WHO Toolkit for Routine Health Information Systems Data
Introductory text
This effort is led by WHO and its Collaborating Centre on Innovation and Implementation Research for Health Information System Strengthening at the University of Oslo, with support from Health Data Collaborative partners, including UNICEF, Global Fund, GAVI and PEPFAR.
For questions or comments, please contact healthinfo@who.int
Health service data play a crucial role in patient management, facility administration, disease surveillance, and monitoring service delivery and resource utilization. These data are indispensable for countries as they strive to evaluate the effectiveness of their healthcare systems, and subsequently achieve Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs).
Health facilities continuously generate data as part of their service delivery activities. Routine health facility data are collected and reported on a regular basis through Routine Health Information Systems (RHIS). These data are analyzed and used at all levels of the health system.
The RHIS toolkit is a collection of resources for country implementation designed to enhance the collection, quality, analysis and utilization of routine facility data. This toolkit is the result of collaborative efforts involving various WHO programs and partners. Its core objective is to advocate for an integrated, standards-based methodology, emphasizing a select set of standardized core indicators along with suggested analytics, data visualizations, and dashboard tools.
The toolkit consists of a series of integrated general and programme-specific modules which contain guidance documents, electronic configuration packages and training materials.
The RHIS toolkit consists of a series of general and programme-specific modules, such as:
- Standards for measurement and analysis of RHIS, including general principles, core indicators and metadata, and data quality review toolkit;
- Guidance for planners and managers, including integrated health service analysis at the facility, district and national levels;
- Programme specific guidance documents, as well as training materials (e.g., immunization, HIV, TB, Malaria, MNCAH, rehabilitation, mortality, surveillance), which are continuously expanding to cover more programmes.
These modules are designed to be software agnostic. However, with the collaboration of the University of Oslo, the modules have been digitalized into DHIS2 configuration packages.
This toolkit will be reviewed and updated periodically to ensure that it remains aligned with the most recent guidelines and evidence.
Modules
Standards for measurement and analysis
Health Facility Core Indicators
This module provides a list of core indicators that can be calculated using routine health facility data. It includes all the indicators (with metadata) from the guidance for planners and managers and the programme-specific guidance documents (see below).
Data analysis and use can be strengthened by focusing on a limited, standardized list of core indicators that:
- Reflect programmatic and service delivery standards
- Can be used to guide country selection of indicators and definitions
- Promote alignment among programmes and other stakeholders
- Can promote a reduction in the reporting burden of health facility workers
General Principles
This module introduces key concepts of routine health facility data analysis that are applicable to all modules, including:
- Standardized core indicator lists
- Representativeness of routine facility data
- Key dimensions of data quality assessment
- Challenges of population estimates and denominators
- Basic analytical concepts
- Principles for presentation and communication of data
- Basic concepts for data interpretation and use
Data Quality Review - A standard methodology for assessing data quality
Data Quality Review (DQA) - A standard methodology for assessing data quality
A training package for monthly use of DHIS2 data quality dashboards at district and health facility levels. This training package aims to improve the quality of RHIS data through building capacity in the regular use of DHIS2-based data quality tools at district level. Two approaches are presented:
- The DHIS2 version of the WHO Data Quality Tool;
- Specially-configured data quality dashboards that are visible when users log into the DHIS2 website.
The package includes set of tutorials and an exercise book that can be used in workshops or for self-learning. The core analysis parameter includes:
- Completeness and timeliness
- Internal consistency of data (eg. outliers)
- External consistency of data
- Recommended indicators for HMIS data quality review
Guidance for Planners and Managers
Integrated Health Services Analysis
Reference materials :
Monitoring, evaluation and review of national health strategies
This module provides general health service managers with a quick, cross-cutting overview of facility performance, using a set of core indicators representing multiple essential health services.
This integrated approach is central to the comprehensive strengthening of PHC and to achieving UHC.
The national manual provides detailed discussions of indicators and analysis concepts. The district/facility manual takes a practical approach to how RHIS data can be used in district management processes and includes model dashboards, data stories
and questions.
The indicators are presented in the following groups:
- Epidemiological profile:
- Mortality (institutional)
- Morbidity (inpatient and outpatient)
- Health service performance:
- Access and utilization
- Coverage and quality
- Health service resources
Download
Mortality data
Reference materials:
ICD: ICD serves a broad range of uses globally and provides critical knowledge on the extent, causes and consequences of human disease and death worldwide via data that is reported and coded with the ICD. Clinical terms coded with ICD are the main basis for health recording and statistics on disease in primary, secondary and tertiary care, as well as on cause of death certificates. These data and statistics support payment systems, service planning, administration of quality and safety, and health services research. Diagnostic guidance linked to categories of ICD also standardizes data collection and enables large scale research.
Medical certification for cause of death
The principle of a cause of death and an underlying cause of death can be applied uniformly by using the medical certification form recommended by the World Health Assembly. It is the responsibility of the medical practitioner signing the death certificate to indicate which morbid conditions led directly to death and to state any antecedent conditions giving rise to the underlying cause of death.
DORIS:
DORIS is a software that assists finding the underlying cause of death from death certificates using a rule base.
ANACoD3
The ANACoD3 online tool helps the user to perform a comprehensive and systematic analysis of mortality and cause-of-death data. The tool automatically tabulates data and presents basic mortality measures in tables and figures. This latest version allows for the analyses of cause-of-death data coded in ICD-10 as well as ICD-11 formats.
Revealing the toll of COVID-19:
To support national governments with surveillance and response planning, WHO has partnered with Vital Strategies and other global partners to launch a new technical package: Revealing the Toll of COVID-19: A Technical Package for Rapid Mortality Surveillance and Epidemic Response. rapid mortality surveillance generates daily or weekly counts of mortality data by age, sex, date of death, place of death and place of usual residence.
