CONFERENCE ON MEASUREMENT AND ACCOUNTABILITY FOR UNIVERSAL HEALTH COVERAGE IN THE ASIA PACIFIC AND AeHIN 4th GENERAL MEETING 26-30 October 2015 | Bali, Indonesia
CONFERENCE ON MEASUREMENT AND ACCOUNTABILITY FOR UNIVERSAL HEALTH COVERAGE IN THE ASIA PACIFIC AND AeHIN 4th GENERAL MEETING
This document is made possible through the support of the World Health Organization â€“ Regional Office in the Western Pacific, under WHO Registration 2012/256375-0. The contents do not necessarily reflect the views of WHO.
TABLE OF CONTENTS Conference Highlights
Conference Summary 9 DAY 1 – OCTOBER 26, 2015 11 Welcome Remarks
From the AeHIN: Dr. Boonchai Kijsanayotin
From the Province of Bali: Dr. Ketut Suarjaya, MPPM
From the WHO: Dr. Khanchit Limpakarnjanara
From the ADB: Mr. Steven R. Tabor
From UNICEF: Ms. Gunilla Olsson
Keynote Address from Indonesia Ministry of Health Secretary-General
Dr. Untung Suseno Sutarjo, M.Kes
Where we are now, transitioning from the MDGs to SDGs: Measurement and
Accountability for Health in the Post-2015 Development Agenda and the Role of ICT
Parallel Sessions - Measurement and Accountability for Health: State-of-the-Art
1. Ministries of Finance, Planning, ICT and Development Agencies
2. Ministries of Health, Social Protection Agencies, eHealth Experts
3. Ministries of Health, Central Statistics Offices, Civil Registrar
The Role of Governance in Managing HIS and eHealth Complexity
Architecture and Solutions Fair: Designing and Implementing UHC and ICT Method:
Marketplace List of eHealth – HIS Resources
DAY 2 – OCTOBER 27, 2015 57 Empowering the National HIS/eHealth Executive and Management Teams
Live Demonstration – Digital Health for Better Care: The Maternal and Child Continuum of Care Scenario
Three Parallel Sessions: Challenges and Successes in Implementing ICTen
1. Finance and Investment Group
2. Health Group
3. ICT Group
Development Partner Coordination Side-Meeting
DAY 3 – OCTOBER 28, 2015 71 Policy Debate: The Economics of HIS and eHealth – why or why not invest?
The ArcGIS Online Portal for Enabling Health GIS Analysis for Monitoring and
Measuring UHC and Improving Health Systems Performance
Overview of MA4Health Roadmap Development Working Group Session
Parallel Sessions: Monitoring and Evaluation Investment Plan and Measurement
and Accountability for Health Country Roadmaps
WPRO I and EMRO
Pacific Island Countries
Development Partner Forum
Conference Closing Rites
MA4HealthAP Concept Note
List of Participants
Post- Conference Workshops
Conference Highlights by Mr. Mark Landry of WHO-SEARO
This year’s MA4HealthAP Conference and AeHIN 4th General Meeting focused on investment planning and implementation of scalable and sustainable M&E systems, Health Information Systems (HIS), and e‐ Health solutions. The conference built on past annual events focused on HIS/e‐Health capacity building, enterprise architecture, standards and governance to accelerate progress towards universal health coverage (UHC). The conference was attended by 247 participants, including delegates from developing countries plus development partners and global and regional experts. The iCTen! Recommendations from the 2014 UHC with ICT Conference and AeHIN 3rd General Meeting and the Roadmap for Health Measurement and Accountability provided a framework for progressive and meaningful discussions and action planning during the MA4HealthAP Conference. Multi‐sectoral and innovative approaches were highlighted to operationalize a shared strategic vision to support effective M&E systems with reliable HIS platforms and eHealth applications for person‐centric healthcare delivery at country level. The 5‐Point Call to Action outlines priority actions and specific targets for health measurement and accountability going forward that will result in stronger HIS, civil registration and vital statistics, and e‐Health. Implementing the Country Roadmap can drive better information and local capacity to plan, manage and measure health systems performance, monitor national health goals, progress towards UHC, and achieve the new health‐related Sustainable Development Goals (SDGs). Conference Objectives 1. Review current evidence on cost, benefit and impact of ICT‐enabled solutions in health systems from person‐based applications for service delivery to better measurement and accountability of health, and faster progress towards UHC and SDGs. 2. Initiate development of an M&E systems investment plan by operationalizing the Country Roadmap for Health Measurement and Accountability in accordance with the MA4Health 5‐Point Call to Action and iCTen! recommendations. 3. Share, learn, and prepare to implement capacity building strategies, standardized processes, tools and techniques, and ready-to‐use IT solutions towards achieving UHC. 4. Endorse the AeHIN Regional Enterprise Architecture Council for Health (REACH) and Community of Interoperability Labs (COIL).
Day 1: Setting the Stage Opening ceremonies were led by the Governor of Bali as well as representatives from AeHIN, World Health Organization, Asian Development Bank, UNICEF, and the Ministry of Health Indonesia. Once underway, the conference made heavy use of innovative and interactive tools to ensure a high level of participation by all, including mobile app‐based, vote‐driven questions for the plenary sessions, live demonstrations, a marketplace for eHealth innovations, and field trips. The first plenary session discussed strengthening national M&E systems, HIS and e‐Health solutions for transitioning of monitoring MDGs to SDGs. A panel session on HIS/e‐Health capacity building tackled the role of governance in planning and managing the complexities of HIS/e‐Health investments working towards interoperability while managing changes and risks. The plenary was then divided into three multi‐ sectoral groups to discuss the state‐of‐the art in measurement and accountability for health. From the finance, planning, and ICT sectors the discussion focused strengthening HIS and e‐ Health as a socioeconomic development agenda. Health, social protection, statistics, and civil registrars looked at ICT for improving quality, analysis, and use of data for decision making towards achieving UHC and achieving the SDGs. This was followed by what is the most popular event every year: the marketplace session. There were 22 stations set up in the ballroom and hallways for the participants to go and learn from organizations and their experience and solutions categorized in fourth tracks—planning and architecture, implementation and guidelines, tools and toolkits, and software and applications.
Day 2: HIS/e-Health Program Management, Tools and Solutions The day began with a Day 1 recap followed by a panel session on empowering the national HIS/eHealth executive and management teams. The session centered on discussing how countries organize their institutions to run their national HIS. A successful live demonstration showcased ICT‐enabled frontline healthworker information exchange for three scenarios, antenatal maternal care and PMCTC, child immunization across multiple sites over time, and malaria screening and testing. The open source technology showed the benefits of interoperable systems in healthcare.
Parallel sessions on the challenges and successes in implementing the iCTen followed. Three groups discussed: 1) Finance and Investment Actions 2) Health Actions and 3) ICT Actions. Common challenges addressed were interoperability issues, re‐alignment of new initiatives or policies, informatics training, and selecting optimal indicator sets.
Day 3: MA4HealthAP Roadmap plus Launch of REACH and COIL The first session was a policy debate concluding that the economics of more reliable and functioning HIS/e‐Health justify efforts to increase political will, leadership, governance, and effective management by government. Even greater success can be achieved with better coordinated development partner support will result in quantifiable HIS/e‐Health returns on investment. Data management and innovative public health GIS mapping and applications were shared as well as a description of the future AeHIN GIS lab concept within the context of the newly launched Regional Enterprise Architecture Council for Health (REACH) and Community of Interoperability Labs (COIL). This was followed by an overview of MA4Health Country Roadmap followed by country delegate workgroups to catalyze discussions and suggest M&E, HIS, and e‐Health priority actions towards achieving UHC and the health SDGs. Next was a development partner forum where techniques were discussed for accessing funding and understanding current and future investments in HIS and e‐Health by agencies (WHO, ADB, UNICEF, GIZ, JICA, PATH, The Bill & Melinda Gates Foundation). The main conference concluded with AeHIN, country, and partner commitments—including expressions of interest in pursuing MA4Health country roadmap development, AeHIN MoUs with the Pacific Health Information Network (PHIN) and the Africa Network for Digital Health (ANDH); the launch of and country/AeHIN member participation in REACH, COIL, the GIS Lab, an e‐Health evaluation focus group; development partner continued support for AeHIN; a response to the MA4Health Call to Action; and outline of planned activities heading into 2016.
Day 4 (morning): Field Trips With the help of BPJS (Indonesian social health insurance provider), delegates were brought to four sites for a half‐day site visit—(i) a BPJS regional division office; (ii) a district hospital that had deployed integrated HIS (DHIS2 software) and BPJS information systems; (iii) a primary care clinic using a BPJS‐ provided cloud‐based Web applications; and (iv) a primary care clinic using paper‐based registries and reporting forms and in the process of integrated with ICT‐enabled HIS. Delegates had the chance to see how their systems work and how person registrations are done.
Day 4 (afternoon) and Day 5: Post-Conference Workshops 1. National Health IDs Workshop Health, civil registrar, and statistics professionals discussed concrete steps for building capacity and investing in unique ID schemes and link CRVS and UHC. Guidance to overcome barriers, such as data security and interim approaches such as building a master person index (MPI), were addressed. 2. AeHIN GIS LabWorkshop Participants learned the value of data management, geospatial analysis in health, and how to use Esri GIS tools in support of UHC—such as equity and access to health services. The AeHIN GIS lab was launched, including free subscriptions to the ArcGIS online platform for AeHIN, access to free and low cost software, and opportunities for capacity building, and a GIS community of practice using GEONet. 3. Indonesia M&EWorkshop The Indonesia delegation discussed findings of their M&E systems analysis and planned key actions to strengthen HIS. 4. REACH and COIL AeHIN launched two strategic initiatives at MA4HealthAP to build regional and national e‐Health architecture expertise and establish a community of practice for HIS/e‐Health technical support leading to standards‐based, interoperable, and durable solutions.
Major Conference Outcomes
• AeHIN formal response to the MA4Health Call to Action to support transitioning from MDGs to SDGs and national UHC agendas • Country commitments made towards strengthening M&E systems, HIS, CRVS, and e‐Health in line with the iCTen, Call to Action, and Country Roadmap for Measurement & Accountability • Launch of REACH, COIL, and AeHIN GIS lab • Initiation of e‐Health evaluation, RHIS, and DHIS2 focus groups • Identification of HIS/e‐Health capacity building priorities for AeHIN and partners to support in 2016 • AeHINMoUs with other networks, PHIN (Pacific) and ANDH (Africa) • 87% of participants rated the conference ‘excellent’ or ‘very good’ and the remaining 13% rated it ‘good’
Conference Summary Ms. Jane Parry
Conference on Measurement and Accountability for Universal Health Coverage in the Asia Pacific and AeHIN 4th General Meeting, Bali, Indonesia. October 26-30 2015 The five-day event comprised a three-day main conference and two days of site visits and focused workshops. The week took participants along a path from examining the problems of developing an ICT-enabled health system to formulating country-level and regional solutions. The goals of the conference were: • To review the current evidence on cost, benefit and impact of ICT-enabled solutions • Initiate the development of monitoring and evaluation systems and investment plans by operationalizing country roadmaps for health measurement and accountability in accordance with the MA4Health Five-Point Call to Action and the ICTen! • Share, learn and prepare to implement. An overarching theme was the role of ICT for health as countries transition from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). Whereas the MDGs fostered a silo-ed approach to specific health issues, the health-related SDGs have a clear focus on equity and demand measurement and accountability for achieving the SDG targets. Both these factors put the role of ICT at the forefront. The conference made heavy use of innovative and interactive tools to ensure a high level of participation by all, including app-based, vote-driven questions for the plenary sessions, live demonstrations, a marketplace for eHealth innovations; and field trips to health facilities on Bali. After opening remarks by representatives the Government of Bali, WHO, UNICEF and ADB, and a keynote address by Dr Untung Suseno Sutarjo, secretary-general of the Ministry of Health, Indonesia, the first plenary session of the conference considered the current state of play as countries transition from the MDGs to the SDGs and examined the role of ICT in the post-2015 development agenda. The role of governance was also examined in more detail in plenary and three parallel sessions looked at the state of the art in measurement and accountability for universal health coverage from the perspective of (i) ministries of finance, planning and ICT and development agencies; (ii) health social protection and eHealth experts; and (iii) ministries of health, central statistics offices and civil registrars. The marketplace section of the conference presented 22 different eHealth architecture tools and solutions, enabling presenters to engage with smaller groups of participants and enabled participants to focus on interventions that were of particular interest. Topics covered in the marketplace included electronic health records, civil registration and vital statistics, geographical information systems, and open source software solutions for health information systems (HIS). 9
On day two the conference moved away from setting the scene and presented solutions. The first plenary looked at the challenges of empowering national HIS/eHealth executive and management teams. A live demonstration showed how existing open-source digital health interoperability solutions can bring about better care, using a scenario of maternal/child health to illustrate the role for digital health solutions in continuity of care. Participants could see in real time how a barcode-based unique health identifier can be created at any point of care, and the information shared not only with national databases but also with other points of care in different locations and over time. Parallel sessions gave participants the opportunity to explore the challenges and successes to date in implementing the ICTen!, created at the AeHIN conference a year earlier. Three groups examined finance and investment actions, health actions and ICT actions. Across three groups common challenges were the need to have national policies and a governance framework in place before attempting to introduce new technical solutions; and challenges in creating a sufficient workforce of ICT professionals with an understanding of health, and vice versa. Lack of direct evidence to demonstrate actual health outcomes of ICT for health also makes it difficult to make the case for investment, either of financial resources by government, or human resources by already overburdened health care workers. The lack of interoperability between existing HIS systems and the challenges of building on legacy systems were also raised, as were privacy and human rights issues. On the final day of the conference the penultimate plenary session explored the economics of HIS and eHealth. The final plenary, a development partner forum, brought together panelists from WHO, ADB, JICA, PATH, The Bill & Melinda Gates Foundation, Norad, and GIZ. This gave participants an invaluable opportunity to better understand the particular focus of each agencyâ€™s work in the field of ICT to UHC, and learn more about how to engage them as partners. Parallel sessions took the discussion about how to move forward to the country level. Most countries represented have a national health plan and a monitoring and evaluation plan in place but there is still much to do, from the level of basic civil registration, through data collection and management to fully ICT-enabled HIS and continuity of care. National groups each developed their own set of concrete priority actions to work on in the coming year. In addition to the main conference, there were four site visits: (i) a BPJS (Indonesian social health insurance provider) regional division office; (ii) a district hospital that had deployed integrated HIS and BPJS information systems; (iii) a primary care clinic using a BPJS-provided cloud based application; and (iv) a primary care clinic that has not yet integrated its HIS. Post-conference workshops then ran for the rest of the week, including sessions on: GIS in support of UHC; establishing a routine HIS network for Asia; unique identifiers/national health ID training; a national M&E workshop for Indonesia and Pacific Health Information Network meeting. â€ƒ
DAY 1 – OCTOBER 26, 2015 Welcome Remarks From the AeHIN: Dr. Boonchai Kijsanayotin Asia eHealth Information Network
Excellencies, Distinguished Delegates, Ladies and Gentlemen, Good morning. My name is Dr. Boonchai Kijsanayotin. I am a health informatician and co-chair of AeHIN. I am delighted to be here with you this morning for the Conference on Measurement and Accountability for Universal Health Coverage in the Asia Pacific and AeHIN 4th General Meeting. Please allow me to express my deepest thanks to people who has met the challenge foisted upon them for organizing this Conference. I am grateful to the Ministry of Health (MoH) of Indonesia and the BPJS who have accepted our invitation to convene this Conference, here in Bali. I extend my special greetings and best wishes to all the people who made the journey to Bali from different continents, to be with us today. Since its inception in 2011, AeHIN has fostered relationship-building between its members with the goal of developing an environment for strengthening country Health Information Systems and eHealth through effective human capacity development, collaboration and cooperation towards regional interoperability. AeHIN now comprises over 600 members from more than 20 countries in South, Southeast Asia and the Pacific. We are all part of a community where each member is bound by a strong AeHIN spirit, “If we help friends, friends will help us”. It is in the spirit of AeHIN to work together and hence, AeHIN maintains affiliation with the several networks such as Pacific Health Information Network (PHIN ), Africa Network for Digital Health (ANDH), the Joint Learning Network ( JLN ) for Universal Health Coverage and the Routine Health Information Network (RHINO). This kind of cooperation will help us to learn from each other, and we have much to gain by working together, and sharing knowledge. The focus of the Conference on Measurement and Accountability for Universal Health Coverage in the Asia Pacific (#MA4HealthAP) and AeHIN 4th General Meeting is to gather state and non-state actors to discuss how they can improve health information systems, health service delivery and measure health outcomes in the post-2015 development era. It is actually built on previous AeHIN conferences that have spurred interest in ICT-enabled change in health services and effective M&E systems to achieve UHC goals. This year’s Conference seeks to galvanize a multi-prong approach to better health care with stronger political will and unified multi-stakeholder engagement needed for operationalizing ICTen! Practices. These underpin better M&E and health information systems for evidence-based decision-making. It is hoped that through this Conference, government officials and professionals from over 20 countries have another opportunity to understand in more detail what it will take to deliver #MA4HealthAP results that are cheaper, faster and better using effective digital health solutions. 11
Please note that the agenda of the Conference covers a wide range of very interesting topics relating to the short- and long-term M&E, HIS, civil registration and vital statistics (CRVS), and eHealth investments and capacity building actions intended to impact on UHC. The schedule over the next days will be intensive yet productive. We have three parallel sessions on day 1 and day 2, 18 â€˜stalls in the market placeâ€™, plenary sessions for the first three days, followed by four special side meetings to be held starting in the afternoon of the 4th day and concluding on day 5, Friday 30 October. The Conference includes sessions such as Measurement and Accountability - State of Art, the role of governance, empowering the National HIS/eHealth Executive and Management Teams, Challenges and successes with implementing the ICTen and the policy debate on economics of HIS and eHealth. In addition to the those sessions, there will be live demonstration on Digital Health for Better Care and the market place which provide architecture and other digital health solutions. A very concrete example of what AeHIN can do is the Health Information Systems Strengthening Workshop hosted at Nay Pyi Daw, Myanmar last August. Upon the request of the Ministry of Health Myanmar, we organized a workshop with different sectors from Myanmar such as ICT, Planning, and Social Protection and showed how they can build good national health information systems with governance, enterprise architecture and standards. While AeHIN has been involved in organizing for this Conference, and sessions, it is your input that will determine its success, and benefits to eHealth community. I hope that this conference will be an enjoyable and productive opportunity for you to meet and discuss with AeHIN members, development partners, and international organizations. Having given the Conference overview, I am pleased to introduce our lead facilitator Oliver Gehlen, who will support, and make sure the achievement of goals of this Conference.
From the Province of Bali: Dr. Ketut Suarjaya, MPPM Head of the Provincial Health Office Bali Province Republic of Indonesia
Om Swastiastu, may God bless as all. First of I would like to thank the God, Ida Shang Hyang Widhi, because through His blessing we can gather here to attend the opening ceremony of the 4th AeHIN General Meeting and Asia Pacific Regional Workshop on Measurement and Accountability for Universal Health Coverage here in Bali. Welcome to Indonesia, especially Bali. On this very special occasion, let me extend my gratitude and sincere appreciation to the organizing committee for choosing this wonderful island of Bali as the place for such important event. I hope in this meeting we further Universal Health Coverage. Ladies and gentlemen, the Province of Bali has a motto – to advance, secure, prosper, and maintain peace in our community. Health is our priority because only in a healthy condition that we can learn and work, to be a strong nation. The health care system in Bali is enhancing the quality health for our community. In 2010 we implemented the Health Insurance Program of Bali. This ensures that everyone without health insurance gets complete health care in all government health services. In 2014 Indonesia launched the Universal Health Coverage program. Gradually, the local health system will integrate more with the national health care system, and local health coverage with contribute nationally. By 2019 all Indonesian people will have health insurance and can use all the health facilities that exist in Indonesia. Ladies and gentlemen, we hope that through this program, aside from giving equal access to health care services, we can improve health care systems. By uniting human resources of health – all physicians, nurses, and other professionals – to work together to improve the access to health services, more efficient use of resources including health human resources, satisfaction of work providers and partners, and result in better health. I hope this meeting and workshop will provide further knowledge and be beneficial for all of us to achieve universal health coverage. Ladies and gentlemen, to all participants, especially for those who have travelled from overseas, I would like to share my warm welcome to Bali and we hope the atmosphere of Bali could be motivating. Finally with God’s blessing, we wish this meeting and workshop will be successful and may all of you have a wonderful and memorable time in Bali. Thank you very much. Om Santi Santi Santi Om 13
From the WHO: Dr. Khanchit Limpakarnjanarat WHO Representative to Indonesia
Excellency Minister of Health, Prof Nila Moeloek, Dr. Alvin Marcelo, Chairman of Asia eHealth Information Network, Co‐organizers from AeHIN, UNICEF, ADB and WHO colleagues, distinguished speakers and conference delegates: It is my pleasure to welcome you all to this important meeting on Measurement and Accountability for Universal Health Coverage in the Asia Pacific and the Asia fourth General Meeting of the Asia eHealth Information Network (AeHIN). As you already are aware, the Measurement and Accountability for Universal Health Coverage in the Asia Pacific and AeHIN meeting is being co‐organized by AeHIN, WHO, UNICEF, Asian Development Bank and other partners and is graciously hosted by the Ministry of Health, Indonesia. I am pleased to note that this meeting is being held at an opportune time, very soon after the endorsement of the Sustainable Development Goals and Indonesia’s participation in the Measurement for Health Conference in Washington early this year. I believe some of the other countries represented here, also participated in the Washington meeting. Key documents that came out of the M4H Washington meeting are the Call for Action and the Roadmap. The world attention and focus has changed from MDG’s to SDG’s and we are supporting Indonesia response to the Measurement and Accountability for Results in Health. I am glad to note that Indonesia embarked on actions needed for establishing these protocols at the national level by work being carried to develop the National Roadmap for health measurement and monitoring and evaluation of sustainable development goals. This meeting is timely and important to not just Indonesia but also the many countries represented here. I believe the meeting will offer government officials and professionals the opportunity to understand in more details what it will take to deliver results that are cheaper, faster and better, using effective digital health solutions. Participants will also be able to share experiences and information and identify solutions for their own situations. I am pleased that Indonesia is hosting this meeting and that WHO has the opportunity to be a part that support this important not just because it is being held in this beautiful island of Bali, but also because Indonesia will have the opportunity to showcase its efforts to streamlining the information for good governance and better investment in ICT being made to support the recent development in its Universal Health Coverage programme. It is a great pleasure for me that WHO is able to be part of this important process. I wish you fruitful discussions and exchange of learning. I hope that it is not all only about the meeting and that you are also able to see a bit of Indonesia, a bit of beautiful Bali.
From the ADB: Mr. Steven R. Tabor
Country Director, Indonesia Resident Mission, ADB Distinguished guests, ladies and gentlemen, on behalf of the Asian Development Bank I am delighted to welcome you to this conference on Measurement and Accountability for Universal Health Coverage in Asia and the Pacific. I would like thank the Indonesian Ministry of Health, WHO, UNICEF, and the Asian eHealth Information Network who, together with ADB, organized the conference. I also want to gratefully acknowledge the support of our numerous development partners, who are with us today. This conference focuses on issues that are of key importance to ADB: universal health coverage, and information and communications technology, or ICT. And so I am particularly happy to have the honor of opening this event. More than this, ICT in development is also something very close to my heart. I was involved in developing ADB’s first ICT for development strategy back in 2003. I have also seen throughout the course of my career across Asia, Africa, and Latin America the transformative power of ICT, both socially and economically. ADB’s ICT for development strategy grew from a clear understanding: ICT can help to shape the social and economic development of Asia and Pacific. It has the potential to help developing member countries leapfrog stages of economic development. In health, ICT has a crucial role to play in the reform of our region’s health systems. The three elements of universal health coverage: equitable access, quality services and financial protection, all benefit enormously from the deployment of ICT solutions. The evidence is already in: used effectively, ICT improves health service delivery, leads to better health governance, and ensures that policy decisions are driven by accurate and timely data. It’s important to remember that ICT is not a health intervention in its own right. ICT is a tool, to ensure that health systems perform well for the greatest good of the population, making the best possible use of available resources. It’s very important that the countries in our region reaching for universal health coverage develop a solution-oriented digital health infrastructure. Investing in digital infrastructure for its own sake is not the answer. Instead, it is important that we always ask ourselves: what is the problem for which we are seeking a digital solution? These problems span the entire health system and beyond. Countries need accurate, timely data on population health, including civil registration and vital statistics, as well as on specific health issues. At all levels of the health system, data must be collected, disaggregated and analyzed in ways that makes it easy to share. It must promote interoperability with other parts of the health and social protection systems. ICT solutions pave the way to sound health system governance and accountability. They can 15
capture health data in new ways and use evidence for planning and for financing health. The data revolution, based on open standards, is already transforming the ways in which disease surveillance and risk assessment are conducted. It is empowering decision makers with real-time reporting of health statistics. All these aspects of ICT for universal health coverage will be no doubt be discussed in the coming three days. But this conference is not simply a talking shop. Many of you will have attended a similar conference last year, on Measuring and Achieving Universal Health Coverage with ICT in Asia and the Pacific, hosted by ADB at our headquarters in Manila. Participants at that event hammered out the priority actions needed to further the use of ICT in achieving universal health coverage. The consensus on the top ideas that emerged from that process, became the ‘ICTen’: interventions with impact that participants could then take home and begin to implement in their own country’s health system. In June this year, countries, global health leaders, civil society and development partners gathered in Washington, DC for the M-A-4 Health Summit to build a common agenda to improve and sustain measurement and accountability for health systems. The Country Roadmap for Health Measurement and Accountability, and the Five-Point Call to Action, that came out of that event, together with the ICTen are the foundation stones of this conference. This event has similarly ambitious goals: to review the hard evidence on the cost, benefit and impact of ICT-enabled solutions at all levels of the health system. To operationalize the ICTen and the Country Roadmap for Health Measurement and Accountability. To share your first-hand experiences, learn from others and prepare to implement ICT solutions towards achieving universal health coverage. With 30 years’ experience in Indonesia’s development, and since June as ADB’s Country Director, I continue to be both gratified and impressed by the tremendous progress that the country has achieved and continues to achieve. Indonesia is an excellent and appropriate choice of venue: I am sure this event will prove to be a gratifying experience for you all. I wish you all a stimulating and productive conference. Thank you.
