• Best wishes for 2014 from RHINO

    December 19, 2014

    Rhino Card 2014

  • RHINO’s Next Online Forum: Assessing and Improving Routine Health Information Systems (RHIS)

    November 19, 2014

    Join us online from Dec 8th till the 19th for an engaging discussion on assessing and improving routine health information systems in Low and Middle Income Countries (LMICs). In this online forum, hope to hear about methods you and your colleagues have applied to assess or monitor RHIS performance, types of information generated through such assessments, and on how the assessments have been used to create change.

    In the past ten years, various tools have been developed to assess the performance of RHIS. Two commonly used tools are the Performance of Routine Information System Management (PRISM) tool—a comprehensive assessment tool assessing the system from multiple angles at multiple levels, and the Data Quality Assessment (DQA) tool –which is focused on assessing accuracy, completeness and timeliness of routine information.

    During the two weeks we will further explore the following areas:

    1. What were your experiences in assessing RHIS performance (ad hoc, PRISM, DQA, supportive supervision, etc) –

      • What were the strengths and weaknesses of the method(s) you used?
      • What tool did you choose and what information did you expect the tool to provide you?
      • Looking retrospectively, what would have you liked it to capture or enable you to do?

    2. Experience in using the RHIS assessment to create change

      • What actions or activities have allowed you to translate the results from an assessment into tangible improvements
      • What are the success stories or best practices of assessment leading to action?
      • What are the challenges or obstacles you faced in using the assessment results to bring change?

    Registration is open from now until December 1st. Click HERE to fill out the registration form and register automatically.

    Thank you for your participation.


  • RHINO’s Newsletter

    June 24, 2014

    Summer Edition

    What is happening inside RHINO

    RHINO held its on-line forum on May 12 – 16, 2014. Thank you to all participants (more than 160 representing all the continents of the world) who participated directly by sharing their experience and their ideas. We also thank our three wonderful moderators who did a wonderful job at guiding the discussion and providing feedback to many questions. You can access the transcript of this on-line forum on RHINO’s website.


    Lessons and Recommendations from Assessment of HMIS Performance in Ethiopia

    As part of an ongoing effort to scale up health management information system (HMIS) reform in Ethiopia, the Regional Bureau of Health (RHB) of Southern Nations, Nationalities and People’s Region (SNNPR) of Ethiopia, in collaboration with the MEASURE Evaluation HMIS scale-up team, planned to enhance efforts for strengthening HMIS performance in four phases: (1) zonal HMIS performance assessment; (2) developing a HMIS strengthening action plan; (3) implement HMIS strengthening interventions, and (4) routine monitoring of the HMIS performance to measure the effect of the interventions.

    In August 2011, the first round of the zonal HMIS performance assessment was conducted in a cluster of zones (viz. Hadiya and Kambata Tembaro) and special woreda (Halaba) who were implementing the reformed HMIS since mid or late 2010. The assessment was based on the Performance of Routine Information System Management (PRISM) framework. This framework promotes strengthening of the HMIS performance, i.e. better data quality and improved information use by addressing technical, organizational and behavioral factors affecting HMIS data quality and use for health service performance improvement. Access the Document

    This document reports on the assessment findings that serve as a basis for formulating interventions to improve the HMIS performance and as a baseline for future monitoring of HMIS performance improvement in the zones.

    The recommendations from the performance assessment of the health management information system in SNNPR, Ethiopia include:

    Short term recommendations:

    •  Standardize supervision practices – develop supervisory checklists. Supervision should be conducted on a regular schedule with feedback provided to the facilities. Performance data (data quality and use indicators) should be collected, monitored and reviewed regularly.
    •  Link HMIS data with program monitoring – integrate HMIS quality controls activities into integrated supervisory visits. That is, if an EPI supervisor visits a facility they should be able to conduct the supervision for HMIS at the same time.
    • Expand remote access to the processed data set to woreda health offices to facilitate timely use of information for decision making at local level. Roll out the eHMIS to the woreda level.
    • Establish a standardized feedback mechanism between levels. eHMIS provides an opportunity for generating automated report from the HMIS software that should be forwarded to reporting sites at regular intervals.
    • Create linkages with service delivery managers – i.e. the facility in-charge should be integrated into the monitoring of HMIS performance.
    • Review the existing training materials on use of information and revise accordingly. Conduct on the job training on data analysis, interpretation and continuous use of information at all levels.
    • Conduct training/re-training for WoHOs and HCs on Family Folder procedures
    • Develop mechanisms to integrate data need by different programs – ensure HMIS data are used to generate reports for the vertical programs (HIV/AIDS, TB, malaria, nutrition).


    Long term recommendations:

    •  Establish systematic periodic assessments of HMIS performance in terms of data quality, data use and management functions on a periodic basis.
    •  Promote transparency and accountability of HMIS data. For example – institutionalize the use HMIS information to make everyone accountable for health system performance.
    •  Create procedures for dealing with non-compliance with performance targets.

