1. How can operational research be used to strengthen health information systems? PHIN Annual meeting Fiji June 7, 2013 Damian Hoy, Sione Hufanga, and Adam Roth

2. Overview 1.Background (Damian) 2.Case study: Tonga (Sione) 3.Group exercise (Adam): Operational research questions for strengthening HIS in the Pacific

3. What is operational research? “The search for knowledge that informs policy and practice in the short and medium term, with a special focus on interventions, strategies or tools that can enhance the performance (quality, effectiveness or coverage) of the program in which the research is being conducted.” SPC, Public Health Division. It helps us to be more efficient. It means we are doing the best we can for the people we are accountable to.

4. So what methods are used? Literature reviews; systematic reviews; meta- analyses Qualitative methods: observation; focus group discussions, interviews Quantitative methods: e.g. Surveys, trials, etc *************************************** Capacity building, capacity building, capacity building!!! -> identifying the issue, information collection, analysis, and use.

5. Systems operational research  Delves into the (HI) system gaps/barriers/ facilitators/strengths /etc,  Examines these in detail in a formalized and scientifically rigorous manner, and  Determines what strategy would help to improve the situation.

6. Why do (HI) systems operational research? Given the current scenario with over-strained and under-resourced systems, we need to be as clever as possible in how we go about planning, and implementing them. “All truths are easy to understand once they are discovered - the point is to discover them” Galileo

7. Why do (HI) systems operational research? “The very first steps to success is to become interested in it”. Sir William Osler (via Dr Paula Vivili) “Those that say it can’t be done should get out of the way of those who are doing it”. Chinese Proverb (via Dr Paula Vivili)

8. Systems operational research

9. Adam et al 2013. Trends in Health Policy and Systems Research over the Past Decade: Still Too Little Capacity in Low-Income Countries. PLOS One.

12. E.g., Why is ICD not well utilised? What are the barriers, facilitators? How can this be improved?

13. E.g., What lessons can be learned from this and applied to the HIS? How can TB surveillance be better integrated with the HIS?

14. Research need: Completeness of peri-natal deaths was poor Methods: Qualitative research: recording and reporting practices for peri-natal deaths, interactions b/w MWs and TBAs, their opinions on the strengths/weaknesses of existing recording and reporting systems.-> improving completeness and ownership Findings: Majority of women deliver at home. Inadequate collaboration and data sharing b/w MWs and TBAs. In cases of delivery in health facilities, the details of delivery are recorded on discharge cards, and these details are entered in the delivery register. Individual variations/inconsistencies in accessing local health services leads to duplication of records or losses to follow up, hence compromising data accuracy. Recommendations: Link data on village births with the official vital statistics systems. Develop appropriate guidelines on the maintenance of local registers. ACTION Burke et al 2011: Utility of local health registers in measuring perinatal mortality: A case study in rural Indonesia

15. Systems OR is ‘embedded’ in the PHIN Strategic Plan 1.1a: Systematic development and strengthening of the HIS of member countries. 1.1c: Development of mechanisms for effective and efficient knowledge management. 3.3: Conduct further research and evaluate the current sustainability of health IT investments. 4.6a: Conduct regular, systematic and institutionalised monitoring and review of HIS incl.: periodic review of information requirements; continuous monitoring of disease surveillance systems; monitoring and assessment of the efficiency of the core and support components of the HIS.

16. Examples of HIS OR questions from this week “How do we better engage doctors to collect data?” “What impact does feedback have on reporting?” “How do we create demand from: our leaders; other sectors; those who collect data?” “How can data be better analysed and used for decision making?” “How can we better integrate and harmonise our HIS?” “How do we better present research to make it easier for our leaders to change policy and practice?”

17. Overview 1.Background (Damian) 2.Case study: Tonga (Sione) 3.Group exercise (Adam): Operational research questions for strengthening HIS in the Pacific

18. Acknowledgements The following individuals are thanked for their helpful insights: Sione Hufanga Yvan Souares Adam Roth Kerri Viney Pascal Frison Mark Landry Karen Carter Audrey Aumua Nicola Hodge