Functional public sector routine health information systems are essential for monitoring health situation in all countries, and Haiti is no exception. Until 2000, however, Haiti had a rudimentary system that did not meet the needs of the health managers.
At that time, USAID was familiar with routine health information system (RHIS) work that had been developed in Morocco by the Ministry of Health, JSI’s Morocco Family Planning/Maternal and Child Health Project, Tulane University, and the EVALUATION Project. So in 2000 USAID asked JSI, through MEASURE Evaluation, to help the Haitian government develop a similar system.
We were asked to provide technical assistance to help the Haitian Ministry of Health and Population to develop and strengthen its national health management information system (HMIS). The initial goal was to improve the management and analysis of information needed to manage health services at the department and district (Unité Communité de Santé) levels through increased use of appropriate software (système HSIS) and information technology.
There were many challenges to building a health information system in Haiti. The Ministry of Health and Population (Ministère de la Santé Publique et de la Population – MSPP), while recognizing that it needed a health information system to monitor activities in the country, moved slowly. At first, no one wanted to accept responsibility for managing the HMIS until told to do so by the director general, who was replaced every time a new government came into power. Furthermore, communication and electrical infrastructure in the country were not reliable.
When the project was launched, the workplan included training to enable public and semi-public institutions to use the national HIS registers and monthly reporting forms, the production and distribution of registers and forms, conduct a baseline survey, and support the national système HSIS consensus-building workshop.
At the same time, we adapted the computer application that was developed under previous projects in Morocco and elsewhere for Haiti. Système HSIS’s interface can easily be learned and used by local district staff. Système HSIS enables departmental health managers to collect, process, and analyze the monthly reports that are designed for use in the health facilities.
An important feature of système HSIS is a robust decision support system (DSS) that enables decision makers to interactively visualize health indicators and data elements collected by the system in tabular, graphical, and geographical presentations and dynamic multidimensional analyses capabilities (data triangulation). The process involves choosing the level of analysis, health program, program-specific indicator, and graphical display. These displays include line graphs for time trends, histograms and thematic maps for geographic comparisons, as well as pie charts and summary tables. The DSS is widely appreciated by departmental health officers as a planning and programming tool for health activities.
Throughout the rest of the decade, JSI, through MEASURE Evaluation, continued to provide support to the Ministry of Health and Population for system strengthening activities and further development/updates to système HSIS.
In 2009, the project conducted a PRISM assessment to make sure the system was meeting the Haitian health system needs/goals. PRISM is a tool developed by MEASURE Evaluation to determine the strengths and weaknesses of routine health information systems by quantifying the technical, behavioral, and environmental/organizational determinants for the system.
The Haiti assessment showed that departmental health officers recognize the value of the user-friendliness of système HSIS, but that there was a need for improved supervision. We responded by integrating data quality assurance into the supervision by department teams and through training on RHIS at the departmental level and training for the MSPP Planning and Epidemiology Units to manage the HSIS application and data.
On January 10, 2010, Haiti was struck by an earthquake that registered more than 7 on the Richter scale. The epicenter was near the capital of Port-au-Prince and caused massive damage. The toll of human deaths and suffering was extensive and is ongoing.
The international community quickly provided disaster relief. One of the most pressing issues was to know where health facilities were located. The MSPP building, however, was flattened and all its computer equipment destroyed. Fortunately, in the month prior to the earthquake, MSPP and the MEASURE Evaluation/JSI team had conducted their annual Master Health Facility List update, and this information was available on the système HSIS website. The list showed where facilities had existed before the earthquake, and as information from Haiti was received, this list was updated to show where functional and temporary health facilities were setup during the disaster relief effort. A multinational group led by U.S. Health and Human Services (HHS) was formed to manage the development of this evolving master facility list. MEASURE Evaluation played a key role in the updating and verification processes of this list.
In the months following the earthquake, MEASURE Evaluation assisted the MSPP with a health facility census to determine the post-earthquake status and amount of damage to the country’s health facilities. The information helped prioritize and identify which structures were still functional and the extent of the damage. Although MEASURE Evaluation activities in Haiti ended last year, the MSPP has continued to use système HSIS. The data collection, analysis, and decision support system are greatly appreciated by both national and departmental health managers, and the graphs and maps generated by users of the system are proudly displayed on departmental health office bulletin boards.
What led to this accomplishment? I think two things, primarily. First, the system is easy to use—district health personnel can now use the information collected for their own decision-making, rather than simply passing it up to the national level. Second and most importantly, the system was successful because of the ministry’s support and recognition that système HSIS was theirs and they needed devote attention and resources if it was to be useful.
While MEASURE Evaluation is longer implementing the activity, it’s clear that the system has enabled the Haiti MSPP to make decisions based on facts and thus better plan their health service interventions. We hope this system will continue to help Haiti in its long recovery from the earthquake.