Integrated Health Information Architecture to Facilitate State-wide and National Evidence-Based Public Health Monitoring: A Case Study Based in India
Creators: name: Kumar, Manish
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2015

description: The fact that significant investments are made toward large-scale health programs both at national and state levels requires close scrutiny of such programs based on routine surveys and data collection operations besides increased use of data for decision making and policy formulation. In order to effectively meet diverse data needs of various stakeholders, accurate and timely information exchange among information systems becomes a pre-requisite. To facilitate information exchange among different levels of health system an Integrated Health Information Architecture (IHIA) is required especially when the national health system and the health information systems are comprised of state level systems. However, the Health Information System (HIS) landscape in India, unfortunately, is highly fragmented and operates in silos. As a result, data-based health policy and program development has become tedious. Interestingly, the proposed national health policy of India envisions to expand universal health coverage, and strengthen health information systems for effective monitoring and assessment of policy implementation. Furthermore, this health policy aims to develop an IHIA to drive evidence-based monitoring, evaluation and quality improvement efforts at all the levels of healthcare system. In the backdrop of the health policy mandate and lack of pertinent knowledge and in-country experience, conducting a research study on health information architecture for improved policy decision making is a timely and useful exercise. For the purpose of this research study the Indian state of Bihar, one of the poorest states in the country, was selected as a case. It is a high priority state not only for the national health programs but also for international donors like Department for International Development, United Kingdom, and the Bill and Melinda Gates Foundation that are implementing innovative health information technology interventions. The objective of this research study was to analyze the current state level health information systems landscape in Bihar and then suggest an integrated, but decentralized, health information architecture that will encourage information system innovations at the district and sub-district levels while meeting the data and information needs of healthcare providers, and health policy and program leaders. Besides, such an architecture will enable both vertical and horizontal scalability. Two principal research techniques namely secondary literature review and primary data collection were used in this study. The literature search was conducted in PubMed and Web of Science. The primary data collection involved eleven key informant interviews in Bihar. The research findings highlight the fragmented HIS landscape and describe the a) health system of Bihar, b) HIS in Bihar, c) key stakeholders of IHIA, and, c) organizational mapping. Based on the research findings, the paper presents an IHIA for Bihar state. In the penultimate section, the paper describes the factors that are most likely to influence implementation and sustainability of the IHIA in a low resource setting. The paper concludes with few suggested next steps to take forward the output of this research.