Health Policy and Planning Advance Access originally published online on September 2, 2005
Health Policy and Planning 2005 20(6):375-384; doi:10.1093/heapol/czi044
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Original article |
Design and implementation of a health management information system in Malawi: issues, innovations and results
1 ETC Crystal, Leusden, The Netherlands, 2 Ministry of Health and Population, Lilongwe, Malawi and 3 PHC Consultants, Amsterdam, The Netherlands
Correspondence: Chet Nath Chaulagai, Kapan-1, GPO Box 12159, Kathmandu, Nepal. Tel: +977 1 481 0504; Fax: +977 1 481 0740; E-mail: chaulagaichet{at}yahoo.com or chaulagai{at}info.com.np
As in many developing countries, lack of reliable data and grossly inadequate appreciation and use of available information in planning and management of health services were two main weaknesses of the health information systems in Malawi. Malawi began strengthening its health management information system with an analysis of the strengths and weaknesses of existing information systems, sharing findings with all stakeholders. All were agreed on the need for reformation of various, vertical programme-specific information systems into a comprehensive, integrated, decentralized and action-oriented simple system. As a first step towards conceptualization and design of the system, a minimum set of indicators was identified and a strategy was formulated for establishing a system in the country. The design focused only on the use of information in planning, management and the improvement of quality and coverage of services. All health and support personnel were trained, employing a training of trainers cascade approach. Information management and use was incorporated into the pre-service training curriculum and the job description of all health workers and support personnel. Quarterly feedback, supportive supervision visits and annual reviews were institutionalized. Civil society organizations were involved in monitoring coverage of health services at local levels. A mid-term review of the achievements of the health information system judged it to be one of the best in Africa. For the first time in Malawi, the health sector has information by facility by month. Yet very little improvement has been noted in use of information in rationalizing decisions. The conclusion is that, no matter how good the design of an information system, it will not be effective unless there is internal desire, dedication and commitment of leadership to have an effective and efficient health service management system.
Key Words: health management information system, health information management, Malawi
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