From UNICEF: Ms. Gunilla Olsson UNICEF Country Representative to Indonesia
Good morning, distinguished guests and delegates, colleagues from the UN family, the Asian Development Bank, the World Bank, development partners including members of the Asia Pacific eHealth Network, ladies and gentlemen. On behalf of the UNICEF Regional Office as well as the Indonesia Country Office, please accept my warmest welcome to all of you this morning, particularly those of you who have travelled from other parts of the region and beyond. I would like to especially thank the Ministry of Health of the Republic of Indonesia for hosting this important event. This is a very special time in history for all of us working in international development. The last quarter of this year sees the end of the MDG era and the transition into the SDG’s – goals that will drive what we prioritise and do over the next fifteen years. It will be a critical time to build on the lessons of the MDG era and challenge ourselves to strive for exponential rather than linear progress. New technologies and innovations mean that we can do things differently with greater efficiency and effectiveness. The fact that the 2030 agenda, the SDG’s, cover wider ground than the MDG’s and includes an explicit focus on equity means that we can ensure a more comprehensive approach to development, including the establishment of accountability mechanisms. Moreover, the shift in focus from national data to subnational data including all population subgroups provide opportunities to track progress in closing equity gaps. Persisting inequities are a major concern not only for UNICEF, but for all governments and development partners. There is now a large body of evidence highlighting the persisting bottlenecks to reducing disparities in health care including policy gaps, supply and access challenges and very importantly demand side barriers and quality gaps. Our challenge is to work more deliberately to address the specific bottlenecks in each context. There is tremendous diversity in the region and bottlenecks differ radically in different countries and different parts of the same country. Indonesia, for example, is a country of 250 million people, spanning three time zones. Consequently, within this fascinating country the context varies widely and requires tailored approaches for each different context. But, in order to make best use of limited resources and to tailor approaches for maximum impact, DATA is critical. Data is essential to ensure that our approaches are evidence based and are targeting the right elements to resolve ongoing bottlenecks. That is why this workshop is extremely important and timely. 17
The potential to use state-of-the art ICT for eHealth backed up by appropriate legal frameworks could be really powerful in providing the required data for decision making and for tracking progress. In addition, the potential of adopting National Health IDs, particularly linked to Universal Health Care and Civil Registration & Vital Statistics (CRVS) is very exciting. Most of the countries in our region have now committed to UHC and CRVS and it is our collective responsibility to ensure that the most vulnerable are not left out and do not remain ‘invisible’ in our respective societies. We can now explore how some of these new technologies and approaches can help ensure that Universal Coverage is indeed ‘Universal’ and thus true to its name. Over the rest of the week, we have the opportunity to learn from each other’s experience and explore how ICT and digital health can be used in our respective countries. We have to remember that we seldom start with a clean slate. All new initiatives in information and data management are layered on a series of previous initiatives and interoperability could pose challenges. I also hope that we can attempt to address lingering concerns about confidentiality and privacy when personal information is collected and retained. We have to ensure that the principles of ‘Doing no harm’ remains at the top of our mind as we move forward. With your participation, from as many as 30 countries, from the Asia Pacific region as well as from countries in Africa, I am confident that we have the right people in the room to deliberate on the topic of ‘Tools for the Measurement & Accountability of Universal Health Care’. I would also urge us to forge links and partnerships beyond the health sector as we acknowledge the role of other sectors in addressing complex problems like maternal mortality and stunting. Finally, this is an opportunity to also link with our colleagues from civil society and the private sector towards a common goal of improving the status of women and children’s health. I wish you a very productive week and I hope you will also have an opportunity to enjoy the charms of this wonderful island.
Keynote Address from Indonesia Ministry of Health Secretary-General Dr. Untung Suseno Sutarjo, M.Kes Republic of Indonesia
I thank AeHIN for selected Bali Province as a meeting venue for the Conference on Measurement and Accountability for Universal Health Coverage in the Asia Pacific and AeHIN 4th General Meeting. The large numbers of population (240 million) of Indonesia affects national development especially the health development. The President of Indonesia has decided on nine priorities for his development agenda – called Nawa Cita – for his presidency from 2014 until 2019. One of them is to improve the quality of life of the Indonesian by improving the quality of education and training through “Smart Indonesia” program and improving Indonesia’s social welfare and health programs. Indonesia is updating data and information activities for public health services by targeting all health facilities to be the online, increasing from 40% in 2015 and 100% of community health centers and hospitals by 2019. This means adoption of electronic information systems and communication technology is really needed. Establishing strong health information system is expected to improve health development. The President of Indonesia is concerned about ICT improvement in all development sectors. We realize that developing an integrated and comprehensive information system that enables health measurement require immediate urgent action. The biggest challenge Indonesia will face is the fragmentation of existing health information system within the national health information system. For example HIV, Malaria, TB, and immunization program have different health information systems. To make any country health information system sustainable, we will need to unite all the separate systems into a unified national health information system. In moving towards a new and advanced system, interoperability is needed. In many countries they have not implemented this advanced interoperable systems yet. Therefore, it is important for each country in the global community to support and to be supported in implementing efforts to improve and link systems so that health information is available for national development.
Where we are now, transitioning from the MDGs to SDGs:
Measurement and Accountability for Health in the Post-2015 Development Agenda and the Role of ICT Moderator: Prof. Vajira Dissanayake President Health Informatics Society of Sri Lanka, Sri Lanka Panelists: Dr. Deddy Kuswenda Director, Primary Health Care, Ministry of Health and Task Force for SDGs, Indonesia Dr. Fahmi Idris, M.Kes Chief Executive Officer Badan Pengelenggara Jaminan Sosial Kesehatan, Indonesia H.E. Dr. Thein Thein Htay Deputy Minister Ministry of Health, Myanmar Dr. Susann Roth Senior Social Development Specialist Asian Development Bank, Philippines Dr. Samuel Mills Senior Health Specialist Health, Nutrition & Population Global Practice World Bank Group, United States Objectives • Share experiences with measurement and accountability for health in your country. • Share insight about the Post-2015 Development Agenda and the SDGs. • Share perspectives or lessons learned from MDGs that can inform the new measurements for accountability for SDGs and what you perceive will be the role of ICT.
Summary of Discussions The MGDs are a useful tool in focusing achievement of specific development gains as part of a broad development vision and framework for the development activities. The panelists also emphasized that sustainable development goals should be action oriented, concise and easy to communicate, limited in number, aspirational, global in nature and universally applicable to all countries while taking into account different national realities, capacities and levels of development and respecting national policies and priorities. The Roadmap and Call to Action provided the platform for progressive and meaningful discussions during the Summit. It articulatied a shared strategic approach to support effective measurement and accountability systems for health programs at the country level. The 5-Point Call to Action proposes priority actions and specific targets for health measurement and accountability for post-2015 that will enable countries to monitor implementation of the Roadmap. The Roadmap aims to ensure that countries have the necessary information and local capacity to plan, manage and measure their health programs as well as monitor and achieve their national health goals and the health related Sustainable Development Goals (SDGs). Advancing Universal Health Coverage (UHC) is driving health sector development plans of many developing countries in Asia and the Pacific and is expected to be a key component of the post2015 sustainable development agenda. As information and communications technology (ICT) forms the backbone of UHC monitoring systems, ICT investments towards measuring and achieving UHC is essential for this to be a reality. The Indonesiaâ€™s UHC program are already engaging various social health insurance schemes under one fund-management agency called Health-BPJS. The objectives of the UHC in Indonesia are: To enable people accessing healthcare services without financial hardship; To perform cost contained and quality controlled healthcare services; To strengthen healthcare services at primary and referral health facilities; To prioritize preventive and promotive measures in rendering healthcare services to reduce prevalence of diseases, lower the numbers of sick-people with efficient healthcare services. Myanmar is at a turning point, with far-reaching implications for its health sector. The policy options for UHC in Myanmar remain myriad, but paths will be more certain after the upcoming national elections. Most immediately, significant investments will be required to rebuild the primary health care system and expand its geographical coverage. Questions raised by audience through the Pigeonhole 1. For countries that have not achieved or are near to MDGs, how do they prioritise and set their SDGs when there are still unmet goals? 2. Are there new health SDG targets not part of the MDGs that you feel will change or improve service delivery? 3. What is your most important lesson from the challenges of MDG reporting? How are you addressing this for the upcoming SDGs? 4. Set indicators driven at global level sometimes forfeit the purpose of building accountability and ownership at local level. How can we improve ownership of indicators? 5. What are the most important indicators for evidence based evaluation and assessment to support financing of eHealth?
Measurement and Accountability for Health: State-of-the-Art Overview In preparation for the Post-2015 Development Agenda, parallel sessions were conducted to provide an avenue for discourse on measurement and accountability for health among three groups: 1) Ministries of Finance, Planning, ICT, Development Agencies; 2) Ministries of Health, Social Protection Agencies, eHealth Experts; and 3) Ministries of Health, Central Statistics Offices, Civil Registrar. Objectives • Share country/ agency initiatives on current state-of-the-art on measurement and accountability for health • Share country/ agency experiences with preparations for the Post-2015 Development Agenda and SDGs • Share investments strategies for the new measurement and accountability system
1. Ministries of Finance, Planning, ICT and Development Agencies Moderator: Ms. Lori Thorell Senior ICT Programme Specialist United Nations Children’s Fund Regional Office for East Asia and the Pacific Panelists: Dr Eduardo Celades Technical Officer on Strategic Planning, Monitoring, and Evaluation World Health Organization Headquarters Topic: Health Targets and Indicators in the SDGs and Roadmap for Health Measurement and Accountability The MDGs have been successful in such a way that has few goals and targets, and that it is widely accepted. Its limitations, on the other hand, include variable progress, lack of equity focus, vertical approach, and an unfinished agenda.
For the forthcoming SDGs, highlighted are the aspects of people, planet, prosperity, peace, and partnership. Achieving SDGs will now be much more a country-led process, which is â€œintegrated and indivisibleâ€?, yet global in nature, and universally applicable. The ongoing debate now for health in the SDGs is the two different approaches to attaining these, namely, the health target-oriented agenda versus the holistic view of health and its links with other goals. There are five considerations for health in the SDGs: 1. Having one health goal might be sufficient SDGs are very broad and complex, but health is in a relatively good place. From three out of eight health-related goals in MDGs, there is now one out of 17 health-related goals in SDGs. There are only about 20 health indicators out of over potentially 200 SDG indicators. There is a comprehensive set of targets for health; it has with multiple linkages to other SDGs, with health as a contributor (to other non-health target/s) and as beneficiary (of other SDGs/ targets when these are reached). This makes health a critical measure of overall development. Hence, SDG health-related targets align well with global plans of action that have been developed. 2. Health targets relate to each other And health is linked to many SGDs and targets
The second consideration is that Universal Health Coverage provides a platform for an integrated approach to SDG health-related targets. This should be an opportunity to avoid the compartmentalized approaches to MDGs, where strategies to address the concerns were created almost independently of each other. 3. â€œBusiness as usualâ€? vs a deeper debate about health architecture The MDG stimulated fragmentation of programmes within the health sector. For the forthcoming SDGs, agenda needed to be proactive in reducing fragmentation, and in promoting integrated people-centred quality health services within the context of UHC. The SDG agenda provide a critical opportunity to consider health in a much more holistic manner, in such a way that health is integrated with the economic, social and environmental goals, such as the financing and production of global public goods, and improvement of cross-border health security. 4. Not clear yet how the SDGs will influence financing for health Full implementation of the agenda is estimated by UN to be around US$3.3-4.5 trillion per year. However, it must be noted that estimating the costs of some of the aspirational targets will remain imprecise; it is even difficult for the more established targets including health. SDG will be largely financed from domestic sources and market-related borrowing, and not from development assistance. Countries must be able to take into account more investments and alignment to effectively monitor health-related targets in the SDGs. 5. There will be a growing focus on monitoring and accountability at country level The fifth consideration is that while the SDG monitoring framework is likely to be complex, the health sector should use an integrated framework that assesses country progress towards SDGs. SDGs will be monitored at different levels. At the country level, civil society may use the SDGs to hold their governments to account. At the regional, greater focus will be centered on regional mechanisms of review. Lastly, at the global level, a high-level political forum will play a critical role in overseeing a network of review processes. Framework for monitoring the health goal requires a high-level health goal such as healthy life expectancy, a focus on progress towards universal health coverage, and a high-level assessment of progress towards the 13 health targets and selected determinants that influence health.
Dr Maria Rosario Vergeire
Director III, Health Policy Development and Planning Bureau Department of Health Philippines Topic: Aligning the Philippine National Health Objectives with the Post-2015 Development Agenda Dr. Maria Rosario Vergeire discussed the Philippine experience in aligning National Health Objectives (NOH) with the post-2015 development agenda. The NOH is the Philippinesâ€™ strategic health plan. It contains what the health sector seeks to achieve (i.e. goals, targets) and how these can be accomplished (i.e. measurable indicators, targets, and strategies).
It provides the “road map” of key ideas, targets, indicators and strategies to bring the health sector to its desired outcomes. It also defines the collective and individual roles that the various stakeholders play in shaping the future of Philippine’s health system and in bringing better health outcomes for the people.
A Technical Working Group formed by the Department of Health within the Health Policy Development and Planning Bureau is in-charge with the formulation of NOH by following core processes. The NOH is set every five years with the theme Kalusugan para sa Masa or “health for the poor.” For 2011-2016, the NOH address remaining gaps and challenges on health inequity. It contains the operational strategy called Kalusugan Pangkalahatan (KP) which aims to achieve universal health care for all Filipinos, as fulfillment of the Aquino’s “social contract” of advancing and protecting public health. The Aquino Health Agenda focused on three health goals with corresponding components: 1. Financial risk protection: PhilHealth coverage, utilization, support value 2. Access to quality health care: health facilities, pharmaceuticals, and health human resource. 3. Better health outcomes: health-related MDGs, communicable diseases, NCDs, health risks and disasters, and health specific population groups The Philippine Department of Health (DOH) measured the MDG-related indicators and added supporting data needs and strategies to meet them. Specifically, for child health (MDG 4), the key strategies were immunization and child-survival services. For maternal health (MDG 5), the key strategies were maternal health services, control of STI, and reproductive health services. For HIV/ AIDS, TB, Malaria (MDG 6), the key strategies were HIV testing, counseling, and treatment.
The most recent assessment of National Economic Development Authority (NEDA) and the National Statistical Coordination Board (NSCB) found that the country is on track to meet the 2015 MDG targets with respect to reducing infant and under-five mortality, reversing the incidence of malaria, increasing tuberculosis detection and cure rates, and increasing the proportion of households with access to sanitary toilet facilities.
Facilitating Factors for Achieving the MDGs in MOH The Philippines implemented a significant number of initiatives to create an environment to facilitate attainment of the MDGs in the country. These are: 1) clear vision, targets, indicators; 2) supporting policies, programs, and projects; and 3) engagement and partnerships with other sectors. Barriers for MDGs in MOH Some barriers determined for MDGs in NOH are mostly related to the indicators. These are 1) no established/ accepted data sources; 2) lack / poor quality of local data; 3) timely information not available; and 4) regional/ international comparison difficulty. Proposed Statistical Programs for 2015-2017 To address the issues on indicators experienced with MDGs, the Philippines through the Department of Health and the Philippine Statistics Authority proposes statistical programs for 2015-2017: 1) expenditure breakdown to make Philippine National Health Accounts internationally comparable; 2) improvement of critical periodic surveys; 3) improvement of administrative reporting systems; and 4) methodological studies on health-related indicators. SDG Role in the Philippine Development Plan (PDP) and NOH 2017-2022 For post-2016, the NOH is currently being crafted, and the use of SDGs will be a key feature of this national strategy. Both NEDA and DOH are synchronously drafting the goals for the Philippines and the Health Sector for the next medium term plans. Reform areas of focus for the next NOH shall still use a health system approach. Previous components to capture the more comprehensive health system deliverables in the SDGs shall also be expanded such as 1) inclusion of financial protection indicators; 2) systematic measurement of tobacco and substance use, accidents, exposure to hazardous chemicals; and (3) areas shown by SDGs to support further (ie. health human resource and emergency response to health risks).
Dr Rofyanto Kurniawan
Director of Center for Budget, Policy, Fiscal Policy Agency Ministry of Finance, Republic of Indonesia
Topic: Managing Fiscal Sustainability of the Indonesia National Security Program Subsidy, investment, infrastructure, fiscal sustainability, and social protection are the major issues for Indonesia to face. Indonesia’s GDP growth slowed amidst the backdrop of also falling growth in other emerging economies, most notably China, which is a key commodities importer. Part of the growth decline was engineered by the administration’s focus on stability ahead of growth in this recent volatile market environment. Healthy growth in times of global deceleration is characterized by a focus on sustainability rather than absolute growth. Continuing Prudent Fiscal Policy A long-term fiscal policy program and a sufficient health insurance and pension fund will run a budget expenditure risk due to the increasing aging population. It must be noted that approximately more than 60% Indonesia’s population is below the age of 35 years, and dependency ratio will likely to decrease up until 2025. In line with this, a budget reform should achieve the tax collection target and increase tax ratio; efficient and productive expenditure; and institute structural change. Since there will always be a trade-off between infrastructure spending and budget deficit, promoting investment and PPPs, positive primary balance and controlling inflation, and fiscal responsibility must be observed. 27
Indonesia has a medium-term budgetary framework which projects budget components from 2016 until 2019. Tax revenue is also projected to increased in the medium-term, where improvement will come through bureaucracy reforms, organization and structural changes, and intensification of personal income tax. Also, the country strengthens the quality of spending to improve efficiency and spending productivity. Subsidy has become more efficient and as a result, capital expenditure increased significantly. National Social Security System â€“ BPJS Kesehatan
Indonesia started a social protection program, known as National Social Security System, which consists of health program and employment programs. Health program for all citizens started on January 1, 2014, with a goal of universal health coverage by 2019. The employment programs were started in July 1, 2015, consisting of four programs namely, work accident, term insurance, old age saving, and pension. The design of employment program is still being formulated with emphasis on pension. Since pension program can create a long-term fiscal sustainability risk, it needs to be carefully designed considering factors on sustainability, adequacy, and coverage or affordability. Managed by a single administrator, BPJS Health, the system aims to implement mandatory health program for all citizens gradually. The fiscal cost for GoI is the premium for civil servants, polices, and armed forces (as employerâ€™s responsibility) and premium for the poor. Currently, premium collected is smaller than benefit cost. National Health Insurance - Jaminan Kesehatan Nasional (JKN) First and foremost, to manage the sustainability of the national health insurance, there has to be a balance between contribution paid by the member and benefit given. This is exemplified by a high collectability ratio and a prudent method of contribution setting. Second, the Principle of Insurance or the law of large numbers must be observed by improving participation, particularly of the informal sectors. Third, high quality and robust service through the availability of supply side, managed care system, fraud prevention, and claim management; monitoring and evaluation through accurate data; and regulation should be practiced. 28
Challenges in Implementing Health Program Challenges in implementing the health program are ensuring membership and premium payment, instituting a managed care system, cost containment, regulation, and data accuracy. These challenges result to deficits in the health fund, wherein contribution becomes lesser than benefits payment. Ultimately, this situation affects the effectivity and sustainability of the program.
Some Discussion Highlights
The discussion centered on equity indicators used for the SDGs. To attain Universal Health Coverage, some of the measurement indicators for each sector should be certified such as sex, age, geographical access, and others. In terms of any specific gap reduction indicator, measurement does not solely rely on getting the ‘numbers’, it is also important to relate these numbers to preliminary targets. Aside from SDG indicators, the discussion also dwelled on the eHealth governance in the Philippines in terms of budget. In the case of the Philippines, the government has invested around 200,000 USD – 300, 000 USD for their eHealth program. In line with this, it is critical for ministries involved to work together to integrate programs and make it work.
2. Ministries of Health, Social Protection Agencies, eHealth Experts Moderator: Mr. Mark Landry Regional Advisor, Health Situation and Trend Assessment World Health Organization South East Asia Regional Office Panelists: Mr. Lito Abando IT Consultant to PhilHealth PhilHealth Office of the President & CEO Topic: Philippine Health Business Intelligence and Dashboard The Philippine Health Insurance Corporation (PhilHealth) use dashboards through a phased solution implementation approach to measure and account for accomplishments of the country’s national health insurance program. Report Analysis: Needs and Pains While PhilHealth performance, service compliance, and management reports are growing, an integrated reporting system – a “single version of the truth” – is not available. The critical problem is rooted on data processing. Pains 1. Performance, compliance, & management reports are growing 2. Integrated reporting (single version of the truth) is not available resulting in data silos 3. Timely reporting is not the norm – Adhoc reports are the norm 4. Reporting tools are insufficient for nationwide use and are expensive 5. Lack of self-service and collaborative reporting tools 30
• Replace minimum 20K reports with
automated reports for UHC primary care
• Integrated KPI’s, financials, etc. • Start reduction of at least 10 major national
–regional reporting silos • Start creation of production reports refreshed from daily-monthly • Transition from various reporting tools to recently-acquired enterprise information management suite • Commence use of new and common tool for self-service reporting
6. Reporting-data responsibilities and accountabilities are not well defined or enforced 7. IMS capacity to support Business reporting/ analysis needs is insufficient
• Sustain new data and report governance committee
• Reduce-eliminate current 6.7 day report/ data development turn-around-time
• Significant organization upgrade of IMS-BI team
The best step in rectifying the problem is to begin with improving the transaction system between the health provider and the patient. This should further good data analyses to produce integrated data. Aside from that, a “call to action” is needed to increase the level and efficiency of investment, strengthen the nation’s capacity, ensure data resources belonging to the country, maximize use of the data revolution, and promote national governance.
Emerging PhilHealth Analytics: Dashboard Solutions Key solution considerations are: 1.) end-to-end suite: data quality-master data-ETL-data warehouseanalytics-mining-visualization; 2) integrated strategic-operational reporting-analysis; 3) cloud and onpremise solution for availability-performance-load balancing-scalability-supportability; 4) support of Oracle, open-source, and other key PhilHealth technologies; 5) build once and deploy to mainstream devices (PC-tablet-smartphone) and OS (PC-IOS-Android); 6) compatibility with PhilHealth productivity and content management solutions; 7) self-service and collaborative; 8) conventional and emerging Excel technologies; 9) in-memory capabilities minus the complexity and cost; and 10) excellent ratings (Gartner & Others).
Business Intelligence Solution Framework Business Intelligence (BI) solution framework basically refers to a best practice step. The solution is based on the government and the system of how information is used as information. BI results from high-level data flow and plan. Best practice and incremental methods such as Kimball will be used in this plan.
Initial Plan and Target Timelines PhilHealth has set target timelines for the initial plan with regards to membership, claims, treasury, and contributions.
Centre for Health Financing Ministry of Health, Indonesia Topic: Policy of Health Financing in Indonesia Health expenditure in Indonesia is only 3% of the countryâ€™s Gross Domestic Product (GDP); this is still low compared to the standard set by the World Health Organization (WHO), which is 5% of GDP. With this situation, out of pocket spending has increased from IDR 42.3 trillion in 2005 to IDR 113.2 trillion in 2012. Healthcare proportion in the spending by the public, however, has reduced since 2005 when the government introduced health protection scheme for the poor, namely Askeskin and later named as Jamkesmas. It is expected that out of pocket payment will continue declining with the expansion of social security in health. Strategic Decision Demand for healthcare is expected to rise significantly in the next few years due to a combination of factors: 1) a growing population at a rate of 5 million per year â€“ about the size of entire Singapore; 2) an aging population, whereby 2025, the elderly population will almost double to 23 million; and 3) a changing disease profile. To improve health outcomes of the nation, it is important to improve health financing towards financial protection. The way forward is by implementing of National Health Insurance (NHIP). Social Security Law 2004 perpetuates the existence of these components: health insurance; accident insurance; old age pension; public pension; and life insurance.
Challenges and Solutions In terms of challenges in cost containment, an emphasis is made that there must be measures to avoid adverse selection, fraud prevention, utilization, health technology assessment, referral system, claim verification, prevention, and health promotion, and performance management wherein BPJS needs to mature into a strategic purchaser of health services. Meanwhile, challenges in governance can be combated by better identification of the poor, monitoring and evaluation systems for performance management, stakeholder communication in a complex system, and local government capacity as oversight body at the local level. In health services availability and quality, challenges may be overcome through infrastructure distribution, voluntary engagement of the private sector, improving HRH distribution and competency to improve the quality of care, and hospital accreditation. To address inequity, high utilization is observed in urban areas â€“ the rural communities must be engaged better. In terms of tariff setting and provider payment, there must be premiums. In the areas of data, development of grouper software must deal with coding and IT needs, case mix refinement, costing, quality and utilization review, updating, and monitoring of different system levels. Lastly, to fill the â€œmissing middle,â€? informal sector must be enrolled in the insurance. Health Accounts: Evidence for Health Financing Planning Health Accounts (HA) is a systematic, comprehensive and consistent way of monitoring utilization of funds or financing of health systems (health spending). This measurement strategy is adopted in the international community, through the WHO. The main benefits of the Health Accounts are to identify health intervention areas, propose health financing interventions as needed, monitor and evaluate interventions and reduce the possibility of health expenditures which do not fit needs and policies.
Updates In the Asia Pacific, there are five groups used to classify the institutional state of health accounts. In 2011, Indonesia is recognized as part of Group 2, consisting of territories with NHA systems intending to produce routine updates in future.
In 2013, personal health care expenditure per capita increased while prevention and public health expenditure per capita decreased. In the same year, hospitalization accounted for half of health expenditure in Indonesia, and there was low spending on infrastructure and health personnel in primary care. In the following year, 2014, Indonesia started NHIP, health system reform, strengthening in primary care system (Nawa Cita), and moving towards achieving a balance in public health spending. By 2019, NHA should show achievement in Universal Health Coverage. For almost two years, NHA data have been highlighted to inform various policy makers at the government in preparing law and technical regulation or guidance on Social Health Security Reform.
Dr Founkham Rattanavong
Deputy Director General, Department of Planning and International Cooperation Ministry of Health Lao PDR Topic: Leadership, Legal, Teamwork, and Financing: Transforming the Lao eHealth Landscape Lao PDR needs the power of information. Hence, the country also has to establish a legal framework for processing the information. From the Washington (meeting) results, the Ministry of Health has strengthened advocacy to the government and to the people on managing the shift to SDGs. However, it has been challenging to convince leadership in the country. A plan is now in place to show that data processing is not only to make information available at the national level but also can be used for convincing the local governments on health investments. On that point, they will need a good information system, and they will have to adjust the target of SDGs according to their finance resources as well. Leadership or legal bodies cannot work without public support. So, they have to work together if they want to go far in terms of our national goals.
Mr Dadang Setiabudi
Chief Information Officer BPJS Kesehatan, Republic of Indonesia Topic: Indonesia’s Journey to Universal Health Coverage with Information and Communication Technology BPJS’s vision in terms of achieving Universal Health Coverage is that by 1st January 2019, all Indonesian citizens must become members of National Health Insurance Program (NHIP). This means that by 2019, all Indonesians should gain access to healthcare benefits and protection. To fulfill this vision, BPJS has outlined these thrusts: 1) building strategic partnerships; 2) strengthening effective, efficient, and excellent health service; 3) optimizing fund management; 4) good organization governance; 4) considering risk management; and 5) strengthening communication and information technology. It is important to strengthen communication and information technology to support business operations. To support the UHC target, ICT takes a role in (1) membership enrollment, (2) health services, (3) premium collection, (4) enterprise data warehouse, and (5) IT infrastructure. Membership Enrollment For member enrollment, BPJS built a web portal application and provided username and password for a secure access to enrollees. In every new membership, they need to validate their national identity number before admission to the NHIP and access services. There are two types of enrollment: corporate and personal / individual membership. Benefits of ICT’s role in membership enrollment include (1) improved membership enrollment process, (2) more accuracy in data quality and transparency, (3) efficient business processes, (4) decreased queuing in branch offices; (5) less hardcopy printing of the registration forms, (5) improved premium collection, and (6) decreased costs for operations.