     What’s New in RHINO’s bibliography

     An article written by Sachiko Ozawa and Krit Pongpirul on the Health Policy and Planning Journal discusses the best resources on mixed  methods in health systems research.

    Abstract: Mixed methods research has become increasingly popular in health systems. Qualitative approaches are often used to explain quantitative results and help to develop interventions or survey instruments. Mixed methods research is especially important in low- and middle-income country (LMIC) settings, where understanding social, economic and cultural contexts are essential to assess health systems performance. To provide researchers and programme managers with a guide to mixed methods research in health systems, we review the best resources with a focus on LMICs. We selected 10 best resources (eight peer-reviewed articles and two textbooks) based on their importance and frequency of use (number of citations), comprehensiveness of content, usefulness to readers and relevance to health systems research in resource-limited contexts. We start with an overview on mixed methods research and discuss resources that are useful for a better understanding of the design and conduct of mixed methods research. To illustrate its practical applications, we provide examples from various countries (China, Vietnam, Kenya, Tanzania, Zambia and India) across different health topics (tuberculosis, malaria, HIV testing and healthcare costs). We conclude with some toolkits which suggest what to do when mixed methods findings conflict and provide guidelines for evaluating the quality of mixed methods research. Access the full article.

    Summer Greetings from RHINO!

  • RHINO On-line Transcript

    June 19, 2014

    Here is the transcript of the on-line RHINO forum that took place from May 12 to 16, 2014. We thank all our participants (more than 160 representing all the continents of the world) who participated directly by sharing their experience and their ideas. We also thank our three wonderful moderators who did a wonderful job at guiding the discussion and providing feedback to many questions and situations. Fromdatareportingtodecisionmaking

  • RHINO on-line Forum POSTPONED for the week of May 12

    April 24, 2014

    Dear RHINOs,

    We have been transitioning to a new email and listserv format and during this transition, the listserv has been down longer than predicted. We will fix it within a few days however, we regret to announce that the on-line forum needs to be postponed.

    The new dates of the on-line forum are May 12th – 16th.

    The registration is still open and you can register until May 10th. Click HERE to register. No need to register if you already have done so.

    Thank you for your patience and understanding and we look forward to hearing from all of you during the on-line forum week.

  • RHINO’s next on-line forum

    April 4, 2014

    From data-reporting to decision-making – are routine reporting systems  designed to support “business improvement” in the health sector.

     A Management Information System is a “system” that provides specific information support to the decision-making process at each level of an organization (Hurtubise 1984). Similarly, Health Information System (HIS) is designed to provide necessary information to guide decision-making and solve health problems at health facility and community level.

    Join us for a discussion on Routine Health Information System commonly known as Health Management Information System (HMIS) and Community Health Information System (CHIS). We will explore how health facility and community level information systems are being helpful to health workers, managers and policy makers to improve the business of improving quality and coverage of health services. We are eager to hear from you; on how you have used your routine data to improve the process, quality or coverage of health services. Bring your innovations and share with all the members around the world on how you and your team have used data at health facility and community level for improving the business of health service delivery. Tell us your story of what types of behavioral, technological, technical and organizational interventions were helpful to make this change.

     We would like to juggle our brains and ask ourselves the question: if given an opportunity, what is the one thing that you would like to change in the design of the information system (health facility and community) in your country that will help the managers at national, district, health facility and community or frontline health workers make better decisions on improving service delivery and increase coverage? Can we identify one behavioral, technological, technical and organizational interventions that you think will support the “business” of improving quality and coverage of health services.

     During the five days we will further explore these questions:

    •  What are some innovations that you have introduced to improve information use at health facility and community levels?
    • Are information system designed to support “business Improvement” at health facility and community levels
    • What are some of the behavioral, technological, technical and organizational interventions to improve the design and performance of HIS

    Date: April 28th to May 2nd, 2014

    Moderators: Vikas Dwivedi, Tariq Azim and Chris Wright

    To register please submit your information to this online form with you name, job title and country of work

  • Happy Holidays from RHINO

    December 24, 2013

    Happy Holidays and RHINO Greetings

  • Register for the next RHINO on-line forum

    March 12, 2013

    We are happy to announce the next RHINO forum that will be held from April 2 – April 8, 2013.  The topic of this upcoming forum isInnovative Applications of Mobile Technologies with Routine Health Information Systems.” 

    The forum will discuss various aspects of mobile technology and Routine Health Information Systems (RHIS), including innovative applications of mobile technology with RHIS, appropriate uses and limitations of using mobile technology, and costs and barriers to using mobile technology with RHIS.  Forum moderators will be Joy Kamunyori and Michael Edwards. 

