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Health Information systems

Source: TropIKA.net editorial team

Title of presentation: Health Information systems

Date: 18 Nov 2008

Location: Yeelen

Chair: Ricky Richardson, Vice President, The international society for telemedicine and eHealth (ISfTeH)

Presenters:

• Ivo Njosa, coordinator, Health Information Systems, World Bank Washington DC
• Amha Kebede, Deputy Director-General, Ethiopian Health and Nutrition and Research Institute, Ethiopia
• Karl Brown, Associate Director, The Rockefeller Foundation, United States of Africa
• Hassan Mshinda, Director, Commission for Science and Technology (COSTECH), United Republic of Tanzania

Official Rapporteur: Akunda Pallangyo, Health Metrics Network, Switzerland

TropIKA Rapporteurs: Deborah Sumari

Major topics: Resource allocation for Health Systems Research

Scope: Health Systems Research

Overview

An interactive debate was hosted by the HMN Secretariat, on the motion that responsibility for budgetary allocation for health systems research should be at the national, government level.

There were two speakers on either side of the motion. Dr Amha Kebede and Mr Ivo Njosa supported the motion and their arguments were predicated on governments knowing what is best and needed most in their countries and in a position to allocate resources appropriately. Dr Hassan Mshinda and Mr Karl Brown were against the motion, stressing that resources for health should also be owned by other stakeholders in developing countries. This would sustain interest and funding for health systems research and encourage innovative solutions to tackle related challenges. Both sides provided convincing arguments. However, a final vote held at the end of session, showed the audience in favour of resources for health being channeled through governments in developing countries, to fund health systems research initiatives.

Introduction

The Chair introduced the event and the motion; the framework for the debate was agreed by the audience. Dr Richardson then introduced the panel members.

Akunda Pallangyo briefly introduced the Health Metrics Network (HMN), a global partnership based in Geneva and housed by WHO. HMN is “owned” by a wide range of partners, including low-middle income countries, development agencies, bilateral and multilateral institutions and technical partners. Its goal is to facilitate better health information at the country and global levels.

HMN objectives include building consensus around an established HMN Framework and strengthening health information systems (HIS). To do so most effectively, HMN aims to bring together health and statistical constituencies within countries in order to build capacity and enhance the availability, quality, dissemination and use of data for decision-making.

In accordance with these objectives, HMN has proposed an implementation/operational research agenda, which will help further refine the HMN Framework.

Context and issues

The goal set for this session was to look into approaches that can facilitate better health information in the countries and globally. The aim is to enable dissemination and use of information.

The session was a lively debate on the following issue: whether “the responsibility for budgetary allocation for health systems research should be held at the national, government level”.

Two opposing arguments were heard on the above motion.

Ivo Njosa, supported the motion by emphasizing that: the budget of the health research system should be controlled by the government, for the following reasons:

• Donors usually allocate funds, based on their own priorities which may not always converge with countries’ needs and help define solutions to their problems.
• Through negotiation with government, donors may come to agree with national priorities in allocating research funds; this will foster harmonization of activities and systems country-wide.
• The government may make mistakes in their research priorities, but over time will revisit its options and revise them on the basis of experience. There must be opportunities for government to exercise such choices, analysis and assessment with regard to funding allocations for research in countries.
• Government should lay the foundation for health research to work and for supporting framework and services. Government should also build up and diversify its capacity for resource mobilization, budgeting and management of funding.

Amha Kebede, also supported the motion by arguing that;

• The government should make decisions on allocation of funds for research, as it is best placed to know what the research needs of the country are
• The government will thus have a better opportunity to manage and mobilize its own research resources
• Health research will be better addressed by the country itself than by donors
• As countries are involved in the budgeting of the research funds, allocation of those funds to the specific needs and issues identified and finalization of reports thereon will be easier

Hassan Mshinda, spoke against the motion, arguing as follows;

• Governments have shown little interest in allocating money to research; eg in Uganda, funds for research were sometimes diverted to other areas of more direct political interest, and research got out of the picture
• A precondition would be that governments adhere to the principle that good science requires rigorous, evidence-based work, and that this cannot be confused with political rationales and preferences.
• Governments nowadays do not accept conditionalities on funding; if budgeting for research is controlled by government, then the government itself has to do the whole planning and preliminary analysis of needs, requirements and implications.
• In Tanzania, 80% of health-related activities are within the private sector and are not run by the government; in such circumstances, channeling research funds to and through the government will not help.

Karl Brown also spoke against the control and allocation of funds by the government. By definition donors have to account to their own administration for the ways in which decisions have been made on specific allocations of research funds, how the money has eventually been used and what the results have been. Such reporting and accountability requirements need to be factored in and accommodate.

From open discussions

Institutions should not depend on government to mobilize funding for health research.

Serving and representing the country does not give government ownership over the country.

The government should not be given responsibility in areas for which it has no proven ability or capacity.

Main points of agreement

Building on the strength of the country’s research institutions and network may be a better approach to attracting and mobilizing funding for research for health.

Operational aspects/Recommendations

Principles of transparency and accountability in establishing mechanisms to manage funding;

Control and monitoring should not be exclusively in the hands of government but shared with other stakeholders.

Background documents:

The Health Metrics Network, events, publications and related links, on WHO website

"National Strategies for the Development of Statistics", NSDS, with online access by country (French/or English) to national data, on Paris21 and OECD website

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