Promoting and using core health indicators and related
tools for data collection and analysis
– in humanitarian crises A Participatory Workshop
Nairobi, 19-20 November 2009
1
The Global Health Cluster
‘Promoting and using in core health indicators and related tools for data collection and
analysis – in humanitarian crises’
A Participatory Workshop
Nairobi, 19-20 November 2009
Table of content
Introduction......................................................................................................................... 3
Day 1............................................................................................................................... 3
The Day 1 Objectives.................................................................................................. 3
Core Indicators................................................................................................................ 4
Health Resource Availability Mapping System (HeRAMS) See powerpoint
presentation ..................................................................................................................... 4
Initial Rapid Assessment (IRA) See powerpoint presentation ....................................... 4
Health events Analysis & Nutrition Data Surveillance (HANDS) (Formally Health
Information and Nutrition Tracking System (HiNTS)) .................................................. 4
Health Information System (HIS) See powerpoint presentation 1 ................................. 5
Working Groups.............................................................................................................. 5
Day 2................................................................................................................................... 6
The Objectives of the workshop on Day 2...................................................................... 6
The priorities for the roll out of cluster tools from global to country level. ................... 6
The priorities for the roll out of cluster tools at the country level. ................................. 7
Case-study - promoting and using the GHC tools in North Kivu................................... 7
Recommendations............................................................................................................. 10
Conclusion ........................................................................................................................ 10
Annexes............................................................................................................................. 11
1. Core Health Indicators overview presented by Nevio Zagaria, WHO ............. 11
2. HeRAMS presentation by Samuel Petragallo, WHO ....................................... 11
3. IRA presentation by Jonny Polonsky, HNTS/Merlin ....................................... 11
4. HANDS/ HANDS (formally HiNTS) presentation by Xavier De Radigues,
HNTS/WHO ............................................................................................................. 11
5. HIS presentation by Christophe Haskew, UNHCR .......................................... 11
6. HIS Data analysis by Christophe Haskew, UNHCR ........................................ 11
7. Sphere indicators presentation by Mesfin Teklu, World Vision International . 11
Reports from Working groups on day 1 ....................................................................... 11
8. Group 1 - HeRAMS .......................................................................................... 11
9. Group 2 - HANDS (HiNTS) ............................................................................. 11
10.
Group 3 - HIS................................................................................................ 11
11.
Group 4 - IRA ............................................................................................... 11
Reports from Working groups on day 2 ....................................................................... 11
12.
Group 1 - Global Health Cluster priorities in roll-out of cluster tools.......... 11
13.
Group 2 - Country Level Strategy ................................................................ 11
14.
Group 3 - Promoting and using GHC tools in North Kivu ........................... 11
15.
List of Participants ........................................................................................ 11
16.
Summary of Evaluation of the meeting ........................................................ 11
17.
HeRAMs ....................................................................................................... 11
18.
HANDS (formally HiNTS)........................................................................... 11
19.
HIS ................................................................................................................ 11
2
Introduction
The Promoting and using in core health indicators and related tools for data collection and
analysis – in humanitarian crises workshop was held over two days, with specific objectives to
achieve each day. Participants (see attached list) worked together and in groups to review and
identify the main issues around core health indicators and how to encourage the use of available
tools for achieving and measuring core indicators.
The Workshop arose from recognition of a number of challenges, including:
• The need to shift the focus from tools to the core health indicators, and how tools serve
the purpose to generate and process the indicators related data
• The need to confront a lack of capacity to generate the indicators and produce knowledge
from their analysis
• The scale of the capacity building effort needed at field level on indicators & tools and
their use for producing knowledge to inform strategic planning of international and
national technical staff.
Recent studies have shown, that the majority of nutritional surveys and data collection exercises
have not been inline with global standards. Therefore, analysis and conclusions of the data
collected can not compared and responses may be inappropriately targeted and implemented. The
right tools collecting appropriate data can enhance accountability of the response. It is important
to try an ensure that these tools are updated in order to reflect lessons learnt from implementation
in order that these tools are appropriate for everyone. It is important to begin with the field tests
of the tools to be able to then scale up the use in all countries.