In a primary healthcare integrated system, ICTâ€™s role is critical in (1) real time online membership validation, (2) admission process (into whether the member is eligible for the service), (3) health services delivery (procedure, medicine, laboratory), (4) electronic referral (integrated with destination hospital) (5) fee for service claim (non-capitation benefits), (6) shared management program and disease management program, and (7) warning for non-special diagnose.
In a hospital integration system, ICTâ€™s role can be evidenced in (1) faster admission process, (2) improved data quality and accuracy, (3) improved claim accuracy to minimize rejection, (4) faster claim process, (5) support for coordination of benefit with private insurance, (6) electronic claim, and (7) claim transparency.
Premium Collection ICT has paved the way for a payment integration system in the premium collection of National Health Insurance. Enterprise Data Warehouse Through ICT, development of data warehouse has become possible. The data warehousing process comes in three phases, namely, extraction from transactional, transformation in the staging area, loading into a warehouse; Warehouse data is then presented in a cube or mart. This has also enabled the creation of premium collection and primary health care dashboards.
Network Communication and Infrastructure BPJS continuously strengthens and expands the communication network to support every service point in Indonesia.
Dr Alvin Marcelo
Member National eHealth Technical Working Group, Philippines Topic: Ensuring Accountability through IT Governance Frameworks The national government is the accountable party in the countryâ€™s MDGs and SDGs. Challenges they face include: (1) unclear reporting framework, (2) varying interpretations of the countries about MDGs, (3) unstandardized dimensions involved in the reporting such as facilities, locations, providers, etc., and (4) difficulty in integrating raw non-standardized data coming from different sources. Adherence to data standards across a country is the biggest challenge in ensuring accountability through investments in computerized systems among provider institutions.
AeHINâ€™s response to these challenges is the National eHealth Capacity Roadmap. Guided by this roadmap, the country must also be able to strengthen its national eHealth strategy. The Philippine experience is exemplified: the Philippine eHealth Strategic Framework Plan 2013-2020 is a joint technical document, work output jointly led by Department of Health (DOH) and Department of Science and Technology (DOST).
Governance Through this framework, a multi-sectoral governance body called eHealth Steering Committee has been formed, under the leadership of the Ministers of Health, and Science and Technology – organized to take care of ICT for health management nationwide. An IT strategy team was also created as part of this governance strategy called Technical Working Group under the Directors of the DOH Knowledge Management and IT Bureau and the DOST Health Research Council. Management An eHealth Program Management Office is appointed to manage technical requirements and provide staff support. It mainly takes care of the day-to-day operations of the Philippine eHealth Strategic Framework and Plan. This initiative is guided by the WHO National eHealth Blueprint and Strategy which is the master list of problems in all aspects of the strategy. IT Governance Framework To manage the complexity of merging health and IT, a country must adopt an IT Governance Framework. In the case of the Philippines, the National eHealth Steering Committee, with the recommendation of the Technical Working Group, approved the adoption of COBIT5 as its IT Governance Framework. Through AeHIN and development partner support, the technical staff has undertaken the IT governance (COBIT) training, which tackled processes for management of enterprise IT. The governance role is to evaluate stakeholder needs, provide directions, and monitor progress. On the other hand, the management role is to align, plan, and organize; build, acquire, and implement; deliver, service, and support; and monitor, evaluate, and assess. After the training, the IT governance framework has served as a guide for the Technical Working Group in implementing the Strategy. Yet there were still fundamentals to be addressed: stakeholders must be able to appreciate and strengthen IT governance, which navigates the complexity of eHealth. In ensuring government accountability, devising a strategy is an important first step to adopting an IT Governance Framework, which will serve to help MoH/MICT to manage eHealth development. It must also be highlighted that key staff on IT governance must also be well-trained.
Dr Susann Roth
Senior Social Development Specialist Asian Development Bank Topic: Donor Perspective: Infrastructure Investments - Foundations for National eHealth Development Dr. Roth started with ADB’s initiatives in terms of measurement and accountability for health and furthered with their experiences from SDG preparations. Finally, Dr. Roth discussed ADB’s investment strategies for the new measurement and accountability systems. ADB Initiatives on Measurement and Accountability for Health The initiatives taken by ADB in line with these infrastructure investments are technical assistance, loans, and regional knowledge sharing. 1.) Technical Assistance ADB in collaboration with WHO WPRO started supporting the development of a UHC M&E tool and UHC Dashboard to 1) provide a decision support tool for policy makers, planners, and managers; 2) visually presents KPIs in a highly simplified, summarized manner; 3) intelligently use data visuals (charts; traffic lights) to effectively inform on health situations, trends and progress towards targets; and 4) apply M&E tool in ADB’s health sector loans. 40
It is also important to note that ADB and WHO are guided by a Health System Performance Framework for achieving the health-related SDGs and UHC in the Western Pacific. This framework shows impacts and outcomes that may result from inputs and outputs.
Apart from the mentioned M&E initiatives, ADB also provides advisory services on standards and interoperability, courtesy of OpeNHIPE Group, to assess digital health investment needs. It supports operational research such as capacity development for geographic data applications for better health service delivery planning and calls data records as an additional tool to identify high malaria transmission spots, for instance. 41
2.) ADB Loans One facet of ADBâ€™s initiatives are the loans granted to countries to support measurement and accountability (of development investments). ADB has supported projects in different countries in the Western Pacific through ADB loans. Sample projects can be found at 3.) Regional Knowledge Sharing In the regional level, ADB collaborates with AeHIN to promote knowledge sharing in the field of eHealth.
Learnings from Supporting the Development of SDGs In 2004, ADB, ESCAP, and UNDP established a regional MDG partnership (). Key lessons in the MDG partnership include: 1) not enough, not always the right, and not timely data for planning, quality control and decision-making difficult; 2) data management silo-ed, often decentralized; 3) lack of standards and definitions indicators donâ€™t capture quality and equality of care; 4) access to medicine goal not measurablealso in SDGs difficult to measure, need proxy, tools not standardized; and 5) mortality data not always reliable- countries depend on donors, need to build national capacity.
ADB’s Investment Strategies for the New Measurement and Accountability Systems ADB’s investment strategies include a new operation plan for health, an eHealth flagship program, and an ICT for development project. 1. New Operational Plan for Health The new operational plan for health is a focusing-and-model building from best practices, knowledge sharing, and impact evaluation to strengthening health systems for UHC. 2. eHealth Flagship Program ADB is developing a flagship program building project on ICT in health and other sectors to increase efficiency, and improve management, speed and transparency (). 3. ICT for Development Project From 2000 to 2013, ADB’s ICT for development projects have accumulated to a total of 547 projects amounting to $17.67 billion. Some Discussion Highlights In working with different partners, Lao PDR’s eHealth landscape takes into consideration the importance of good leadership and governance. The government has to be strong and manages activities through policy and laws. It is very challenging to have different partners; and partnership is also very critical since SDGs management must be coordinated in the operational and technical levels. To convince the Prime Minister and other country leaders to share their information remain a big challenge. Through technology, the country can create bridges (with other sectors) and focus on the processes (of engaging others). Public confidence (in information sharing and ICT for health) is important as well. In Indonesia, they have worked with other sectors such as the Ministry of Social Affairs, which has programs concerning different poor and non-poor populations. That is the kind of collaboration the country does in order to identify the needs of the community. In the future, they will involve research institutions, universities, and other private sectors. Various sectors work together to produce the single unique ID; this is provided to citizens through the Ministry of Social Affairs. They also work with the Informatics and Communication Ministry in building the information system. On the other hand, government finds it a big challenge to work with a diverse population. The role of the country’s unified information system is to help eliminate a double IDs for a single person. With regards to the capability of information systems to cover difficult or remote areas in Indonesia, BPJS Kesehatan explained that they undertake different strategies including coverage through public health and hospital providers, and also mobile services.
3. Ministries of Health, Central Statistics Offices, Civil Registrar Moderator: Ms. Kate Hunter Wilson Director, Digital Health Solutions PATH Panelists: Mr Haitham El-Noush Senior Advisor, Health Innovation Lead NORAD Topic: Donor Perspective: Maximizing Innovation and Investments from the Global Financing Facility (GFF) for Women and Children The AeHIN Conference is unique in the sense that it applies a hands-on approach, focusing on operationalization of the global initiatives under the ICT component. This Conference is about modeling progress since the last Conference; we want to see how domestic resources are better mobilized. In addition, it is also important for development partners to provide a platform as well, and that the role of AeHIN is to provide that platform, as a source of knowledge, and technical assistance. This platform serves as the link between what is happening globally and matching these with country priorities. The link between AeHIN, WHO and ADB is quite interesting. It is important for AeHIN to operationalize and build capacity that transcends health systems. We need to be smart in order to secure investments for the health sector since other sectors are also competing for limited resources. The smart move is to choose investments for global health. As an example, improving solutions for diseases control are some of the investments that development partners should tap into. Bhutan is now using its own resources on financing vaccination, and precision medicines. Before, financing of these medicines came about through the government and partners but now, Bhutan has found a sustainable way of financing vaccines and essential medicines in the country. This approach has yielded a success story which other areas can learn about. Highlighted is what we have learned in the last five years: that ICT’s role in the health sector is critical. Success stories of rural technology innovations tap into development partner technical expertise, participation in live forums like AeHIN. With regards to measurement and accountability, ICT’s role is important in the sense that it should show the actual situation of poverty and verify country response to that. In September, a new global strategy was launched which has a broader focus not only about how to ‘survive’, but also about how to “thrive” and “transform”. On the thrive part, the focus of this strategy is quality development, wherein UHC is deemed as a major tool. UN Secretary General Ban Ki Moon, in another conference, emphasized three things: 1) GFF (Global Financing Facility for Women and Children); 2) accountability; and 3) innovation marketplace, as building blocks for implementing strategies (to achieve the SDGs). The GFF and the innovation marketplace is something close to NORAD, as it is involved very much in bringing innovation to countries. I encourage countries to build commitments from partners through platforms in Asia. AeHIN, in cooperation with WHO and ADB, is an example of this platform, that links between country priorities and global initiatives. Highlighted are different resources available through these platforms to ensure that the commitment by technical partners is coordinated smoothly. 44
Dr Mohamed Mahmoud Ali
Coordinator, Health Information and Statistics World Health Organization Eastern Mediterranean Regional Office Topic: The Reference List of 100 Core Global Health Indicators and Regional UHC Indicators The WHO EMRO region stretches across two continents, starting from Morocco all the way up to Afghanistan. There are rich countries while there are also countries in conflict. They are extremely heterogeneous: different religions, languages, and backgrounds â€“ in nearly 550 million population. In the last two years, WHO EMRO embarked on two interrelated initiatives: one is to improve CVRS and one is to come up with a core list of indicators to guide countries how to measure improvements in health and health systems and implement the ICTen actions. Improve Civil Registration and Vital Statistics In 2002, with regards to the improvement of CRVS, WHO, government bodies, ministries, and other involved stakeholders formed a regional government body as a committee who will act on decisionmaking. In 2012, health information systems became one of the priorities of the Regional Director in which birth and death registration must be improved. In the regional level, when we ran a selfassessment of country CRVS systems, only a few countries were classified with weak CRVS system, while the others say that their system is functioning. In the country level, however, itâ€™s probably dysfunctional. There is a great challenge to improve CRVS. To address the issue through introductory meetings and trainings, they reunited all of the CRVS agencies involved and urged them to implement CRVS improvement, unique ID, information dissemination as key components. With their global and regional partners, countries came up with their plan and strategy to improve the CRVS in the region. There are very few countries in the region who report to WHO on annual causes of death. The reason is that a lot of countries have the data but they donâ€™t have the skills to synthesize these. For other countries, in the last 12 months, they have been able to report to WHO on mortality data because they were provided with tools, feedback, and workshops on data analysis, among others. Development of Core Indicators The second initiative is to develop a core list of indicators that will assist countries to evaluate health information and processes better. As there are many global initiatives within the health sector, to guide the government, there is a need to have a metadata registry that explains what is the definition of universal health care, core indicators, and how data can be generated, and so on and so forth. This helps some of the countries to report on the same indicator and makes it easy for crosscountry comparisons. One of the biggest progress core indicators development is the definition of and management of routine data. Many countries have been assisted through the use of the DHIS-2 program to report data to central offices. Lastly, an emphasis is made on how the country health leaders need to allow their data be accessed by policy makers and the donors so that priorities will be known better. Information dissemination mechanisms have to be strengthened likewise.
Mr Shivnay Naidu
Representative Regional CRVS Steering Committee Topic: #getinthepicture – 10-year Regional CRVS Action Framework and Support Program The Asia-Pacific Regional Action Framework on CRVS Strengthening is comprised of three goals, 15 targets set individually by countries, and seven action areas. The goals and targets of the Regional Action Framework (RAF) offer measurable outcomes that reflect progress towards the achievement of the shared vision that “all people in Asia and the Pacific will benefit from universal and responsive CRVS systems that facilitate the realization of their rights and support good governance, health and development” during the decade 2015-2024. Monitoring and reviews are not only to document the gradual implementation of the RAF at regular intervals during the Asian-Pacific CRVS decade, but these feed into informed planning and programming at national, sub-regional, and regional levels. National and regional reviews generated will help identify gaps and challenges in the implementation and inform policy recommendations for Asia and Pacific. These approaches and considerations may be taken into account by countries in order to set realistic goals. They are not intended to be prescriptive, but rather to point national stakeholders towards the pertinent issues and resources that can provide further guidance. Commitments The RAF outlines commitment to the achievement of universal civil registration of all births and deaths and other vital events by 2024. It also targets that all individuals must be provided with legal documentation of births, deaths, and other vital events. The most important outcomes of this regional commitment would be the timely and complete registration including identification of causes of death. This would be produced based on registration records, and that this information will be disseminated. Currently, most often, we are involved with correcting the information in the death registration forms. We also need to think more about how we are going to use better the information we are collecting. To implement the Asia-Pacific Regional Action Framework, the Regional Steering Group was established to provide oversight and guidance with regards to the implementation of the framework. They also act as custodian for CRVS and facility registries in the regional initiative and global initiative. It is important to note that there are subgroups within the regional steering group, such as communication, monitoring and evaluation, research, and also reporting. In implementation, we are focusing on strengthening CRVS mechanisms and identifying community focal points in each country who would communicate with the regional secretariat. In principle, the countries take the lead, and a stepwise approach is important. There has to be flexibility and responsiveness. Also, building local expertise within the countries is important. In line with this, local expertise must be identified first within the country before seeking help from abroad. However, it is critical to request assistance from international bodies for alignment of national initiatives with international standards. Action Areas First among action areas to “get everyone in the picture”, a country needs political commitment, political support to move forward. In countries where political support is very challenging, progress is limited where investments should touch CRVS and health systems. In addition, it is important to have public engagement and participation, and for various stakeholders with the different ministries and departments to convene. Also, countries must have policies, legislation, implementation of these through policy procedures, and practices of innovation among others. In the same way, it is important for countries to have good data quality, a method for correction, dissemination, and use of vital statistics.
The first implementation step for the regional steering group is crafting a national CRVS coordination mechanism. There must be an established head of the coordination group within a country that will coordinate regular assessments. To set a national target review, the target varies and thus, the country needs to determine first where it is heading. An issue for the implementation for most countries is that they do not have baseline figures. It is important to establish baselines before a country sets their target. Assessing progress related to CRVS must be experienced by the subgroups of the population and with appropriate set measure targets to address those inequalities. In order to do so, a comprehensive monthly sectoral measurement CRVS strategy should be taken by assigning a national focal point who will report information to the executive secretariat. The role of the focal point is to identify crucial growth areas and monitor progress in the framework. In the case of Fiji, the Minister for Health serves as the focal point to leverage country commitment to move in the advocacy on CRVS. He is responsible for inviting other ministries to apply evidence-based policy making. All CRVS stakeholders in the country report to the focal point. Goals The goals of the framework include setting national targets, conducting assessments in the country, setting of targets with subgroups, and reporting progress to the assigned secretariat. By 5th of December this year, all countries in the Asia Pacific involved should have set their national targets where the countries need to be in 2024. For the next year, they aim to come up with a regional baseline and submit midterm report among others. These reports will guide countries as well as development partners and donors what assistance a country may need. This report shall show where investments are needed in the country. The report should highlight status on needed support for political commitment in terms of strengthening CRVS, and structure and overview of the current CRVS situation, CRVS tools, and stakeholders in member countries. Other support that can be provided consists of guidelines on setting the national goals to assist countries, direction to further resources, holistic targets that adapt to the national context, reporting template, means for development partners to coordinate activities, and training materials among others, all of which are involved in improving the CRVS system. More information about the framework can be found at
Drg Theresia Ronny Andayani, MD MPH Director of Health and Community Nutrition BAPPENAS, Indonesia
Topic: Civil Registration and Vital Statistics Implementation in Indonesia There are three commitments in pursuit of improved systems on civil registration and vital statistics in Indonesia: 1) Priority Target in National Midterm Development Plan (RPJMN) by 2019; 2) Asia-Pacific Ministerial Declaration and Regional Action Framework on CRVS by 2024; and 3) One Target in the Sustainable Development Goals by 2030. Under the National Midterm Development Plan (2015-2019), in the next five years, Indonesia is trying to put reach target indicators for the CRVS, i.e. to improve birth certificate ownership and increase the proportion of children (0-17 years old) with birth certificate.
Planning and Implementation Coordination CRVS data which covers birth, death and the cause of death data is very important in multi-sectoral development planning. It synergizes program implementation, achieve budget efficiency, as well as harmonizes all related regulations.
Many government and non-government institutions are involved in CRVS program implementation. In order to achieve its goals, the Minister of National Development Planning (BAPPENAS) in cooperation with its main stakeholders is on the lead in coordinating CRVS planning and implementation in Indonesia. BAPPENASâ€™ main stakeholders are the: 1) Ministry of Home Affairs; 2) Ministry of Religious Affairs; 3) Ministry of Health; 4) The Court; 5) Ministry of Education and Culture; 6) Ministry of Social Affairs; and (7) The Police. Apart from the main stakeholders, BAPPENAS is also working with non-government organizations.
Achievement 1: National Coordination Mechanism The Minister of National Development Planning (BAPPENAS) coordinates the establishment of a multisectoral (whole of government and the Supreme Court) CRVS National Steering Committee. Four working groups are organized at the national level and consists of 1) working group on birth registration, chaired by MOHA; 2) working group on death registration, chaired by MOH; 3) working group on marriage-divorce registration, co-chaired by the Supreme Court and MORA; and 4) working group on policies, regulations, and cross-cutting issues, chaired by BAPPENAS. Each working group has a responsibility to construct planning documents. Achievement 2: Procedures, Practices, and Innovations MOHA had budgeted 3.6 billion rupiahs to input all birth certificates produced since 1998 (to cover 0-17 yo) into the SIAK system (only launched in 2008) so that real administrative data on how many children have and do not have a birth certificate may be obtained. Pilot initiatives undertaken at sub-national level has also addressed bottlenecks including the initiation of public-private partnership. Currently, BAPPENAS is drafting a standard operating procedure (SOP) for an integrated service centre for Muslims, and for other religions. Communication materials for integrated service centre will also be developed. Challenges Challenges so far encountered are in three areas, namely (1) cost, (2) distance, and (3) complexity of identity requirements. Discrimination in service delivery, especially for the poor, low community awareness, and lack of and poor quality of field officers are the existing challenges that BAPPENAS is experiencing in terms of CRVS implementation. Progress: Inclusive Legal Identity Programs Initial steps have been undertaken towards the development of the CRVS improvement plan, such as mapping of key stakeholders working on CRVS related areas and identification or documentation of good practices on birth registration among others. In the area of political commitment, some actions have been undertaken: 1) revision of the Population Administration and Civil Registration Law; 2) inclusion of legal identity as one of the main poverty reduction strategies in RPJMN 2015-2019; 3) removal of administrative fees for marriage registration during office hours, while setting a standard and transparent fee for processes outside office hours; and 4) national directive to simplify legalization of marriages. In the area of coordination, CRVS National Steering Committee and Birth Registration National Task Force have been organized. In the area of policies and legislation, some documents have been formulated such as draft Presidential Regulation to accommodate the new law 24/2013, draft National Civil Registration Road Map, and draft Civil Registration SOP and Guidelines. By 2024, BAPPENAS is expected to implement the National Action Plan on CRVS, including resources allocation by the government and non-government organizations, implementing the seven action areas stated in the Regional Action Framework CRVS 2015-2024.
Dr Pradeep Kumar Ray
Director, WHO Collaborating Center on e-Health University of South Wales, Australia Topic: The Role of eHealth Research in Measurement and Accountability What do we need to do for the next 15 years so that we may achieve the objectives of SDGs? If we take it from the perspective of a common man, the objectives of the SDGs may be well-summarized in Muhammad Yunus’ terms: 1) zero poverty; 2) zero unemployment and 3) zero net carbon emission. These are the objectives that we should be considering for the next generation - 15 years and beyond that and look at our strategies based on this. We need to provide young minds with basic data and entice them to do great and thus, innovate. Second is the use of information, communication and technology as one key element to achieving these goals. There should be good governance. Our initiatives should not just for the sake of achieving the statistics but for the sake of actual advancement of the society, and truly address the social determinants of health. SDGs have now taken into account social, financial, and environmental factors. Hence, the typical way of segregating funding can no longer work – fund sourcing and expenditure should be holistically considered. In Bangladesh, there is progress because of this kind of principle. We cannot use the same techniques, approaches, and values to solve development problems: we have to come up with new technologies and abilities. That’s why training students and engaging in activities are important. He also mentioned that collaborating centers in the universities must be utilized much more effectively in this process of interaction. His experience with ITU for telecommunication and WHO for health made him see and understand that developing countries need to craft their own solutions. Countries may start with solutions from developed countries, but in the end, it has to be their own country’s solutions. Focus should be shifted on partnerships and capacity development so that people in developing countries learn from each other and can get various country perspectives in solving problems. This is also applicable to research. The UNSW offers scholarships to developing countries, such as China, India, Bangladesh, Indonesia, and many more. There is rich exchange from countries in solving the problems of their respective home towns. The UNSW is home to the WHO Collaborating Centre on eHealth in Asia-Pacific and has worked very closely with SEARO countries for projects and initiatives over the last 10 years. mHealth research for the last 10 years has been undertaken for solutions for health-related MDGs, HIV treatment, CRVS, smoking cessation, lifestyle diseases and many others. The use of ubiquitous technology such as mobile electronic devices to support medical or public health practice and health systems is embraced as the new frontier of ICT that will improve efficiency and the effectiveness of health care, especially for the majority of the world’s population that live in low and middle-income countries.
The Role of Governance in Managing HIS and eHealth Complexity Moderator Dr. Eduardo P. Banzon Senior Health Specialist, Asian Development Bank Panelists Dr. Wang Caiyou Vice Director, Center for Health Statistics and Information National Health and Family Planning Committee China Dr. Oscar Primadi Information, Ministry of Health Indonesia Ms. Limatula Yaden Director, National Health Mission, Policy, Ministry of Health & Family Welfare India Engr. Jovita Aragona Chief Information Officer, Philippine Health Insurance Corporation Ms. Roszaini Omar Chief Information Officer, Ministry of Health Malaysia Dr. Hannan Khan GIZ - Bangladesh Overview This session brings together top-level chief information officers involved with eHealth development in their respective countries who have a deep understanding of the challenges faced by officials tasked to build national scale information systems. Objectives 1. Share challenges with complexity with your country eHealth system 2. Share your thoughts about the role of governance in managing this complexity 3. Share other innovations you have implemented in your country HIGHLIGHTS Ms. Roszaini shared that implementing HIS (hospital information systems) in Malaysia is challenging because it is not yet implemented in all hospitals. Approximately 30 out of 100 hospitals have or are developing their HIS. Itâ€™s really complex and they are still developing and processing HIS. 51
Ms. Limatula shared that there are information in each Indian state that only the state can release. Each state also implements their own health information system and hospital information systems. The biggest challenge for them is to integrate these into the National Health Information platform. Dr. Oscar Primadi of Indonesia shared that they have a decentralization policy, thus allows every province to innovate and create their own systems to meet their local needs. Each of health services and providers—both private and state-health services—create their own system. The challenge they are facing is integrating these into a national health information system, a task spearheaded by the Indonesia Government. They have started to develop an electronic hospital registration system that includes the private hospitals. However, the completeness of the information from hospitals is questionable and a challenge, likewise. Therefore, governance of health IT becomes an even more important regulator, ensuring standards are met. Dr. Wang emphasized that China faces lots of challenges in improving their system due to the unbalanced information technology. Every ministry has their own authority to make policies and every region has their own target and investment. Dr. Hannan Khan shared that Bangladesh has a different situation compared to the other countries. Governance is the biggest challenge in their country. What they need is support from their political leaders. Engr. Jovita Aragona shared that they have identified challenges in the Philippines such as governance, people, technology, and data. She said that they are using COBIT5 and they want to strengthen governance to build strong and integrated policies. They empower their people for transformational technology in order to learn, allocate, adopt, and develop sustainable solutions. For technology, they phase out those that are no longer sustainable and look into the market to see what will complement those that are already existing and looking into solutions. They know their responsibility to become transparent but at the same time not forgetting their obligation for data privacy. OPEN FORUM Question: How do we tackle the issue of harmonizing various primary care/ community health information systems as well as hospital management information systems in a federal nation? Question: How do you cope with eHealth capacity-building gaps with the health workforce? With the IT workforce? Question: Will centralising HIS in a heavily decentralised country add or reduce complexity? How do we balance the need to have comprehensive national picture vs simpler district measures, available for local use? Answer: It’s actually easy to maintain a centralized information system – in the long run, it will be simpler for all levels. But to get there from our current information system silos is a big challenge. Question: How are the eHealth strategies in the panelists’ countries? Answer: In China, the strategy is not created by the health organization but the technical department. As a national strategy, China should have a health network organization. Answer: In Indonesia, the strategy now is how to consolidate, how to make a governance role more prominent by ensuring collaboration of the stakeholders. Question: How does the panel think SDGs are going to be implemented or monitored? Answer (Dr. Eduardo Celades): The SDGs are complex because there are 17 SDG. Each of those targets are complicated by itself. MDGS took a long time to be measured. Rather than how to answer it right now, it’s important to simplify the plan of how to reach and measure the SDGs.
