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Developing
Health Management
Information Systems
A PRACTICAL GUIDE FOR
DEVELOPING COUNTRIES

WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC

Acknowledgements
The WHO Regional Office for the Western Pacific acknowledges the contributions made
by Dr Ophelia Mendoza, WHO Consultant, and Dr Y
...
Chong, Regional Adviser in
Health Information
...
Management information systems 2
...
Developing countries

ISBN 92 9061 1650

(NLM Classification: WA 26
...

The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of the World Health Organization concerning the legal
status of any country, territory, city or area or of its authorities, or concerning the delimitation of its
frontiers or boundaries
...

The mention of specific companies or of certain manufacturers’ products does not imply that they are
endorsed or recommended by the World Health Organization in preference to others of a similar nature
that are not mentioned
...

The World Health Organization does not warrant that the information contained in this publication is
complete and correct and shall not be liable for any damages incurred as a result of its use
...
int)
...
int)
...
O
...
No
...
who
...

The named author/s alone is/are responsible for the views expressed in this publication
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ii

Abbreviations


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v

1 Introduction
...



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...


1

2 The basic concepts


...



...



...



...



...


3

3 Reviewing the existing system
...



...



...



...


5

4 Defining data needs
...



...



...



...



...


9

5 Determining the data flow
...



...



...



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21

8 Developing the training programme
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45

References
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...
It serves as a primer on HMIS development and provides a general
overview of the basic principles, as well as the fundamental steps and issues
involved in the different activities to be undertaken
...
It aims simply
to provide the basic elements on HMIS development for people who do not
have the time or the need to read deeply on the subject
...


Prospective Users of the Manual
This Manual was designed with the following persons in mind:
➤ Heads and staff of Statistics Units at the national, provincial, or even the
district health service level who are actively involved in the development of
their HMIS
➤ People who do not have the in-depth background on HMIS but need to have
a general overview of its components because they are members of Multidisciplinary Committees tasked with overseeing the development of the HMIS
in their country
➤ Managers and staff of vertical programmes whose responsibilities include
any component of the information system of their respective programmes

Scope and Style of the Manual
Each chapter in this Manual has four parts:
(a) Principles
(b) Steps
(c) Issues
(d) Worksheets

1

The worksheets give the reader an idea of how to go through the different steps,
or how to process the different issues in an organized and systematic manner
...

The last part of the Manual gives an example of a list of basic indicators that
might be used in Ministry of Health programmes, together with the corresponding
data sources, modes and frequency of data collection, as well as the lowest
administrative level where the indicator is computed
...
Also provided
at the end of the Manual is an example of a flow chart of the HMIS of hypothetical
country X
...


2

2 The basic concepts
Some Definitions
System A collection of components that work together to achieve a common
objective1
Information System A system that provides information support to the
decision-making process at each level of an organization2
Health Information System A system that integrates data collection,
processing, reporting, and use of the information necessary for improving health
service effectiveness and efficiency through better management at all levels of
health services3
Health Management Information System An information system
specially designed to assist in the management and planning of health
programmes, as opposed to delivery of care4

Steps in Developing a Health Management Information System
(1) Review the existing system
(2) Define the data needs of relevant units within the health system
(3) Determine the most appropriate and effective data flow
(4) Design the data collection and reporting tools
(5) Develop the procedures and mechanisms for data processing
(6) Develop and implement a training programme for data providers and data
users
(7) Pre-test, and if necessary, redesign the system for data collection, data flow,
data processing and data utilization
(8) Monitor and evaluate the system
(9) Develop effective data dissemination and feedback mechanisms
(10) Enhance the HMIS

1

World Health Organization (2000)
Hurtubise (1984)
3
World Health Organization (2000)
4
World Health Organization (1993)
2

3

4

3 Reviewing the
existing system
P R I N C I P L E

D

o not destroy existing systems; build on the strengths and learn
from the weaknesses of what already exists
...

(2) Assess the quality of the data being collected using the existing forms at different
levels
...

(4) Determine the current status of the other components of the HMIS like:
➤ Data processing
➤ Data analysis
➤ Data dissemination
➤ Supply and logistics
➤ Staff development
➤ Coordination, cooperation and communication within and between different
units in the Ministry of Health, as well as with related agencies outside of the
ministry

5

(5) Identify the aspects of the system that need to be:
➤ Retained
➤ Modified
➤ Abolished
(6) Summarize the results of the assessment in a formal report
...


