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Health Information Management in Crises: An Introduction

Hearnet, November 2006Sandro Colombo

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Objectives of this session

• agree with the key definitions, components and features of health information and health information management in a crisis,

• be aware of the main challenges in HIM• be familiar with key lessons learned from the

experience • better understand the opportunities and

obstacles in information exchange and our role in IM

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The importance of (Health) Information

• "in a disaster, accurate information, like clean water, is an indisputable good" Keen & Ryle, 1996

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Information in crises

but "the nature of contemporary disasters militates against the rapid collection of, for example, nutritional and demographic data. …reliable base-line statistics that pre-date the crisis are seldom available. Parties to the conflict may attempt to manipulate information … and relief agencies may promulgate statistics that owe more to guesswork and imagination than research. News media tend to repeat and simplify these interpretations… information flows outwards; the last people to have access to it are the victims themselves" Keen & Ryle, 1996

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IM in Crises: any progress?

• Some findings from an evaluation of IM in the response to the Pakistan earthquake in 2005:

– HIC perceived as being of limited use by many field workers, who felt that their information products were either not timely or not relevant

– Senior management not enough involved in IM– Despite the technology advances, still gaps in remote

access to the internet– Little coordination of data collection

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Health information: general

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A Few Useful Definitions Data:Raw material that has not been analyzed; on its own data have no meaning, apart from what they state

Information:The meaningful collection, manipulation and transformation of data in a way that enhances the comprehension of the studied events

Intelligence:in-depth knowledge of an issue, information in a context

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Activity #1. Data, information, knowledge: What is the difference?

Break in 4 groups and discuss briefly which of the following statements refers respectively to:

a) data or b) information or c) intelligence/ knowledge:

1. Mortality among IDPs in Alpha camp (country Beta): 1. CMR: 2.3 (95%CI 1.2 – 2.9);

2. CMR one year ago: 0.8 (95% CI 0.3-0.9)

3. CMR among IDPs arrived in the last 3 months: 1.6; CMR among IDPs staying in the camp for over 6 months: 3.2

2. In camp Alpha there have been 79 deaths since January 2006

3. From the analysis of data of the survey in camp Alpha it can be concluded that mortality has increased substantially over last year, consistently with the findings of other surveys in the same area and the overall deterioration of the security situation, and…

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What is Data made of?

• TIME element

• SPATIAL element

• POPULATION element

• ATTRIBUTE elements

For instance: on 29th November in Alpha refugee camp there were 1234 refugees

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From Facts to Decisions

Judgement / decisions / actions assessing options /

Decision-making attributing values

Facts/events deaths

Data nr. of deaths counting

Indicators mortality rates calculating

Information rates by sex, age, analysing

provenience, etc

Knowledge / trend analysis, interpretingUnderstanding comparison with

other areas, benchmarks,contextual information

Steps example function

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The Circle of Information Management

Data

Information

Knowledge

Activity

Process

LearnApply

Collect

Adapted from: Information Management for non information-managers, 2004

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Desired Qualities of Information in Crises

• Timeliness

• Relevance

• Validity / accuracy

• Precision

• Acceptable cost

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Timeliness / Speed

• Information needs and demands are high in a crisis and are often difficult to meet within useful timeframes and with acceptable quality

• Time for processing information is often a function of security and humanitarian access

• Conflict between speed and the other desired qualities, like completeness, coverage, quality of information

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Accuracy versus Precision

• Assuming that in the area X in August 2002 the “real” (unknown) CMR is 1.6/10,000/day

–Accurate (unbiased) & precise estimate: 1.5 (1.4 - 1.7)

–Accurate & imprecise estimate: 1.5 (1.0 – 2.2)

–imprecise estimate: 1.2 (0.8 - 1.9)

–biased estimate: 0.6 (0.3 - 0.8)

–biased & imprecise estimate: 0.6 (0.1 - 1.2)

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Accuracy and Precision

C. Precision only

A. Both accuracy and precision B. Accuracy only

D. Neither accuracy nor precision

J ekel et al., 1996

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The Cost of Information

Accuracy of information

Co

st o

f o

bta

inin

g in

form

atio

n

From A..Green, 1999

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Summing-up: what are the qualities we are pursuing in information in crises?

Accuracy and timeliness are the key features of good information in a crisis, together with relevance:

“It is better to be vaguely right than precisely wrong” John

M Keynes

and we can add:

“it is better to be vaguely right and on time than precisely right and late”

Precision is a lesser concern: "precise quantification of incidence and prevalence rates rarely influences the choice of programmes offered by the health services” Sandiford, 1992

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Health Information in Crises

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The impact of crisis on information 1

• During a crisis, pre-existing information systems deteriorate, and their coverage is reduced:

– Insecurity & population movements lack of reliable denominators

– Poor communication,

• Collection & analysis of data clash with other priority activities

• Proliferation and fragmentation of information systems; they often increase the "background noise": good data are hidden by bad ones

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The impact of crisis on information 2

• A large part of the collected information remains unused

• Old, precious information (and institutional memory) is lost

• There are strong incentives for manipulating the information

• Information flaws are common (see following slide)

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Common information flaws

• Computing mistakes• Incomplete reporting• Use of different denominators• Inconsistent levels of aggregation• Disregard, or lack of access to information related to

partners• Biases, or deviations of results –or inferences- from the

truth• "fossil" figures, endorsed by authoritative agencies• Data out of context• The application of elegant, sophisticated presentation

techniques to poor datasets

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The Myth of IM in crises

• Persisting MYTH:

– No information is available, or what is available is biased to such a degree to be useless.

