Assessment of the ability of the health management information system in India to use information for action
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This thesis explores the interconnected problems of ―why health information is not used in practice?‖ and ―what can be done to address this problem?‖ The primary aim of the thesis was to make an assessment of the existing Health Management Information System (HMIS) in India with respect to its ability to support the use of information for action in priority areas identified by the national and state governments. The problem of lack of effective information use in health management has been fairly well documented in the literature, but much less has been said about what can be done about it, other than the rather superficial advice of increasing the levels of training. The empirical setting for the examination of these research questions was within the public sector in India, where the research took place within an action research framework. The author was actively engaged as a participant with national and state authorities in the process of redesigning of the HMIS, building and deploying to the states various HMIS reform systems including the software, capacity building and making systems sustainable and scalable. A key focus area of the action research was aimed at enabling systems that would promote the utilization of the routine data being collected through the HMIS, and integrating the same with action areas such as related to planning, monitoring and evaluation. Data collection was carried out through various methods including interviews with key stakeholders, observations, formal and informal discussions carried out face to face and through emails or telephone communication, and the writing of various reports which were then commented on by various people including the state and national level user departments. Both quantitative and qualitative data was collected and analyzed. Quantitative data collected through the ―Readiness Matrix for Information for Action‖ across the three dimensions of human resources, technical infrastructure and institutional conditions helped to see how states performed individually and how they ranked compared to each other on information generation and use. The matrix also helped to diagnose the dimensions for strengthening in order to improve the overall readiness to use information for action in the states. This diagnosis was supplemented through qualitative analysis to further probe into ―the why‖ of the performance of the states at various rankings and what could be done to improve matters. The readiness matrix,12 arguably, could be used by researchers in other settings to help diagnose key areas that need to be strengthened in order to improve information use, and also evaluate where a state is in terms of its maturity towards the same. While progress was noted in areas of data coverage in that some sporadic examples of information use were present and enhancements in capacity and infrastructure were accumulating, challenges still remained. Key ones included poor data quality, the unfulfilled promise of integration and a continuing weak culture of information use. Some key strategies identified to address these challenges included the promotion of decentralization of information to support decentralized action, the adoption of a data warehouse approach and strengthening collaborative networks. Achieving this however, requires some structural interventions such as the broad basing of education in public health informatics, institutionalization of a cadre of public health informatics staff within the Ministry of Health, and promoting the use of software which is open source and based on open standards such that widespread local use is supported.