I S S U E S
(1) Who has the authority to make the assessment?
(2) Availability of technical expertise and resources to do the assessment
...

(4) Formation of a body (ideally an inter-departmental committee) tasked with planning,
monitoring and managing all phases of the development of the HMIS, from the
baseline assessment to the evaluation phase
...
1: Checklist of Problems Encountered With the Existing HMIS, at Different Administrative Levels

W O R K S H E E T S

8

Low level/no dissemination of data collected from this form

Lack of utilization of data being collected from this form

Lack of technical expertise of staff to properly analyze the data collected from this form

There are difficulties in collecting data for this form from all geographic or service areas covered

Not all items in the form are filled out or completed

High degree of inaccuracies in data collected

Inadequate training of health workers on how to fill out the form

Completed form not submitted on time

Lack of constant supply of this form

Written instructions on how to fill out the form are not available

Difficult to collect the data required to fill out the form

Structure of the form is too complicated, making it difficult to fill out

Too many data elements required to complete this form

Entries in this form duplicate those of other forms

Type of Problems Encountered

✓
✓

✓
✓
✓

✓

✓
✓

MCH Form

Worksheet 3
...


ot all data needs should be generated through the
routine system of data collection
...


S T E P S
(1) Define the different roles/functions of each level, for each of the major programmes
...
Note that
some levels, especially at higher administrative levels, need data coming from other
ministries or departments related to the health sector
...


9

Group discussion on selecting relevant health indicators
...
The major sources can be:
➤ Routine data generated from the health management information system of
the Ministry of Health
➤ Special studies and surveys conducted by the Ministry of Health, as the need
arises
➤ Other health-related information systems under the responsibility of other
agencies or institutions (Examples of these are the vital registration system –
usually under the Department of Justice or the National Statistics Office – and
the nutrition data collected by the Ministry or Department of Agriculture)

I S S U E S
(1) Roles and functions of different units with respect to data generation and utilization
are not well defined
...

(3) Differentiating data that should be included in the routine data collection system,
from data that are best generated through the conduct of special studies and
sample surveys
...


10

11

Conduct seminars for
hospital staff on the
prevention and control of
hospital-acquired infections

To decrease the incidence
of nosocomial infections by
30%

EPI = Expanded Programme of Immunization

1

Strengthen the referral
system

To increase the utilization
of hospital services by 20%

Number of seminars conducted
Number of hospital staff trained

Programme:

• Number of health education
classes on immunization
conducted
• Number of the following
information, education and
communication (IEC) materials
developed and distributed:
– posters
– leaflets

Input
Programme: Immunization (EPI)1

Implementation of a health
education programme on
immunization for mothers

Unit: Department of Hospital Services

To increase the coverage of
immunization by 20% at
the end of the year

Strategies
Programme Objectives
Unit: Maternal and Child Health (MCH) Division

Bed-occupancy rate

Year: 2003

• Percentage of mothers who
attended health education
classes on immunization
• Percentage of mothers who
have seen/received each of
the IEC materials on
immunization developed

Year: 2003

Indicators
Output

Incidence of nosocomial
infections

• Change in the knowledge and
attitudes of mothers on
immunization
• Change in the percentage of
fully immunized children (FIC)
<1 year between 2002 and
2003

Effect/Impact

Worksheet 4
...
of FIC among 1
yr old children / Total
no
...
of occupied beddays/total available
bed-days) x 100

(No
...


Medical
Records Dept
...
2: Identification of Data Needs at Different Levels

Dist
...


Unit Requiring Indicator
Prov
...

Natl
...

Serv
...

Ofc
...
The most detailed data should be kept at the
source, and reporting requirements to higher levels should be kept
at a minimum
...
This involves the:
➤ Identification of variables/indicators that need to be submitted to higher levels
➤ Identification of most appropriate unit and position of person to whom
summaries will be submitted
A major determining factor for this step is the function of the office and/or the
person to whom the data is submitted in relation to the generation and utilization
of information
...
g
...

(3) Determine in what form data will be submitted to each level
...
An example of this flow chart is shown in Figure 5
...
Another example
is shown in the Appendix
...

(2) Inability to distinguish which data are needed for service delivery and which data
are needed for programme management and monitoring
...
)
➤ Lack of computer skills of staff
(4) Lack of storage facilities for raw data at lower administrative levels
...


