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Health information system

  • Page updated onMarch 17, 2025
Health information system
Photo: Bruno Abarca

A good health information system basically has three objectives. The first is to generate information about the health status of the population, the performance of the system and its services, and the social determinants of health. It achieves this by generating, collecting, analyzing and communicating data that enable decision-making to achieve universal health coverage, for example. The second objective is to enable reacting to threats to public health. The third is to synthesize information for transformation into applicable knowledge.

What makes up a health information system?

A health information system is composed of several elements: resources, indicators, data sources, data management, information products, and the dissemination and use of information.

Health information system resources include media, governance and technology.

Health information system resources include coordination and leadership, funding, personnel and logistical support, and the legal and regulatory framework that supports it, but also the communication and information technologies.

Among these technologies, it is worth highlighting some tools that have marked a before and after in many middle and low-income countries, such as DHIS2 (District Health Information System 2). It is an open source software with low hardware requirements for its use that has enabled health areas in more than 80 countries to have modern technology adapted to contexts with low resources and connectivity. DHIS2 allows the collection, management and synthesis of data for decision making. Other tools such as KoboToolbox, designed specifically for use in humanitarian contexts, have also enabled thousands of organizations to implement surveys and questionnaires quickly, securely and at low cost.

Indicators are at the heart of the health information system

Indicators allow synthesizing key information about health determinants, population health status and health system status. A good selection of indicators can form a minimum data set to support health system functions and decision making. However, it is often not feasible to increase the number of indicators to be calculated and reported too much, because of the overload it may place on the system and the inability to produce them with sufficient reliability and accuracy.

Many health systems include among their minimum set of indicators those recommended by WHO, or those that contribute to providing information about the Sustainable Development Goals. Organizations working to support health services sometimes require access to these or other indicators to monitor their performance. These organizations' support to the health system and its information system allows them to benefit from the availability of these key data.

Data sources are multiple

Data for the calculation of indicators and for the health information system in general can be obtained from different sources:.

  • From the health units it is possible to obtain individual patient records, their health status and the interventions they receive. They also have the capacity to generate structured information about available services, infrastructure and facilities, the logistics management of medicines and supplies, the health personnel, and the financial management.
  • The sources of information that provide data about the population include the civil registry, the population census and the results of population-based surveys. These allow details to be obtained about risk factors, social determinants of health, knowledge, attitudes, practices and access to services, among other aspects.
  • Finally, it is also worth mentioning the epidemiological surveillance systems, which provide information on threats to public health and the incidence of diseases with the potential to produce epidemics, to which it is necessary to respond.

Adequate data management allows the generation of products such as reports

There needs to be adequate data management to enable its collection, storage, cleaning, processing, compilation and analysis.

This is clearly explained with an example: epidemiological surveillance. It is useless to have powerful tools and data sources if there is no procedure for the person responsible for a health center to report a case of acute watery diarrhea that makes him/her suspect a possible cholera infection, or if the person responsible in the health district does not receive an alert in time that makes him/her investigate the case. Likewise, the system must be able to translate the data obtained through its different sources into indicators, thus allowing its analysis and monitoring.

Finally, the available information already analyzed must be converted into products such as reports and concise, easy-to-understand documents. In this way, data are converted into evidence and evidence into knowledge, to be made available to the people who must make decisions about health actions.

How to secure health information during an emergency?

In a humanitarian crisis, the difficulties in obtaining reliable information are multiplied.

When it is most essential to have complete information ready for use and dissemination in record time, it is precisely when there are fewer resources. In fact, emergencies usually also have an impact on healthcare systems and their information systems, reducing their resources and capacity.

In these contexts, many additional humanitarian actors come into play who, while they may contribute their own resources to generate information and sustain the system, also have priorities and specific needs for data to assess needs and identify or monitor interventions, as well as their own tools to obtain, analyze and synthesize them. As a result, and despite the efforts of humanitarian coordination mechanisms, fragmentation of the health information system is almost inevitable.

The calculation of mortality: an example of the challenges in the health information system

The crude mortality rate is the number of deaths that occur in a period per 1000 population. It is an indicator that is (in theory) easy to measure, with many strengths: it can give us key information about the magnitude of a humanitarian crisis, it does so in a way that is easy to understand by the general public and decision-makers, and it also allows us to work with emergency thresholds. For example, traditionally, 1 death per 10,000 people in a day, or twice the initial value of the rate, has been used to define whether there is a true humanitarian emergency.

The problems in calculating these data and using their thresholds in fragile contexts, however, are many:

  • The national registry of births and deaths may not be reliable, or may contradict data from other institutions. In some cases, moreover, this registry falls apart, making it necessary to establish a mortality surveillance system.
  • It is common for there to be political groups that deny the figures given, with or without foundation. Rarely is there an independent entity (and accepted by all sides) that verifies the information.
  • It may be impossible to keep track of the number of indirect deaths, as they occur among the missing population.
  • The use of the emergency threshold may be unfeasible outside refugee camps (where population numbers are difficult to count), when there is no clear baseline reference value, in populations already hit by previous crises and high baseline mortality values, or if the crisis develops slowly, without producing obvious peaks, despite the high suffering of the population..

Given the challenges for mortality, it is easy to imagine the difficulty in calculating other key indicators that give us much more information. These include the global rate of acute malnutrition, the coverage of births attended by skilled personnel, or the percentage of the population with adequate food consumption or the child immunization coverages, among many others.

In many cases, it is essential to use population-based surveys

It is common that, as part of humanitarian action in crisis-affected countries, and as a complement to the support to health services and the information system they employ, it is key to conduct surveys that allow monitoring of the situation under difficult conditions.

Among the surveys, those with multi-stage random sampling are worth mentioning. This methodology makes it possible to select a representative sample of the population by dividing the population into several clusters and selecting some of them randomly in a first phase. A random sample of families is then selected from these clusters in a second phase, for example. This methodology is commonly employed in mortality surveys, SMART (Standardized Monitoring and Assessment of Relief and Transitions) surveys, to measure mortality and nutritional status of children under five years of age), and MICS (Multiple Indicator Cluster Survey) surveys, to measure aspects linked to reproductive, maternal and child health, for example.

We also use many other surveys and methodologies that allow us to measure the food insecurity situation, collect data on humanitarian needs, or analyze the situation of health services.

Epidemiological surveillance and early warning systems can detect "signals"

In humanitarian crises, it is also necessary to maintain risk control of diseases with epidemic potential. In fact, surveillance and detection of potential public health events is the first step in responding to epidemics.

When the usual health information system cannot assume these functions, it is possible to cover this need temporarily with methodologies such as EWARS (Early Warning and Response System). This is a rapid installation system that allows the detection of possible public health events, and also includes procedures and tools for managing alerts and responding with public health actions. An EWAR system, however, does not cover (nor is it intended to cover) all the functions and roles of a national health information and surveillance system. Measuring the burden of disease, the mortality of a population, or the performance of health services is beyond its scope.

The community control can also be key to sustaining a community system of epidemiological, nutritional and health risk surveillance through the voluntary collaboration of neighbors. Thus, well-trained and well-paid community health workers can monitor the nutritional status and child immunization coverage of their village. They can also monitor access to prenatal care and the ability of pregnant women to have an assisted delivery. They can even monitor the occurrence of diseases with epidemic potential, or report possible suspected cases of cholera, polio, meningitis or other serious and notifiable diseases.

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