Forum Introduction & Some Lessons to Date John A. Novak PhD USAID/Washington

1. Country Ownership Strategies:Asia Pacific Leadership Forum on Health Information SystemsWHO WPRO Conference Center13-16 June, 2011

2. Forum Introduction & Some Lessons to Date John A. Novak PhDUSAID/Washington

3. Forum Purpose • Background & Purpose of Forum • Delegates to broaden their perspectives on implementation options, challenges and roles related to health information systems (HIS) • Delegates will develop a shared awareness of the roles of various sectors in strengthening HIS & strategies for improving cross sector coordination • Delegates will explore leadership roles in managing HIS • Country teams will develop preliminary action plans to promote national stakeholder engagement and commitment to HIS • And, Donors will highlight their follow-on support to strengthen national HIS initiatives at the country level

4. Forum Purpose • Commitment to Country Ownership & the other Paris Declaration Principles • Donors, multinationals & country governments have signed on to the Paris Declaration principles – including USG – see Amb. Goosby’s letter (August, 2009) • This will require a new relationship including: • Donor alignment with country strategies • Country leadership to achieve results • Harmonization, transparency, managing for results, etc. • To be successful, we will have to manage major individual & institutional behavior changes in the way we relate to each other • This process begins today…….. • The Nigeria example -

5. “HIS is not a technology issue alone… • Strategy alone will not resolve problems… • The biggest challenge is changing • how people do things.” • Southern Africa Region Delegate

6. Forum Outcomes • Credible, practical country action plans that build upon policies and plans in place in country • A credible, practical & timely donor plan to provide coordinated, follow-up support at the country level • Some demonstration that we have begun to align our behaviors with the principles of the Paris Declaration.

7. Donor Involvement • Why the donors are present: • We have our work to do in figuring how to support country ownership • We have to better manage our own institutional change and behavior change process • We have to usher in a new era of partnership and how to be more responsive to country expectations of us • We’re here to participate in the development of a donor plan • We will participate in a series of meetings to discuss and agree to a coordinated plan for supporting follow-on activities

8. Lessons Learned to Date • HIS strengthening is NOT primarily a technical challenge. • Rather, your most important challenge is to establish sufficient: • Political will • Institutional capacity • Supportive policy/regulatory environment • The primary challenge, then, is to design and facilitate individual & institutional behavior change

9. Lessons Learned to Date • Establish a management/coordination unit to monitor implementation with sufficient authority, resources and expertise to succeed, including these specific skills: • Task Management • Organizational Development • Change Management • And, HIS Technical Support

10. Thank you!

11. Country Ownership Strategies:Asia Pacific Leadership Forum on Health Information SystemsWHO WPRO Conference Center13-16 June, 2011

12. Introduction of Delegates • Mongolia • Philippines • Thailand • Vietnam • Bangladesh • Cambodia • Fiji • Indonesia • Lao

13. Introduction of Sponsors and Donors • Philippines Department of Health • Asian Development Bank (ADB) • Centers for Disease Control (CDC) • Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) • Health Metrics Network (HMN) • HIS School of Population Health, University of Queensland • International Development Research Center (IDRC CRDI) • Japan International Cooperation Agency (JICA) • Norwegian Agency for Development Cooperation (Norad)

14. Introduction of Sponsors and Donors • The Rockefeller Foundation • Secretariat of the Pacific Community (SPC) • UK Department for International Development (DFID) • UN Economic and Social Commission for Asia and the Pacific (ESCAP) • UN International Telecommunication Union (ITU) • United States Agency for International Development (USAID) • United States Department of Defense (DOD) • United States President’s Emergency Plan for AIDS Relief (PEPFAR) • World Health Organization (WHO)

15. Other Introductions and Appreciations • Country Delegate Points of Contact • Donor Points of Contact • WPRO Staff • Conference Support • Management Sciences for Health • Futures Group • Training Resources Group • Small Group Facilitators • Rapporteurs

16. Pre-forum HIS Survey ResultsHealth Policy Project, Futures GroupAnita Datar Garten

17. Overview • Why was it important to gather this information? • What methodology was used? • What were the limitations? • What were the findings? • What are the implications for the forum?

18. Why was it important? • To inform the design of the forum • To understand importance of HIS strengthening • To produce a snapshot of HIS in each country • To identify cross-border promising practices

19. What methodology was used? • Semi-structured interview guide posed questions: • Who is currently coordinating, contributing, and using HIS data? • What are some challenges to strengthening HIS? • What steps have been taken to strengthen HIS? • Interviewee profile • Technical experts in health, finance, statistics, telecommunications • n = 27 (February – June 2011)

20. What were the limitations? • Technology and scheduling challenges • Language limitation • Not representative of all sectors in each country • Resulted in broad, thematic summaries

21. What were the findings? • Common Challenges across all countries • Promising Practices by country • Actions Taken • Barriers Broken • Reflections from sectors

22. Common Challenges Governance and Multisectoral Engagement • Secure political leadership for HIS • Reduce siloed activities and increase multisector coordination • Enforce private sector reporting Strategic Planning and Financing • Ensure evidence-based decision-making in planning • Increase donor coordination and harmonization of systems Information Use • Increase data quality and confidence • Strengthen data analysis skills • Encourage health information sharing and use • Build strong data culture at all levels

23. Common Challenges (cont’d) Human Capital Development • Build stable health care workers trained in HIS • Train medical professionals in management System and Data Interoperability • Address fragmentation of HIS sub-systems • Increase interoperability across HIS sub-systems

24. In your words… Capacity-building “ We cannot deal with HIS as a technology issue alone…80% of strengthening HIS is about building the capacity of people and strengthening organizational development.”