Discussion on how to streamline morbidity/mortality reporting
...
1: Summary of Data Flow of EPI Report at Each Administrative Level

W O R K S H E E T

16

Statistics Unit of the District Health Service
(EPI District Nurse Supervisor)

Village Health Centre
(Public Health Nurse in charge of the EPI Programme)

Village

Statistics Unit of the Provincial Health Service
(EPI Provincial Nurse Supervisor)

MCH Division of the Ministry of Health
(MCH Programme Officer)

District

Provincial

National

Planning and Statistics Office of the Ministry of Health
(Information Officer)

Figure 5
...

he most effective data collection and reporting tools are simple
and short
...
This step entails either the modification
of existing forms, or the development of new ones
...

(3) Present the first draft of the form to relevant staff members and discuss with them
the following aspects of the new form:
➤ How does it compare with the old forms?
➤ What are the advantages and disadvantages of the new form?
➤ What modifications need to be done to the new form to enhance its advantages
and minimize the disadvantages?
➤ For countries that have a number of dialects, is it necessary to translate the
forms into the major dialects used in the different regions of the country?
(4) Prepare a draft of the Instructions Manual on how to fill out the new forms
...

(6) Assess the results of the pre-test
...


17

I S S U E S

(1) Technical expertise/capability of data providers at data source is not consistent with
the level of complexity needed for data collection tools to meet the data needs of
users
...

➤ Where?
➤ Who will be involved?
➤ How long?

18

19

Number of 1-year-old
children who are fully
immunized

Data Elements Needed

Village

Fully immunized
Not fully immunized

Categories (If Applicable)

Name of Form: EPI Form 1
Level Accomplishing This Form:
Province

Review all the immunization registers/cards for all 1-year-old children in the service
area of the Village Health Centre
...
1: Identification of Entries for the Development of New Forms and the Preparation of an
Instruction Manual

W O R K S H E E T

20

7 Developing
procedures for
data processing
P R I N C I P L E

T

he way the HMIS data is processed should be consistent with
the objectives for data collection and the plans for data analysis
and utilization
...
Among the important considerations in
choosing this level is the presence of staff trained in system maintenance
...
Among the important aspects to be decided are:
➤ Summary Reports to be routinely generated
➤ Data quality control mechanisms/checks to be incorporated within the software
➤ Data analysis requirements of the data users

21

(4) Develop the software needed to process the data at each level where computers
will be used, based on the required specifications
...
In this situation,
the resources needed to acquire and customize the software should be determined
...

(5) Pre-test the software, paying attention to:
➤ Identification of bugs
➤ Ability of software to generate the expected data
➤ Ability of staff to use it
(6) Develop and pre-test the User’s Manual for the software
...


I S S U E S
(1) Capability of existing hardware, especially at the lower levels, to accommodate the
software, as well as its ability to store all the data
...

(3) Basic system maintenance procedures
...


22

23

2

3

Existence of staff within MOH who know how to use the software
1 – None
2 – Some
3 – Several

Availability of local technical support in case of problems
1 – None
2 – Limited availability
3 – Highly available
2

2

Software 1

Cost of acquiring/developing the software
1 – Very expensive
2 – Moderately expensive
3 – Nil/free

Criteria for Selection

Worksheet 7
...


S T E P S
(1) Conduct a training needs assessment for data providers and data users
...
These are:
➤ Training of trainers
➤ Training of data providers at the peripheral levels on how to fill out forms
➤ Training of computer operators on the use of the software and hardware
➤ Training of staff at different levels on data utilization
A separate training-needs assessment should be conducted for each type of training
...
The following aspects should be covered:
➤ Target group (For Whom?)
➤ Content (What?)
➤ Strategies (How?)
➤ Duration (How long?) – This refers to the total duration of the training
programme, as well as the time allocated for each topic included in the training

25

The output of this step is a course syllabus for each training programme to be
conducted
...
The following training materials are suggested:
Type of Training

Training Material

Contents

Training for Data
Providers

Data Dictionary

List of indicators, formulas, definitions,
data sources

Manual for Data
Providers
(separate Manual for
each level)

Instructions on how to fill out forms

Training for Data Users

Manual for Data Users
(separate Manual for
each level)

Data analysis, interpretation and utilization

Training for Computer
Operators

Computer Software
User’s Manual

Detailed instructions (with examples) on
how to use the software; troubleshooting

Training of Trainers

Trainer’s Manual

Instructions on how to implement the
training programme for data providers and
data users; teaching strategies; guidelines
on the use of the Manual for Data Users
and Manual for Data Providers

The participants of the Training of Trainers should be provided with a copy of the
Data Dictionary, the Manual for Data Providers and the Manual for Data Users
...
Since there is a chance that some modifications
in the format, structure and content of the training materials will be made based
on the evaluation results, the number of copies to be reproduced at this point
should be limited
...
It is important to
determine this prior to the conduct of the training activities, since most evaluation
designs require the collection of a baseline or a pre-training level of knowledge
among the participants
...