Guidance for Specific Programmes
HIV
The overall goal of this module is to analyse, visualize, and report on various elements of HIV programme and facility performance and for patient management and retention. The WHO health facility data analysis tool provides
analysis and interpretation of information derived from routine data reported from health facilities. It covers a comprehensive range of routine health facility data as well as coverage key HIV/AIDS services which are critical
to public health managers, planners and analysts in their efforts to assess and improve health system performance.
This output information from the DHIS2 HIV Module can in turn be used for programme and health facility planning, to monitor and evaluate programme performance, and to guide management decisions.
Immunization
The immunization module for DHIS2 contains:
- Core and optional indicators for immunization programme monitoring which can be adapted to individual countries depending on the vaccines in the national schedule and on national monitoring priorities.
- A standard dashboard with common visualizations, tables, and maps
- An EPI App containing visualizations that could not be implemented within standard DHIS2 packages, such as the monitoring chart and categorization table
- An export routine that can be used to extract data from DHIS2 in a standardized way
Vaccine Safety:
- Adverse Event Following Immunization (AEFI)
COVID – 19 Vaccine Monitoring
- Interim Guidance (English)
Tuberculosis
The tuberculosis (TB) modules for DHIS2 include a digital version of the aggregate quarterly reports defined in the Definitions and Reporting Framework for Tuberculosis and a digital version of the TB case-based surveillance based on the standard paper TB register as specified by the minimum recording and reporting standards recommended by WHO. In both modules, entered data is also automatically aggregated and core TB indicators are calculated which are then displayed in standard dashboards containing tables, charts and maps as suggested in Understanding and Using Tuberculosis Data and in Standards and Benchmarks for Tuberculosis Surveillance and Vital Registration Systems: Checklist and user guide.
The WHO DHIS2 TB modules should be taken as an absolute minimum for routine TB data collection and analyses, which should be adapted and customised according to national context.
Malaria
The Malaria Module for DHIS2 provides support to endemic countries on malaria surveillance from data collection and validation to analysis, interpretation, and dissemination. The same recommendations provided by WHO Global Malaria Programme in their publications
have been implemented into the DHIS2 malaria module. This includes a core set of recommended data to be captured by frequency and disaggregation and at what levels of the health system. Pre-configured data validation rules and a data quality tool
accompany these elements to ensure high-quality electronic data.
The package also contains a core set of recommended indicators to track the data and visualizes it in the form of tables, charts, and maps. Guidance on the interpretation of the charts and graphs is provided in the curriculum and exercises address the
strengthening of malaria surveillance at the country level.
These combined elements not only strengthen malaria surveillance but also serves to harmonize malaria surveillance and reporting across countries. The module is the result of collaboration between WHO, countries and partners.
Maternal, Newborn, Child and Adolescent (MNCAH)
Reference materials:
Maternal, Newborn, Child and Adolescent Health and Ageing Data portal
More on maternal, newborn, child and adolescent health
This guidance describes a catalogue of indicators for maternal, newborn, child and adolescent health (MNCAH) that can be monitored through health management information system data. The document provides guidance on possible analysis and visualization of the indicators, including considerations for interpreting and using the data for decision-making. An annex on data quality considerations for MNCAH managers provides suggestions for reviewing and interpreting routine health facility data through a quality lens.
Accompanying this guidance are a series of presentations and exercises, including a facilitator guide, that can be used in workshops to strengthen capacity of analysis, interpretation and use of data by MNCAH managers.
Guidance: Analysis and use of health facility data: guidance for MNCAH programme managers.
Accompanying materials including presentations and exercises.
MNCAH routine health information system indicator country mapping template.
Companion exercises to strengthen analysis and use of health facility data for maternal, newborn, child and adolescent health – Facilitator guide.
For more information, please contact mncahdata@who.int
Rehabilitation
Data collection for rehabilitation through routine health facility reporting is required to underpin rehabilitation decision-making in health policy, management and clinical care. Data from both individual and service records are used for defining rehabilitation sector targets and outcomes, clinical decision-making, estimates of service utilization, and quality management. Regular monitoring of rehabilitation services at national and subnational levels provides information on service availability and distribution which may be used to guide policies aimed at achieving universal health care (UHC). Information on individuals’ level of functioning is essential since the goal of rehabilitation is to optimize functioning for people with impairments, injuries, and acute or chronic diseases.
This Routine Health Information Systems – Rehabilitation toolkit supports the integration of rehabilitation into health facility reporting and the analysis of collected data through a standard set of indicators and considerations for their interpretation and use. It is targeting rehabilitation policy-makers and program planners as well as facility managers and service providers.
Routine data collected from health facilities on eye and ear and hearing care, provide information on morbidity, estimates of services utilization, and quality and coverage of services, to allow management and clinical decision-making. Analysis of data on the distribution, availability and coverage of eye and ear and hearing care services at national and subnational level informs national planning and decision-making in health policy, management, and clinical care. This information will further help to monitor progress towards achieving universal health coverage (UHC).
The Routine health information systems – sensory functions toolkit aims to facilitate the monitoring of both eye and ear and hearing care services through a standard set of core facility indicators that guide data collection and reporting. The indicators aim to support the integration of eye and ear and hearing care data into the facility level reporting system. The core eye and ear care facility indicators are described in the guidance document along with considerations for analysis and use of routine health information.
Coming soon
- TB case-based module
- Vaccine Preventable Diseases Integrated Surveillance
- Neglected tropical diseases
DHIS2 Integrated Packages
DHIS2 Metadata Standards