OTHER QUESTIONS (from the PIGEONHOLE) 1. How many of the countries in the panel have a national eHealth strategy? If none, why not? If they have one, what is their experience (challenges and best practices) in development and implementation? 2. Speaking of governance, can government suspend private health facilities not completing HIS data requirements and not reporting to government? 3. Is there any Health Informatics Association in your country? How did you develop it? 4. Considering the complexities in handling multiple silo systems of different agencies would it be better to work on integration using unique identifiers (if exists) using standard messaging protocols? 5. Do governments take the populace’s perspectives into consideration when designing health systems?
Architecture and Solutions Fair: Designing and Implementing UHC and ICT Method: Marketplace Marketplace List of eHealth – HIS Resources MECHANICS: The event was divided into 15 minute discussion periods wherein participants clustered around “market stalls”. Resource persons provided an overview of their work and Q&A with the participants ensued. Process facilitator Jost Wagner beat the gong to prompt the participants to move to their next station of choice. AeHIN GIS Lab The GIS lab is about data management and standardization of different data sets that can be used in a geographic information system which can be an extension of the Community of Interoperability Labs (COIL). It has been decided that the REACH and COIL will be working together with ESRI. AeHIN National eHealth Capacity Roadmap In support of AeHIN’s Strategic Action Points, is the roadmap of action for eHealth success. The roadmap starts with the WHO-ITU National eHealth Strategy Toolkit and shows a systematic progression from strategy to implementation hinged on capacity-building. Badan Penyelenggara Jaminan Sosial (BPJS) BPJS is the national health insurance of Indonesia established for the benefit of health care and protection in fulfilling the basic needs of health. Data quality self-assessment for routine data (DQS) DHIS2 DHIS 2 is the preferred health management information system in 30 countries and even more organizations across four continents. DHIS 2 helps governments in developing countries and health organizations to manage their operations more effectively, monitor processes and improve communication. 53
Digital revolutions (Bangladesh) EHR Research Unit, Kyoto University The EHR Research Unit of Kyoto University aims to achieve personalized healthcare information infrastructure by research collaboration with multiple domain companies; information technology (IT) service consultation, medicine manufacture, laboratory testing services, and caregiving services in collaboration with research companies GlaxoSmithKline, LSI Medience Corporation, NTT DATA Corporation, SRL, Inc., Tokyo Midtown Medicine Co, Ltd. Guidebook on CRVS Digitization Plan International is one of the oldest and largest children’s development organizations in the world working in over 70 countries creating lasting change for children in communities. The CRVS Digitization Guidebook is an integral part of the CRVS strengthening support offered to African countries by the African Programme for the Accelerated Improvement of CRVS (APAI-CRVS) and will be used in conjunction with the development of a national CRVS strategic plan and work program. HealthEnabled HealthEnabled is a non-profit organization that activates effective integrated digital health systems and supportive health policies in low- and middle-income countries by advising governments and health programs, facilitating connections among experts, and promoting best practices in digital health. HIS/CRVS Strengthening, Verbal Autopsy—India Verbal autopsy techniques are used for determining causes of death among non-facility deaths using networks of key informants. However, where medical certification of cause of death can be obtained, this should take priority. Where verbal autopsy is required, verbal autopsy could be performed for either all non-facility deaths or a representative sample, depending on population size. Indonesia Integrated Emergency Information System ISO TC215 (Health Informatics), Integrating the Healthcare Enterprise (IHE) The scope of ISO TC215 is standardization in the field of health informatics, to facilitate the coherent and consistent interchange and use of health-related data, information, and knowledge to support and enable all aspects of the health system. IHE, on the other hand, is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. OpenEHR OpenEHR is a virtual community working on interoperability and computability in e-health. Its main focus is electronic patient records (EHRs) and systems. Malaysia Health Information Exchange (MyHIX) MyHIX is Malaysia’s nationwide health IT interoperability platform. Exchange of health information is achieved through electronic discharge summaries for the purpose of continuity of care and public health reporting. MOTECH Suite Platform—India The Mobile Technology for Community Health (MOTECH) Platform is an open source software project delivered by Grameen Foundation through funding from the Bill & Melinda Gates Foundation. It enables organizations building mHealth solutions to develop, manage, and monitor those solutions more quickly and cost-effectively with fewer technical resources. It also allows multiple mHealth solutions serving the same population to be deployed in a way that enables data sharing (where appropriate) and a better experience for users of the system. 54
Open Smart Register Platform (OpenSRP) (THRIVE Consortium) Evidence for UHC and eHealth The Technologies for Health Registers, Information, and Vital Events (THRIVE) Consortium is a group composed of leading academic, research, donor, and IT institutions that are focused on adaptation, scaled deployment, and impact assessment of the OpenSRP platform and associated technology innovations in multiple countries. The Open Smart Register Platform aims to address each of these issues by creating a comprehensive smart register platform based on global standards of care and integrating with leading edge technologies. OpenMRS OpenMRS is a multi-institution, non-profit collaborative led by Regenstrief Institute. It is a software platform and a reference application which enables the design of a customized medical records system with no programming knowledge (although medical and systems analysis knowledge is required). The Regenstrief Institute is an internationally respected informatics and healthcare research organization, recognized for its role in improving quality of care, increasing efficiency of healthcare delivery, preventing medical errors and enhancing patient safety. Philippine Health Information Exchange The partnership forged among the Department of Science and Technology (DOST), the Philippine Health Insurance Corporation (PHIC) and the Department of Health (DOH) to come out with the Philippine Health Information Exchange (PHIE), is an initiative that would ensure accurate and timely health information exchange that can be instrumental in improving the services of these three agencies as well as the other organizations that could use the said data. Regional UHC Monitoring Dashboard Setting targets and visualizing progress towards UHC using the regional monitoring framework, core indicators, and monitoring dashboards are helping countries target and implement interventions for better health. SIJARI Emas, mhealth for MNCH SIKDA (Pusdatin, District health information system, MOH Indonesia) Thailand HISPA and Thai Medicines Terminology HISPA standardizes healthcare services data, harmonize and provide healthcare services claim data processing and curate the healthcare services data. It harmonizes healthcare services process of the country’s three major healthcare insurance schemes: National Health Security Office’s Universal Coverage Scheme (UCS), Comptroller General Department’s Civil Servant Medical Beneficiary Scheme (CSMBS) and Social Security Office’s Social Security Scheme (SSS). Thai Medicines Terminology (TMT) is Thailand national standard codes and descriptions of medicinal products (both generic and trade products) that are used in the country’s healthcare systems. WHO Collaborating Center for eHealth WHO collaborating centers for eHealth, telemedicine and health informatics are institutions around the world that help WHO to fulfill its eHealth mandate. They are an essential resource to extend WHO’s capacity and expertise in eHealth.
DAY 2 â€“ OCTOBER 27, 2015 Empowering the National HIS/eHealth Executive and Management Teams Moderator Mr. Paul Rueckert Chief Technical Advisor, GIZ Nepal Panelists Mr. Shivnay Naidu Director of Health Information, Research & Analysis, Ministry of Health & Medical Services, Fiji and President of The Pacific Health Information Network Dr. Ashwin Sasongko Sastrosubroto Director General National ICT Board Ministry of Communication and Technology, Indonesia Dr. Fazilah Shaik Allaudin Deputy Director, Telehealth Division Ministry of Health, Malaysia Dr. Bhim Prasad Acharya Director of Management Division, Department of Health Service, Ministry of Health and Population, Nepal Ms. Charity Tan Chief, Knowledge Management Service, Department of Health, Philippines Dr. Polawat Witoolkollachit Director, Information Technology and Communication Center, Office of the Permanent Secretary Ministry of Public Health, Thailand.
Overview This session brings together executives involved with eHealth development in their respective countries who have a deep understanding of the challenges faced by officials tasked to build national scale information systems. Objectives 1. Share your structure for eHealth development; 2. Share challenges your eHealth teams are facing 3. Share insights about your eHealth teams can be further empowered HIGHLIGHTS
Dr. Fazilah Allaudin introduced the eHealth Governance Structure of Malaysia starting from the branches to the teams under it. Dr. Allaudin also shared Malaysiaâ€™s ICT shift: for a long time, Malaysiaâ€™s Health ICT Project was considered a mere IT project. It was just recently that it was handed to the health sector making it a big and challenging shift. Teams were set up, led by the director general of health, Secretary General of the Ministry of Health at the high level, and the operational level is either led by hospital directors or the project managers. Malaysia has the Economic Transformation Programme that involves various vertical sectors including healthcare and the private sector. Collaborations are between government ministries/ agencies and the private industry. The Telemedicine Development Group is set in motion in 2015 as a collaborative platform of policy makers, regulators, academia, reserchers and industry stakeholders coming together. Dr. Ashwin presented about empowering the National Health Information System in Indonesia. Indonesia has a National ICT Council consisting of representatives from government, businesses, and other experts. The Council has its steering committee and operational committee. ICT strategy in Indonesia consists of building/ maintaining a telecommunication infrastructure, internet infrastructure, applications, and contents. The ICT infrastructure must be able to deliver faster and give more accurate data in order to serve patients more effectively and efficiently. One of the critical success factors is e-health utilization in support of quality health services.
Dr. Polawat shared that Thailand has started developing their eHealth policy program for about a year and a half already. They had four meetings: the first one they did was with the ministry and some stakeholders to assess where they are currently standing. They are currently forming a team together with the health and ICT sectors, such as offices that specialize on standards. Ms. Charity Tan stated that in the Philippines, the ICT / eGovernment strategy is headed by the (ministry) Department of Budget and Management together with the Department of Planning (National Economic Development Authority) and the Department of Science and Technology. Under this, and for the health sector, the National eHealth Steering Committee is chaired by the Department of Health, co-chaired by the Department of Science and Technology; members are from the Social Health Insurance, Academe: University of the Philippines and the Commission on Higher Education. Under this is the backbone of the movers of the entire national eHealth strategy: the eHealth Technical Working Group. It is responsible for the implementation of their eHealth strategy. It has members from the public and private sectors. Below that are their special experts’ group, for instance, the need for policies on data security and standards approved by the steering committee. The group holding all these together is the Project Management Office (PMO) who acts as the technical secretariat. Mr. Shivnay Naidu from Fiji shared that their strategy is divided into two pillars – eHealth and health systems strengthening. They are divided into areas such as healthcare, development, medical supplies, and financing. They developed strategic specific objectives on policy and program planning, second is for the use of information systems in which they aim to provide relevant and accurate information to the right people at the right time, and third is results-based quality information as a guide for decisionmaking and behavior change. The National Health Information Committee is comprised of sectors and some universities and donors. When Fiji defined their specific objectives, donors must align their investments with Fiji’s strategy. The country’s Health Information System Strategy has key areas such as patient management, clinical information system, and civil registries. Standards, technical infrastructure, and the ICT infrastructure are key areas of development as well. Dr. Bhim described Nepal’s health management information system, but also cited vertical information systems. Nepal has had trainings on health management information system as well as reporting systems.
OPEN FORUM Question: For Malaysia, how are the various health IT projects connected with each other? Dr. Fazilah: When there’s an ICT project of the MoH, there is the ICT steering committee, technical committee and also staff. This is the normal processes for project governance and approval for implementation. For projects that are outside the Ministry of Health, for instance, funding comes from the national level – the project committee would have representatives from the health sector, and other ministries and the private sector sitting for this inter-ministry collaborative project. For example, for the project on internet connectivity, it can’t be done by the Ministry of Health alone. The Ministry of Communications has to come in. So this project “sits” or is directly under the Prime Minister’s control. For the telemedicine development group led by Dr. CP Wong of Monash University – here we want to bring innovation to the country. This is very new and we would also like to see how we can integrate with AeHIN’s efforts. Question: What are your recommendations on how to get eHealth agenda in order and what are the things that should be avoided? Dr. Polawat: The most important thing is eHealth education for everyone involved. We also have to connect with each other and find out what each sector can do. Dr. Fazilah: Acceptance by all stakeholders is very important. Top down approach doesn’t work anymore; it must be more collaborative, consensus-building, and collective decision making approach. Dr. Ashwin: One very important thing in Indonesia is cooperation and cross communication through the strategic planning of the government. We standardize the program nationally through this step. We have to work together instead of separately. This helps in increasing efficient use of funds. Ms. Charity: What we need is support from the Minister of Health. We need to be collaborative and act collectively. Mr. Shivnay: I recommend having strategies. Investing on technology is costly. We need to implement effective strategies. Dr. Bhim: The health information system should be supported with a legal framework. Question: What are the specific challenges you have faced? Dr. Bhim: There are a lot of challenges including financial, technical, and managerial. The critical challenge is building capacity of the people who work with the HIS. Everyday, there is a new technology in the market. As we adopt what technology works for us, we have to train the people how to use them. Question: What are the key elements that the MoH should have to optimize ICT’s usefulness the in health care system? Ms. Charity: The key elements are standards and information sharing. Dr. Polawat: Developing people, software, and infrastructure. ICT infrastructure is really important. Dr. Ashwin: We have to pay attention to building infrastructure in Indonesia— the priority is to establish ICT backbone that would enable integration of information systems in the whole country. Question: In ICT use, human resource is a big challenge for countries. How do we address these? Dr. Ashwin: We have a big challenge because the health industry is not yet ready for ICT. We plan to integrate ICT use in the curriculum. Ms. Charity: We also have to look at the national certification system of ICT use of eHealth. The ASEAN Integration calls for a national profession certification system and in 2016, it will be integrated cross ASEAN countries. But eHealth / ICTs in health is not yet thoroughly discussed. Mr. Shivnay: We need to plan in recruitment strategy of the human resources. 60
OTHER QUESTIONS (from the PIGEONHOLE) 1. How do we identify the eHealth/ HIS executives? What qualifications should they possess? 2. In eHealth. we have several stakeholders: doctors, IT staff, etc. The problem is doctors know little about ICT and IT team know also little about health. How do we address this issue better, i.e. the connection health and ICT? 3. What is a best or appropriate IT framework and architecture that best fit to a country’s health system? 4. Does Ministry of ICT plan and manage HR for ICT for the whole country? (But, the distribution of ICT HR is even more problematic than health workers.) 5. How much of these problems is generational? As younger people gain experience and seniority within the MOH and as clinicians, will this change? Ten years from now we may not be talking about this. 6. Is it still possible to empower NHIPS / management team without having champion if you have a good framework for sharing the goals and sharing the credits? 7. What are the big challenges to improve ICT in our primary health care? How do we face and solve these, include internet connectivity? 8. How well does eHealth reduce the gender disparity in delivering health to citizens? 9. We’ve talked about technical side; how about considerations of costing / financing? Without secure and sustained funding, eHealth can’t work. How do we manage this? Who is supposed to responsible?
Live Demonstration – Digital Health for Better Care: The Maternal and Child Continuum of Care Scenario Engr. Derek Ritz Principal Consultant, ecGroup Inc., Canada Mr. Klaidi Bido Chief Executive Officer, AIRIS Solutions Ms. Doriana Delja Technical Director, AIRIS Solutions Prof. Duane Richard Bender Director, MoHawk College Canada Mr. Justin Thomas Fyfe Software Architect, MoHawk College Canada Mechanics An interactive live demonstration was held in this year’s general meeting. During the session, three stories were presented that matched real-life situations faced by frontline health workers and program managers. The demo showed the benefits of interoperable systems specifically how data and information can flow across disparate systems. Four stations were prepared in the plenary hall; each with laptops connected to large TV screens showing various electronic medical records and mobile phone-based applications communicating through a standards-based interoperability layer. The live demonstration focused on the maternal and child continuum where the following were featured: • Flow of encounters at multiple points of service delivery (e.g., PHC to hospital setting) • Good practices in longitudinal patient monitoring linkages with lab/pharma/billings and claims/ other systems • Tracking through unique IDs and registries • Effective use of paper-based data collection forms related to interoperable ICT-enabled platforms • Rolling up equity stratified data into routine HIS • Integrating multiple data sources and using data standards to interoperate across systems OPEN FORUM Question: What if the patient has HIV? Can we share the information or not? Answer: There are explicit steps to acquire consent. There is explicit consent and implied consent. The option to share or not to share health information with the community depends on the patient. Question: What about the barcode scanning? Answer: We already use barcode scanning and it’s very successful. As long as there are barcode and barcode scanner, you can use a barcode scanner to get the information from the barcode. Question: How do you manage distributing unique barcode around the country? Answer: Let us see the way Brazil is doing it. Their municipal offices issue the ID barcode card: they ask the patient’s name, other information, encode this, produce an ID card with a unique number/ barcode and give it to the patient. 62
Question: What happens when you lose your ID card? Answer: You have to collect the name of the patient, birthday, gender and other information. These can be used to statistically match a group of names. The patient can then identify one of those names as theirs. Question: What can be used to demonstrate the health problems and the solutions for the politicians? Answer: As a politician, you can use the DHIS2 because it is good in providing and displaying reports. But first of all, you must input all the data to populate the database and display these on a dashboard. Question: How do we prioritize indicators? Answer: Itâ€™s a difficult process to prioritize the indicators. It needs time. Certainly, focus on what is significant to your country. Question: How do we integrate all these data and information? Answer: If you want to connect all of them, all of the software, use an agreed upon architecture. 63
Three Parallel Sessions: Challenges and Successes in Implementing ICTen At the 3rd AeHIN General Meeting and Conference on Measuring and Achieving Universal Health Coverage with Information and Communications Technology, the assembly agreed on a 10-point agenda called ICTen (http://bit.ly/whoadbAeHINICTen). This was an output of leaders from the Health, Central Statistics Offices, Civil Registrars in different countries with UHC initiatives to share how they plan to sustain their ICT investments on measurement and accountability systems as they relate to the Post-2015 Development Agenda. These ICTen actions are: 1) know your baseline; 2) get everyone on board and bring your best team; 3) adopt, adapt, or develop tools; 4) commit to UHC; commit to integrated ICT systems; 5) invest in unique ID schemes and link CRVS and UHC; 6) build institutional readiness and a skilled workforce; 7) keep data safe and secure; 8) plan for sustainable financing mechanisms from the start; 9) get concrete; have an implementation plan with quick successes; and 10) define success; measure progress based on M&E criteria. This 4th AeHIN GM would like to bring together countries to share their current experiences on how they use ICT to achieve UHC initiatives with ICTen as guide. During parallel sessions, participants were divided into three groups: 1) finance/investment; 2) health and social protection; and 3) CRVS/ICT to talk about a particular set of actions. They were asked to discuss the following: 1. Share country benefits in implementing ICTen 2. Present challenges encountered in implementing ICTen 3. Identify specific support (from AeHIN) in implementing ICTen Highlights of the parallel sessions on challenges and successes with implementing the ICTen were presented per group.
1. Finance and Investment Group Chair: Ms. Donna Medeiros Senior Global Health Informatics Advisor Regenstrief Institute Ms. Medeiros facilitated the ICTen session of the finance and investment group, with focus on these actions 1) plan for sustainable financing mechanisms from the start; 2) get concrete; have an implementation plan with quick successes, and 3) define success; measure progress based on M&E criteria. The discussion is summarized in the table that follows. Themes
• Private sector in-
• DHIS 2 and other
novation sometimes drives public action/ improvement for adopted • Leveraging PPPs that incorporate value for all stakeholders (government, industry, people) • Some business models established: for instance Grameen social business model from Bangladesh
systems • Capacity building of country teams from AeHIN
• Lack of support
financing the information integration from both public and private sector information (and agreed solutions such as cloud based) • Lack of evidencebased planning on ICT in overall health sector financing • Reoccurring ICT and HIS costs not allocated well over time • Big gap in countries lacking economic models to utilize • Failing on sustainability of systems – for instance connectivity in rural to collection and send information
• M&E is good to
have in place but staff already overburdened – need to be streamlined and tools are not available for finance
Needed Support from AeHIN • Social business models • Connection to financing partners, PPP encourage research to develop replication models • Case studies and knowledge platform/sharing, such as Thailand integrating health system costs through incentives HIS (linked to insurance scheme) national discussions • Tutorials for financing (national and subnational
• Seeing is believing
– help with Dashboards for high level consumption • Leverage expertise of others and adapt and catalyze • M&E tools
2. Health Group Chair: Dr. Alain Labrique Director Johns Hopkins University Global mHealth Initiative Dr. Labrique facilitated the ICTen session on the health group, with focus on these actions 1) know your baseline, 2) get everyone on board and bring your best team, 3) adopt, adapt, or develop tools, and 4) commit to UHC; commit to integrated ICT systems. The discussion is summarized in the table that follows.
Themes Baseline Readiness
• National strategies developed / ing
• National steering
committees / working groups • Semantic and other interoperability standards being developed • Infrastructure assessment, improvements and solutions deployed • Building communities of practice / leadership • Development of indexes to measure “readiness” • Multi-stakeholder dialogues (including non-health actors) Getting everyone on board and bringing the best team
• Include all districts
/ states in sharing needs for Needsbased approach • Creating national and international networks for experience sharing • “Collapetition” friendly competition between districts • Crowdsourcing
Needed Support from AeHIN • Some areas lack • Need similar apwith baseline data proach / common • Some data are not indicators for the aggregated region through a • Selecting comshared instrument mon indicator sets • Core indicators for - reducing forms regional benchrelevant to decisionmarking making • Shared instrument to measure readiness. Challenges
• Integrating local
feedback is difficult • Informatics training and HR limited • Engaging private sector is challenging / motivation limited
• Ways to integrate
feedback into user design
Adoption, Adaptation, and Development of Tools
• Good community of
• New initiatives /
• E health func-
Commitment to integrate ICT systems
• Very high consensus • Some resistance
• Problems with infra-
• Digital and con-
resources • Regional experiences are helpful to support / convince stakeholders • Robust to re-use systems where basic problems have been addressed
to integrating ALL systems due to security, flexibility or resource-intensiveness
policies require realignment • Last mile connectivity and cost • Limited sense of ‘ownership’ of open-source tools • Private sector incentive to use ‘common’ non-proprietary tools is low • User-engaged design / feedback limited (although necessary for ‘ownership’)
• Flexibility or ‘ap-
propriateness’ of existing systems to use case not always enough • Getting to interoperability is difficult resource intensive • Integrating legacy systems from historically fragmented (pre-strategy systems) • Coordinating multiple ICT agencies / Networks
tionality tools - to assess the architectural
nectivity infrastructure • Shared Interface across implementors (SHR) • Scenarios to be applied across countries with time constraints to “test” system functionality • Practical strategies to integrate legacy systems
Dr. Labrique also presented the general agreements among participants on the four ICTen actions discussed. First, there is a need to balance the pros and cons of integration of various separate HIS; considerations should include costs and managing the human resources required to manage transformation to an integrated one versus maintenance of separate systems. Second, local ownership of the product being used must be managed since it is the end users who are critical and use pointof-care systems real-time and daily; their input / feedback have a major bearing on the success of our desired eHealth based HIS. Third, there is no need to re-invent the wheel. However, customizing – for example, OpenMRS alone – does not fully address the needs of all facilities all the time. When the existing applications don’t do what is needed, it is advised to develop particular software by giving frontlines a chance to learn and own it through participation in software development.
3. ICT Group Chair: Dr. Garrett Mehl Scientist, Department of Reproductive Health and Research World Health Organization Headquarters Dr. Mehl facilitated the ICTen session on the ICT group, with focus on these actions 1) invest in unique ID schemes and link CRVS and UHC, 2) build institutional readiness and a skilled workforce, and 3) keep data safe and secure. The discussion is summarized in the table that follows.
Needed Support from AeHIN
Unique ID Schemes
• Investment in ID card systems in their countries • Application plans
• Introduction of unique IDs will be challenging if they already have they own insurance protection • Too many ID card systems
• Interoperability of ID system centers • Unique ID and the governance structure
Unique ID Schemes
• In some countries, there is an opportunity at birth to get Unique IDs • In some countries, benefits are linked with CRVS • In some countries, there is verbal autopsy application for causes of death • Existence of digitization guidebooks for CRVS • Unique IDs help people get a better life for their health insurance.
• IDs are not regionally unique • Individual death identification is not decoupled from cause of death valuable
• Incentives to ensure ID is adopted • Technical instruction and district regulation for the introduction of unique ID • CRVS across boarders – harmonized data dictionary
• Lack of governance • National policies are given more importance than technical solutions • Challenges with different technology solutions and infrastructure
• Move towards cloud based services • Pre-deployment guidelines on skills needed
Safe and Secure Data
• Privacy issues in terms of unique ID • Human right issues in terms of unique ID • Security and privacy is not differentiated • Circle of trust is difficult to operationalize in terms of data security
• Putting of patient record in a safety box to ensure that the right person will have access to the data • Open exchange of data, ensure that viewing of data is tracked
Day 2 – October 27, 2015
Development Partner Coordination Side-Meeting The Development Partner Coordination Meeting was moderated by the AeHIN co-Chairs, Dr. Alvin Marcelo and Dr. Boonchai Kijsanayotin. Discussions for donor coordination of technical assistance and support to countries for health information systems strengthening is a cornerstone as well of AeHIN’s efforts to support country members. AeHIN activities were presented and free discussions ensued. After the live demonstration of interoperable HIS for continuing care during the second day of the conference, participants approached the AeHIN WC also hoping to show the same kind of demonstration jointly to their own Minister of Health and Minister of Information Technology.
• AeHIN formed the REACH: Regional Enterprise Architecture Council for Health. Currently, there are 12 certified architects who now understood better what enterprise architecture (EA) is all about, especially for the enterprise of Ministry of Health. The logic behind EA activities is to connect the horizontal and vertical processes through a very clear blueprint.
However, these 12 architects are not professional enterprise architects. AeHIN’s REACH needs to get input from professional architects, like in the last live demo. As a collective, they advise countries on how to build their country health EA. AeHIN needs capacity building and more architects in each country. These 12 now comes from the Ministry of Health, the Ministry of Information, Communications, and Technology, and the academe. The next move for the REACH to request their ministries to officially delegate them into that type of work. Consequently, this will make the ministry take some ownership in whatever architecture is being developed, guided by the Council. Hence, AeHIN believes the MoH will be predisposed to a fund their agreed on EA. One question raised is the investments on capacity development is happening, enabled by development partners / donors, but the implementation of cognates and action is not being followed through by the country. One participant raised that this gap pertains to clarifying the business case or value of the (eHealth) EA training. AeHIN identifies now its priority: that a good health EA will improve the business processes of primary care, vaccination, and maternal care – eventually resulting in better maternal – child health outcomes. Thus, when countries develop and implement their EA, countries share these lessons and artefacts that can be re-used by others. These artefacts will now go to an EA repository, made accessible to AeHIN member countries. The REACH needs to engage members in a meeting at least twice a year, where they will serve as the enterprise architecture board. Their task is to conduct evaluation of implementations, which, will serve as the basis for them to recommend best practices. AeHIN proposes a global architecture for interoperable health information systems, and countries can adapt it depending on the need of each. The interoperable health information systems, the ID, and the infrastructure must have a felt value for the policy makers.
