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Health-Related MDGs Plus

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					        Key areas in HMIS


   Dr Hamid Reza Jamshidi PhD

Vice Deputy for health in MOH
Director of National Health Sector Reform
 Unit in MOH
  Structure of presentation

1-Map of health system
2-Key areas in HMIS
3- HMIS in Iran
4- Recommendation
Understanding the map of health
system is essential to find the key
areas in HMIS
-Tax
-Public
insurance
-Private
insurance
-OOP              Financial
-Charity          resources

-Natural
resources                                  -Health promotion
                                           -Primary prev.
-Borrowing
                                           -Screening
                                           -Diagnosis and
-Demographic                               treatment
change            Need and
                                  Basic    (outpatient)
-Epidemiologic    Demand         package   -Diagnosis and
change                                     treatment
-Utilization of                            inpatient)
com.
-Community
expectation
-Technology


selection of
Cost-effective
                      Priority
interventions
                 WHO      Comm.-pub.-priv.-charity-cooperatives…

                 Where                      Stratification

 Provider
                 How much             Payment

                                      Standards of services, human and non human
                 What standards       resources



                  Health improvement

                  Responsiveness to expectation
   Client

                                   Equity



                                   Stewardship
strategic planning-information system-Tool for implementation( rule and
regulation -incentive-sanction..)-monitoring and evaluation-capacity building……
  -Tax
  -Public
  insurance
  -Private
  insurance
                  Financial
  -OOP
                  resources
  -Charity
  -Natural
  resources                                -Health promotion
  -Borrowing
                                           -Primary prev.
                                           -Screening
                                           -Diagnosis and
-Demographic
                                           treatment
change
                  Need and        Basic    (outpatient)
-Epidemiologic
change
                  Demand         package   -Diagnosis and
-Utilization of                            treatment
com.                                       inpatient)
-Community
expectation
-Technology




-List of
interventions
-Cost-effective       Priority
interventions
     Financing information
A number of key information include:
what is total spending on health?
who is spending it? (poor/rich? rural/urban?
north/south?)
what is it being spent on? (PHC? hospitals? MoH ?)
what are the sources of this expenditure? (Government?
donors? NGOs? private?)
How does this compare to other countries in the region?
what are the main trends?
National Health Accounts is a systematic approach to
mapping the flow of health sector funds around the
health system.
  -Tax
  -Public
  insurance
  -Private
  insurance
                  Financial
  -OOP            resources
  -Charity
  -Natural
  resources                                 -Health promotion
  -Borrowing
                                            -Primary prev.
                                            -Screening
                                            -Diagnosis and
-Demographic
                                            treatment
change
                  Need and
                                   Basic    (outpatient)
-Epidemiologic
change            Demand          package   -Diagnosis and
-Utilization of                             treatment
com.                                        inpatient)
-Community
expectation
-Technology




-List of
interventions
-Cost-effective        Priority
interventions
  Needs and demands information
Demographic changes
Epidemiological changes
Utilization and community expectations
Technology progress.
  Needs and demands information
The Measuring the burden of diseases (DALY)
is a measure of health benefits which takes into
account the effect of health interventions on both
life expectancy and quality of life.
to get the best possible value for money by
allocating their scarce resources
utilization study: For determining community
behavior to receive health services and the
behavior of the health system during provision.
  -Tax
  -Public
  insurance
  -Private
  insurance
                  Financial
  -OOP            resources
  -Charity
  -Natural
  resources                                 -Health promotion
  -Borrowing
                                            -Primary prev.
                                            -Screening
                                            -Diagnosis and
-Demographic
                                            treatment
change
                  Need and         Basic    (outpatient)
-Epidemiologic
change
                  Demand          package   -Diagnosis and
-Utilization of                             treatment
com.                                        inpatient)
-Community
expectation
-Technology




-List of
interventions
-Cost-effective        Priority
interventions
      Determining the priorities
Preparing list of interventions
Selecting the cost-effective
interventions
1000/000                         Y

Cost

   1000                          X

           DALY saved per year
  -Tax
  -Public
  insurance
  -Private
                     Financial
  insurance
                     inf.
  -OOP
                     (NHA)
  -Charity
  -Natural
  resources                                   -Health promotion
  -Borrowing
                                              -Primary prev.
                                              -Screening
                                              -Diagnosis and
-Demographic         Need and                 treatment
change               Demand.         Basic    (outpatient)
-Epidemiologic
change               (DALY-         package   -Diagnosis and
-Utilization of      Utilization)             treatment
com.                                          inpatient)
-Community
expectation
-Technology




-List of
interventions
-Cost-effective   Priority
interventions     (interventions)
           WHO      Comm.-pub.-priv.-charity-cooperation…

           Where                    Stratification

Provider
           How much             Payment

                                Standards of services, human and non human
           What standards       resources



           Health improvement

           Responsiveness to expectation
 Client

                             Equity



                              Stewardship
    Information about WHO
          (Providers)
Public
Private
Charity
Cooperatives
……….
PHC-Clinics-Hospital beds (Human
resources-Important Medical equipment-
building)
           WHO      Comm.-pub.-priv.-charity-cooperation…)

           Where                          Stratification

Provider
           How much             Payment

                                Standards of services, human and non human
           What standards       resources



           Health improvement

           Responsiveness to expectation
 Client

                              Equity



                              Stewardship
Where are the facilities are
 located? (Information for
stratification to achieve the
         best access)
                 Equitable resources allocation
Allocation based on population density-patient admission-physical
accessibility……..
           WHO      Comm.-pub.-priv.-charity-cooperation…)

