Information for Health Governance and Public Health Management: Cross-cutting Health Systems-based Analysis

All management is essentially about the processes involved in converting available inputs to achieve the maximum possible objectives. Public health management in the usual LMIC is always a struggle to optimize health outcomes from the very limited financial, human, and material resources available. Governance concerns the challenges of making policy choices, setting priorities, deciding strategy, making resource allocation, and ensuring accountability. Every one of these actions requires more and more information, best approached through a systems framework, which seeks to understand interlinkages between the organization of service delivery, human resources, access to medical technologies, financing of healthcare, information systems, management, and governance.

With regard to human resources, the introduction of ICTs has made hitherto routine personnel management functions like payroll and salaries, postings, transfers, and promotions easier, and has also improved recruitment and skills development processes. But the real power of ICTs would be realized by going beyond this and using cross-cutting analysis to improve the efficiency and quality of service delivery. Better allocation of resources, measurement of workforce performance, and better delivery of incentives can all be facilitated by PHIs. Similarly, ICTs have demonstrated their use for the management of logistics and inventory systems that enhance access to essential drugs and diagnostics. When combined with turnover of drugs, it provides valuable information about morbidity patterns, and about utilization of services and efficiency of care. This taken in conjunction with service delivery data can be scaled to the population level. Similarly, computerization of financial information in addition to increasing the ease of accounting and auditing, when combined with the study of patterns and rates of expenditure, can provide vital information about the progress of programmes and schemes and make budgeting and financial flows more responsive to needs.

Another important dimension that has recently evoked considerable interest relates to result-based financing, or performance-based financing (Meessen et al. 2011), with the intent to promote certain types of provider behaviour and motivation. Result-based and performance-based financing requires information to have much higher standards of reliability and verifiability. More often than not, such payments would not only require information about the quantity of services delivered, but also considerable details about the quality of care, especially the adherence to standard treatment guidelines, and checks against irrational or excessive care provision, denial of care, or fraud of different types. Many countries are shifting to a model involving the greater role of the government in purchasing care, rather than directly providing it. Purchasing care could be typically through insurance mechanisms, or a wide variety of contracting arrangements, or through partnerships with the private sector. By necessity, today all insurance schemes are supported by HIS and there is much to learn in developing these.

There are two related information challenges here. One is collating information on out-of-pocket expenditures, which is not captured as part of routine reporting, but is becoming central to the measurement of health systems’ performance in the context of universal health coverage. The second is the ability to cull aggregate information of public health importance out of the individual level insurance and other purchase-of-care arrangements. But the interoperability required between different information systems to achieve such objectives is often absent.

Health information therefore can be characterized as ‘the tide that lifts all the boats’, as it can help improve workforce management; access to technologies and the financing of healthcare; support better planning and implementation of all health programmes; and the better organization of service delivery. Information is also the glue that binds together all these building blocks with the leadership and governance of the health sector. Public health informatics is essentially about the generation, analysis, dissemination, and use of information required for making these decisions.