Day 1
The Day 1 Objectives
1. To present the core health indicators developed by the Global Health Cluster in collaboration
with HNTS, relate them to field examples and discuss their use in real situations during the
implementation of needs assessment, monitoring and planning functions by health cluster at
national and sub-national levels
2. To present and discuss the main tools proposed to collect, process and analyse the
information needed to generate the core health indicators (IRA, HeRAMS, HANDS (formally
HiNTS), HIS). These tools are:
• Initial Rapid Assessment (IRA)
• Health Resources Availability Mapping System (HeRAMS)
• HANDS (formally HiNTS)
• Health and Nutrition Tracking Service
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Core Indicators
The core health indicators were developed to assist the daily decision making process in the
health cluster at country level. The core health indicators can highlight what is needed and what
is being done by the country health cluster.
Some of the challenges faced with the collection of the data include: the current context of the
situation - access, security concerns; the status of the population - numbers of refugees, internally
displaced persons, local population; the level of humanitarian aid available; and seasonal
hindrances.
Data collection can only be useful if it is then linked to action. The core health indicators are
aligned with other indicators including SPHERE and the Millennium Development Goals (MDGs)
which can allow for a broader use of the gather information.
Health Resource Availability Mapping System (HeRAMS)
The Health Resource Availability Mapping System (HeRAMS), is a tool developed to support the
collection and analysis of data to promote and support good practice in mapping health resources
and services. HeRAMS is a tool designed to support the data collection process. The HeRAMS
provides a health services checklist by level of care, by health sub-sectors, for health
facility/mobile clinic/community-based interventions at each point of delivery. Data collections
should be limited to what the health cluster has decided are the critical priorities to support their
programmes. Further areas can be added as the situation develops.
Initial Rapid Assessment (IRA)
It serves to collect, compile and analyse information on the health status of the population, the
determinants of health (nutrition, water supply, sanitation, etc.), and current health services
characteristics (coverage, resources, services available, access, etc.). It is targeted at the team
members of initial assessment teams, ideally within 72 hours of the onset of a crisis situation. It is
designed to provide a quick, initial description of the current situation and identify the priority
public health problems, risks and gaps in service provision.
Health events Analysis & Nutrition Data Surveillance (HANDS)
(Formally Health Information and Nutrition Tracking System (HiNTS))
The HANDS is a health facility surveillance tool. It is an Excel based software application for
data entry and automatic analyses of health events and the nutritional status of children under five
years old.
4
Health Information System (HIS)
The Health Information System (HIS) was developed as tool to support standardized, facilitybased data collection, surveillance and evaluation of primary health care HIV programmes in
refugee settings. The aim of the HIS tool is to provide evidence-based policy formulation,
improved management of health programmes and, ultimately, direct actions that improve refugee
health. The HIS is a flexible tool that can be scaled up to deal with large populations The HIS is
currently used in 17 countries, 25 partners, over 85 camps (1.5 million refugees).
Working Groups
Participants of the meeting were split into four working groups reflecting the four tools. All
groups were given three questions to discuss a possible set of strategies for introducing and
extensively using each the tools in the field during a humanitarian crisis (IRA/HeRAMs/ HANDS
(formally HiNTS)/ HiNTS/HIS)?
The three questions were:
1. Challenges and possible solutions to plan and set up a training cascade up to field
workers to use the tool?
2. Challenges and possible solutions to adapt the tool according to the context and
introduce them in a humanitarian crisis?
3. How do you manage the data, produce the related core health indicators, make the
analysis, disseminate the outcome of the analysis and use for the planning re planning of
the health service delivery?
Each group identified key challenges and proposed a variety of responses and strategies to
confront those challenges and further advance the extended awareness and use of the tools. (See
minutes for detailed outcomes of group work). This included suggested strategies for piloting
introduction; the diverse degree of adaptation which might be useful; how to assess capacity of
partners to use the respective tools; possible training needed; how to engage government and
NGOs in use of tools for effective collection, analysis and application of tools and data; who
should carry responsibilities for specific implementation; the level and nature of resources likely
to be needed – including human resources and personnel. Many of these proposals were reflected
in specific recommendations formulated at the close of the Workshop.