• The AeHIN COIL Community of Interoperability Laboratories will also be organized. An
Interoperability Laboratory (IL) is proposed to work at a country level for stakeholders to understand how this EA or blueprint can be localized/ operationalized, i.e. how disparate 69
electronic health information systems can be linked. The IL will serve as a reference facility for the country HIS developers/ providers, implementers, and funders: i.e. any innovative HIS would / should / could be run through the IL and demonstrate that information can be exchanged across health facilities and institutions. If interoperability is demonstrated, then large scale implementation and continuous funding can be supported. The COIL which will be organized at the Asia-Pacific level is a way for interoperability laboratories to connect to each other, learn from experiences of member ILs In the recent AeHIN Interoperability Meeting in Manila, one of the emerging topics was medicines or drug information exchange as a use case. The ASEAN Economic Integration Program beginning 2015 implies cross-border flow of health resources â€“ health workers and essential drugs, included â€“ across ASEAN member countries. The importance of interoperability laboratories is becoming more and more imminent. AeHIN has to produce output. ICTen is actually very interesting, especially because of the categories chosen by AeHIN: investment & financing, health (including workforce capacities & measurement) and ICT. AeHIN can help develop a model for these three different categories in each country. In line with this, suggestion was made on how AeHIN can help in the creation of the eHealth strategy investment plan because the country is ready to invest but they need help how they can come up with a plan. eHealth Governance. More countries are now beginning to understand that it is their role to provide governance over health IT development and give development partners the architecture to plug into. They are frustrated that development partners support different solutions that eventually do not integrate with each other. At the end of the day, they have realized that it is actually their role to give an architecture and the rules on how to integrate these solutions with one another. The architecture consists of four parts: 1) foundation; 2) common components (reusable across the country, across the regions); 3) unique component/s, and 4) connection with interoperability layer. A suggestion raised for AeHIN to implement a pilot project on governance by supporting a country that will serve as an example to other countries. The demonstration project should show the real challenges and struggles so other countries can evaluate it honestly, learn and make it work better in their own countries. A counter opinion was raised in that the pilot would not be very helpful since the government always makes the pilot project look good and successful. One participant encouraged the AeHIN to work with national governance and funds/ resources available to them in efforts to harmonize health IT systems. In the country level, it was opined that there has always been a reason or another why they do not want to harmonize their system and integrate the health information system. Countries need to use AeHIN as a platform to connect with all the development partners that support national governments set up expensive HIS solutions. It is not going to be easy, but at least there are some mechanisms to get some agreements on HIS improvement. The country must make a commitment; they have the technology, and they have a way to do the health information system. The task for AeHIN and development partners is to make the Minister of Health, the Minister of ICT and the President of insurance agencies cooperate with one another to make this work in a country. The country can do a live demo or a real demo, and show it to them in one place to deliver the message that they need to work together to make this demo implement and really work.â€ƒ
DAY 3 – OCTOBER 28, 2015 Policy Debate: The Economics of HIS and eHealth – why or why not invest? Moderator: Dr. Theo Lippeveld Vice-President International Division John Snow International Panelists: Mr. Rajendra Pratap Gupta Chairman, Personal Connected Health Alliance India
Ms. Aye Aye Sein Deputy Director General Department of Public Health Minister of Health, Myanmar
Dr. Rofyanto Kurniawan Director of Center for Budget Policy, Fiscal Policy Agency, Minister of Finance, Indonesia
Dr. Massod Anwar Director Health Services Directorate General Health Services, Punjab, Pakistan
Dr. Founkham Rattanavong Deputy Director General Department of Planning and International Cooperation Ministry of Health, Lao PDR
Ms. Rumanusina Maua Assistant Chief Executive Officer Health Information Systems & ICT Ministry of Health, Samoa
Overview This session brings together country leaders at the center of investment decisions regarding national eHealth systems. It provides an opportunity for countries and development partners to understand the issues and concerns around decision-making for funding large national-scale health ICT programs. Objectives 1. Share your organization’s vision for country health information systems 2. Share your organization’s insights about the importance of ICT in measurement and accountability 3. Share your ideas on how you plan to invest on your national eHealth program 4. Comment on other participants’ ideas on investments 71
HIGHLIGHTS What is your vision for Health Information Systems? How do you make your business case to policy makers to invest in health information systems? And if it was successful, what factors made it successful? Dr. Founkham from Lao PDR MoH shared that they discussed lessons on how to monitor MDGs like choosing the best data indicators, identifying important information, and the leadership needed. He also shared their 5 pillars in health reform: Human resources, Health Financing, Health service delivery, Governance Management, and Health information system. Dr. Founkham also stated that governments need to invest more, consult with partners. These two have to come into agreement: it is critical to help each other in solving the problem. The challenge is how we keep a team, how we can invest a public-private sector partnership model. We also need to bring in the academe. To conclude, “information is important for government itself; country leaders need to empower various sectors to work together”. Dr. Rajendra, of India, described that the government has to invest on the following: infrastructure, information, human resource, and connectivity. Investing in health care entails planning where you need basic information hence there must be investments made on technology. Most countries are also moving in this direction. Dr. Rajendra also shared that they are using the EMRI 108 Emergency Response which works in real-time. How far are you in Samoa with your HIS strategic planning and financing? Ms. Rumanusina stated that Samoa is an example of good investments in health IT and doing this properly. Samoa has a small land area with a small population; systems are “easy” to integrate, advocating for an integrated policy and strategy is easy. They determine prevalence rate and incidence rate of disease conditions from surveys conducted. As a developing country, they are now making huge investments in terms of national infrastructure and improving ICT to be at par with the rest of the world. They have completed their strategy in the past two years and is working on how they can operationalize investing on health information systems. They have covered as well areas such as setting up the governance and leadership structures, the strategy, identifying hardware and software needs. They have a business case which they showed to the national government and gotten leaders onboard. In terms of ICTen, Samoa has organized a network, have gotten the stakeholders that need to be onboard and it adopts software they need and do not reinvent the wheel. It also has cost estimate amounting to (USD) 10 million that they need to invest in HIS across all its facets. In the next two years, they are expecting to see lots of changes in terms of health information. How do you finance HIS and eHealth solutions in Myanmar? How can that be turned into a sustainable system? Ms. Aye Aye Sein said that Myanmar recognizes the importance of ICT for health but it is a lot of work. Through planning, investments and benefits of eHealth solutions can be maximized. Their Ministry of Health is carefully utilizing ICT to strengthen eHealth and Health Information Systems. The most important thing in this endeavor is political commitment and leadership. Ms. Sein also shared their investments and implementation of HMIS2. They started implementing paper-based HMIS2 in 1995 and it was well-integrated in health care all over the country. They used have a data dictionary which they review and revise depending on the changing health conditions and treatment procedures. Today, one of Myanmar’s objectives is to expand the use of ICT in current HIS. They started to move paper-based HMIS to eHMIS by using DHIS2, which is supported by Oslo University. They have already piloted it in four townships. They also trained in-country teams from the HMIS Department of their Ministry of Health. Aside from trainings, they have provided computers and related infrastructure. The establishment of DHIS2 including maintenance 72
is funded under their own budget. They keep the health data server in the data center of the Ministry of Communication and Technology. With the success of the implementation of DHIS2, they are looking into expanding it in 200 more townships. With expansion and scale up, they plan to expand the modules of DHIS2 as well and initiate reporting systems like HIV, TB, and Malaria, and integrate reporting and tracking solutions. Coordination of support from government body and the development partners is important in outlining resource requirements of our long-term development strategies to ensure that sustainability is made. Our government has increased the budget to invest more in strengthening HIS. Are pilots able to be scaled up in the future and honed by the government naturally? According to Dr. Rajendra, pilots are important. They are implemented in phases: phase 1—someone picks up the need / the identified gap and start working to address this. In their experience, pilots started as a joint initiative of the public and private sector and then scale it up. Scale up will be a challenge if there are no pilots. “Who delivers best?” must be identified. From there, you can scale up. Pilots are “part of the development stage. They will never go out of the scene.” It was also observed that projects aren’t equally done with the same quality. OPEN FORUM Question: What is a good approach to convince the government specially the Ministry of Finance invest on eHealth/ICT for the health sector? Answer (Dr. Founkham): Good communication—formal and informal—is key to convincing the government in investing on eHealth and ICT. It must be done regularly not only with the Ministry of Finance but with other sectors like the Ministry of Law. It must be planned, reasonable, and wellresearched. Technical meetings with partners and consultants are important as well. Aside from building good relationships, it is also important to invest in hardware and set it up in the whole country. Government commitment is important. We can use our roadmap for the future as we have agreed; apply it how we see fit. We can use this tool on to get more support. Answer (Ms. Rumanusina): There can never be a ‘champion’ approach to convince the Ministry of Finance – because they always cut budgets at any given time. But in terms of how you would convince them to invest in eHealth and ICT, for a country like Samoa with its health system that is heavily subsidized, evidence would manage to convince them. For instance, look at the “bag of money” that you have to, say, a pharmaceutical drugs - subsidized health system, then you will need to measure the money you are getting back from this subsidization. You must bring it with evidence. You have to have small gains in terms of convincing the MOF invest in eHealth and HIS. Comment (Timor Leste): The Prime Minister of Timor-Leste appreciates how the Ministry of Health is moving and investing on eHealth. The Prime Minister also instructed the Minister of Finance to provide hardware for the Ministry of Health to scale up eHealth. However, the capacity of the people in the Ministry of Health is still lacking. Now the Ministries of Infrastructure, ICT, and Health are working together to integrate everything because they are using different softwares due to differences in interest. Comment (Bangladesh): In the past 2-3 years, Bangladesh focused on laying the infrastructure, and now they are focusing on collecting data. They have medical call centers people can call 24/7. They are focusing on quality data. They need to make more investments, including those in research. Comment (Dr. Founkham): To get more support, there is a need for third parties or partners outside the country to share and compare (data) HIS strengthening progress with. Maybe WHO can help give data on these so we can compare eHealth expenditure assessment and figures for us to see why we should invest and how we can get more support.
OTHER QUESTIONS (from the PIGEONHOLE) 1. Has any country used investment-costing tools for eHealth? Please cite. 2. What are the needed to incentivize investment in eHealth services and devices? 3. What is the best way to leverage these eHealth technologies at low cost? 4. Suggestion--- AeHIN to organize inter-ministry (minister level) meeting on ICT/eHealth in coming years. Aim at crafting an investment plan for eHealth. 5. As ICT investment is costly, government can drag bluechip IT company to partly utilize their CSR (corporate social responsibility) funds to help develop the country.
The ArcGIS Online Portal for Enabling Health GIS Analysis for Monitoring and Measuring UHC and Improving Health Systems Performance Dr. Estella Geraghty Chief Medical Officer & Health Solutions Director, ESRI Ms. Canserina Kurnia Solution Engineer, Esri Global Asia Pasific Mr. Mark Landry of WHO-SEARO opened the plenary session by briefing the audience on how, with the blessing of the AeHIN Working Council, they have thought of working with ESRI to help developing countries. The GIS lab is about data management and standardization of different data sets that can be used in a geographic information system. This can be an extension of the Community of Interoperability Labs (COIL). ESRI will work with REACH and COIL. Many countries have expressed their interest in building these centers of excellence. There are no answers yet as to how the labs might look like but the idea is introduced.
Dr. Estella Geraghty of ESRI introduced ESRI and how their geographic systems can be useful in health and to the Network. Waldo Tobler, creator of the first law of geography, said, “Everything is related to everything else, but near things are more related than distant things.” Finding out what nearby can help bring content to the dynamic situations and deepen one’s understanding of the location. Placing things in geographic space puts things in immediate perspective. Figuring out the proximity of the patient to the hospital or clinic and the risk factors for disease in particular populations can be very useful in a right context. Defining the interconnectedness of things can help make faster and accurate decisions. Solutions can be delivered faster when important parts of the network are identified. Problems can be traced and possible outcomes that may occur to its interconnected parts can be predicted. It also helps restore services and improve health in communities more quickly. Geographic Information System (GIS) is an entire system that lets us visualize, question, analyze, and interpret data to understand relationships, patterns, and trends. GIS’s exponential growth has made it easier to use. It works like any system of record such as emails. Everyone in the organization who needs access to spatial intelligence can get it. It can connect programs and departments internally and help reach communities and partners. It can support everyone. It can be connected to other applications which users can configure according to their needs with no programming required. Users can access data anywhere through any device. It is an open platform that ensures data and system interoperability. How GIS can help countries make informed decisions to improve Universal Health Coverage Dr. Geraghty and Ms. Canserina showed features of ArcGIS Online—how it can facilitate analysis and how it might influence policy decisions related to improving care access. This is advantageous for population health management and hospital systems. ArcGIS’s interface provides opportunity to select population of interest—example, the entire population, women of child-bearing age, or children. Users can also look at modes of transportation from walking, biking, riding or some combination thereof as well as hospitals and health clinics. The analysis shows the access by times and administrated areas. Users can see how many of the population for a certain area has access to health care in 30, 60, 90, or 120 minutes of travel. The ArcGIS dashboard has a scenario report for all the data for any administrative level. Say, users want to improve areas, they can add a clinic in these locations. They can check the interest level in this area and place proposed clinics. In viewing results, users have the option to view it by the percentage of the population or just the raw population numbers. There are also higher administrative levels which show district levels and subdistrict levels. Obtaining the data for mapping First, ESRI collects quite a number of data variables from census information to spending and behavioral data. The availability of data varies by country. There are also a number of open data sources; some are curated by governments and some come from other sources. It is important that sources are trusted and authoritative. You can geographically plot your data assets to create new data sets and bring in data through field collection as well. Once you have data, it is pretty easy to get it on a map. To get information on the map, users can use simple applications like excel spreadsheet containing any kind of geographical information they have. It may be longitude and latitude but, if not available, district names can be used too. By dragging the spreadsheet to the map, data is generated on the map. Symbolizations are also made easy through ArcGIS’s smart mapping capability.
OPEN FORUM Question: Why shouldn’t we use open source GIS? Answer: There are many types of workflows that require a stable and supported environment. mHealth is certainly one of them. This is also true for emergency response activities where situational awareness is critical. The platform approach is kind of a big deal. There’s no open source GIS that functions in that way. That means it would have limited capacity to scale or extend as it needs to. With open source, there are also fewer tools available for your analyses and no collaboration or sharing platform. ArcGIS is fundamentally an open platform. It ensures that your data and your systems are interoperable with other kinds of technologies. This is challenging because different organizations have different approaches, different philosophies, and different perspectives for having implement interoperability. As we support open standards and an active number of organizations to drive and develop standards. We ensure that our system has open APIs and we even open source many of our libraries for our tools. We also bring many other open source packages into our environment. Question: Is it possible to automatically transfer the DHIS 2 database to ArcGIS? (Bangladesh) Answer (Mark Landry): Yes. This is a tool. Think of it as an extension of some of the mapping technology for pre-existing HIS or data warehouses that can help extend the use of this kind of software. Answer (Susann Roth): We think it’s especially interesting to put data from different sectors together so you can use this tool for your road planning, grid connection or off-grid electricity connection to health clinics. You can look at mobile phone card distribution and see how you can leverage that data. It is particularly interesting in countries where lots of infrastructure investments are happening now. You can make strategic investments, leverage also philanthropist money or development partner money. For instance, this is an underserved area and thus, it is critical that we have more mobile phone towers here or electricity or find off-grid solution. That’s another interesting thing I’ve mentioned, and of course the whole climate change planning and disaster risk assessment. Question: Are there any unique and simplified tool to create our maps or we need to do all the steps and processes you made during the demo? Answer (Dr. Geraghty): You don’t have to be a total GIS professional. If you understand what question you’re trying to answer, the tools should be there to do something very similar to this (presentation) on your own.
Overview of MA4Health Roadmap Development Working Group Session Mr. Mark Landry Regional Advisor, Health Situation and Trend Assessment, WHO SEARO In this session, Mr. Mark Landry talked about the transition from MDGs to SDGs and how countries can be guided by the MA4Health 5-point Call to Action in strengthening their Health Information Systems and build capacity to ensure access to information and analyze and use data to deliver quality care to everyone. Health is a small part of the much larger set of Sustainable Development Goals but it is well positioned. Universal Health Coverage can serve as an umbrella to drive all health system strengthening support. Good quality data underpin reporting all of the health-related SGDs. A good health information system is needed to support this. The 5-point Call to Action and Roadmap are presented to prepare countries for health-related SDGs.
Investing on Health Information Systems is the key-point of the 5-point call to action. It is important to build adequate capacity to ensure access to information from well-functioning sources and the ability to analyze and use reliable data not only for Routine Health Information Systems but for surveys, census, to civil registration, biostatistics and so forth. It is also important to work on how to ensure more effective use of information for objectives-and-evidence-based decision-making at levels of the health system underpinned by good governance, transparency, engagement to civil societies, etc.
The goal of the Roadmap is to enable all low and middle-income countries to have the necessary information to improve health and health services and achieve national and global health-related Sustainable Development Goals by 2030. To achieve this, countries need to create an enabling country environment. This is useful for AeHIN and there must be explicit agreement on eHealth architecture and standards. Countries also need to build demand for quality data used in clinical care and health program and health service system strengthening and strengthen the supply of quality data and recognizing them from multiple sources. Moreover, countries need to create a good relationship that serves national priorities first and let information be used to enable SDGs. In the roadmap are seven strategic areas with some points relevant to AeHIN: 1. To invest in strengthening data sources and capacities The investment to strengthen national health information governance, eHealth architecture, and data standards. These information help allow interoperability. 2. Align stakeholders in support of country health information systems Understanding and engagement 3. Use the digital revolution to scale-up health interventions and engage civil society Opportunity embracing digital health revolution and scaling up of health information in using innovations for example mHealth in big data more effectively
4. Strengthen public goods for health information and accountability Articulate emphasize in the roadmap open source technology and acknowledging open access data, greater transparency and collaborating with the private sector 5. Use data throughout all levels to improve policy, systems and delivery Importance of equity and maintaining this aggregated data for ensuring more effective analysis of not only quality care but access to care of the marginalized and underserved populations 6. Capture data on determinants of health as part of the country health information systems Great linkage to how we think about other sectors and data because you have to have information around water sanitation, traffic safety, and other areas like that that are not part of the MDGs but are part of the SDGs looking more intensively at mental health, social requirements about nutrition and other areas as well would require bringing in other data sources 7. Strengthen accountability and reporting of results In exercising national health accounts and other data sources as well and making data more transparent and available The core objectives and monitoring framework within the country roadmap are about the use of data, emphasizing the importance of health information and eHealth governance referring to the document of architecture and standards, and thinking about a broader array within the accountability platform and all the multiple data sources that will be required. The roadmap also has other features. It is linked to a time-bound set of targets, a number of milestones for the next 15 years including the roadmap itself. It has several pathways to achieve the set milestones and it mentions a number of stakeholders for consideration for engagement and explores some of the risks and mitigation strategies that will be needed in the implementation of the roadmap.â€ƒ
Parallel Sessions: Monitoring and Evaluation Investment Plan and Measurement and Accountability for Health Country Roadmaps In June 2015, the leaders of global health agencies and participants at the Summit on Measurement and Accountability for Health endorsed the Health Measurement and Accountability Post 2015 Roadmap, identifying a set of priority actions and targets that aims at strengthening country data and accountability systems for the post-2015 sustainable development agenda. The Roadmap is a unique opportunity to convene global and regional efforts to support the national country-led platforms on information and accountability. The Roadmap will be implemented through national plans for the health sector that will include a monitoring and evaluation framework. In this way, data will be used to improve the national response to priority health problems through an evidence- based policy cycle. At the country level, the national Roadmaps could result in increased level and efficiency of investments; strengthened institutional capacity to collect, compile, disseminate and use data; improved country data sources and enhanced accountability; and effective use of the data revolution based on open data standards. In this session, country delegates were divided into groups depending on the size of the country team and regional affinities. These groups are: 1) SEARO I - composed of India, Myanmar, Sri Lanka, and Thailand; 2) SEARO II – Bangladesh, Bhutan, Maldives, Timor-Leste, and Nepal; 3) WPRO I – China, Malaysia, Philippines, and EMRO (Pakistan and Afghanistan); 4) WPRO II – Cambodia, Lao PDR, Mongolia, and Vietnam; 5) Pacific Island Countries – Fiji and Tonga; 6) Africa –Kenya, Mali, Ghana, and Nigeria, and 7) Indonesia. Groups advocated for additional investments and aligned efforts to support the country –led platforms on information and accountability by sharing their priority actions in different areas, such as M&E plans; country institutional capacity; health survey plans; CRVS strengthening; facility and community reporting systems; disease surveillance, facility assessments and quality of care monitoring; health workforce and national health accounts; analytics, data use and open data, and scorecards and profiles. The first section should describe the current status of the Health Sector Strategic Plan; and the existing health sector M&E plans, including programme-specific M&E plans. The governance and coordination mechanisms of the information and accountability platform should be described also. The second section of the country template is focused on identifying the strategic actions needed to implement the country –led platform on information and accountability. Ten strategic areas have been identified. The actions should include responsible and key partners involved. The indicative budget could be useful. Objectives 1. Help countries reflect about the strategic actions and next steps needed to strengthen the national platforms on information and accountability. 2. Produce a series of country profiles and strategic actions (including responsible and indicative budget) outlining main priorities at country level to implement a country-led Roadmap for health measurement and accountability. Discussions Highlights of the parallel sessions on monitoring and evaluation investment plan and measurement and accountability for health country roadmaps were presented per group. 81
SEARO I Chair: Dr Eduardo Celades Technical Officer on Strategic Planning, Monitoring, and Evaluation World Health Organization Headquarters Dr. Eduardo Celades summed up that all countries in the group namely, Myanmar, Thailand, India, and Sri Lanka has a national health strategy and M&E plan with coordination mechanisms in place. However, they are under review to respond to the new SDG agenda and UHC. Specifically, in Myanmar, the national health plan 2011-2016 with M&E plan involves different partners for coordination. In Thailand, the national health strategy has been approved in 2015 with M&E systems. Its coordination for the strategy is informal. In India, it has a five-year health strategy and also a health implementation plan until 2017. Currently, the country is already finalizing UHC policies for their health strategy. Coordination mechanisms in place are at the national and state levels. In Sri Lanka, their health master plan is until 2016. They are currently drafting the new plan for the next ten years. Similarly, their coordination mechanisms are at the national and provincial levels. Consequently, participating countries have presented their priority actions. First is the development of the new national health strategy and M&E plan. This includes costing, SDG monitoring mechanisms, and national survey plan. Secondly, countries would like to prioritize the development of institutional capacities, such as peer-to-peer learning (i.e. regional and international forum), and Health Management Information System (HMIS) curricula. Some countries also expressed the need for technical and financial support. Third, in terms of CRVS, the countries would like to link efforts with national ID cards, with emphasis on reporting causes of death, and creation of in-country capacity. The fourth priority action is to address fragmented and weak disease surveillance systems. Hence, integrating reporting mechanisms, expansion of disease surveillance to private hospitals, and EMRs are needed. Fifth is the mobilization of partners and governments for political and technical support to develop an adequate enterprise architecture. Lastly, countries would like to prioritize action on strengthening data analysis and use at all levels.
SEARO II Chair: Mr Mark Landry Regional Advisor, Health Situation and Trend Assessment World Health Organization South East Asia Regional Office
Mr. Mark Landry reported the discussion for the health strategies and priority actions per country namely, Bhutan, Timor-Leste, Maldives, Nepal, and Bangladesh. In Bhutan, they donâ€™t have a national health strategy yet; however, they have five years plan document from 2013 to 2018 with M&E and strategy plans. Their strong M&E plans and aligned investment include NCDs, emerging and re-emerging diseases. To improve country institutional capacity, Bhutan prioritizes the provision of skilled human resource to all facilities. This country also implements EMR and ICT system to open, use, and analyze data. In Timor-Leste, the Ministry of Health has a 20-year National Health Sector Strategy Plan (NH SSP 2011-2030). Their strong M&E plans and aligned investment include five years M&E road map plan, community base monitoring, and supervisor supportive tools. To improve the country institutional capacity, they are introducing and training eHealth. Timor Leste also has strategic actions to improve the capacity in data analysis. The identified key partners to apply this strategic actions are Ministry of Health, WHO, UNICEF, and USAID. In Maldives, they have a national health strategy on eHealth. Meanwhile, their mHealth (20162025) strategy needs to be developed. Priorities of this country is capacity building to the infrastructure and human resources, and the integration of both. In Nepal, they have a National Health Sector Strategy 2016-2020, and an eHealth strategy (20152020). For the M&E plan, the result framework has been already finalized, while the implementation plan and M&E framework are being prepared.
WPRO I and EMRO Chair: Dr Manju Rani Senior Technical Officer, Health Information and Innovation Unit World Health Organization Regional Office for the Western Pacific Dr. Manju Rani presented that all countries (namely China, Malaysia, Philippines, and EMRO countries: Afghanistan and Pakistan) have a National health plan and an M&E Plan. For example in China, they have an M&E plan to assess National Health Reforms and in the Philippines, they have the National Health Objectives. In addition, all the countries have some form of coordination mechanisms in the form of interagency committees or national steering committees or committees It must be noted also that effectiveness of these mechanisms may vary. The countries have also presented their priority actions in line with their roadmap. For one, they have highlighted the importance of strengthening CRVS. Secondly, they have prioritized the 83
improvement of data utilization because of weak demand. It must be taken into account that decision-making in countries with CRVS and without CRVS might be different. In line with this, countries have also stressed the improvement of the quality of data. Next is the harmonization of data collection, M&E initiatives, timing, and also donor coordination in the case of Afghanistan and the Philippines. Some initiatives are already underway in some countries. Fifth is the data capture from the private sector, especially where it accounts for a substantial proportion of service delivery in the case of Philippines and Malaysia. Lastly, countries in this group emphasized priority actions on policy, legislation, and data ownership issues.
WPRO II Chair: Ms Rosebelle Azcuna M&E Consultant World Health Organization West Pacific Regional Office The countries involved in this session include Cambodia, Lao PDR, Mongolia, and Vietnam. In terms of their National Health Strategy & M&E Plans, they are already developing or launching the next health plan for 2016. In line with this, they have identified core indicators to monitor the broader goals and objectives; however, this needs alignment for the upcoming SDG indicators. Countries also aim to develop M&E plans which are (1) detailed from data collection, quality improvement, and use with baseline and targets, and (2) cost by requiring costing tools and TA. For the coordination and system integration of the plan, the countries target to develop or strengthen coordination mechanisms across line Ministries and within Ministry of Health for both policy and operational levels to better align investments, optimize resources, improve efficiencies. Moreover, they aim to improve harmonization and sharing of data across programs and registries. The countries involved highlighted the application and optimization of ICT to (1) improve data access especially at subnational levels, (2) data quality, (3) reporting efficiencies including generation of reports and dashboards, and (4) design and development of information architecture not only to serve the needs of the Ministry of Health but all the other line Ministries. Also, the countries highlighted the importance of RHIS and CRVS capacities and the role of surveys. For one, countries need to improve the quality of data from RHIS and CRVS for lesser reliance on surveys for some types of data (eg mortality). This includes strengthening of COD use which comprises VA tools and adoption of ICD-10 short list for COD. Another is the need to strengthen capacities for collection and use of data at primary health facility levels to develop a more sustainable system. Also, surveys are still required to provide data to monitor equity and validate results of RHIS/CRVS; however, there is a need to fill funding gaps. On analytics and data use, although the countries have some good experience with the use of dashboards at the national level, this should now be applied at the subnational level and even down to the districts to guide actions.