25. In your words… Governance "Money is required for systems development, but for governance you need a shared vision and a willingness to engage to ensure consensus building.”

26. In your words… Information Use “I had no idea that our health information was so vital to other Ministries.”

27. Promising Practices: Bangladesh • Actions Taken • Draft Health Sector Development Plan (2011-2016) emphasizes development and strengthening of routine HIS; • All public health hospitals connected to DHIS 2.0, which allows for interoperability in reporting from the field to central level; • Priority Communicable Disease Surveillance data also updated weekly through web-based software from 64 districts and 6 divisional headquarters. • Barriers Broken • Challenges in data reporting are being addressed to improve timeliness and produce a clearer health information picture.

28. Promising Practices: Cambodia • Actions Taken • In 2009 MOH redesigned and rolled-out web-based national HIS; • Ongoing, regular meetings between MOH and URC programmers ensures capacity transfer and ownership of web-based HIS; • Result: 100% reporting from all public facilities across provinces; • Next steps include expanding roll-out to NGO hospitals and private clinics. • Barriers Broken • Reliance on external expertise decreasing, while simultaneously building in-country capacity to manage national HIS.

29. Promising Practices: Fiji • Actions Taken • Health sector issues fall under social sector within MOF; • MOH and MOF work in close collaboration, meeting regularly to discuss health sector needs and funding priorities; • When MOH comes up with new policies, they work directly with MOF to understand budgetary implications and determine priority needs. • Barriers Broken • Siloed agency activities giving way to coordinated strategic planning that ensures stakeholder engagement and buy-in.

30. Promising Practices: Indonesia • Actions Taken • MOH currently developing HIS strategic plan (2011-2015) ; • Led by MoH with strong engagement from educational institutions, the Agency for Population and Family Planning, the Central Bureau of Statistics, and the Ministries of Communication and Information, and Home Affairs. • Barriers Broken • Isolated planning replaced with MOH leadership of a multisectoral and coordinated process.

31. Promising Practices: Lao PDR • Actions Taken • In 2010, adopted LaosInfo, which serves as a national database intended to improve coordination and sharing of information; • First piloted at the MOH , including training for health workers to understand data needs for M&E and reporting on MDGs; • By 2011, expanded roll-out to five Ministries including Agriculture, Forestry, Education, Finance, and Commerce. • Barriers Broken • Efforts underway to build awareness of data needs and understanding of relationship to better health outcomes.

32. Promising Practices: Mongolia • Actions Taken • Currently drafting five-year HMIS strategic plan, which aligns with e-health strategy; • Established HIS steering committee (led by Vice Minister of Health) to coordinate and harmonize HIS activities among partners, donors, and other key agencies including the Ministry of Finance. • Barriers Broken • Emphasis on leadership, political commitment, and multisectoral engagement.

33. Promising Practices: Philippines • Actions Taken • 2007, establishment of Philippines Health Information Network; • PHIN built linkages between stakeholders, assessed the state of HIS, and formulated the strategy for HIS development; • Drafted plan outlining need to implement standards and improve access to and dissemination of health information. • Barriers Broken • Fragmented HIS giving rise to improvements in sub-system data flow, interoperability, and a clearer health information picture.

34. Promising Practices: Thailand • Actions Taken • Assessed status of eHealthto understand ICT uptake and identify and areas for improvement; • Strength: Thailand is leading with respect to use of ICT; • Challenge: Need to strengthen eHealth foundation with emphasis on establishment of governing body; • Efforts underway to establish national level, multisectoral authority to support e-Health. • Barriers Broken • Expanding definition of HIS strengthening to go beyond the technology challenge and focus on leadership.

35. Promising Practices: Vietnam • Actions Taken • In 2010, revised National Statistical Indicator System; • Government Statistical Office collects data on over 350 indicators including 20 health indicators from the MOH; • Established central repository, which serves as the source for annual statistical publication. • Barriers Broken • Transparency and increased access to information leading to emerging information picture.

36. Reflections from Health Improve communication “We recognize the need to have a multisectoralapproach. The forum will help us create dialogue in- country.”

37. Reflections from Statistics Strengthen data culture “We hope to increase access to health data and encourage data use to improve health outcomes.”

38. Reflections from Finance Evidence-based decision-making “We really need to have reliable information in place to ensure proper financing.”

39. Reflections from Telecommunications Community of practice “There is a growing demand to apply ICT to solve health challenges…[the forum] will help [us] establish a community of practice for the region and strengthen South-to-South collaboration.”

40. What are the implications for the forum? • Common challenges across countries provide a starting point for developing an action plan and a roadmap for strengthening HIS. • Promising practices highlight country-owned, country-derived solutions and encourage sharing of information and lessons learned within and across country delegations. • Reflections from each sector reinforce the importance of this work and the critical role that each of you will play for the next four days and beyond.

41. Thank You!

42. Agenda

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44. Agenda

45. Agenda

46. Adjustments • Keynote Speaker • Assistant Secretary Bayugo • Technical Overview of HIS • After Keynote Address • Presented by Dr. Ramesh Krishnamurthy, WHO

47. Adjustments • Design based on two prior forums, extensive interviews with delegates • Facilitated working groups/brief plenary reports • Maximum interaction among delegates within and across countries and sectors • Rigorous documentation of working group findings that will be disseminated to all delegates • Follow up by forum organizers to enable knowledge sharing, exchange of lessons learned, and continued progress

48. Orientation Norms • Be Curious • Be Fully Present • Be Courteous • Be Prompt • Be Engaged • Be Open

49. Orientation Norms • Obsession with a belief limits your ideas. • Think before you do, not after you’re done.

50. HIS Impact Story Development and Status of Health Information Standard in ThailandPresenter: Dr. Boonchai Kijsanayotin