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Day 2
The Objectives of the workshop on Day 2
1. To identify key challenges linked to the introduction, adaptation and adoption of the
proposed tools by health cluster partners and the ones linked to their daily full use in the
field by the health clusters' partners staff, and formulate action oriented recommendations
to address the issues
2. To discuss and develop a strategy and plan of action for both the GHC and the Health
Clusters at country level for the promotion and adoption of the core indicators and the
tools at field level in countries with humanitarian crisis
3. To agree on a division of responsibilities and identify available resources for the
implementation of the plan of action for the roll out of the tools and indicators.
The priorities for the roll out of cluster tools from global to country level.
Inherent in such a roll-out from global to national level are a number of key areas for
consideration and implementation. Each of these would require specific strategies and some were
suggested in the workshop.
This time, participants were split into three groups (Global, Country and a first pilot study) to
develop the specific needs for the roll out of the tool at the different levels.
Groups proposed responses and strategies in a number of areas. (A full detailing of these
proposals can be seen in the Minutes and many are reflected in the recommendations).
Key areas for consideration included:
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•
•
•
•
Technical Support
Advocacy
Implementing the roll out
Monitoring
The Workshop stressed the need to capture lessons as they are learnt from each tool.
The priorities for the roll out of cluster tools at the country level.
When considering country level priorities for the roll out of Cluster Tools, it was noted that it
would not be possible to roll out all 4 tools at once, there would need to be a clear preparedness
phase as part of implementation planning and the leadership of HCC would be key to this process,
taking responsibility for ensuring cluster members are aware of available tools and ensuring use
of those tools. It was recommended that participants in the roll out would need to include the
health Cluster, Government, WHO. It would need to be rolled out to all partners and would need
to be a phased process involving a number of essential steps:
Sensitization (Phase 0)
y Each organization to sensitize internally (including WHO)
y Each organization to feedback to global cluster on sensitization of staff
Training (Phase 0 and 1)
y Training package to be discussed/organized at global level
y Health cluster country teams trained in tools
Ensuring there is a Focal Point at each organization for all Health Cluster Tools
Incorporating the rolled out understanding and awareness into Emergency Preparedness Plans of
Government, RC – with Health Cluster, where exists, to sensitize Government and RC and WHO
where there is no Health Cluster.
Implementation of tools would require discrete phases including:
y Phase 0: HeRams implemented (ideally), with HCC to promote, advocate with all
partners/stakeholders (including government) and coordinate appropriate training
y Phase 1: IRA implemented (within first 2 weeks, earlier if possible) in countries
with chronic emergencies and/or specific situations i.e. sometimes IRA used after
Phase 1
It was noted that not all indicators needed by all organizations are currently included and while
discussion here was limited there should be a review of tools after one year.
Advocacy is key. It is important that field level advocacy is inline with inline with global
advocacy and that all partners advocate same messages at all levels.
Case-study - promoting and using the GHC tools in North Kivu
Participants considered specific aspects of promoting and using GHC tools
in North Kivu. They reviewed the current status of tools and recommended possible actions.
•
Initial Response Assessment (IRA): There should be a purposive sampling on basis of
needs and a plan to include ad hoc roll-out in 6 priority zones
7
•
HeRAMS:
Focus on 6 priority zones as a means of assessing the feasibility of
province-wide roll-out
•
HANDS (formally HiNTS): is currently implemented with provincial coverage
•
HIS: is currently implemented in 3 zones but should be scaled up to 6 zones (25 facilities)
in 2010
•
Surveys: There needs to be support for mortality/nutrition surveys in 6 priority zones
Participants considered human resource requirements, with specific personnel roles
identified as desirable.
•
Ownership should be the Health Cluster in Goma and there should be a plan in place
before cluster meeting on the plan of action/ way forward
•
There should be a Health Cluster Coordinator in Goma
– Responsible for advocacy with MoH
– Coordinating with cluster partners
– Updating of HeRAMS
•
There should be a HNTS Focal Person
– Providing support for IRA, HANDS (formally HiNTS), surveys
– Monitoring visits for HIS
•
There should be an HIS Coordinator
– Maintaining flow of data
– Analysis, dissemination + use
– Training and supervision
•
There should be two data assistants
•
There should be field presence, monitoring data quality and responsible for data
management and analysis
•
For broader implementation – need to consider using partners on the ground.