Chair: Dr Salma Burton Team Leader, HSS and RMNCAH World Health Organization Indonesia Dr. Salma Burton reported that Indonesia’s National Health Strategy is a five-year plan from 2015 to 2019. They also have a draft version of the multi-sector integrated National Strategic Planning for Health Information System 2015-2019. For the country’s M&E plan and specific plans, Dr. Salma reported that BAPPENAS has a major role to play in this endeavor. The Ministry of Health has different roles on CDI (Pusdatin) to Monitoring. NIHRD (Badan Litbang) focuses on evaluation while MoH Programme Units concentrates on M&E specific indicators on diseases and data which do not come from the health facilities. Indonesia’s key points of action include these thrusts: 1) development system for coordination; 2) capacity building; and 3) implementation prioritization. The country has also come up with their strategic action plan, which foremost includes the role of MoH’s SDG Task Force to indicate agreed SDGs indicators, M&E, and accountability process. Second is the country’s priority to improve country institutional capacity and skills of health informatics personnel by doing mapping for health workforce. Third, in terms of CRVS, BAPPENAS at the national level has coordinated multi sectors to develop national strategic planning. At the same time, in MoH, Pusdatin has the role of leading the CRVS implementation in active collaboration with BAPPENAS. Next is the country’s thrust towards the strengthening of facility and community reporting systems. Fifth, in terms of disease surveillance system, Indonesia is working on how to combine NCD group data with chronic diseases data through BPJS. However, the ownership of this strategy is still under discussion at high-rank level. Sixth, facility assessment and quality of care monitoring is still ongoing in Indonesia. PQSDS is supported by the World Bank, while point of actions on utilization is still being planned to identify who’s going to do what. Lastly, Indonesia is also optimizing its National Health Workforce Account: PPSDM (Human Resource for Health National Centre), and National Health Account: P2JK – SHA-2011 version. These two activities will also spring the development of strategic planning after the study is finished. On analytics, data use and open data, the country still has issues regarding the capacity building for health provider, especially in health management and information systems. Public information for health information is still in discussion– “portal satu data” while health information research access and use must be enhanced.
Pacific Island Countries Chair: Mr Shivnay Naidu President Pacific Health Information Network
Mr. Shivnay Naidu reported the National Health Strategy and M&E Plan of two participating countries in the pacific island namely, Fiji and Samoa. In Fiji, there is a national health strategy which defines a five-year strategy (National Strategic Plan 2016-2020 M&E 2016-2020) they wanted to achieve by using annual cooperate plan. In this plan, there is donor collaboration between the public and private sector. In Samoa, the National Health Strategy 2008-2018 was reviewed in 2013. The strategy remains the same, but they were able to review the impact from the M&E, wherein findings will indicate that something is on track. Strong M&E plans and aligned investments include development of metadata for core indicators by setting definitions and measurement mechanisms in line with UHC. Indicators exist such as the performance indicator reference sheet (whatâ€™s the definition, numerator, denominators, who collects it) but interpreting the metadata needs to be worked on. Moreover, they would also strengthen investment on EA in terms of standards. In terms of improved country institutional capacity, PIC-represented countries would like to focus on data analysis, and data quality/quality assurance. Support needed for these thrusts include capacity building, biostatistics, and EPI for better training to advocate for eHealth. In terms of health survey plans, they would like to harmonize regional and in-country surveys over a period of time to avoid multiple surveys in the same year. They are also exploring the possibility to design survey in electronic or mobile platforms. In addition, planning of country-level and regional donor perspective has to be clear. To strengthen CRVS, PIC countries targets the use of mobile application for verbal autopsy, training of doctors on how to fill out death certificates, and training of medical coders on how to code cause of death through the tool, IRIS. They are also proposing a regional collaboration center for coding. Strengthening collaboration between health institutions and CRVS stakeholders to seek assistance from NGOs, private sector, village leaders, and decision-makers is also key. With regards to facility and community reporting systems, PIC-represented countries would like to invest in community-based reports and programs like DHIS2. In facility assessments and quality of care monitoring, they would like to invest in audit tools (Monitoring and Evaluation Framework) to see how things are implemented. They believe that if you have 90% of whatâ€™s on the list, youâ€™re considered a good facility. In addition, they would like to kickstart the development of Clinical Practice Guidelines, wherein for each guideline there will be a corresponding standard. There is also a need for more qualified people to work with this kind of thrust. In terms of disease surveillance, PIC-represented countries expressed their intention to invest in GIS and mHealth, map collaborations between GIS systems from island to island, and synergize border control efforts. In terms of health workforce and national health accounts, knowledge sharing across the Pacific is
important. Collaboration must be extended into the Pacific and not only in the Asian region. In terms of analytics, data use, and open data, there is a need to provide training, and develop policy briefs in support for ministerial meetings which contains the summary of the country’s performance. Lastly, PIC-related countries also expressed their willingness to report on the core health indicators to WHO and synergize with other donors such as SPC and UNICEF that also has country-level profiles.
Chair: Ms Kate Wilson Director, Digital Health Solutions PATH Ms. Kate Wilson summed up the discussions in the African group and reported that the group decided to change the topic and spend the time focused on discussing the development of the African Network for Digital Health. The questions reviewed the plan of the network, stakeholders who will be involved, resources to be shared, and template for multi-day meeting. Priority actions from the group have four major areas namely, policy, product, practices, and process or next steps. In terms of policy, the group’s priority actions include (1) donor coordination for ICT initiatives, (2) advocacy efforts for ICT, (3) measurement for accountability tied to SDGs, and (4) focus on CRVS. In terms of product, priority actions include (1) ICT4UHC, (2) National ID, (3) HIS, (4) and (5) CRVS. In terms of practices, priority actions include (1) building eHealth capacity at the country level, and (2) building the culture of data use. In terms of process or next steps, the group proposed to host multi-day meeting to follow AeHIN model. In the first year, they aim to solicit from members, set charter or priority topics, and scale and attract funding.
Development Partner Forum Moderator: Mark Landry Regional Advisor, Health Situation and Trends Assesment, WHO-SEALRO, India Panelists: Dr. Susann Roth Senior Social Development Specialist Asian Development Bank (ADB), Philippines
Ms. Skye Gilbert Program Officer, Bill & Melinda Gates Foundation
Dr. Theo Lippeveld Vice President, International Division, John Snow International
Ms. Kate Wilson Director, Digital Health Solutions, PATH
Mr. Paul Rueckert Chief Technical Advisor, GIZ Nepal
Dr. Eduardo Celades M&E Technical Officer, WHO Headquarters
Dr. Samuel Mills Senior Health Specialist, Health, Nutrition & Population Global Practice, World Bank Group
Mr. Yojiro Ishii JICA Myanmar
Ms. Lori Thorell Senior ICT Programme Specialist, UNICEF-EAPRO Overview This session brings together development partners with interest in national eHealth systems and in supporting countries respond to the 5-point call-to-action. It provides an opportunity for countries to understand their development framework and see potential for collaboration and partnership.
Objectives: 1. Share your organization’s insights about the forthcoming Post-2015 Development Agenda and Sustainable Development Goals 2. Share your organization’s vision for country health information systems 3. Share your organization’s projects or programs related to eHealth that may benefit countries HIGHLIGHTS Why are you here? How is your organization working with AeHIN? Dr. Susann Roth: ADB, in the past two years, had become an active collaborator of AeHIN. We believe in peer-to-peer learning, in working with centers of excellence, and collaboration and coordination that AeHIN espouses. We can move forward in national development through eHealth, as development partner groups coming together for dialogues. As a bank, we are interested in supporting countries through loans and grants but in a systemic approach. We need technical partners like AeHIN to further facilitate sustainable financing for eHealth as it helps countries. Dr. Theo Lippeveld: We have four result areas and two of them are purely HIS strengthening. Result 1 is particularly over RHIS, result 2 is in overall HIS management meaning governance and use of resources for HIS strengthening, human resources, financial resources, commodity systems, etc. In that sense with the call for action recently been put forward, MEASURE is in all the points of the call for action. On investment and governance we are there via result 2. We are there to assist many countries in strengthening their institutional capacity for data collection analysis and use at all levels. We are trying to improve reporting on vulnerable groups like maternal deaths and prenatal deaths via community and facility-based systems and combine that in the community. We are trying to be strong in promoting strong RHIS--facility-based and community-based systems. RHIS is another network we’d like to link and set up under AeHIN. Mr. Paul Rueckert: GIZ is one of the founding agencies supporting AeHIN. We believe that having a platform where countries can share their experiences with each other and learnings is fundamental. Having such a meeting from time to time where you can directly talk to your peers is essential for progress. GIZ is starting a new component of an overall health program on strengthening Information System in Nepal. Dr. Sam Mills: The twin goals of the World Bank are to eradicate poverty and boost shared prosperity. We see in the UHC as a way to achieve these goals. The UHC ensures that poor have access to essential health services and ensures protection that nobody gets poor as a result of high out-of-pocket health expenditure. From our side, we see strong country and health information systems as critical for planning, monitoring, and evaluation of health programs. Ms. Skye Gilbert: Gates Foundation is trying to build an institutional perspective on peer networks. Historically, there were times where we invested in them and times where we haven’t. We wanted to see one with reputation for being highly-functioning and to learn and observe. There are wonderful examples of highly functioning country implementations here. Ms. Kate Wilson: Our organization had the pleasure of hosting and being facilitators of the IT track for the Joint Learning Network (JLN) in the last five years. It is delightful for us to see the joint learning approach in AeHIN. Where from a small group, it has grown into the vast network that AeHIN is today. Dr. Eduardo Celades: We develop and harmonize standards of global level and build institutional capacity (for standards) in the country level. This kind of regional networks are unique opportunity to link these two levels (regional and national level). Having a strong regional network could be very useful to continue supporting countries. 89
Mr. Mark Landry: These regional offices of the UN Agencies – WHO and UNICEF – are keen and supportive of AeHIN. We find that by joining our workplans with AeHIN is quite effective – to have some synchronization and shared priorities – in the way we go about supporting countries. Mr. Yojiro Ishii: We are directing our support in the area of eHealth as well as ICT in the health sector. Transitioning from MDGs to SDGs: How does that influence the way you will be investing, allocating loans, designing projects, engaging counterparts in countries? What is going to change or, if at all, how is this going to impact your development plans for the next 15 years? Mr. Yojiro Ishii: The Prime Minister of Japan agreed to the announcement of the policy of global health at the place of UN general assembly where he stressed the shift from MDGs to SDGs. The contents are changing therefore support from the Japanese government on health is also changing; the support for infrastructure, technical support, administration and finance aspect are important for the establishment of resilient government system and health sector. The importance of life cycle of seamless care system by the healthcare provider was also mentioned. JICA has to follow this direction according to the Prime Minister’s commitment and review all projects in the health sector to that direction to establish resilient health governance and continued care. Dr. Susann Roth: We felt the support of Japan for the UHC. We are able to endorse and improve new operational plan for health which brings the health sector back to the core of ADB sectors. ADB is known as an infrastructure bank and this opens an investment window of around a billion dollar project of health projects per year up to the year 2020. There is a need to engage again with countries on how we can support, collaborate with partners particularly the World Bank. We now have joint loan program in Laos – a policy program – which, is a good example how we can bring our strengths together. Dr. Eduardo Celades: With the MDGs we have 3 goals we are working on. The only way to achieve these targets is through the UHC approach. This is going to force us to change the game of how we work and seek to integrate more. This is going to influence how we work on a global level and country level. How are we going to monitor this? Indicators are not approved yet but there are frameworks to monitor the SDGs and these should still be developed and learn how to do it. Harmonization is going to be the effort for the coming years but in our perspective. Ms. Skye Gilbert: The SDGs are enormously ambitious. The real question is how do we do this with good stewardship? How do we implement this to let it stand, do we focus on trying to do this as efficiently as possible in order to achieve everything that we’re looking to commit to? Interlinkages between health and other areas whether it’s finance through UHC or infrastructure for ICT are exciting. Dr. Sam Mills: The SDGs are broader, more encompassing compared to the health MDGs. If we are able to implement these very well and able to achieve them it will go a long way in improving health outcomes. We drafted the 5-point call to action long before the MDGs were promulgated. we did it with WHO, UNICEF, and some other agencies. We are committed in its implementation. We had a steering group from other countries and agencies that looked at how to take the 5-point call to action forward. The small group has to draft a 5-year plan. We are going to see how they’re going to implement that. We are helping countries and developing their health sector strategies with one common M&E. We also provide technical assistance and for strengthening capacity in countries and for knowledge-sharing. We monitor the progress together with partners. As for the indicators, one of the ways to do this is through joint projects with partners through advisers, knowledge-sharing of experiences across countries. Mr. Paul Ruckert: Over the last 10 years, the health sector investments of GIZ in a number of countries were cut: we had to end our collaboration with a number of countries. There is hope, in GIZ, that the 90
trend will be reversed. My hope now is with the SDGs and the commitment of our Chancellor – who made commitments in several occasions in 2015 – that the German government is willing to invest in resilient health systems. My hope is we will be funding that in the future and get to continue our work. It might take some time for this to materialize, however. What are these key ingredients of successes, in your view, going forward with the SDGs campaign? Dr. Susann Roth: ADB is member state-owned and driven by the demand of the member states and countries. Thus, it is really the country’s ownership and wish to invest in ICT and health; we do not want to impose something that cannot be sustained at the national level and that would be just a donordriven initiative. So that’s why we think it’s important to integrate the digital health infrastructure: in the movement towards universal registration, strengthening the CRVS, unique identifiers, M&E for the SDGs – these constitute a whole package – these need to be tackled all together. Mr. Paul Rueckert: The important ingredient of success is when you are arriving in the country and you find the people who are interested to bringing some change. You need to identify the change agents and bring them together with the decision-makers because of the many times the change agents are not the decision-makers. When you have these people with their vision and you support them from the technical side to make them the political changes in the country, then you can go very far. The difficulty is identifying these people because they are sometimes hidden; but it is worth looking around. It is not necessarily the highest ranking people in the country; sometimes, the more senior they are the less likely to change. They don’t like to bring the change because they are, many times, the product of the system they developed and where they are working for the last 30-40 years. Looking outside and academe, there are many bright people that you want to bring them along to become your agents. The technical partner, financial resources, infrastructure--these will come. It’s the leaders who have the vision “I want to do something for my country” then you can go very far. Dr. Sam Mills: Country ownership is very critical. Development partners are well-meaning. They come to the country, they want to support. It becomes fragmented sometimes because of poor coordination of the partners. If the government is able to bring partners together then it can be made sure that investments are well-aligned. Ms. Kate Wilson: We are working in the health sector and ICT. These two disciplines don’t always go together. We can have country ownership and country advocates; but there’s a big gap in helping people articulate demand. There might be one or two people who truly understand IT infrastructure (and what an integrated one can do for the country). Throughout this conference we talked about that need to develop capacity and demand. We have to be careful about what’s being asked for so we can support that usefully. There role of development partners )such as Banks, and the UN agencies) play are different from say, JLN. Our role is to help people become better consumers of the IT and articulate demand. Dr. Eduardo Celades: Country leadership and ownership. Today we are friends but when we go to the country sometimes countries have different systems and behaviors. Guidance like the 100 core indicators, we have tried to have it harmonized. These should be translated as well into the country level if we have a strong country leadership. Mr. Yojiro Iishi: The important thing besides leadership of the country is the network, regional network, is also very important to enhance each country’s diversity. To drive the sector and that will become more relaxed rather than to meet with donors or development partners. If they meet together with similar situation countries in the region they can become closer and intimate to discuss their own problems.
What are the specific outcomes you have seen in this Conference already and next steps that might present additional opportunities in increasing or exploring further collaboration with AeHIN? Dr. Theo Lippeveld: Up to now, people have real troubles in how to measure the progress they were making because they were dependent on surveys. They cost a lot of money and can only be done only every three years or five. So people were a bit blindly moving forward. With the SDGs now we have an opportunity to strengthen the systems; then countries, at a certain point, can meet every quarter, six months of the year and look at the particular indicators and see how progress is made. That’s going to be triggered by these regional networks; and my aim, at RHINO, is not to only do that in Asia, we are also talking about Africa. It is very right to put that network of routine HIS (RHIS) strengthening under a network like AeHIN, which is looking at the broader architecture of the HIS. The RHIS are still in a lot of countries doing paper-based work and support. We need to have a peer-review network to share the lessons, because it’s gonna be difficult (to reach the SDGs). It will take time to get there but we can see that we can get there somewhere. I hope that subgroups under AeHIN is going to be a leader in that kind of movement. Dr. Sam Mills: AeHIN can help develop standards to be used by countries and support these countries in implementing them. More important is since you organize this Conference annually it will be an opportunity to invite countries to process annual progress reports and to share lessons learned. Dr. Susann Roth: ADB will continue to support AeHIN in a cooperation process, and establish the interoperability lab. We would like to be seen as one part of the group bringing in these development partners together in providing a platform for funding, mobilizing from different sources. And as a next step, we would like to assist countries to host AeHIN meetings like the one in Myanmar (proposed by MoH Deputy Minister for the AeHIN GM in 2016) – and in different countries and whoever invites us. We would like to be a part of that and facilitate the dialogue with the ministries of finance – because they are ultimately the ones who make the decisions for budgets. This is how we see the next year: strengthening the public and private partnerships, engaging with universities, building the capacity, human resource capacity in the countries. Ms. Kate Wilson: The JLN tools developed an entire toolkit for helping countries map their data, and then taking that through to a dashboard. These process tools were developed with the group of countries both in Asia and Africa – were produced in the last five years. We are transitioning those completely (and hopefully) to AeHIN here. The JLN will continue to support the development of the African Network Health which has been set up to mirror AeHIN. Dr. Eduardo Celades: Set the priorities for the succeeding years for the platform of information accountability. On the WHO’s side, we are going to support the countries requesting for technical support to really move the Roadmap forward. OPEN FORUM Question: Most of donors have their own priorities. How can countries convince donors to invest in eHealth? How can countries request TA from the donors? Dr. Susann Roth: Through AeHIN. You call AeHIN and AeHIN brings everybody at these joint meetings and you decide what is going to be discussed. AeHIN is your technical help – but if you need financing or want to discuss possible grant financing you need to go through Ministry of Finance and they can send a request to ADB country office or headquarters. Mr. Paul Ruckert: The countries where the GIZ are supporting the health sector – which are few in Asia – steps to engage are relatively easy. You have to send the MoH to send a request to the German 92
Embassy that you want to add such a component to the (TA) portfolio. Then it will be discussed in the next government consultations and negotiations whether it should be added or not. Mr. Yojiro Ishii: I respect regular dialogues between development partners and host countries. No need for special occasions. During monthly meetings they can discuss in detail and deepen understanding of the meaning of the request. Ms. Skye Gilbert: Within the areas we do focus on it’s just to prepare for any negotiation. There’s doing a lot of planning that’s understanding in your landscape who your donor is and what they care about and tying that to the eHealth plan. Within country government sometimes there’s an issue between health technical experts and ICT technical experts that’s not just in country governments, that’s also in donor organizations. You have a challenge communicating back to us and translating to us across ICT and health. Dr. Sam Mills: Set priorities for your countries. Usually we have three year country partnership where we discuss elements with the government – we develop in partnership the ideal national strategy. Mr. Mark Landry: Know your donor. Know the rules of engagement. Understand their model for development assistance. One potential way to understand that is make a request to AeHIN or WHO and we’ll help find the right technical assistance working through other development partners. There are lots of ways to access support that you’re not familiar with because you may not know your donor. I encourage AeHIN to try help profile various types of development assistance from loans to financing to technical assistance agencies at the UN to bilateral donors and other kinds of foundations and donor assistance. Question: What are requirements to get the development partners help in country projects? Ms. Skye Gilbert: In the Gates Foundation there are 26 strategies so it must be related to one of those and tie it to meaningful health impact. Questions to ask yourselves – Is there a theory that tells you how investing in eHealth leads you to having equal value? It’s worth thinking about in your own context in what ways it ties to help impact. Is it something that is feasible? Does it have probability of sustaining even after the support finishes? Is this investment we’re gonna engage with you something that could be use a broader agenda worldwide? (Because) that is how we can uniquely push things at a global level. Dr. Sam Mills: If you have a proposal that’s looking at high-end hospitals in the cities and there are those in the rural areas, it’s more likely that we would be pleased to support projects to reach the poor and ensure that they have access to services. Dr. Susann Roth: We would like to see the mid-term (that is, longer-term as opposed to short term) engagement. Proposals should have integrated and a systems approach rather than a grand or lone project. As technical agency we cannot do small projects. We do not have procurement capacities for that. Mr. Paul Rueckert: The German government selects two to three priority sectors in the country. When health or social protection happens to be the sector, then they stay for a long time. We have regular evaluations that we try to follow the trends. For example we started at the beginning of this year, knowing that Nepal was preparing for a new sector program. The idea was “how can our future support fit into the new upcoming sector program?” A number of topics we cannot go through all major outcomes but we agree that we would be supporting the information system. This is in a mutual dialogue together with our partners which is also the foundation of the likelihood of success. If you know each other for a long time, you trust each other, you know what you can get from the other side, 93
and there’s a firm commitment to stay for a longer period of time. When there’s such commitment you can do it step-wise. Evaluate the progress. It’s important that we make it a standalone to show the importance and make it more attractive. What are your thoughts in terms of investing in redefining/refactoring the human information system that are using all of the data streams that we’re generating through these technologies? Mr. Skye Gilbert: There are a couple of case studies that show that human resources is far more important than the technology and if you as a country came to me and gave me the two proposals--1. to do a change management program on top of a paper system or 2. go and take a legacy paper system and make it digital--I would pick the change management one almost every time because it has a higher probability of success and we’re ultimately all people using tools and you can do a lot more people than you can with a passive tool. The challenge with change management in general is that many donors have short term funding cycles and change management is a 10-year program. A lot of human interventions that are proposed to us in any case are quite costly. There’s a need for innovation in this space to find ones that are easier to fund over a long time frame easier to co-fund with countries. Dr. Theo Lippeveld: Ultimately where we want to reach is information translated into an action that improves the health system if not that information system is useless. I still have not seen that there’s difference between paper-based system or electronic system in getting to that action. It’s not the electronic system that will move people into action, it’s things like information culture where information is valued as a good that can lead to action. But action how does it come then? It has something to do with behavior interventions where people solve problems. Problems are not solved with tools always. Tools can put the problem into a clearer light but do not necessarily lead into the action that is a human thing, an institutional thing of an organization. Dr. Susann Roth: There is a significant contribution that ICT brings to social development. This is the speed we can access information and we see this in social media and how we use ICT socially and how the network is expanding. It’s more than just a different presentation of information. This is why it’s so powerful. ICT brings change. OTHER QUESTIONS (PIGEONHOLE) 1. Fragmented reporting systems and indicators are supported by the donors – how can donors instead support an integrated system and reinforce ICT for measuring health performance? 2. How can the development partners connect eHealth/HIS work with earlier initiatives? (These previous/ current work are based on global recommendations such as the CoIA) If CoIA efforts are not taking off, what are the lessons from these implementations? 3. We have 5-point call for action, SDG and ICTen – from donor point of view, what area should country start first? Or is there any way to harmonize the three? 4. How can countries that have moved out of donor’s criteria request for technical assistance for capacity building?
5. Would World Bank be interested in supporting a study to profile successful, scalable eHealth implementations, reference sites in the region? (such as a follow-up to the previous InfoDev grant from WB?)
Conference Closing Rites On the last day of the conference, co-chairs Dr. Alvin Marcelo and Dr. Boonchai Kijsanayotin together with the AeHIN Working Council have presented future plans on AeHIN subgroups like the AeHIN Regional Enterprise Architects Council for Health (REACH), Community of Interoperability Labs (COIL), AeHIN Research to name a few. At the end of the presentations, AeHIN together with co-organizers WHO, UNICEF, ADB, FIKI, BPJS, MOH were thanked for helping make the conference a successful one. Special mention is made on the local organizing team of Udayana University, Governor of Bali, the provincial government of Bali, BPJS, and WHO Indonesia. Myanmar and Sri Lanka have also volunteered to host the fifth general meeting.
MA4HealthAP Concept Note
A Roadmap from Design to Implementation 26â€“29 October 2015 | Bali, Indonesia Summary The Conference on Measurement and Accountability for Universal Health Coverage in the Asia Pacific and AeHIN 4th General Meeting (hashtag: #MA4HealthAP) aims to gather state and non-state actors to discuss how they can improve health service delivery and measure health outcomes in the post-2015 development era. The meeting will be held in Bali, Indonesia 26-29 October 2015, hosted by the Ministry of Health Republic of Indonesia and in cooperation with the the Forum Informatika Kesehatan Indonesia (FIKI). It will be co-organized by AeHIN, WHO, Asian Development Bank (ADB), and UNICEF with support of several other development partners (see list at the end of this concept note). The #MA4HealthAP and AeHIN 4th General Meeting will build on previous AeHIN conferences that have spurred interest in ICT-enabled change in health services and effective M&E systems to achieve UHC goals. The aim is to galvanise a multi-prong approach to better health care with stronger political will and unified multi-stakeholder engagement needed for operationalizing iCTen! practices (person-centric ICTenhanced investments) underpinning better M&E and health information systems for evidence-based decisionmaking (country HIS roadmap investments). The Meeting will offer government officials and professionals from over 20 countries an opportunity to understand in more detail what it will take to deliver #MA4HealthAP results that are cheaper, faster and better using effective digital health (HIS, eHealth and mHealth) solutions. The meetings also intend to prepare the groundwork for development of detailed, costed, and prioritized Country Roadmaps for Measurement and Accountability for Health for all, ahead of the finalization of the Sustainable Development Goals (SDGs) in March 2016 and to strengthen national M&E systems and HIS reliability in general. Side meetings following the event, 29-30 October are being organized to (1) address National Health ID development and implementation; (2) convene a special session of the Pacific Health Information Network; (3) form a group focused on Routine Health Information Systems; (4) support an Indonesia National M&E workshop; and (5) review evidence on UHC performance from social health insurance programmes.
