The aim of this website is to share expertise and experience on health care systems with policy makers, managers of health services, health care providers and health system researchers. The website is a product of a network Switching International Health Policies and Systems (SWHIPS).The articles are publisher versions or author versions, depending on the archiving policies of the publishers. Of all articles, the copyright remains with the editor or author, respectively. Contact us: healthsystems@itg.be.

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Information & Knowledge

This element is the ‘software’ of the HS. It includes the information that is collected in different ways for monitoring and evaluation and the knowledge that feeds into decision-making at different levels in the HS. Knowledge and information is needed for monitoring, evaluation and research; clinical decision-making; organisational management and planning; analysis of health trends; and communication. It relates to individual patient-provider interaction, health facility level and population level decision making.
Health information comes from different data sources. Most well-known are the routine data collection and reporting systems usually operated in health facilities (often called health information systems). Other sources are population surveys, census, civil registration, (sentinel) surveillance systems. Also action/operational research and individual patient records are sources of information for planners. From the other side, there are guidelines, protocols, etc., that feed decision making at other levels in the system. These are iterative processes which are supposed to feed into each other. These methods of collection serve different purposes.

What should be measured and provided is a balance between comprehensiveness and pragmatism, functionality and workload. All information systems should be reliable, authoritative, useable, understandable and comparative. The Health Metrics Network identifies key components and standards of a country health information system (World Health Organisation 2008c).

In our view, the priority of routine information systems should be their potential to contribute to sound decision making, limiting the collection to those data that are necessary for that purpose and be kept as simple as possible. Additional information should be collected via other ways, such as surveys, research etc. Data needed for disease-specific programmes, general health services and for different authorities (donors, government) are as much as possible integrated into one system of collecting and reporting (Unger et al. 1992; Unger et al. 2004).

The processing of knowledge and information is greatly helped by developments in technology. New communication and information technology has great potential to ease the processing and accessibility and use of information, both at system level and at individual patient record level. Electronic patient card systems can be stored and transferred to a referral centre; the use of a database enables stratification of patients according to certain characteristics, which allows to develop, for instance, a defaulters tracer and retrieval system. New technology has also great potential for service delivery itself, for instance with telemedicine or reminders to patients about their medication scheme, but should be used with caution, for instance with regard to privacy and accuracy of information (Kahn et al. 2010).

The collection and processing of data and information are the first steps in creating knowledge and understanding that can lead to decisions and actions. The know-do or implementation gap, describing the gap between knowledge and action or between plans/policies and practice, is not unique to HSs and is described in many other organisations and domains of life. In large organisations with multiple layers such as HSs, knowledge, planning and implementation (practice) are located with different persons and the diffusion between layers, bottom-up as well as top-down, is often problematic. Knowledge needs to be shared in all directions, between people at operational level, mid-level managers and policy-makers, but also horizontally, with other people at similar levels in and outside the system. Research and practice are an ongoing activities and both processes need to continuously feed each other (Parkhurst et al. 2010). Networks and communities of practice with people from different levels and from different organisations (research, policy, management and the field) and contexts can stimulate this exchange of knowledge and the barriers to implementation.
The steps between the generation of knowledge and implementation so that the intervention reaches all those in need (universal coverage) has many steps. To enable all processes to take place (usually at the same time), there need to be the possibility for research of all sorts, pilot projects, communication and sharing of results, and looking at system constraints that impede further implementation (Mangham et al. 2010).