Health Management Information Systems improve data quality to support health sector development and reform in Laos

Since 2013, the World Health Organization has been collaborating with the Ministry of Health, under the framework of the National Health Sector Reform to set up and customize District Health Information Software (DHIS2) – a web-based open source system to replace the paper-based reporting system for health management information, one of many Health Information Systems currently used in Lao PDR.

The use of technology in developing countries to manage the way data is collected, reported, organised, stored and generated has helped these countries developed their National Health Information Systems that support many of their programs and the overall health sector development in term of better planning, monitoring and response.

DHIS2 builds on the existing health management information system under the Ministry of Health which routinely collects information on maternal and child health, vaccination, infrastructure and hospital patient flows, population served under each of the health facility.

It improves the system’s effectiveness by strengthening the way data is reported, processed, analysed at the same time, made it easier for all health managers nationwide and development partners to have access to information in a timely manner.

Census, population-based surveys and special studies results can be transferred to DHIS2 - which also serves as the national data warehouse. This together with the use of routinely collected health management information has enabled the health system managers, policy makers and partners to have a more comprehensive and detailed picture of the performance of public health programmes, making them better informed of gaps that they have to address in order to build a more resilient health system nationwide.

Information supports decision making, development of health policies and interventions, governance, health research, human resource development in health, health education, training of health workers in area where shortages has impacted heath service delivery in the country.

At the same time, the collection of essential health information also contributes to attaining universal health coverage by informing policy makers and health managers at central, provincial and district levels of where and what would be appropriate to improve quality, access to health service and utilization, thereby to attain better health outcomes for the population.

To encourage and enable use of health information by policymakers and health staff, the data collected, generated and analysed for use, have to be tailored to the local settings and needs. Different administrative levels in the health systems have different roles and therefore different data needs. This determines what needs to be included and structured in the routine health management information system, and what will be done on ad-hoc basis such as surveys or special studies to fill the information gaps that are crucial for the country.

The effectiveness of DHIS2 system depends on the users, especially those at the district and provincial levels that are responsible for managing the data and are the primary users. With better data collection and management, it will serve the needs of local health authority for better response to local needs. It also serves development partners and donors in justifying funding that is needed in the country for health promotion and intervention programs by creating an open and transparent monitoring and evaluation platform.

In Laos, one of the striking examples was the use of DHIS2 for maternal and child health (MCH) reporting, of which maternal deaths is one of the information regularly collected. Realising the needs for coordination and taking advantage of information technology, the ministry has planned to adapt DHIS2 to support the data collection for maternal death surveillance and review in 2016.

Once this extended function of DHIS2 is applied, it will help district and provincial official staff working in maternal and child health programme to capture information on why mothers die; their access to health facility; challenges that health workers faced in term of delivery of maternal services, thus supporting the planning for service improvement.

This extension of the use of DHIS2 – currently used as routine health information management platform for surveillance of maternal deaths will be a symbolic gesture of the collaboration between the MCH centre of MOH and WHO. It shows how information collected by different sources, if put together for a common cause can help determine other related issues to health such as socioeconomic, cultural, languages, level of education and together with the practice of health service providers can contribute to a mother’s decision whether or not if she would use the health services.

Health inequities have also impacts health outcomes in term of mortality and morbidity of mothers. Free MCH Policy was introduced by the government to lower the financial barriers for women to deliver at health facilities and to bring their young children less than 5 years to use both in-service and out-service treatment throughout the country.

Currently the challenge is to strengthen the service quality so that more people will be encouraged to visit health facilities to use the services, and this would address the issue of limited use of services by people living in remote and poor rural areas.

A good health management information system should provide information that highlights where service coverage is the lowest and how to address a critical intervention that is needed in these areas. It should also allow relevant partners to have access to much needed reliable, timely and authorized data for their programs implementation of which will contribute to the overall outcomes of the Lao health system.

WHO has been working with health development partners in Laos to support the Ministry of Health on promoting the use of DHIS2 as a health information platform for multiple purposes; health workers from the district and provincial levels are trained regularly on data reporting and how data can be generated for their own use.

The use of DHIS2 should be further extended to policymakers, donors and partners for better coordination and support to effective governance and policy formulation.

Community outreach activity by the Ministry of Health staff to improve access for MCH services
Women in rural areas are encouraged to use the MCH services in their community