Building Local Health Systems with Information Systems

On my trip to India last month, I didn’t plan to focus on maternal health care, but walking through the maternity ward in Bihar, I couldn’t help but worry about the long lines and hours that keep a woman waiting to see a doctor. The health officials I met with are incredibly committed to serving their communities. In one case, I actually had to walk through the maternity ward to reach my meeting with members of the chief surgeon’s office and the head of district medicine. I realized these men and women walk by the patients every day—women like the proud new mother who urged me to come over and take a photograph of her new daughter. Although the hospital I was in is among the nicest in the state, it lacks many of the essential information systems that can make a health system run efficiently and effectively. In practical terms, this might mean the women I walked by would not have to spend so long waiting to be seen.

This brings me to the real reason why I was in India: to work with local groups and state officials to assess the needs for a human resources information system (HRIS) in the states of Bihar and Jharkhand. Often when I do this kind of work, I have to start with basic explanations about the value of an HRIS, which offers a way to manage data entry, data tracking, and data information including things like keeping track of the management and reporting of the health system and health workers. But in India, I found that everyone I spoke to—from the directors, to managers, to assistants—already understood the purpose and need for an HRIS. As a first step in the project, we are now working to launch a pilot iHRIS Manage system in the Ranchi District of Jharkhand and another in Vaishali District of Bihar.

Even as we work to strengthen health systems through projects like building local human resources information systems, we also have to work within the very real limitations of countries that are still developing their national technology infrastructure. Like many people, I have read many articles about high-tech jobs moving from the United States to India, which perhaps fed my expectation that all over India there would be a robust information, communications, and technology structure. Although in the more centralized offices, technology access and support was better, often at the local level it was lacking. A local health center might have a computer but little access to technical support if the computer malfunctioned, a limited back-up system, or no plan for catastrophic failure of the system. For many people, these aspects of the health system seem mundane, but the reality is that for the many women I passed in the halls waiting to be seen, a more efficient health system can have a wide-reaching, positive effect.