Health information

The generation and strategic use of information, intelligence and research on health and health systems is an integral part of the leadership and governance function, and requires a well-functioning health information system which ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status. This in turn requires the development of health information and surveillance systems, the development of standardised tools and instruments, and the collation and publication of national and international health statistics.

Notwithstanding their status as “fragile states”, even countries in conflict or with weak governance are expected to work towards achieving the Millennium Development Goals, while donor funding for any health sector is normally conditional on demonstrating progress or impact. Monitoring and reporting progress/impact ideally requires facility and population based information and surveillance systems, but these tend to be weak or non-existent in fragile states. Instead, health information in these states relies heavily on local surveys conducted by NGOs, or on national surveys such as Demographic and Health Surveys or the Multiple Indicator Cluster Surveys conducted by UNICEF. Surveys pose significant methodological and logistical challenges, and results can be contentious. Nevertheless, they are often the source of “best data” in fragile states.

Health Management Information Systems, to the extent they are functional in fragile states, are often limited in scope, and seldom include data from the NGO or the private sector, or include records of births and deaths. Furthermore, reliable population figures for the calculation of coverage and morbidity/mortality rates is frequently unreliable in these settings, as Census data tends to be incomplete or severely outdated and insecurity can result in significant (cross-border and internal) population movements.

A number of tools and guidelines are available describing the collection and estimation of health information and indicators in the context of fragile states. This includes methodological descriptions of surveys as well as tools and guidelines developed by the Health Metrics Network.