Participants stressed the need for training and the need for a general training package.
They identified specific target groups and topics.
Target group: cluster leads and MoH + NGO focal points
Key topics:
– Basic epidemiology and statistics
– Roles and relationships between tools
Action: provide specific training on tools
Target group: NGOs, MoH - frontline health staff
Key topics:
– Implementation and use of HIS and HANDS (formally HiNTS)
Action: Collect all training packages – and make them easily accessible.
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A number of additional questions remained for attention of participants:
•
Practical issues
– Ownership should be the Health Cluster in Goma
– A decision is needed as to where the team will sit
– A decision is needed as to who will be report focus
•
Importance of advocacy
– There was support for a new approach
– It was noted that there is a need for strong advocacy at all levels
•
Funding needs
– Will there be package or individual funding? Will funding be packaged in the
name of the GHC? Or on a individual agency basis? This requires follow up).
Will funding be at country-level or provided as HQ support?
Participants recommended a specific Timeline for next steps.
•
Dec/Jan:
Initial visit (HeRAMS implementation)
Advocacy + meetings with donors and cluster partners
•
Jan-Mar:
General training for lead data managers
Ongoing trainings at field level on implementation (HIS,
HANDS (formally HiNTS))
HeRAMS baseline available ◊ monitoring
•
Mar-Dec:
Ongoing analysis and sharing of HANDS-HIS-HeRAMS
results
IRA on basis of need and possibility of planned mortality surveys
explored.
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Recommendations
It was noted that if tools are implemented, this would ensure implementation of the core health
indicators, while, if tools are not implemented, it would be difficult/impossible to ensure
countries reporting on indicators.
•
•
•
•
•
•
•
•
To tools and use of the indicators in the field needs to be actively promoted and
supported.
There should be a review of core indicators after one year.
There should be a Health Cluster Information Manager at country level (designated by
each country’s health cluster).
HCC should ensure that partners have access and use data coming from the tools.
Advocacy at global level and at country level needs to be harmonized.
Funding for implementing the tools needs to be available.
Training at the implementation level is needed.
The first case study of the implementation/roll-out of the four tools should take place in
North Kivu, Goma DRC, early 2010.
Conclusion
It was concluded that WHO HQ has a number of grave tasks ahead, which must be achieved with
limited resources and would formulate a clear action plan and budget The Workshop had helped
to catalyze the finalization of the tools and had contributed to a joint willingness and dedication to
adopt and use the tools. It had highlighted the complementarity and synergy of the tools. There is
a beginning of buy in to using the tools by partners, with clear indications of willingness to build
partnerships on the tools. It has been recognised that no-one has the resources to do all the work
alone.
The report should be utilised and shared to record what has been done and what is still to be done.
In particular, the indicators need to be mainstreamed in the work of the partners.
A broad representation of partners helped to make the Workshop very successful. It is effective to
build partnerships but there is much to do and time and resources must be allocated to this
developing process. There is a sense of affiliation in this group.
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Annexes
1. Core Health Indicators overview presented by Nevio Zagaria, WHO
2. HeRAMS presentation by Samuel Petragallo, WHO
3. IRA presentation by Jonny Polonsky, HNTS/Merlin
4. HANDS/ HANDS (formally HiNTS) presentation by Xavier De Radigues, HNTS/WHO
5. HIS presentation by Christophe Haskew, UNHCR
6. HIS Data analysis by Christophe Haskew, UNHCR
7. Sphere indicators presentation by Mesfin Teklu, World Vision International
Reports from Working groups on day 1
8. Group 1 - HeRAMS
9. Group 2 - HANDS (HiNTS)
10. Group 3 - HIS
11. Group 4 - IRA
Reports from Working groups on day 2
12. Group 1 - Global Health Cluster priorities in roll-out of cluster tools
13. Group 2 - Country Level Strategy
14. Group 3 - Promoting and using GHC tools in North Kivu
15. List of Participants
16. Summary of Evaluation of the meeting
Tools
Core Health Indicators
17. HeRAMs
(available online: www.who.int/hac/global_health_cluster/guide/tools)
18. HANDS (formally HiNTS)
(available online: www.who.int/hac/global_health_cluster/guide/tools)
19. HIS
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