An efficient strategy to use is to identify and train a core set of staff who can act as
trainers for the neighbouring areas
...

(7) Conduct the training of data providers
...
This is usually conducted after sufficient data
from the HMIS has been collected for use as examples during the training
...


26

(10) Modify the training materials and the training programme itself based on the results
of the evaluation
...


I S S U E S
(1) Selection of the appropriate participants for the different training programmes to
be conducted
...
Are they very different?
(3) Language/dialects to be used for the training materials
...

(5) Preparation of adequate facilities to conduct training
...


27

28

Training for Data Users

By the end of the session, the
1
...
1 Sources of health data
1
...
The health
international sources of health
information system of
data that are collected either
the Ministry of Health
on a routine or on an ad hoc
b
...
Know the types of data
c
...
Be aware of the problems
the police for
faced by the routine data
accidents, etc
...
International sources
and health-related data,
of health data (WHO,
particularly on the MOH health
UNICEF, etc
...
2 Assessing the quality of
vital registration system
health data
4
...
Timeliness
set of health data according to
b
...
Adequacy
adequacy, accuracy and
d
...
Reliability
5
...
0 hrs

1

Training for Data Providers

Duration of Lecture (in hrs):

Session No
...
1: Preparation of a Lesson Plan for the Training of Data Users and Data Providers

W O R K S H E E T

9 Pre-testing
the system
P R I N C I P L E

T

he system should be pre-tested in conditions that reflect as much
as possible the actual conditions prevailing during its
implementation
...
This involves addressing the
following questions:
(1
...

There is a need to develop criteria for selecting the pre-testing sites
...

(1
...

(1
...
4) How? What modes and tools for data collection will be utilized to
systematically collect the data required for an efficient pre-testing of the
forms?
(1
...

(2
...

(2
...


29

(3) Implement the pre-testing activities
...

(5) Formulate recommendations, based on the results of the pre-testing
...

(2) Systematic updating of the software in all units where it has been installed
...


30

31

Problem solved

Bug in the software identified;
correction of software installed in all
districts scheduled for next week
Age cut-off verified to be <1;
written clarification of definition of
FIC distributed to all health centres

Additional supply of new
forms sent the following day
Problem referred to software
developer

Problem referred to EPI Unit

Ran out of supply of new
forms
Computer doubles the
entries for some forms

Confusion in definition of
FIC – whether cut-off age
is <1 or <2

3/1/03

3/3/03

3/10/03

Date

Includes both software and hardware-related problems

1

Result/Status of Problem

Month/Year: __________________
March 2003

Action Taken

Village Health Centre: __________________

Description of Problem

District: __________________

How Problem
Was Identified
Problem Area
Phone Field Others
Visit (Specify) Forms Computer1 Others
Call

Province: __________________

Worksheet 9
...


S T E P S
(1) Develop a plan for the systematic monitoring and evaluation of the system
...

(3) Prioritize the activities, based on availability of resources and need
...

(5) Document and disseminate the results of monitoring and evaluation activities
...


33

Checking data entry work at a health centre
...

(2) Availability of technical expertise and other resources for monitoring and evaluation
...
Of particular
importance are monitoring activities for the following areas:
• data quality
• data extraction from various sources
• utilization of HMIS products
➤ Monitoring activities at the national and provincial level on the use of the software

➤ Supply of forms, computer supplies, and other materials needed for the various components of the HMIS
➤ Forms and sources of additional support needed at the national, provincial, district, and village levels

Computer
software
and
hardware

Training

Monitoring

General

of the training for data users and data providers
of the training of trainers
of the training on the use of the software
of the User’s Manual for the software

Key informant interviews
Focus group discussions

➤ Extent and nature of interaction among staff at different levels on the HMIS forms and reports
➤ By whom and how data generated from the HMIS are utilized at the national, provincial, district, and
village levels

Data
utilization

Assessment
Assessment
Assessment
Assessment

Key informant interviews
Focus group discussions

Data quality including timeliness, completeness, accuracy and reliability
Correct computing of indicators
Appropriateness of data sources
Extent and nature of problems met by village health centre staff on data entry and report generation
Adequacy of forms to meet the needs of the national, provincial, district and village levels

➤
➤
➤
➤
➤

Data
generation
and report
compilation

HMIS evaluation
Consultant

HMIS evaluation
Consultant

HMIS evaluation
Consultant

IT specialist,
National Office

HMIS evaluation
Consultant

HMIS evaluation
Consultant

Mode of Data Collection Data Collector

Major Variables to be Covered

Area

Worksheet 10
...


