Use of information in health

The use of health information presents a contemporary problematic, which many stakeholders, including ministries, donors, state- and district-level managers, and global agencies are constantly trying to address, but often with limited results. This problematic represents a paradox, where data overload impedes relevant information use; to solve this, more information technology (IT) systems are deployed creating more data, which further confounds information use. Finagle’s laws on information may be humorous, but they are insightful in understanding this paradox.

IT solutions are often not sensitively designed to the context, ending up providing lots of data which does not stimulate action, and could even on occasions do the reverse. Relevant information remains buried in the mass of data collection, and in reaching this stage of data flow, the energy to use it is dissipated. Why is this the case, and what can be done about it? These are the issues that this chapter seeks to address. Technology and information are not ends in themselves, but only means to better decisions in policy design, health planning, management, monitoring, and the evaluation of programmes and services (Lippeveld et al. 2000).

While there is much more data in flow than what existed before, this statement by Chambers of more than three decades ago is as true now as it was then—or even more so.

Much of the material remains unprocessed ... or If processed, unanalysed ... or If analysed, not read ... Or If read, not used or acted upon

Only a miniscule proportion of the findings affect policy, and they are usually a few simple totals

(Chambers 1983).

Despite the massive advances in computerization and IT enabling health information systems, the analysis and use of information in decision-making remains limited. We begin with this problematic, because it is a powerful illustration of the challenges that public health informatics is facing. The rationale for the introduction of IT in healthcare rests on the premise that the effectiveness and efficiency of health sector performance would greatly increase with the availability of relevant information. And yet when all the technical hurdles are apparently crossed and the information made available, it not only fails to show measurable improvements in health sector performance, even its use remains very limited.

We classify broadly the reasons and pathways for suboptimal use of information into five sets. One relates to the failure of IT system design to meet and match the needs, and failing to differentiate between wants and needs. The second relates to data quality. Most programme managers and policy makers fail to use information from the systems that they have built up with such great costs and efforts, due to a perceived lack of reliable data. But then the use of data is, as we shall see, is one of the most important determinants of data quality. Thus a vicious cycle is set up, where poor use of information leads to poor data quality, which justifies poor use of data—a cycle which is not easy to break out from. A third set of reasons relates to the capacity to use information at both the institutional and individual levels. Institutional capacity relates to the skill mix needed, but part of it is also about the work processes in place for enabling the use of information, and above all a culture where information use is valued organizationally. At the individual level, health staff do not often possess the necessary incentive to use information, as they see the associated work to not be of value. Fourth, there are reasons that do not relate to information at all, but to the structure and function of the health system itself, and to the processes of governance. Finally, there are often political reasons which deter information use as it may represent the uncomfortable truth of the ‘reality’ becoming visible through use.

This categorization is only for convenience in discussion and to provide analytical sharpness. In real life, these reasons are intimately intertwined, and come mixed with varying emphasis in different contexts. Similarly, there is no one way of overcoming these constraints. There are many ways forward. But the contention of this book is that underlying these many ways forward—as expressed in the case studies—are some essential principles, which if internalized can be more broadly applied across situations. We start with an extended case study example from Odisha, a state in India, to frame this problematic of information use (Case Study 3.1).

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