Background The Asia eHealth Information Network (AeHIN) was created by the World Health Organization to facilitate peer-to-peer learning among national Health Information Systems (HIS) and eHealth focal points and advocates in the ministry of health, ministry of information and communications technology, academe, and non-government sectors. Since its inception in 2011 following the Asia-Pacific HIS Country Ownership and Leadership Forum, AeHIN has fostered relationship-building between its members with the goal of developing an environment for effective capacity development, collaboration and cooperation towards regional interoperability. AeHIN now comprises over 600 members from more than 20 countries in South and Southeast Asia and maintains affiliation with the Pacific Health Information Network (PHIN), Africa Network for Digital Health (ANDH), the Joint Learning Network (JLN) for Universal Health Coverage, and the regionalized community of practice focussing on Routine Health Information Systems (RHINO) to be formed. After a series of capacity-building programs, AeHIN has accumulated a cadre of members who have been trained and/or certified on eHealth strategy formulation (Bangkok 2012, Manila 2013), IT Governance (April 2014 and September 2015), enterprise architecture (Ulaanbatar 2013 and Kuala Lumpur 2014) and data standards 97 1
CONCEPT NOTE (August to November 2013). With these resources, AeHIN is now poised to employ these newly-found knowledge and skills towards creating capacities for regional HIS and eHealth interoperability to support achieving UHC. In the first AeHIN General Meeting (GM) (Bangkok, August 2012), the participants approved the AeHIN fourpoint strategy1. The second meeting (Manila, September 2013) had three sub-events: the IT4UHC conference where consensus was reached about the important role of information technology in achieving universal health coverage (UHC) while planners from six countries concurrently underwent a national eHealth strategy writeshop. In the third sub-event, the AeHIN Business Meeting, the participants approved the strategic implementation plan 2012-20172. The third GM hosted by the Asian Development Bank (ADB) (Manila, December 2014) started with a workshop on Monitoring and Evaluation (M&E) followed by the Measuring and Achieving UHC with ICT Conference. The UHC with ICT Conference featured major statements of policymakers in support of eHealth and multi-sectoral engagement galvanizing the importance of leadership and governance, enterprise architecture, standards, and capacity building leading to consensus proclamation of 10 key UHC with ICT recommendations—or iCTen!3 This fourth AeHIN general meeting combined with the MA4Health meeting aim to galvanise a multi-prong approach to better health care from personalized health data through ehealth and mhealth solutions at the service delivery level up to reliable Health Information Systems (HIS) from multiple data sources leading to better M&E of health sector policies, strategies, and plans. The innovations and solutions from individual to aggregate level data will require concrete tools and scalable solutions that can interoperate and be used to begin measuring health system performance – specifically for universal health coverage. Emphasis will be given to open source and open standards-based tools and technologies that can help countries begin or accelerate their use of ICT-enhanced solutions with governance, enterprise architecture, standards, and effective capacity building programmes to support HIS and eHealth investments. Innovation and eHealth—or digital health solutions—are enablers for UHC and better measurement and better health outcomes in the post-2015 development agenda. From 9 to 11 June, 2015, the World Bank, World Health Organization and USAID gathered state and non-state actors to discuss HIS, eHealth, and CRVS readiness for the forthcoming Sustainable Development Goals (SDGs), targets and indicators and how they may be measured and used effectively as a means of assuring accountability. This “Measurement and Accountability for Results in Health Conference” (MA4Health) succeeded in networking countries and eliciting insights from the participants leading to the formulation of a 5 -Point Call to Action and a new C ountry Roadmap for Measurement and Accountability. The next steps will be focused on advocacy and greater country ownership for post-2015 national health policy development including establishing next generation monitoring and evaluation (M&E) frameworks and core indicators for measuring SDGs, UHC, and national health sector strategy progress for better health service delivery. Figure 1 illustrates how the #MA4HealthAP and AeHIN GM may be strategic to maximize the global and regional approaches for country impacts. Figure 1: How Countries Can Maximize Global and Regional Initiatives for Country Impacts
1 AeHIN Strategic 2011-2017. 1) Promote leadership and governance for eHealth; 2) build capacity for eHealth; 3) adopt networking and peer learning approach; and 4) promote standards and interoperability in eHealth (accessible at http://bit.ly/aehinstratplan) 2 AeHIN Strategic Implementation Plan 2012-2017 accessible at http://bit.ly/aehinstratimplementationplan 3 WHO-ADB-AeHIN iCTen may be accessed at http://bit.ly/whoadbaehinicten
CONCEPT NOTE Stronger political will and unified multi-stakeholder engagement is needed for operationalizing iCTen! practices (person-centric ICT-enhanced investments) underpinning better M&E and health information systems for evidencebased decision-making (country HIS roadmap investments). The #MA4HealthAP and AeHIN GM will engage government officials from multiple sectors (health, finance, planning, statistics, ICT), development partners and experts to share experiences and review the current evidence on cost-benefit and impact of various ICT-enabled health services and reliable information systems to support UHC. The #MA4HealthAP intends to prepare the ground work for the Country Roadmap for Measurement and Accountability ahead of the finalization of the SDGs in March 2016. Around 150 participants from 20 Asia-Pacific countries will participate in plenary and panel discussions, parallel sessions, meet the experts open forum, displays to discover critical issues related to monitoring and evaluation of UHC, and the role of ICT-enabled health information systems may play in better measurement and accountability in health. At the end of the conference, a set of proceedings will be made available for countries as a guide for their post-conference actions. Interlinking the AeHIN 4th General Meeting with #MA4HealthAP and will facilitate a technical series of presentations, panel discussions, marketplace tech transfer, and expert networking. There will also be sessions featuring the Regional Enterprise Architecture Council for Health, the Regional Interoperability Lab, an architecturesolutions fair, and other knowledge-sharing and learning sessions. The meeting will emphasize a peer-partnership approach to national HIS and eHealth development in contrast to the usual isolated efforts of the past. The peerpartnership approach brings together countries as peers and development agencies as partners to address better governance, enterprise architecture, standardization, interoperability, and program management that can effectively aid scaling and sustaining current and future HIS and eHealth investments. The launch of the AeHIN Regional Interoperability Lab is an innovative platform and resource to accelerate iCTen! and operationalize the 5-point Call to Action of the MA4Health in Asia and the Pacific. Co-organizing the high-level, multi-sector #MA4HealthAP and AeHIN 4th General Meeting will provide a unique opportunity to explore breadth and depth of the realities, key challenges, opportunities, feasible solutions related to better quality, analysis, and use of health information and deployment of strategic and scalable ICT investments. The multi-sector dialogue, consensus-where-feasible, and even country-specific factors and priorities declared will potentially influence short- and long-term M&E, HIS, civil registration and vital statistics (CRVS), and eHealth investments and capacity building actions underway impacting UHC. Improving the information culture, applying lessons learned in HIS, CRVS, eHealth and mHealth through systematic and normative techniques and standards can potentially change behaviour and derive more effective, equitable, quality, and lower the costs of integrated patient-centred health services delivery. The AeHIN 4th General Meeting will offer technical professionals an opportunity to understand in more detail what it will take to deliver #MA4HealthAP results that are cheaper, faster and better using eHealth and mHealth. The AeHIN Regional Interoperability Lab, the Joint Learning Network (JLN) for UHC, the Routine Health Information Network (RHINO), and other aligned global and regional platforms and resources can help. Four special side meetings are envisioned immediately following the main #MA4HealthAP and AeHIN General meeting for select participants, to be held starting in the afternoon of Thursday, 29 October and concluding on Friday, 30 October. These are: (1) Delegates from Pacific island countries will be invited to join a special convening of the Pacific Health Information Network (PHIN); (2) HIS professionals from South and Southeast Asia will have an opportunity to build a RHINO community of practice to address specific M&E and RHIS needsâ€”including capacity building and support with data quality, analysis, and use; (3) UNICEF, ADB, and AeHIN will spearhead a technical curriculum development process designed to implement national health IDs (NHID) schemes for longitudinal monitoring of individuals through the healthcare system; and (4) Indonesia delegates and stakeholders may hold a national M&E workshop to continue their M&E investment planning.
AeHIN Meeting and #MA4HealthAP Workshop Objectives • Review current evidence on cost, benefit and impact of ICT-enabled solutions in health systems from person-based applications for service delivery to better measurement and accountability of health, and faster progress towards UHC and SDGs
• Initiate development of an M&E systems investment plan by operationalizing the Country
Roadmap for Health Measurement and Accountability in accordance with the MA4Health 5-Point Call to Action and iCTen! recommendations
• Share, learn, and prepare to implement capacity building strategies, standardized processes, tools and techniques, and ready-to-use IT solutions towards achieving UHC
• Endorse the regional interoperability laboratory Profile of Participants • 150 representatives from 20+ countries in Asia and the Pacific and development partners consisting of:
• Key government officials involved in planning, financing or regulating social health • • •
protection (Health, Social Welfare, Finance, Planning, ICT Ministries) Social Health Insurance Agencies Academic institutions (health informatics, health financing) Multilateral technical agencies and donors
Pre-Meeting Activity • A brief SurveyMonkey questionnaire to participants and partners will be deployed to rapidly assess and highlight current HIS and eHealth situations, priorities, needs, and technical support opportunities—which will be summarized and shared during the meeting
26-30 October 2015 | Bali, Indonesia
Monday , 26 October 2015 Setting the Stage (MDGs to SDGs, Country HIS Roadmap) 7:00 8:30
Registration Dr. Boonchai Kijsanayotin, AeHIN Co-chair
Engr. Oliver Gehlen, Lead Facilitator Hon. Made Mangku Pastika, Governor of Bali Dr. Khanchit Limpakarnjanarat WHO Representative to Indonesia
Dr. Steven Tabor, Country Director, Indonesia Resident Mission, ADB Ms. Gunilla Olsson, UNICEF Country Representative to Indonesia
Introduction to the Keynote Speaker 9:15
Dr. Untung Suseno Sutarjo, MKes, Secretary General, Ministry of Health, Indonesia
Keynote Address 9:30
BREAK AND PHOTO SESSION Where we are now: Transitioning from the MDGs to SDGs: Measurement and Accountability for Health in the Post-2015 Development Agenda and the Role of ICT
Moderator: Prof. Vajira Dissanayake, President, Health Informatics Society of Sri Lanka
MDGs to SDGs in Indonesia
Dr. Deddy Kuswenda, Secretary General, Ministry of Health Indonesia Task Force for SDGs
MA4Health 5-Point Call to Action and Country Roadmap
Dr. Samuel Mills, Senior Health Specialist Health, Nutrition & Population Global Practice, World Bank Group
Achieving UHC with iCTen! Investments
Drg. Oscar Primadi, Head of Center Data and Information, Ministry of Health Indonesia
Dr. Susann Roth, Senior Social Development Specialist, Asian Development Bank
UHC in Indonesia
Dr. dr. Fachmi Idris, MKes., president Director of BPJS Kesehatan
UHC in Myanmar
Dr. Thein Thein Htay, Deputy Minister of Health, Myanmar
26-30 October 2015 | Bali, Indonesia
Monday, 26 October 2015 (continued) 11:00
Three Parallel Sessions: Measurement and Accountability - State of the Art (1) Ministries of Finance, Planning, ICT, and Development Agencies Chair: Ms. Lori Thorell, Senior ICT Programme Specialist, UNICEF EAPRO
(2) Ministries of Health, Social Protection Agencies, eHealth Experts Chair: Mr. Mark Landry, Regional Advisor, Health Situation and Trend Assessment, WHO SEARO
(3) Ministries of Health, Central Statistics Offices, Civil Registrar Chair: Ms. Kate Wilson, Director, Digital Health Solutions, PATH
Health Targets and Indicators in the SDGs and Roadmap for Health Measurement and Accountability (Dr. Eduardo Celades, M & E Technical Officer, WHO)
Using Dashboards for Measurement and Accountability for National Health Insurance (Mr. Angelito Abando, IT Consultant to PhilHealth Office of the President & CEO)
#getinthepicture â€“ 10-year Regional CRVS Action Framework and Support Program (Mr. Shivnay Naidu, President, Pacific Health Information Network, and Representative of the Regional CRVS Steering Committee)
Ensuring Accountability through IT Governance Frameworks (Dr. Alvin Marcelo, AeHIN Chair)
Leadership, Legal, Teamwork, and Financing: Transforming the Lao eHealth Landscape (Dr. Founkham Rattanavong, Lao PDR)
The Role of eHealth Research in Measurement and Accountability for UHC (Dr. Drg. Theresia Ronny, Director for Public Health and Nutrition, National Planning and Development Board (BAPPENAS))
Aligning National Health Objectives with the Post-2015 Development Agenda (Dr. Maria Rosario S. Vergeire, Health Policy Development and Planning Bureau - Department of Health Philippines)
Indonesiaâ€™s Journey to UHC with ICT (Mr. Dadang Setiabudi, IT Director, BPJS)
The Reference List of 100 Core Global Health Indicators and Regional UHC Indicators (Dr. Mohamed Mahmoud Ali, Coordinator, Health Information and Statistics, WHO EMRO)
Donor Perspective: Infrastructure Investments: Foundations for National eHealth Development (Dr. Susann Roth, Senior Social Development Specialist, Asian Development Bank)
Donor Perspective: Primary Health Care Architecture Framework and Getting Impact at Scale (Ms. Skye Gilbert, Program Offier, Bill & Melinda Gates Foundation)
Donor Perspective: Maximizing Innovation and Investments from the Global Financing Facility (GFF) for Women and Children (Mr. Haitham El-Noush, Senior Adviser, Health Innovation Lead, NORAD)
Managing Fiscal Sustainability of the Indonesia National Security Program, Ministry of Finance (Dr. Rofyanto Kurniawan, Director of Center for Budget Policy, Fiscal Policy Agency, Minister of Finance Indonesia)
Financing Universal Health Coverage in Indonesia (Dr. Widiarti, Center for Health Financing, Ministry of Health Indonesia)
The Role of eHealthh Research in Measurement and Accountability for UHC (Dr. Pradeep Kumar Ray, Director of WHO Collaborating Center on eHealth, UNSW, Australia)
Moderator: Dr. Eduardo P. Banzon, Senior Health Specialist, Asian Development Bank Drg. Oscar Primadi, MPH, Head of Center Data and Information, Ministry of Health Indonesia
Plenary Panel: The Role of Governance in Managing HIS and eHealth Complexity
Dr. Wang Caiyou, Vice Director, Center for Health Statistics and Information, National Health and Family Planning Committee China Ms. Roszaini Omar, Chief Information Officer, Ministry of Health Malaysia Ms. Limatula Yaden, Director, National Health Mission, Policy, Ministry of Health & Family Welfare India Engr. Jovita Aragona, Chief Information Officer, Philippine Health Insurance Corporation
26-30 October 2015 | Bali, Indonesia
Monday, 26 October 2015 (continued) 15:00
Architecture and Solutions Fair: Designing and Implementing UHC with ICT Method: Marketplace (Revolving 20 minute programmes) Planning and Architecture Track
Implementation and Solutions Track
-5-Point Call to Action -Health Information Exchanges (HIEs) & Terminology -Post-2015 SDGs and 100 Core Global Health Indicators Services (OpenHIE) -iCTen! National Health Information Exchanges
Architecture, Standards, Interoperability -ISO TC215, OpenEHR, IHE -WHO-FIC APN ICD-10 Simplified Version -Guidebook on CRVS Digitization (Plan International)
-Philippine Health Information Exchange -Thailand HISPA and TMT -Malaysia HIX -Indonesia Integrated Emergency Information System
Regional Enterprise Architecture Council for Health (REACH)
The AeHIN Community of Interoperability Laboratories (COIL) Solutions
Tools and Toolkits -AeHIN National eHealth Capacity Roadmap (COBIT5, TOGAF, PRINCE2/PMP, ITIL) -HealthEnabled -RHIS and Community HIS (MEASURE Evaluation Project) -HIS/CRVS Strengthening, Verbal Autopsy--India (WHO) -WHO Collaborating Center for eHealth (UNSW) -Regional UHC Monitoring Dashboard (ADB/WHO)
-DHIS2—(U.Oslo, HISP-India, HISP-Vietnam) -MOTECH Suite Platform—India (Dimagi) -Open Smart Register Platform (OpenSRP) (THRIVE Consortium) Evidence for UHC and eHealth -OpenMRS (Regenstrief Institute) -AeHIN GIS Laboratory (Esri) -Digital revolutions (Bangladesh) -EHR Research Unit, Kyoto University - SIJARI Emas, mhealth for MNCH (USAID Indonesia) SIKDA (District Health Information System, MOH Indonesia) - DQS (Data Quality Self Assessment for Routine Data, MOH Indonesia)
End of Day Wrap Up
26-30 October 2015 | Bali, Indonesia
Joint Side Meetings: AeHIN Regional Enterprise Architecture Council for Health Meeting and Community of Interoperability Laboratories 19:00
Networking Reception hosted by MOH Indonesia
Tuesday, 27 October 2015 HIS/eHealth Program Management, Tools and Solutions 8:15
Mr. Jai Ganesh Udayasankaran, Senior Manager and Project Coordinator, Sri Sathya Sai Central Trust (Medical Care Division), Prasanthi Nilayam
Recap of Day 1
Moderator: Mr. Paul Rueckert, Chief Technical Advisor, GIZ Nepal
Dr. Polawat Witoolkollachit, Director, Information Technology and Communication Center, Office of the Permanent Secretary, Ministry of Public Health, Thailand Dr. Fazilah Shaik Allaudin, Deputy Director, Telehealth Division, Ministry of Health Malaysia Empowering the National HIS / eHealth Executive and Management Teams
Mr. Shivnay Naidu, Director, Director, Health Information, Research & Analysis, Ministry of Health & Medical Services Fiji Ms. Charity Tan, Chief, Knowledge Management Service, Department of Health Philippines Dr. Ashwin Sasongko Sastrosubroto, National ICT Board, Indonesia Dr. Bhim Prasad Acharya, Director, Management Division, Department of Health Services Nepal
BREAK Engr. Derek Ritz, Principal Consultant, ecGroup, Inc.
Live Demonstration - Digital Health for Better Care: The Maternal and Child Continuum of Care Scenario
Mr. Jai Ganesh Udayasankaran, Senior Manager and Project Coordinator, Sri Sathya Sai Central Trust (Medical Care Division), Prasanthi Nilayam
Three Parallel Sessions: Challenges and Successes with Implementing the iCTen What is ICTen? Finance and Investments Actions Chair: Ms. Donna Medeiros, Senior Global Health Informatics Advisor, Regenstrief
Health Actions Chair: Dr. Alain Labrique, Johns Hopkins University Global mHealth Initiative
ICT Actions Chair: Dr. Garett Mehl, Scientist, Department of Reproductive Health and Research, WHO
Plan for sustainable financing mechanisms from the start!
Know your baseline
Invest in unique ID schemes. Link CRVS and UHC
Get concrete. Have an implementation plan with quick successes! Define success, measure progress based on M&E criteria 13:30
Dr. Alvin Marcelo, AeHIN Chair
Get everyone on board and bring your best team. Adopt, adapt, or develop tools
Build institutional readiness and a skilled workforce
Commit to UHC, commit to integrat- Keep data safe and secure ed ICT systems!
Development Partner Coordination Side-Meeting
Dr. Alvin Marcelo, AeHIN Chair Dr. Boonchai Kijsanayotin, AeHIN Co-chair
Working Group Feedback and Discussion
Wrap-up Side Meetings: AeHIN Regional Enterprise Architecture Council for Health Meeting, AeHIN Community of Interoperability Laboratories, AeHIN Research Interest Group
26-30 October 2015 | Bali, Indonesia
Wednesday, 28 October 2015 MA4HealthAP 8:15
Recap of Day 2 Moderator: Dr. Theo Lippeveld, Vice-President, International Division, John Snow International Dr. Founkham Rattanavong, Deputy Director General, Department of Planning and International Cooperation, Ministry of Health Lao PDR
Mr. Rajendra Pratap Gupta, Chairman, Personal ConExpert Panel / Policy Debate: The economics of HIS and nected Health Alliance, India eHealthâ€”Why or why not invest? Ms. Aye Aye Sein, Deputy Director General, Department of Public Health, Minister of Health Myanmar Dr. Masood Anwar, Director Health Services, Directorate General Health Services, Punjab, Pakistan Ms. Rumanusina Maua, Assistant Chief Executive Officer, Health Information Systems & ICT, Ministry of Health Samoa
AeHIN Geographic Information Systems Laboratories: Launch of New ArcGIS Online Portal for Enabling Health GIS Analyses for Monitoring and Measuring UHC and Improving Health Systems Performance
Dr. Estella Geraghty, Chief Medical Officer & Health Solutions Director, Esri
Overview of MA4Health Roadmap Development Working Group Session
Mr. Mark Landry, Regional Advisor, Health Situation and Trend Assessment, WHO SEARO
Ms. Canserina Kurnia, Solution Engineer, Esri Global Asia Pacific
Parallel M&E Investment Plan / MA4Health Country Roadmap Cross-sector Working Groups
MA4Health Country Roadmap Working Group Session Feedback and Discussion
Development Partner Forum
Moderator: Mr. Mark Landry, Regional Advisor, Health Situation and Trend Assessment, WHO SEARO
MA4HealthAP Roadmaps and AeHIN Response to Call to Action MA4Health and Next Steps - Highlights from countries - Summary of commitments (Alvin, Boonchai, Anis) - Collaborative partner announcements and initiatives launch REACH, COIL, MOU, with AND, MOU, with PHIN, AEHIN GIS - Meeting Evaluation Closing Remarks - Drg. Oscar Primadi, MPH, Head of Center Data and Information, Ministry of Health Indonesia MEETING END
Thursday, 29 October 2015 Fieldtrips and Post-Conference Workshops 8:30
AeHIN Business Meeting
Side Workshops:-RHIS Network Workshop -AeHIN GIS Lab Workshop -Unique ID / National Health ID Training Curriculum Workshop -Indonesia National M&E Workshop -Pacific Health Information Network (PHIN) Meeting
26-30 October 2015 | Bali, Indonesia
Friday, 30 October 2015 Post-Conference Workshops 9:00
Side Workshops: -RHIS Network Workshop -AeHIN GIS Lab Workshop -Unique ID / National Health ID Training Curriculum Workshop
List of Participants Name
WHO EMRO Delegates Said Yaqoob Azimi
Director Health Management Information System
Ministry of Public Health Kabul
Ahmad Nawid Shams
Result Based Financing/ Health Information System Consultant
GD of Policy & Planning and External Relations Ministry of Public Health, Kabul, Afghanistan
Mohamed Mahmoud Ali
Coordinator, Health Information and Statistics
Hani Faroukh Abdel Hai
eHealth Regional Focal Point Innovation and Health
Telemedicine Focal Person
Department of Medical Services, Ministry of Health, Royal Government of Bhutan, Kawajangsa, P.O. Box 726, Thimphu, Bhutan
Software Engineer/Head, ICT Services
Ministry of Health, Royal Government of Bhutan, Kawajangsa, P.O. Box 726, Thimphu, Bhutan
Asstistant ICT Officer, ICT Services
Ministry of Health, Royal Government of Bhutan, Kawajangsa, P.O. Box 726, Thimphu, Bhutan
Senior Consultant Health Management Information System
National Health Systems Resource Centre Ministry of Health & Family Welfare Government of India NIHFW Campus, Baba Gangnath Marg, Munrika, New Delhi 110067
National Health Mission, Policy Ministry of Health & Family Welfare
Caralyn Khongwar Deshmukh, IAS
Director Capacity Building
National e-Governance Division (NeGD) Department of Electronics and Information Technology (DeitY) Ministry of Communications and Information Technology (MoCIT) Government of India
Assistant Director Health Management Inofrmation System
Ministry of Health & FW Government of India
IT Executive, e-Government Development
National Centre for Information and Technology institute of Maldives
Assistant Computer Porgrammer
Ministry of Health Maldives
Aye Aye Sein
Deputy Director General
Department of Public Health, Ministry of Health Office No. 47, Nay Pyi Taw, MYANMAR.
Thein Thein Htay
Deputy Minister for Health
Ministry of Health
Thet Thet Mu
Division of Health Information Department of Health Planning Ministry of Health
Deputy Director General
Department of Public Health, Ministry of Health
Chief Health Executive
National AIDS Program, Department of Public Health, Ministry of Health
Khin Khin Moe Moe
Central Statistical Organization Ministry of National Planning and Economic Development
WHO SEARO Delegates
Naw Hsah Ka Paw
Central Statistical Organization Ministry of National Planning and Economic Development
Clive Chrishanthan James
Medical Officer of Health Informatics
Health Information Unit, Ministry of Health
Jayawardane Vidana Gamage Nimali
Department of Information Technology Management, Ministry of Finance, Sri Lanka
Danapala Pathirannahalage Shriyananda Rathnayake Jayasinghe
Information Communication Technology Agency of Sri Lanka
Director, Information Technology and Communication Center
Office of the Permanent Secretary, Ministry of Public Health, Thailand
Assistant dean (IT) Head of Bioinformatics and Data Management for Research, Office for Research and Development
Faculty of Medicine Siriraj hospital, Mahidol University
Director of Standard Office
Electronic Transactions Development Agency (Public Agency)
Belarmino da silva Pereira
Head, Policy Department
Ministry of Health Timor Leste
Head, Monitoring and Evaluation Department
Ministry of Health Timor Leste
Himanshu Nalin Negandhi
Indian Institute of Public Health â€“ Delhi, Public Health Foundation of India
Professor of International and Tropical Health
University of Queensland
Program Director AICEM and Co-Coordinator of APMEN Secretariat Co-Director WHO Collaborating Centre for Health Information Systems School of Public Health Poonam Naithani
Rakesh Mani Rastogi
Medical Officer, HIV Team Leader
Jai Ganesh Udayasanakaran
Senior Manager (Healthcare Information Technology)
Sri Sathya Sai Central Trust (Medical Care Division), Prasanthi Nilayam. Puttaparthi - 515134 Anantapur District, Andhra Pradesh, India
Project Coordinator (Telehealth Programme) WHO WPRO Delegates
Deputy General Director of Identification General Directorate of Identification Ministry of Interior Kingdom of Cambodia
Ministry of Interior
Chief of Health Information Bureau Department of Planning & Health Information
Ministry of Health
Deputy Director National Institute of Statistics Department of Social Statistics Ministry of Planning
IT Officer, Department of Planning and Health Information
Ministry of Health
Director of Social Planning Department
Ministry of Planning
Deputy Director of the Identification of Poor Households Programme Chy Sour
Deputy Director of IT Division National Social Security Fund
National Social Security Fund Ministry of Labour and Vocational Training
Director Director of Health Insurance Division
National Social Security Fund Ministry of Labour and Vocational Training
Head Pension Division Insurance and Pension Department
Ministry of Economy and Finance
Center for Health Statistics and Information, National Health and Family Planning Committee Peopleâ€™s Republic of China
Division of Health Information Standard, Center for Health Statistics and Information, National Health and Family Planning Committee
Deputy Director of Health Governance and Nutrition Development Project
Department of Planning and International Cooperation, Ministry of Health Lao PDR
Deputy Director General
Department of Planning and International Cooperation, Ministry of Health Lao PDR
Head of Health Insurance Division
Department of Social Security, Ministry of Social Welfare. Vientiane, Lao PDR.
