The sad state of Health Management Information systems Continues

Health management information systems or HMIS form the backbone of any health care system. Unfortunately in Pakistan, such a concept does not exist owing to the lack of any HMIS policy. Furthermore, most students and healthcare professionals are completely unaware of what is meant by HMIS and its integral role in healthcare provision. The continuing problem despite infusion of the state of the art technologies such as mobile phones of 3G versions, internet accesses and geospatial maps is a sad indication of apathy from the government towards this matter.

Academically, there is dearth of books that are targeting HMIS system education in Pakistan. HMIS systems across the world differ from one another on their actions but remain the same in principle. There are numerous examples of third world countries such as Malawi who have successfully addressed concerns of HMIS through trial and error, although there is still much room for improvement. Pakistan holds much resources if used wisely, but lacks the proper strategic plan and stakeholder interest to attain this goal.

The current situation of the health management information systems in Pakistan was extensively discussed with Mr. Khowaja Azeem presently serving as medical officer Aga Khan Health Services Islamabad. Khowaja Azeem is Masters in Health Economics and Management and has been working with established organizations such as Aga Khan Health Services Sindh Region.

What is the current status of HIS in Pakistan

Currently HIS system is somewhat existing in private sector of Pakistan but public sector still faces great challenges in developing HIS system due to fragmentation of system and variation in geo political and socio economic condition.

You have been involved in various capacities in developing HIS. What is the most significant change that you witnessed in the last five years?

The DEWS (Disease Early Warning System) was an excellent system introduced in Pakistan in which mobile technology and computerized software system was used to develop solo reporting systems but due to unresponsiveness of the participants this system shut down.

How much interest has the government shown towards implementation of HIS? Has it improved, declined or remained the same?

It seems there is lack of interest from key stack holders. Ironically, if tomorrow donors offer funding for HMIS tool implementation the entire machinery will mobilize to implement HMIS tools without knowing pros and cons of the system. Without planning we cannot succeed.

The Punjab HIS system is considered as the first successful attempt in HIS integration in Pakistan. What is your opinion?

Punjab gained good progress in health and education indicators compared to other provinces, in which autocratic leadership of CM Punjab playing central role. Now HMIS in Punjab system can be used as a model for other provinces of Pakistan.

What are the key social barriers preventing complete integration of HIS

The first and foremost barrier is lack of census since 1998 because of improper vital registration mechanism. Secondly, integration needs bottom to top approach in a manner that information is compiled and decisions made on that data base. However expertise, infrastructure, trained human resources, limited finance and very low percentage of beneficiaries from public sector hospital prevent complete integration of HMIS.

What the key technological barriers that you have experienced in integration of HIS

Key technological barrier in integration of HMIS is lack of computer technological expansion in rural masses. Even a good set of computers arranged with high speed internet connection and updated in the timely manner can help update early warning of threats in real time.

Is there a policy devised specifically for HIS

It’s interesting to share that the 2009 National Health Policy is still in its draft form and not yet implemented. At this state, how could we expect HMIS or HR policy to be evolved from that. The National HMIS policy needs to be formulated in a manner that whole Pakistan gets benefits.

What recent attempts have been made to implement HIS in private and public sector?  Can you name any institutes where these have been applied or implemented?

One existing private institute delivering primary care services is Aga Khan Health Services having a very effective HMIS system, in which early warning mechanism and awareness to community with in minimum time is ensured. Internationally, WHO has an effective HMIS system.

The new health record systems and technologies such as Cloud are considered the next level of evolution in HIS systems. What is your opinion and is Pakistan equipped to take up this change.

We can double our system speed from the present state by placing internet and computer level services to the roots but we will face another set of problems which we are probably ignoring at this point in time. So we need to revisit what actually is it we want to collect; health as social, mental and physical wellbeing data or data of diseases to get numbers of cases?  Currently mobile technology has effectively expanded in Pakistan.  This is our potential source of strength for HMIS and community workers can be equipped with these electronic devices so that their paper work is reduced and real time monitoring and evaluation can easily take place.

What is the status of human resources for HIS

Severe shortage of trained human resource in HIS leads another challenge in implementation of this strategy.

What is needed from the government to carry out successful integration of HIS in Pakistan

First of all priority setting followed by involvement of stakeholders and convincing them to start work on National HMIS policy and plan.  There is need to improve and create a clear cut and channeled mechanism of reporting  which is not dependent on availability or absence of the persons. Finally there is need for increased surveillance for vital registration if census not possible.