Presented at the Global Symposium on Health Systems Research in Beijing, China.

1. Routine health Information System Performance assessment in Guanajuato, Mexico 2010.
Alicia Sánchez Parbul, MCP,1 Juan Eugenio Hernández Ávila, D en C,1 Lina Sofía Palacio Mejía, D en EP,1 Beatriz Plaza, MPH,2
1Instituto Nacional de Salud Pública, 2 Measure Evaluation, Population Center, North Carolina University
Background;timely information depend on
reliable and
Health systems
in order to
monitor their performance and to make
informed decisions; every year millions of
dollars are spent in the collection of data
around the world. In Mexico, it has been
estimated that 20% of the time of health
providers is spent filling paper base forms or
electronic systems. Despite of this
effort, little attention is dedicated to the
quality of data and the use of information
throughout all the organizational levels of the
health system.
We present here the results of a study to
evaluate the performance of the Routine
Health Information System (RHIS) in the State
of Guanajuato, Mexico, as well as the
technical, organizational and behavioral
factors that may be influencing it. Guanajuato
is one of the 31 states that along with the
Federal District constitute Mexico. It is locates
in the center of the country and, according to
the 2010 census it 5’ 486, 372 inhabitants.
The health system is fragmented into a set of Protection in Health (Seguro Popular) decentralized MoH’s counterparts in each of
public and private institutions. The public provides services for the population working the 31 states and Federal District. They are
health sector includes Social Security in the informal economy or the unemployed organized in local health systems called
Institutions which provide services and social population. This system is managed by the sanitary jurisdictions. The SHS of the state of
benefits to the population employed in the Federal Ministry of Health (MoH) and the Guanajuato has eight sanitary jurisdiction and
formal economy. The System for Social State Health Services (SHS). The SHS are the operated 521 medical facilities in 2010.
Methods; SystemPerformance of (PRISM)
Information
The
Management
Routine
PRISM Framework
framework was used to assess the
performance of the routine health
information system (RHIS) in the State of
Guanajuato. The PRISM Framework offers an
innovative approach to the design, evaluation
and strengthening of RHIS by measuring its
performance, tracing possible determinants
in three domains: the
technical, organizational and behavioral.
Using this framework it is possible to identify
factors in the causal pathway affecting the
RHIS performance that may be use as a guide
to develop interventions for its strengthening.
Lot Quality Assurance Sampling (LQAS) was
used to calculate sample size (20 facilities per
Jurisdiction). A set of 157 facilities which
included all hospitalization facilities and
administrative offices and a sample of
outpatient clinics stratified by sanitary
jurisdiction and urban/rural location was
randomly selected. During the month of
January 2010 four teams of trained field
personnel accompanied by principal
researchers visited the health Clinics, hospital
and jurisdictional offices in the state of
Guanajuato. We applied the performance
diagnostic tool for data quality and use of
information, the RHIS overview and
facility/office checklist, the process
assessment tool and the Organizational and
Behavioral Assessment Tool (OBAT). A total
of 288 informants were interviewed after
informed consent. This research was aproved
by INSP Internal Review Board and ethics
committee.
some presentation of data in the RHIS. Only
around 50% of the facilities visited reported
having a RHIS manual but most of them
reported to have computers.
Overall self-confidence scores were
consistently high in all jurisdictions but, in
contrast, demonstrable capabilities in the
tasks of managing or operating the RHIS were
consistently low. The lowest scores were
obtained by interviewed personnel were in
their ability to define and resolve problems;
this was consistent with the low analytic C onclusions; Although data quality is good
R esults; data accuracy and timeliness
scores were high in all sanitary
capabilities of the personnel involved with
RHIS at the facility level as well as the overall
and collection and transmission mechanisms
are in place to make it opportune available
use un information showed by the diagnostic there is a need to train qualified personnel to
jurisdictions, completeness had also very high
tool. In general personnel involved in the analyze and disseminate it and to promote
scores. Coverage was also very high;
RHIS in health facilities does not demand the use of information to base the decision
timeliness was not measured in three
data, which is also consistent with the low making processes in the Health System. This
jurisdictions. In the one of the other five only
analytic capabilities. is not only at the operation level, our results
in 47% of the facilities /offices the
information was transmitted in a timely show the need for high officials in the State
The organizational factors were in general a Health Services to fully understand the need
fashion, in the rest of the jurisdictions the
little higher but very few agreed that there is for a sustainable health information service.
information flowed on time in 100% of the
an environment promoting evidence-based The results of this project and al more general
visited facilities/offices. Use of information
decision making although they mostly agree evaluation of the Health Information system
for decision making was poor in the medical
with the idea of a problem solving in Mexico using the Health Metric Network
facilities and a little higher on jurisdictional environment. Framework led to the opening of a master in
administrative offices but the overall average
by sanitary jurisdiction was poor. All of the public health program in the National
The Critical management functions of the RHI Institute of Public Health with emphasis in
indicators in use of information were also received very low scores in general, but
consistently low with few exceptions. health information systems and biostatistics.
financing was by far the lowest. Only around With this program we hope to train the
Sanitary jurisdiction 3 had the highest scores. 50% of personnel involved in the operation of
The scores in the processes of the routine future public health workforce to promote a
the RHIS received training in the three better use of information but also to set the
health information system in Guanajuato previous months. An in general, only 25% on
were also low but Jurisdiction 1 had a score necessary policies to generate a real evidence
the facilities have a statistician among it staff.
of 77%, the highest. This jurisdiction is in the based decision making environment at all
In 63 percent of the facilities the RHIS is
state’s capital the city of León. Most of the levels of the organization of the publich
operated by the physicians or nurses, taking
facilities in the eight jurisdictions reported to health system, we hope this will strengthen
approximately 25 5 of their weekly time to fill
have data processing mechanisms and the health system and have an impact in the
up paper forms, aggregate data and transfer
showed to interviewers presentations of health of the population
information