• Two opposite attitudes:

– Postpone any decision until new data become available (paralysis by analysis)

OR

– there is no time to gather good data; proceed quickly with field activities

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Summing up

In a crisis we deal with: • information that is fragmented:

– information is a precious asset in a competitive market for funding,

– new data collection systems are implanted by newcomers; most aid agencies support information initiatives; surveys proliferate; as a result:

• “amidst the chaotic and rapidly changing situation, no single organization has all the necessary information" King & Dilley, 2001

• limited understanding or uncertainty:– Crises are complex and dynamic and the information

base is weak; • "Uncertainty is a characteristic of scarcity of information

(knowledge/understanding). In abundance of information, ambiguity becomes an issue: the more information I get, the more difficult my choice will be" L.Hoebeke, 2001

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Main Sources of Information in a Crisis

Data exist, almost always. They are often hidden among various sources, for example:

Routine information collected by government agencies

Documentation centres (UN, donor agencies, government, etc.)

Surveillance systems

Evaluation and supervision reports

Demographic and Health Survey (DHS)

Multiple Indicators Cluster Survey (MICS)

Other Surveys

Personal files maintained by knowledgeable people

Informal information networks

Journals

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Improving available information: tips

• Cross-checking and cleaning data

• Identifying, and dealing with outliers, oddities

• Triangulating; choosing among diverging data

• Comparing indicators with those of similar contexts

• Identifying important missing information (HIV/AIDS, the ongoing war, etc)

• Checking the plausibility of data with knowledgeable people

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Lessons learned Before embarking on new data collection, find and

analyze (and learn from) what is already available = use local knowledge

"much of the information remains unprocessed, or if processed unanalyzed, or if analyzed not written up, or if written up, not read, or if read not used or acted upon. Only a minuscule proportion, if any, of the findings affect policy, and they are usually a few simple totals" Chambers, 1989

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Lessons learned Do not discard information for being incomplete or weak

Be pro-active:

– Try and get beyond the idea of only providing the information that is asked for. Intelligent professionals should be able to figure out what would be helpful for partners to know, summarize and volunteer the

information Jim Tulloch, February 2003

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Information Management

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Activity

• In groups, build a list of the different types of information you exchange on a regular basis

• Agree on 3 main types of information

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Information Management

Definition:• “the range of processes by which information

is handled by individuals and organisations. These processes aim to define, collect, process, analyse, interpret, present, distribute and incorporate information internal and external to the organization, aiming to make the work of the organisation more effective” Adapted from: HIC Handbook

• The goal: to get the relevant information to the right person at the right time

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What is IM for?

• In a crisis, the main aim of IM is to improve the humanitarian response in saving lives and reducing suffering

• Rationale of IM:Good information management = better decisions, more effective humanitarian response

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Policy/strategic clearances

INFORMATION AND COMMUNICATIONS

Dissemination AdvocacyDispelling

rumors

Media briefs Q&A

Web siteMaintenance

Reporting to investors

Position papersProposals & Reports

Dialogue for coordination

Minutes

Tracking sheets

Situation reports

List serves

Bulletin boards

Share point/ Myetic village

Protected sites

Positioning

Tele/video- conferences

Templates

Connectivity for operations

Connectivity as a service to partners: e.g. cybercafé for NGOs Connectivity as a product for

beneficiaries: e.g. PCs etc for MOH

Addressee/ circulation listsFilters

Tech validationAdm. clearances

Access to the Web

Compatibility of ware

Energy

Robustness of equipment

Computer skills

Information from the field

Protocols, checklists, forms, etc

Access to sources

Geography Demography Periodicity/time-sensitivity Level of disaggregation ( national/local)Levels of elaboration (data/indicators)

Hierarchy of causation( Determinants/Outcomes)The Known and The Unknown: I.e. How much of the reality are we grasping ? can we expand our catchment area or do we need to plan for contingencies ?

COSTS

Individuals' competencies

Decisions

Analysis

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Focus of Information Management in this session

• Two main purposes of IM in crises:1. it supports coordination and management

2. it provides public information services, raising awareness on the crisis

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IM functions

– Assessment (needs, capacity, damage, etc)– Gap analysis, prioritization, allocation of

resources– Monitoring: early warning, surveillance,

evaluation

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Information Management: what's new?

• Much progress in the area of information management in emergencies :– Establishment of OCHA/HICs– Advances in IT:

• GIS, led by the mine action sector• LSS (ex-SUMA)• Net Hope IT consortium for improved internet connectivity • Sahana project, open-source web based software for

disaster management• etc

– 2002 Symposium on Best practices in Humanitarian Information Exchange: operational principles

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Humanitarian Information Management & Exchange: Operational Principles

• Accessibility• Inclusiveness• Inter-operability• Accountability• Verifiability• Relevance• Objectivity• Humanity

From the Symposium on Best Practices in Humanitarian Information Exchange, OCHA, 2002

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Metadata and standards

Data Infrastructure:

the basis for exchanging information

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Data Security Issues

Main reasons for not making public humanitarian information:

• Privacy/Confidentiality

• Security

• Sensitivity

• Quality

Adapted from: Information Management for non information-managers, 2004

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Benefits of Sharing Information

• Creates a shared understanding of the situation for decision-making, supporting coordination activities

• Makes a wider range of resources available to individual organisations – more than they could develop by themselves

• Enables individual organisations to make their projects more effective, since they have a better picture of the situation

• Builds relations between organisations which will support future cooperation

• Contributes to a culture of openness and accountability that improves data collection and ensures information continues to flow

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Factors Preventing Information Sharing

• Technical issues

• Political issues

• Bureaucracy

• Timeliness of data collection… and data release

• Unclear priorities

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Exchanging information, not just asking for it!