Case studies of health information system impact on health outcomes in four countries

Substantial resources are spent every year to strengthen routine health information systems (RHIS) in developing countries, yet most RHIS remain weak. The assumed rationale for RHIS strengthening is that information improves evidence-based decisions, which in turn lead to improved health programs and outcomes. But little evidence to date supports this hypothesis. To address this gap, the Health Metrics Network-Technical Support Partnership (HMN-TSP) undertook four case studies in 2009, documenting evidence of RHIS impact on health system outcomes in Cote d'Ivoire, Ethiopia, Haiti and Pakistan. Case studies included key informant interviews and record reviews to document evidence of RHIS strengthening, health program decisions based on RHIS information, and resulting interventions. Program records, RHIS data, or surveys were then used to document health program and outcome improvements. Due to confounding factors, no attempt was made to attribute impact to RHIS, though often improvements occurred only in intervention areas, and within a short period following interventions. Case study highlights will be presented, describing a variety of health decisions, interventions and outcomes, including: increases in HIV/AIDS voluntary counseling, testing, and treatment in Cote d'Ivoire; increases in DPT3 vaccination coverage in Hadiya Zone in Ethiopia; increased coverage of HIV/AIDS community care and support services in Haiti; and improved maternal health care in Upper Dir District in Pakistan. All four case studies describe impressive improvements in health outcomes, suggesting that RHIS information can contribute to evidence-based decisions, and that such decisions can contribute to subsequent improvements in health programs and outcomes.