           Where                          stratification
Provider
           How much             Payment


                                Standards of services, human and non human
           What standards       resources



           Health improvement

           Responsiveness to expectation
 Client

                              Equity



                              Stewardship
Information about payment system
    to design the best payment
 Type of payment :
 Fee for services
 Per-capita
…
 Payment for providers
 Pharmacist-Physicians-Radiologist-
           WHO      Comm.-pub.-priv.-charity-cooperation…)

           Where                          stratification
Provider
           How much             Payment


                                Standards of services, human and non human
           What standards       resources



           Health improvement

           Responsiveness to expectation
 Client

                              Equity



                              Stewardship
Information about the Standards
• Standards of services (Guide lines)
• Human standards
• Non human resources standards


For monitoring and evaluation to achieve
 the best technical quality
           WHO        Comm.-pub.-priv.-charity-cooperation…)

           Where                    Rationalization

Provider   How well               Guideline

           How much               Payment

           What standards         Standards of human and non human resources



           Health improvement

           Responsiveness to expectation
 Client

                                Equity



                                Stewardship
   Information about Health
   improvement (First goal )
Health Adjusted Life expectancy
(HALE)
Disability Adjusted Life Expectancy
(DALE)
           WHO      Decentralization (comm.-pub.-priv.-charity-cooperation…)

           Where                          stratification
Provider
           How much             Payment


                                 Standards of services, human and non human
           What standards        resources



           Health improvement

           Responsiveness to expectation
 Client

                              Equity



                               Stewardship
Information about Responsiveness to non
medical expectation (Sociocultural quality)
              (Second goal)


-Respect for dignity
-confidentiality
-Autonomy in choice of treatment
-prompt attention
-quality of amenities
-Choice of provider
           WHO      Comm.-pub.-priv.-charity-cooperation…)

           Where                  Rationalization

Provider
           How much             Payment

           What standards       Standards of human and non human resources



           Health improvement

           Responsiveness to expectation
 Client

                             EQUITY




                            Stewardship
   Information about EQUITY
         (Third goal )
Health information systems should expose
the extent to which health and health
services are equitably distributed among the
population according to sex, socio-
economic, geographic, and socio-
demographic characteristics
Fair financial contribution index
Catastrophic health expenditure for poor
Equality of Child Survival in different deciles
of income-geographic areas-ethnics-…..
                 HMIS in Iran
Areas that information are available in Iran:
NHA
DALY
Utilization
DHS
FFCI
Catastrophic health expenditure
Responsiveness
Census
Household survey
Vital Registration (about 50 information items “vital
horoscope”) For child and maternal health indicators,
malaria and tuberculosis, death rates,
Resources information (Human-equipment-building-PHC
clinics-Hospitals (Public-private-charity-……)
Surveillance system for Polio-Aids-Malaria, Tuberculosis..
Household folder
                  Recommendation
Integration of different isolated information (Integrated information
system)
Accessibility and Web based information system
Uses of information as an evidence for policy makers in all levels
Working more on quality of information
In many cases, new research and development is needed to improve
instruments measurement to provide valid, reliable and comparable
measurements
Having an organization with high authority and national policy
Cost effective Investments in physical infrastructure such as
computer technology, analytical units and human capacity
Building a Legal and institutional frameworks in country
              Recommendation

strengthening national capacities to collect, analyze and
disseminate information
Building an evaluation and monitoring system for HMIS
Harmonization and coherence between different data
collection approaches (definitions, standards,
classifications).
Strengthening Health information at the sub-national,
provincial and district level In the context of
decentralization and health sector reform
Coordination of three core dimensions of information
system (involvement of all partners in the development of
the HMIS )
 Coordination of three core dimensions of
 health Management information systems

             MOH- parliment- Cabinet -community
           Public and private insurance organization
USERS
          Managers- experties-academics
            NGOs- community




        Informatión áreas
-Tax
-Public
insurance
-Private
insurance
-OOP              Financial
-Charity          resources

-Natural
resources                                  -Health promotion
                                           -Primary prev.
-Borrowing
                                           -Screening
                                           -Diagnosis and
-Demographic                               treatment
change            Need and
                                  Basic    (outpatient)
-Epidemiologic    Demand         package   -Diagnosis and
change                                     treatment
-Utilization of                            inpatient)
com.
-Community
expectation
-Technology


selection of
Cost-effective
                      Priority
interventions
                 WHO      Comm.-pub.-priv.-charity-cooperatives…

                 Where                      Stratification

 Provider
                 How much             Payment

                                      Standards of services, human and non human
                 What standards       resources



                  Health improvement

                  Responsiveness to expectation
   Client

                                   Equity



                                   Stewardship
strategic planning-information system-Tool for implementation( rule and
regulation -incentive-sanction..)-monitoring and evaluation-capacity building……
                  Recommendation
Integration of different isolated information (Integrated information
system)
Accessibility and Web based information system
Uses of information as an evidence for policy makers in all levels
Working more on quality of information
In many cases, new research and development is needed to improve
instruments measurement to provide valid, reliable and comparable
measurements
Having an organization with high authority and national policy
Cost effective Investments in physical infrastructure such as
computer technology, analytical units and human capacity
Building a Legal and institutional frameworks in country
              Recommendation

strengthening national capacities to collect, analyze and
disseminate information
Building an evaluation and monitoring system for HMIS
Harmonization and coherence between different data
collection approaches (definitions, standards,
classifications).
Strengthening Health information at the sub-national,
provincial and district level In the context of
decentralization and health sector reform
Coordination of three core dimensions of information
system (involvement of all partners in the development of
the HMIS )

				
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