    Joy Kamunyori is a mHealth Advisor with JSI’s Center for mHealth and a Technical Advisor with the USAID | DELIVER PROJECT. Joy has experience with implementing mobile technology in multiple contexts, including using mobile to administer surveys and routinely report logistics data.

    Michael Edwards is a Biostatistician/Senior Health Informatics Advisor with MEASURE Evaluation.  He was recently featured in the Spotlight section in the January-February 2013 RHINO January/February Newsletter:

    Register for the forum. The last day to register is March 29, 2013.

    If you have any questions regarding the registration process, contact us at the_rhino@jsi.com.

    We look forward to your participation.

  • Global Health Needs More Statistics

    February 19, 2013

    GENEVA, SWITZERLANDWhat is the best way to estimate how many people suffer from tuberculosis, from the forests of Central Africa to the highlands of Peru? At a 2-day meeting organized and hosted by the World Heath Organization (WHO) here, 60 leaders in the field of global health statistics drew up a set of proposals to improve the world’s ability to count the sick and the dead. They called for helping countries to collect better information on disease and death and pledged to work together to produce the best estimates from the sparse data sometimes available.

    Knowing how many people in which areas suffer from which maladies is crucial for designing effective public health policies. But there’s a problem. In areas that have some of the most urgent public health needs, no one is keeping adequate statistics. In many places, there are no records of either births or deaths. “Where disease burden is greatest, our capacity to measure trends doesn’t exist,” said Margaret Chan, director-general of WHO, at the start of the meeting yesterday. And even in places with sophisticated health systems, cause-of-death records are often misleading or incorrect. In the United Kingdom, 17% of the deaths are recorded incorrectly, said Christopher Murray, head of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle.

    Scientists use the available data and complex computer modeling to fill in the gaps and estimate the burden of, say, tuberculosis in Peru or high blood pressure in Italy. In the biggest effort ever undertaken, a group of scientists in December published the Global Burden of Disease (GBD) 2010 study, which estimated disease burdens—death as well as years of life affected by disability—for 291 diseases and injuries in 20 age groups in 21 global regions. On 5 March, the study, which Murray coordinates, will publish its country estimates for the same set of diseases. (They will also announce plans to launch a Global Burden of Disease 2.0, which will be updated annually—or even more frequently.)

    But the computer models that they and others use have become so complex that it is difficult for outsiders to test and validate the estimates. “We are in a time of big data,” said Peter Piot, director of the London School of Hygiene & Tropical Medicine, who co-chaired the meeting. The ENCODE project that tries to make sense of the flood of human genetic information and the CERN high-energy physics lab are examples, he told the meeting, “and the global burden of disease is in that category. In science we strive for independent confirmation, but like the physics discoveries at CERN, it is hard to independently verify the results because no one has the resources to do so.”

    In the last few years, debates over differences between estimates from different groups have become increasingly heated. WHO’s estimates of maternal mortality, for example, were higher than those that the IHME published in 2010. And in 2012, IHME’s estimates of adult malaria deaths in sub-Saharan Africa were dramatically higher than WHO’s numbers. Tensions between the different modeling groups grew so much that WHO, which had originally collaborated on the GBD 2010 study, did not allow any of its staffers to be listed as authors on the papers published in December.

    In an effort to diffuse some of those tensions, the Bill & Melinda Gates Foundation, which supports IHME, funded WHO to organize the meeting. The effort seems to have been successful. The participants agreed that gaps between estimates derived by different groups can sometimes be an advantage. “The challenge of the different numbers can lead to improvement in the science,” says Colin Mathers of WHO’s department of health statistics and information systems. They drafted a set of proposals, which WHO is expected to publish next week, that calls on the global health community to invest in better data-collecting efforts on the ground, something that everyone agrees is desperately needed. Those responsible for health statistics in low- and medium-income countries “are often found in the darkest, farthest corners of the health ministry,” where they get little attention and even less money, said Henk Bekedam, director of health sector development at WHO’s Western Pacific Region in Manila.

    The participants also agreed to try to better explain their work to each other and to the wider public health community by, for instance, sharing data sets and specialized software as much as possible. The group also proposed developing ways to encourage regular communication between researchers working in the area.

    One problem, several participants lamented, is that global health funding agencies prefer to spend limited resources on “sexier” efforts such as vaccination campaigns and treatment efforts than health statistics. That perception should change, said meeting co-chair Hans Rosling of the Karolinska Institute in Stockholm, whose Gapminder Foundation develops popular graphics that often reveal surprising patterns in health and population data. “You do enormously important work,” he told the meeting at the close. “And on Valentine’s Day, I am happy to tell you: What you do is very sexy.”

  • RHINO Greetings for 2013

    January 14, 2013

    Dear RHINOs!

    We belatedly wish you the very best for 2013.