed interventions were phased across five years. The starting times of many of the interventions and their activities were adjusted in order to place the higher priority interventions into implementation the first year, with more dependent and lower priority interventions phased in later in the five-year period. The resulting phasing is displayed in the table below: 15

20 Table 4: Afghanistan HIS Intervention Implementation Phasing by Component Obj Int No. No. Intervention Responsible Component A - legislation, Coordination and Data Sharing 1 1 Legislation is drafted and enacted to support improved reporting from public and private sector MOPH Laws and facilities Regulation Office 5 5 Establishment of inter-ministerial (health and statistical constituencies) coordinating body for HIS, MOPH Pol & Plan g Dir; and liaison offices for coordination and sharing of health, population and social information IM Com on M&E & IS Promote availability and use of CSO pre-census population figures and annual population updates in 6.1 planning at all levels of health service delivery 6 HMIS 6.2 Support the development, availability and use of vital registration data by the MoPH and its partners HMIS 7 7 Prepare and implement a multi-year plan for health surveys that insures timely, efficient availability of priority qualitative and quantitative indicators (reducing survey overlaps and gaps) Establish, supported by legislation, private health provider registration and reporting procedures (including qualified practitioners, pharmacies, private clinics & hospitals, diagnostic centers and laboratories) Component B - Surveillance and Data Use Develop procedures for improving maternal and neonatal death notification from health facilities and for investigation of causes P&P Dir/ M&E, MOPH Research Depart, APHI GD SP, w/ Laws/Regs, GD of SP- L&R RH with support of HMIS Strengthen implementation of Catchment Area Annual Census at the facility level CBHC with HMIS To support development of DEWS including mapping, diagnosis, analysis and response, HW knowledge of standard case definitions and outbreaks supported with lab results DEWS w/ HMIS 16.1 Develop a methodology and plan for measuring MMR APHI w/ M&E & RH 16.2 Design coordinated interventions for assessing child mortality including Demographic Surveillance System (DSS) and MICS M&E, HMIS Devise an approach for assembling and integrating morbidity data from various sources (DEWS, DEWS w/ support of HMIS, prevalence and household surveys) for 12 key communicable diseases HMIS 16.4 Devise a cost-effective method for estimating prevalence of NCDs, including diabetes, hypertension, Disability Dept disability and mental health problems GD Health Care 16.5 Devise a cost-effective methodology for measuring and monitoring <5 severe malnutrition at the Nutrition Dept provincial level, including tools development Develop guidance for and implement team approaches in using routine and survey data at central, PPHO, NGO and facility levels, including the weekly watch of health events, performance monitoring, annual provincial planning and resource allocation and Performance Improvement planning Component C - Data Quality and M&E 3 3 Develop and implement a range of improvements to the HMIS, review of indicators and stratification, HMIS M&E w/ support of HMIS; DEWS and APHI 16