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Health Policy and Planning Advance Access published online on March 20, 2009
Health Policy and Planning, doi:10.1093/heapol/czp010
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2009; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems

Anwer Aqil1,*, Theo Lippeveld2 and Dairiku Hozumi3

1 Senior Advisor, MEASURE Evaluation, 1616 N. Fort Mayer Drive, Arlington, VA 22209, USA.
2 Vice President, John Snow Inc., 44 Farnsworth Street, Boston, MA 02210–1211, USA.
3 Senior Technical Advisor for Health Systems and Policy, Immunization Solutions, PATH, 1455 NW Leary Way, Seattle, WA 98107, USA.

* Corresponding author. Senior Advisor, MEASURE Evaluation, 1616 N. Fort Mayer Drive, Arlington, VA 22209, USA. Tel: +1 713–528–7474 Ext 5122. Fax: +1 713–528–7480. E-mail: aaqil{at}jsi.com

The utility and effectiveness of routine health information systems (RHIS) in improving health system performance in developing countries has been questioned. This paper argues that the health system needs internal mechanisms to develop performance targets, track progress, and create and manage knowledge for continuous improvement. Based on documented RHIS weaknesses, we have developed the Performance of Routine Information System Management (PRISM) framework, an innovative approach to design, strengthen and evaluate RHIS. The PRISM framework offers a paradigm shift by putting emphasis on RHIS performance and incorporating the organizational, technical and behavioural determinants of performance. By describing causal pathways of these determinants, the PRISM framework encourages and guides the development of interventions for strengthening or reforming RHIS. Furthermore, it conceptualizes and proposes a methodology for measuring the impact of RHIS on health system performance. Ultimately, the PRISM framework, in spite of its challenges and competing paradigms, proposes a new agenda for building and sustaining information systems, for the promotion of an information culture, and for encouraging accountability in health systems.

Key Words: Routine health information system, health management information system, health system performance, culture of information, knowledge management, learning organization

Accepted for publication 6 January 2009.


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