S T E P S
(1) Determine the most effective and efficient way of disseminating the data generated
from the HMIS by considering the following factors:
(1
...

(1
...

(1
...
4) In what form should the data be disseminated to each of the different target
groups? The whole range of forms and venues for data dissemination should
be considered
...

(3) Prioritize the different modes of data dissemination to be adopted, based on need
and availability of resources
...


37

(5) Develop and implement a system for monitoring and evaluating the data dissemination and feedback activities conducted
...

(2) Limited financial resources for dissemination
...

(4) Consistency between the data disseminated by the HMIS, and similar data published
and disseminated by other units within the ministry, especially those of the vertical
programmes
...
1: Summary of Data Dissemination and Feedback Activities

W O R K S H E E T

Monthly

Weekly

Annual

Frequency of Dissemination/Conduct

40

12 Enhancing the HMIS
P R I N C I P L E

T

he development of the HMIS is always a work in progress
...


S T E P S
(1) Review the results of monitoring and evaluation activities conducted on the HMIS
in recent years
...
The basic question to be answered is, “Where do
we go next?”
...
This should include specific types of resources for each planned
expansion activity; the budgetary requirements (if any); and the desired source of
support for each type of resource needed
...

(5) Prepare a timetable for the implementation of the different activities for the
expansion of the HMIS
...

(7) Monitor and evaluate the effect of newly implemented aspect of the HMIS
...

(2) Generation of resources to support the different activities for system enhancement
...

(4) Ensuring the continued existence of a body/committee to oversee the HMIS after
the pilot-testing phase
...
)

Printing of new forms

Monitoring and inspection

$500

$2000

Regular budget

$1000

Development and reproduction
of training materials
Per diem of participants
Transportation, food and venue
Honorarium for local consultant/
trainer

Training of district level Information
Officers on the use of the software

Regular budget

Donor agency

Regular budget

Donor agency

$600

Source of Support

Communication costs
Honorarium for local consultant

Q4

Development of training strategies
➤ Identification of participants
➤ Development of training materials

Year 2
Q2
Q3

$15 000

Q1
10 computers and printers

Activity

Provision of computers to all the 10
districts of Prov
...
1: Two-year Plan of Activities for HMIS Expansion and Corresponding Resource Requirements

W O R K S H E E T

44

Examples
Example 1 is a list of basic indicators that might be used in Ministry of Health programmes,
together with the corresponding data sources, modes and frequency of data collection,
as well as the lowest administrative level where the indicator is computed
...

Example 2 is a flow chart of the HMIS of hypothetical country X
...


45

46

Mode of
Data Collection
Other Agencies Routine Special
Frequency of
Lowest Level Where
(Please Specify) System Survey Data Collection Indicator is Computed

EH

NSO

7
...
Percentage of government health
budget in GDP
PHO DOF

10
...
Overall
b
...
Rural

B
...
Percentage of the population using
safe water
a
...
Urban
c
...
Percentage of the population by
age and sex

NSO

NSO

NSO

NSO; MOE

NSO

5
...
Literacy rate
a
...
Males
c
...
Another option would
NSO
Annually
Village
be a quotation
...
Crude death rate

3
...
Natural population growth rate

1
...
Population, Socio-economic and Environmental Indicators

Source

Example 1: List of Indicators Used by the Ministry of Health of Country X With Corresponding Data Sources
and Mode of Data Collection

