Jhabindra Bhandari

In the recent years, there are critical needs of reliable and timely health information which provides a solid foundation for strengthening health system. Therefore, sound health information is a global public good that requires smart investments by governments, development partners, health policy makers, statisticians, community-based organisations, and private sector to generate the health information needed by all.
During global health emergencies such as COVID-19 and other acute health risks and threats, rapid public health response can save lives of many people who are most vulnerable and marginalised in the communities. Furthermore, the requirements of the International Health Regulations (IHR) demands accurate and timely notification of any public health emergency of international concern. That is why health information is particularly critical to ensure effective health sector response during emergencies and disasters.

Essential function
More broadly, the health information system has four key essential functions: data generation, compilation, analysis and synthesis, and communication and use. The system aims to collect data from health and other relevant sectors, analyses the data and ensures their overall quality, relevance and timeliness, and converts data into information for health-related decision-making.
Additionally, an integral component of health information system is public health surveillance which focuses mainly on defining problems and providing basis for action. Thus, policy makers, planners and decision-makers require different kinds of information ranging from health determinants to inputs to the health system including health infrastructure, facilities, equipment, human and financial resources, and performance of the health system such as availability, accessibility, quality services and responsiveness of the system.
Likewise, the health outcomes such as mortality, morbidity, disease outbreaks, health status, disability, health inequities, in terms of determinants and coverage of services are critical in terms of tracking and measuring progress. In developing countries, health information system is further fragmented by disease-focused demands that often relate to donor requirements and global health initiatives. This sometimes creates overwhelming pressure and burden on health workers to ensure reporting requirements for multiple partners.
In Nepal, health policies have underscored the needs and priorities for investments in health information system. There is variety of information systems in health sector. These mainly include health management, logistics, financial, health infrastructure, human resources, training, drug, and few others. In this context, Ministry of Health and Population with the support from UNFPA and USAID first ever developed integrated health management information system (IHMIS) in 1993 which is functional across all districts. This system seeks to collect health information from public and private sector. And the system aims to improve access to and use of quality health services, enhance evidence-based planning and management, monitor and improve the performance of health sector at large.
In 2007, health sector information system strategy was developed to support health policy, millennium development goals, long-term health plan, national poverty reduction strategy, and health sector plan and programmes. Since then, there has been remarkable progress in terms of concerted efforts to strengthen health information management system. The quality of the health related data and information has greatly improved, and more specifically, all the relevant data are readily available in local health facilities.
Due to increasing access to internet and use of information technology, web-based data entry system has been effective for online reporting. More importantly, efforts are in place to scale up the District Health Information System (DHIS-2). The DHIS -2 is a free and open source and health management data platform used by multiple organisations for aggregating statistical data collection, validation, analysis, management and presentation. This is crucially important for health monitoring, improving disease surveillance and access to a range of health related data.
However, there are still some practical challenges to improve the capacity of health workers and managers in analysis and use of data for evidence-based planning at local level. In remote health facilities, there is limited access to internet and good infrastructure. There are critical needs of orientation and training to managers and health workers on IHIMS with simple guidelines. Periodic review, follow up, and monitoring are essentially needed to improve quality of health information and timely reporting across the country.
While there have been significant efforts to initiate reporting of disaggregated data by age, gender, caste and ethnicity in selected districts, the scope of health information system has further expanded in terms of monitoring universal health coverage and Sustainable Development Goals (SDGs). Therefore, innovative approaches and smart investments are needed to strengthen strategic information at all levels.

Capacity building
In the federal context, data collection, management, analysis and use within IHMIS requires clear direction and a roadmap to enhance investments and health impacts. The first and foremost priority is to update existing information system and related investments so that appropriate data policies and capacity building needs could be realistically addressed. This will further help in creating a foundation of reusable and interoperable information exchange that is essential to improve evidence-based policy making and planning within the federal system.
There is an emerging need to strengthen central data repository to house data generated from routine health information system and national surveys. In addition, there are critical needs to promote the appropriate use of digital technologies for health. While information and communications technologies present new opportunities and challenges, there is a growing consensus in the health community that the strategic and innovative use of digital technologies is key to harness evidence-informed health policies and actions.

(Bhandari is senior doctoral research fellow in global health and health systems)