Author: Dr Michel ODIKA - February 12, 2015.

First of all Worldwide, the institutional capacities to enable institutional reforms (1,2) are not a given. In concrete terms, they are typically weak (3) in countries where, by choice or by default, "laissez-faire" dominates the approach to policy formation in health. Even in countries with mature and well-resourced health systems there is scope, and need, for more collaborative, multisectoral and institutionalized approaches - e.g. negotiation between health authorities and professional institutions is often well established, but is much less so with other key stakeholders and usually limited to discussions on resource allocation for service delivery...

How to build a critical mass of capacity for positive change?  Experience from countries that have been able to accelerate institutional reforms suggests three common elements: I) the importance of making information systems instrumental to institutional reforms; II) systematically harnessing innovations; III) sharing lessons on what works and on what doesn't...

Painfully obvious example: information systems and institutional reforms to strengthen the multisectoral response to malaria… Today, evidence-based strategies focused on controlling malaria need to be informed, not just by better data, but also by information obtained through a departure from traditional views on the clients, the scope and the architecture of national health information systems.

Unfortunately… Many national health information systems that are used to inform policy-making processes can be characterized as “closed administrative structures” through which there is a limited flow of data on resource use, service delivery and health status. They are often only used to a limited extent by officials at national and global level when formulating policy reforms, while little use is made of critical information that could be extracted from other tools and sources – i.e. census data, household expenditure, opinion surveys, academic institutions, NGOs, health insurance agencies, etc. -, many of which are located outside the public system or even outside the health sector...

Managing the political process: from launching reform to implementing it... Crucial questions that can be asked (4) prior to launching institutional reforms are quite different from the data that most conventional health information systems currently produce. Such questions go well beyond what can be answered by tracking health outcome indicators, resource use and services output, which is what most conventional health information systems focus on. Consequently, the paradigm shift required to make information systems instrumental to institutional reforms is to refocus on what is holding up progress in reorienting the health system. Better identification of priority health problems and trends is important (and vital to anticipate future challenges) but, from a policy point of view, the crucial information is always that which allows identification of the operational and systemic constraints…

ULTIMATELY… On the whole, routine data from the traditional health information systems fails to respond to the rising demand for health-related information from a multitude of constituencies. Citizens need easier access to their own records, which should inform them about the progress being made in their treatment plans and allow them to participate in decisions related to their own health and that of their families. Communities and civil society organizations need better information to protect their members’ heath, reduce exclusion and promote equity. Health professionals need better information to improve the quality of their work, and to improve coordination and integration of services. In the final analysis, politicians critically need information on how well the health system is meeting society’s goals (5) - e.g. environmental safety and responsibility, social cohesion, sustainable and equitable development, etc. - and, not least, on how public money is being used…

Dr Michel ODIKA (Congo-Brazzaville)

 

1. Observatoire du Paludisme: réformes institutionnelles à l’ordre du jour (Michel ODIKA, Nouvel Observateur, Paris, 2011).

2. See also Malaria Response: Call for New Institutional Landscapes (Michel ODIKA, 2015).

3. This and many other everyday realities of life personify the unacceptable and avoidable shortfalls in the performance of our health systems…

4. That “simply” means asking key questions, such as: I) is care safe, comprehensive, integrated, continuous and effective?; II) is access to health care guaranteed and are people aware of what they are entitled to?; III) are people protected against the economic consequences of ill-health?; IV) are authorities effective in ensuring protection against exclusion from care?; V) are authorities effective in ensuring protection against exploitation by commercial providers, notably in low-income countries?

5. Despite enormous progress in health globally, failures to deliver in line with these social goals are painfully obvious (especially in countries classified as low-income) and, therefore, deserve our greatest attention…