47

PHO DOF
DHS; DP
DHS; DP
DP
DP
DP
DP

14
...
Number of hospital beds per 1000
population

16
...
Number of pharmacists per 10 000
population

18
...
Number of dentists per 10 000
population

20
...
Weight/height malnutrition rate of
children <5 years old

DHS
DHS

25
...
Percentage of insured in-patients
among total in-patients

C2
...
Height malnutrition rate of
children <5 years old

24
...
Weight malnutrition rate of
children <5 years old

C1
...
Health budget per capita

C
...
Percentage of government health
budget in expenditure of national
budget

DP

DP

DP

DP

DHS; DP

DHS; DP

MOH DOF

MOH DOF

MOH DOF

NSO

NSO

NSO

NSO

NSO

NSO

Quarterly

Quarterly

Quarterly

Annually

Annually

Annually

Annually

Annually

Annually

Annually

Annually

Annually

Annually

Annually

Annually

Continued next page ➤

Province

Province

District

Province

Province

Province

Commune

Province

Province

Province

Province

Province

Province

National

National

48

DHS

Unit/Division

DHS

29
...
Bed turn-over rate

CHC; DMCH
CHC; DMCH
FPSF
FPSF

34
...
Percentage of mothers who
received postnatal care

36
...
Contraceptive prevalence rate

38
...
)

H

CHC; DMCH

33
...
Morbidity and mortality ratio of
obstetric complications

CHC; DMCH

32
...
Percentage of pregnant women
vaccinated with Tetanus Toxoid ≥2

39
...
Average length of stay in the
hospital

C3
...
Number of out-patients per 1000
population

C2
...
Percentage of children <1 year old
vaccinated against pertussis, tetanus
and diptheria

44
...
Percentage of children <1 year old
vaccinated against measles

46
...
Morbidity and mortality rate of
6 vaccine preventable diseases of
children

Quarterly

Quarterly

H; DHC PHC

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

51
...
Average number of acute respiratory
infection episodes among children
<5 years old

53
...
Percentage of severe pneumonia
cases among children <5 years old
referred to higher level

Quarterly

Quarterly

Quarterly

H; DHC PHC;CHC

50
...
Average number of diarrhea
episodes among children <5 years old

H; DSS

EPI

42
...
Morbidity and mortality rate of
neonatal tetanus

EPI

41
...
Child Health Care

Continued next page ➤

Village

Province

Village

Province

Village

Village

District

Province

Village

Village

Village

Commune

Commune

Commune

50

DHC PMC

NTCP
NTCP

58
...
Percentage of tuberculosis patients
treated with DOTS
NTCP

NTCP

57
...
Morbidity and mortality rate for
malaria

NIN
HACP
HACP
HACP

65
...
Number of new HIV-AIDS cases

67
...
Number of deaths due to AIDS

69
...
Percentage of households using
iodized salt

63
...
Case fatality rate for tuberculosis
(among treated cases)

DHC PMC

56
...
Percentage of blood smears positive
with parasite

Source
MOH
Unit/Division
Form/Register

55
...
Selected Diseases

Indicator

Example 1 (Cont’d)

Annually

Monthly

Monthly

Monthly

Every 5 yrs

Every 5 yrs

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

Quarterly

Commune

Province

Province

Province

Province

Province

District

District

District

Province

Province

Province

Province

Province

Province

Mode of
Data Collection
Other Agencies Routine Special
Frequency of
Lowest Level Where
(Please Specify) System Survey Data Collection Indicator is Computed

51

MOH
MOH

75
...
Maternal mortality ratio

NSO

NSO

NSO

MOH

74
...
Percentage of hospital admissions
according to different groups of
diseases (based on ICD-10
categories)
MOH

H

71
...
Under-five mortality rate

Annually

CDSS

70
...
Life expectancy at birth
a
...
Females

78
...
Impact Indicators

National

Province

Province

Province

Province

Province

District

District

Village

52

Institutes/Centres

Units/Programmes of the
District Health Service

1

Units/Programmes of the
Provincial Health Service

1

1

Departments

Dispensaries/Village
Health Centres

1

1

Central Hospitals

Minister of Health

Example 2: Data Flow for the HMIS of Country X

1

1

Central Health
Statistical Unit

2

2
District Health Service
Statistical Unit

Provincial Health Service
Statistical Unit

2

2

2

1

Basic health indicators;
demographic data; morbidity
and mortality data; data
from multipurpose surveys

Health services data;
epidemiologic surveillance;
manpower and finance;
other services

Feedback

Report

Legend

References
Hurtubise, R
...
West Hartford, CT,
Kumarian Press, 1984
...
, et al, eds
...

Geneva
...

World Health Organization Regional Office for the Western Pacific
...
Manila, Philippines
...

World Health Organization Regional Office for the Western Pacific
...
Manila, Philippines
...

World Health Organization Regional Office for the Western Pacific
...
Manila, Philippines
...


53

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