Fazilah Shaik Allaudin
Telehealth Division, Ministry of Health Malaysia Level 2, Block E1, Parcel E, Putrajaya, Malaysia
Telehealth Division, Ministry of Health Malaysia Level 2, Block E1, Parcel E, Putrajaya, Malaysia
Chief Information Officer
Ministry of Health Malaysia
SPPD Policy Planning on Information Technology of Health Sector
Mongolia Ministry of Health and Sports
Chief Information Officer
National Center for Health Development
Knowledge Management Service Department of Health
Racquel Dolores V. SabeĂąano
Statistical Coordination Officer IV Demographic and Health Statistics Division
Philippine Statistics Authority
Luong Chi Thanh
Health ICT Administration, MOH Vietnam
Nguyen Thi Thuy Hang
Expert of the Health Statistics Division
Department of Planning and Finance Ministry of Health
Do Thi Phuong Lan
Health Statistician and IT Technical Assistant Health Statistics Division (HMIS)
Department of Planning and Finance Ministry of Health
President, Pacific Health Information Network; Director, Health Information, Research & Analysis
Health Information Research and Analysis, Ministry of Health & Medical Services, 88 Amy Street, Toorak, Suva, Fiji
Assistant Chief Executive Officer Health Information Systems & ICT
Ministry of Health
Palepa Lenara Tupaâ€™i â€“ Fui
Manager, Management Information Systems
National Health Service
Senior Technical Officer Health Information and Innovation Unit
Maria Rosario S. Vergeire
Health Policy Development and Planning Bureau - Department of Health
IT Consultant to PhilHealth Of- Philippine Health Insurance Corporation fice of the President & CEO
Lucille Angela F. Nievera
Technical Officer, Health System Strengthening/ Team Lead, Sub-national Initiative: AcCess for MNH project
ADB Chee Piau Wong, MBBS, MRCP, FRCPCH, PhD, CCST, AMM
Associate Professor, Consultant Paediatrician and Child Neurologist Deputy Director - Tropical Medicine and Biology Multidisciplinary Research Platform Lead - Telemedicine Research Cluster Academic Convenor - Community Based Practice Programme Chairman - The First Malaysia Telemedicine Conference
Jeffrey Cheah School of Medicine and Health Sciences Monash University Malaysia
Vajira Harshadeva Weerabaddana Dissanayake
Health Informatics Society of Sri Lanka
Rajendra Pratap Gupta
Personal Connected Health Alliance 102, Siddhivinayak, Plot no.3, Sector 14, Khanda colony, New Panvel- West, Navi Mumbai, Maharashtra, India 410206
AeHIN Co-chair, Research Manager
Thai Health Information Standards Development Center (THIS), Ministry of Public Health
Lecturer, Department of Community Medicine Deputy Executive Director for Informatics (CIO/CMIO)
Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University Chakri Naruebodindra Medical Institute
Asia eHealth Information Network
Portia Grace Marcelo
National Telehealth Center
Lecturer/Researcher in Public Health Informatics
Department of Public Health Faculty of Medicine, Universitas Gadjah Mada Yogyakarta
Mean Reatanak Sambath, MD, Cambodia MPH
Founder and Executive Director
Partnership for Better Health
Bayanmunkh Battulga MD., PhD
Information Technology Center Mongolian National University of Medical Sciences
Ng Kwok Keung A.K.A. Clube Ng
CEO (eHealth Research Inst) Part-time Consultant (Esri China)
eHealth Research Institute Ltd. Esri China (Hong Kong) Ltd. eHealth Consortium 9/F CEO Tower, 77 Wing Hong Street, Cheung Sha Wan, Kowloon
Wijesekere Mudiyanselage Achala Upendra Jayatilleke
Senior Lecturer in Biomedical Informatics
Postgraduate Institute of Medicine
Principal and Founder
GIS and Data Management Consultant
Social Health Insurance Consultant IT & Business Process Design
Consultant (Technical writer and Communication Expert)
Duane Richard Bender
Director, mHealth and eHealth MoHawk College Applied Research (Experts for HMIS Mock Up)
Justin Thomas Fyfe
Software Architect (Experts for HMIS Mock Up)
Senior Health Specialist
Asian Development Bank
Asian Development Bank
Department of Communications, Ministry of Meteorology, Energy, Information, Disaster Management, Climate Change and Communication
Anne M.C. de Lorm
Family Doctor and Advisor
National Family Doctors Training Association, Netherlands
ADB - Philippines
Senior Social Development Specialist
Asian Development Bank
ADB - Indonesia
Country Director, Indonesia Resident Mission, ADB
Asian Development Bank
Honey May Manzano-Guerzon ADB - Philippines
Associate Operations Analyst (Health) Sector Advisory Service Division (SDAS) Sustainable Development and Climate Change Department (SDCC)
Asian Development Bank
ADB - Philippines
Principal Knowledge Sharing and Services Specialist
Asian Development Bank
Dr. Salma Burton
Team Leader HSS and RMNCAH
Dr. Raden Noviane â€œAnneâ€? Chasny
Specialist Health Information System and Evidence
Ms. Herawati Diyah
Dr. Kanchit Limpakarnjanarat
WHO Representative to Indonesia
Dr. Fetty Wijayanti
NPO Surveillance and Monitoring & Evaluation HIV/AIDS Unit
Ms. Abimanyu Reiko Dewayani
Mohammad Muslim Chowdhury
Additional Secretary, Finance Division
Ministry of Finance, Government of Bangladesh
Md Younus Mian
Deputy Chief, Planning Wing
Ministry of Health and Family Welfare, Government of Bangladesh
Samir Kanti Sarkar
Deputy Director, Management Information System, Directorate General of Health Services
Ministry of Health and Family Welfare, Government of Bangladesh
Sukhendu Shekhor Roy
System Analyst, Management Information System, Directorate General of Health Services
Ministry of Health and Family Welfare, Government of Bangladesh
Director, Health Economics Unit
Ministry of Health and Family Welfare, Government of Bangladesh
Bhim Prasad Acharya
Management Division, Department of Health Services
Mukti Nath Khanal
HMIS, Department of Health Services
Chief Technical Advisor Nepali - German Health Sector Support Programme (HSSP)
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH
Deputy Chief Technical Advisor, Nepali – German Health Sector Support Programme
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH
Programme Officer Health Information Systems, Nepali – German Health Sector Support Programme
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH
Muhammad Abdul Hannan Khan
Senior Technical Advisor - HIS SHSP II
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH
UNICEF Lori Thorell
Senior ICT Programme Specialist
Regional Advisor, HIV and AIDS
Regional Advisor Child Survival and Development
Shirley Mark Prabhu
HIV/AIDS Specialist (Knowledge and Advocacy)
Chief of Health
United Nations Children’s Fund Indonesia
UNICEF Country Representative
United Nations Children’s Fund Indonesia
United Nations Children’s Fund Indonesia THRIVE
Chief Executive Officer
Summit Insitute of Development Lombak, Indonesia
Matt Berg (THRIVE)
Chief Executive Officer
Ona Nairobi, Kenya
Subhash Chandir(THRIVE project lead)
Child Health and Vaccines Interactive Research and Development Karachi, Pakistan
Carolyn Ann Gulas (THRIVE)
Ona Systems North Carolina, USA
Alain B. Labrique (PI THRIVE/ OpenSRP Bangladesh)
Johns Hopkins University Global mHealth Initiative Baltimore, Maryland USA
ICT 4 D Jhpiego Baltimore, Maryland USA
Interactive Health Solutions Karachi, Pakistan
Country-lead for THRIVE Indonesia
Summit Institute of Development Post-doctoral fellow Lombak, Indonesia
Anuraj Shankar (PI Lombak THRIVE/OpenSRP)
Senior Research Scientist
Harvard School of Public Health Summit Institute of Development Boston, USA
Research Scientist, Faculty Research Associate
Johns Hopkins JiVitA Project Gaibanda, Bangladesh
WHO - Geneva
Scientist Department of Reproductive Health and Research
WHO - Geneva
Consultant Department of Reproductive Health and Research
World Health Organization
SELF-FUNDED Haitham El-Noush
Senior Adviser, Health Innovation Lead
Senior HIS Advisor, MEASURE Evaluation Vice-President, International Division, JSI
John Snow International
Senior Technical Specialist Capacity Building MEASURE Evaluation
University of North Carolina at Chapel Hill
Digital Birth Registration Project Manager
The EHR Research Unit, Kyoto University
Senior Global Health Informatics Advisor
Senior Field Manager
Sarah Skye Gilbert
Program Officer, Vaccine Delivery
Bill & Melinda Gates Foundation
Estella M. Geraghty
Chief Medical Officer & Health Esri Solutions Director
Esri Global Asia Pacific
Technical Officer- Health Systems Stewardship & Regulations
WHO India Country Office
Senior Health Specialist Health, Nutrition & Population Global Practice
Health Information Systems Program
Senior Health Specialist
World Bank - India
Professor in Health Information Systems
Department of informatics University of Oslo Norad’s HISP /DHIS2 initiative Global Fund DHIS2 intiative
Morten Olav Hansen
Senior Engineer working as a core developer on the DHIS 2 project
University of Oslo
DHIS2 Expert, Advisor for HISP Health Information Systems Program-Viet (Health Information Systems Nam and University of Oslo Program) - Vietnam
MOH/JICA Health System Strengthening Project in Myanmar
Ei Thaw Win
Progarm Officer in-charge of Information System Development
MOH/JICA Health System Strengthening Project in Myanmar
Pradeep Kumar Ray, PhD
WHO Collaborating Centre on eHealth, AsiaPacific ubiquitous Healthcare research Centre (APuHC), UNSW Business School, UNSW Australia (University of New South Wales)
Chief Executive Officer and eHealth Director
Jembi Health Systems
Professor of Informatics
Department of informatics University of Oslo Norad’s HISP /DHIS2 initiative Global Fund DHIS2 intiative
Nguyen Pham Hoang Quoc Viet
Department of informatics University of Oslo Norad’s HISP /DHIS2 initiative Global Fund DHIS2 intiative
Mia Elisabeth Harbitz
Senior Adviser, Identity for Development (ID4D) Group
Chief Executive Officer
Technical Officer Health Statistics and Information Systems
World Health Organization
Portfolio Officer for mHealth Operations in SEARO, AFRO and WPRO and Technical Officer for New Crosscutting Areas including M&E, UHC AND TB TOBACCO
World Health Organization
Vice President, Sales and Services
Vice President, Information Technology and Services
Chair for Advocacy and Policy
HIMSS Asia Pacific India
Managing Principal, C C AND C Solutions President, Association Of Enterprise Architects , Sydney
C & CC Solutions Association Of Enterprise Architects, Sydney
JLN Ousmane Ly
Agence Nationale de Télésanté et d'Informatique Médicale
Director, Management Information Systems
National Health Insurance Authority
Senior Manager, ICT department
National Health Insurance Scheme, Nigeria
Senior Manager, Information and Communication Technology Department
National Health Insurance Scheme
Katherine (Kate) Hunter Wilson
Director, Digital Health Solutions
Program Officer, Digital Health PATH Solutions Technical Facilitator JLN IT Initiative MOH Indonesia, BPJS, Others
Dr. Untung Suseno Sutarjo, M. Kes
Mr. Made Mangku Pastika
Representative of the Governor of Bali
Dr. Dedi Kuswenda Satjamihardja
dr, M.Kes/ Direktur Bina Pelayanan Kesehatan Tradisional dan Komplementer, Sekretaris Utama Setnas Pembangunan Pasca 2015 Sektor Kesehatan
Ministry of Health
Dr. Drg. Theresia Ronny Andayani
Dr. drg, MPH/ Director for Public Health and Nutrition, National Development Planning Agency (BAPPENAS)
National Development Planning Agency(BAPPENAS)
Dr. Rofyanto Kurniawan
Fiscal Policy Agency Ministry of Finance
Mr. Dadang Setiabudi
Director Information Technology of BPJS Kesehatan
Badan Penyelenggra Jaminan Sosial (BPJS) Kesehatan
dr, MPH/ Center for Health Financing
Mr. Drg. Oscar Primadi
Head for Data and Information Centre
Ministry of Health
Mr. Dr. Ashwin Sasongko Sastrosubroto
Indonesian Institute of Sciences Pusat Penelitian Informatika Building 20, 3rd floor Kompleks LIPI, Cisitu Jalan Sangkuriang Bandung
Mr. Fachmi Idris
Siswandi, SE, MM
Mrs. dr Tri Hesty Widyastoeti
DG Health Service - Refferal
Dr. Triono Soendoro
Ministry of Health
Mr. dr. Daryo Wibowo Soemitro
MOH Indonesia Jln. Zamrud IV Blok E-109 Permata Hijau Jakarta Selatan 12210
Mr. dr. Agus Mutamakin
dr, MS.c/ Head Information System (Kepala IT)
Dr. Cipto Mangunkusumo Hospital RSUPN Dr. Cipto Mangunkusumo)
Mr. Ferdinan S Tarigan
SKM, MKM/ CIC
Mr. Yanuar Iksan
Bureau of General Affairs
Mrs. Evi Fatimah
Direktorat Gizi, SDG Secretariat
Mr. Arief Hargono
Researcher and Lecturer
Faculty of Public Health, Universitas Airlangga
Mrs. Rico Kurniawan
University of Indonesia
Mr. dr. Lutfan Lazuardi
University of Gadjah Mada (SIMKES FK)
Mrs. Imroatul Aflah
Direktorat Kesehatan Ibu
Mrs. dr. Rima Damayanti
dr/ Dit. Bina Kesehatan Ibu
Mrs. dr. Mia Rachmawati Kamal
dr/ Dit. Bina Kesehatan Ibu
Mrs. drg. Titi Aryati Soenardi, M.Kes
drg, M.Kes /Center Data and Information, Ministry of Health Republic of Indonesia
Mr. Yudianto, SKM, M.Si
SKM, MSi /Center Data and In- MOH Indonesia formation, Ministry of Health Republic of Indonesia
Dr. drh. Didik Budijanto, M.Kes
mr. Cecep S Budiono, SKM, M.Sc.PH
SKM, M.Sc.PH/Center Data and Information, Ministry of Health Republic of Indonesia
dr. dr. Fetty Ismandari, M.Epid
dr, M.Epid /Center Data and Information, Ministry of Health Republic of Indonesia
mrs. Winne Widiantini, SKM, MKM
SKM, MKM /Center Data and Information, Ministry of Health Republic of Indonesia
Drg. Rudy Kurniawan Mrs. Istiqomah, SS, MKM
Center Data & Information Industry of Health RI SS, SKM /Center Data and Information, Ministry of Health Republic of Indonesia
Center Data and Information, Ministry of Health Republic of Indonesia
Mr. Ida Bagus Wisnu, SE
SE /Center Data and Information, Ministry of Health Republic of Indonesia
Center Data and Information, Ministry of Health Republic of Indonesia
Mr. Doni Hadi K, S.Kom
S.Kom /Center Data and Information, Ministry of Health Republic of Indonesia
Center Data and Information, Ministry of Health Republic of Indonesia
dr. Guardian Yoki Sanjaya, MHlInfo
Dian Agrianti, SKm
Meiry Nasution, MPH
Jamie Pina, pHD dr. Ketut Budi Riyanta Jefri Kurniawan Nym Harwati Nikd Pina Riantini dr. I Kadek Nomiyantha Bpk. Sawal Sani T Bpk. Jusran Mawardi Bpk. Agung Utama Bpk. Yusef Eka Darmawan Bpk. Bona Ventura Bpk. Agung TM Bpk. M. Yazid Bpk. Ahmad Hidayat Bpk. Nikita Bpk. Andhika Ibu. Nafisa Bpk. Ali Qury Aini Agung Putu D Youk Savithri Cutpuri Arianie Sugeng Hermawan Waloya
Conference Evaluation This evaluation is based on the feedback of 140 out of 247 participants (56.68 %) in the conference. Feedback were collected by distributing survey forms after the third day of the conference. Regarding general satisfaction from the conference, respondents were satisfied with the pre-event organization (91.51%), organization of the day (96.23 %), speakers and presenters (95.28 %), relevance of the topics discussed (94.34 %), time keeping (84.91%), foods served (90.57%), and the venue and facilities (97.17%). For the overall assessment of the event, 45.28 % said that the conference was very good, 41.51 % would remark the event as excellent, and 10.38% said that it was good. No respondent regarded the conference as poor or fair; however, 2.83 % didnâ€™t give a response. Lastly, open-ended questions were also included in the feedback form. The answers were arranged in two categories - program (Table 1) and event organization (Table 2). For the program category, feedback were given on the different parts of the program, including the agenda. For the event organization category, feedback were given on logistics, communications, food arrangement, and others. A. PROGRAM Agenda/Topics -Impact of health sector human resource management on effective and release use of health information system can be added to the topic list. -Discuss framework on insuring how HIS is improving the health sector (identify actions taken based on statistics) -There was a lack of clarity on the concept of the workshop. It would be great if agenda is made very clear to the participants and expectations are addressed.
Live Demo -Add hardware technology -Show case on ICT/Tools
-More breakout sessions with development partners.
-Market hall sessions â€“ to increase the no. of sessions to spread the talk arounds.
-More hands on of running health information exchange. -No modeling role play presentations and demonstrations. -More demos
-Add to research session. -Public address system. -May be include a debate as a new presentation mode. May be document panel discussion on slide as presenters speak (by messages). -Tutorials on new areas/ topics.
Plenary Session -Invite more relevant speakers -Plenary session with fewer panel and strategic action discussions opposed to operational matters. Country sessions stories needs to be shared as well. -Talk shows are very hard to follow and understand tangibly due to various accents. The talks should go hand in hand with powerpoint
Others -Excellent program of general meeting. -eHealth will be the critical issue in the next decade, perhaps capacity building from the perspective of ministry of education can help for long term management: coursework in school. Just to build a new troop from young generation.
-Modify talk shows introducing powerpoint.
-Too many speakers and moderators are white and from donors or technical advisors with solutions. Would be great to have more country participants play more and facilitate.
-Provide more powerpoint presentations.
-Close the sessions at 4pm or early to discuss more networking.
-For plenary use the ‘IN THE ROUND’ can’t show format.
-Time taken is very poor. AHIN needs to decide the role it wants to play. IT needs improvement
-More interactive, practical session -Maybe we don’t start with a panel, but with an introductory presentation. That would help the audience involved and not feel it is meant only for the panelists on the stage. More in person. -Nothing on plans (irrelevant) but only sharing experiences that worked (or failed) -More country to country discussions, less talk show. -More explicitly show/demonstrate how you go for expressed needs to reflection on the content and then ICT solutions -Novel but unstructured discussions like this event had is suitable only for small groups. A big delegation with huge participants need to feel involved and engaged.
Field Trip -Should have some site visit.
-The schedule for each of the day was too long. They were helpful and informative, but also overwhelming. -More participation from participating countries. Every country should commit and present in the next AeHIN, this will keep the momentum going. -Improve networking to share such experiences - time allotted for participants to introduce themselves with one another. -For the next event, same participants shall be invited for easy understanding -The high level meeting on AeHIN should be organized to pushup the country eHealth achieving the regional level.
B. EVENT PREPARATION Logistics -Preparation of itinerary and per diems prior to the event. -Plane ticket preparation as well as per diem management was very un-organized. Some of us want to get things out of the way instead of running around last minute. Lack of response to email queries. -Need more power outlets
Communications Despite advance notice, some profile cannot be found as participant in the website -WiFi is a challenge: connection could have been more stable. This has affected Q & A part. -The participant may have the File/Soft file presentation and report from parallel session. -To be able to get all presentations and materials after meeting - probably soft copies. -Feedback via email very important because we are all busy and this meeting is very important to attend also considering time difference. -Better internet connection and audio/visual to support great presenter, great conference. -They (presenters) should be reading slides download or rapporteur taking notes in the discussion for every session.
Food -Halal not mentioned on food.
Others -Last minute preparation. -Improves very much with network and friendship during meeting -Improves every year. -It is so excellent. Hard to say what to improve. -Excellent job! Congratulations to the secretariat. Big thank you to the sponsors on supporting our country and bringing in here to beautiful Bali. -Well prepared, Bravo. -Thankful for everything -Okay -Already very good -Keep up the excellent work! -Good work! -The time
Field Trip 1. BPJS Regional Division Office – DIVRE 11 Divre 11 is the operational office of the National Social Security Board (Badan Penyelenggara Jaminan Sosial Kesehatan = BPJS Kesehatan) covering three provinces including Bali, West Nusa Tenggara and East Nusa Tenggara province. The office serves 8,573,181 members (61.51 % of total population) in 108 hospitals and 1,362 primary health services. Members could register themselves using national ID (NIK) from the Ministry of Home Affairs database. The field visit to this office showed case on registration simulation using the ICT innovation. Participants of the field visit observed the premium collection mechanism using EDC, ATM, and minimarket. 2. Badung District Hospital This is a type C hospital with 177 beds that deployed integrated HIS and BPJS information systems. Participant will observe the use of national unique ID for registration and used for both systems. The hospital utilized Indonesia DRG methods (INA-CBGs) for electronic claim and reimbursement. 3. Puskesmas Denpasar Utara 1 BPJS provides cloud based application for primary care (called Pcare), in this Puskesmas, participants will observe the role and function of P-care to support: 1. checking BPJS member eligibility using National unique ID 2. routine / daily health services 3. data for capitation claim 4. Puskesmas Denpasar Selatan 2 Existing information system of Puskesmas and Pcare application are two different systems and not yet integrated. In this puskesmas, participants will observed the situation and received information about future solutions for HIE.
Post-Conference Workshops 1. Unique ID / National Health ID Training Curriculum Workshop Development and implementation of unique ID schemes, master person index, and ID management for better longitudinal person tracking and monitoring throughout the healthcare system. 2. Routine Health Information Systems (RHIS) Network Workshop Planning and design workshop is focused on establishing RHIS manager community within AeHIN specifically focused on improving completeness, timeliness, quality, analysis, and use of facility-based and community-based health information. 3. AeHIN GIS Laboratory Workshop Placed under the umbrella of the AeHIN interoperability Lab, this Lab looks specifically at the use of geography and Geographic Information System (GIS) to support UHC policy and planning. During this workshop, participants will be introduced to the geographic dimension of UHC before getting a tour of Esri’s current GIS technology. The Lab vision and Esri’s support in this context will then be presented and the specific needs and expectations from countries discussed. 4. Indonesia National M&E Workshop Monitoring and Evaluation workshop for Indonesian health professionals from both the public and private sector.
5. Pacific Health Information Network (PHIN) Meeting Exclusive meeting for members of the Pacific Health Information Network to discuss eHealth updates and future developments.
Slides The following presentations are available at http://aehin.hingx.org/AEHIN4GM DAY 1 • RHIS Workshop_StrengtheningCountryRHIS_AeHIN_Oct 29 2015.pdf • PLENARY 3 - Empowering the Natl HIS, eHealth Executive and Mgt Teams_eHealth Governance Malaysia_ Dr. Fazilah.pdf • Parallel Session Measurement and Accountability State of the Art_The Role of eHealth Research in Measurement and Accountability for UHC_Theresia Ronny.pdf • Parallel Session Measurement and Accountability State of the Art_Ministries of Health, Social Protection_Indonesia’s Journey to UHC with ICT_Dadang Setiabudi.pdf • Parallel Session Measurement and Accountability State of the Art_Health Targets and Indicators in the SDGs and Roadmap for Health Measurement and Accountability_Dr. Eduardo Celades.pdf • Parallel Session Measurement and Accountability State of the Art_Donor Perspective_Dr. Susann Roth.pdf • Parallel Session Measurement and Accountability State of the Art_Aligning Natl Health Objectives with the Post2015 Devt Agenda_Dr. Rosette Vergeire.pdf • Parallel Session Measurement and Accountability Ensuring State of the Art_MOH, SPA, eHealth Experts_Dashboard for National Health Insurance_Mr. Angelito Abando.pdf.pdf • Parallel Session Measurement and Accountability Ensuring State of the Art_Ministries of Fin, Planning, ICT and Devt Agencies_Accountability thru IT Governance Frameworks_Dr. Alvin Marcelo.pdf • Live Demonstration - Digital Health for Better Care The Maternal and Child Continuum of Care Scenario.pdf DAY 2 • Parallel Session Challenges and Successes with Implementing the iCTen_ICT Actions_Dr. Garrett Mehl.pdf • Parallel Session Challenges and Successes with Implementing the iCTen_Health Actions_Dr. Alain Labrique.pdf • Parallel Session Challenges and Successes with Implementing the iCTen_Finance and Investment Actions_Ms. Donna Medeiros.pdf • Parallel M&E Investment Plan, MA4Health Country Roadmap Cross-Sector Working Grps_ WPRO II.pdf • Parallel M&E Investment Plan, MA4Health Country Roadmap Cross-Sector Working Grps_ WPRO I.pdf • Parallel M&E Investment Plan, MA4Health Country Roadmap Cross-Sector Working Grps_ SEARO II.pdf 121
• Parallel M&E Investment Plan, MA4Health Country Roadmap Cross-Sector Working Grps_ • • • • • •
SEARO I.pdf Parallel M&E Investment Plan, MA4Health Country Roadmap Cross-Sector Working Grps_ Pacific Island Countries.pdf Parallel M&E Investment Plan, MA4Health Country Roadmap Cross-Sector Working Grps_ Indonesia.pdf Parallel M&E Investment Plan, MA4Health Country Roadmap Cross-Sector Working Grps_ Country Roadmaps_Dr. Eduardo Celades.pdf Parallel M&E Investment Plan, MA4Health Country Roadmap Cross-Sector Working Grps_ Africa.pdf PLENARY 7- Overview of MA4Health Roadmap Development Working Group Session_Overview of the Roadmap for Health Measurement and Accountability_Mark Landry.pdf PLENARY 7 - Overview of MA4Health Roadmap Development Working Group Session_Mr. Mark Landry.pdf
DAY 3 • PLENARY 9 - AeHIN Geographic Information Systems Laboratories _Dr. Estella Geraghty.pdf • AEHIN Regional Enterprise Architecture Council for Health_Dr. Nawanan Theera-Ampornpunt. pdf • Post-Conference Workshops • NHID Workshop_What is digital health Infrastructure_Derek Ritz.pdf • NHID Workshop_WBG Identification for Development (ID4D) –Improving CRVS_Sam Mills.pdf • NHID Workshop_The role of biometrics in identity management systems_Mia Harbitz.pdf • NHID Workshop_National Strategic Plan for Identification (NSPI) for 2015-2024.pdf • NHID Workshop_National IDs Linked to CRVS and UHC Thailand Experience_Dr. Boonchai Kijsanayotin.pdf • NHID Workshop_Michael Stahl.pdf • NHID Workshop_JC2640_nationalhealthidentifiers_UNAIDS.pdf • NHID Workshop_Identity Management, Digital Identity_Susann Roth, Seok Yong Yoon.pdf • NHID Workshop_Health Data Sharing and ID Overview_Thomas Hutton.pdf • AeHIN GIS Lab Workshop_Topic 6 - Performing analysis.pdf • AeHIN GIS Lab Workshop_Topic 5 - Getting your data on a map.pdf • AeHIN GIS Lab Workshop_Topic 4 - Using Mobile Applications.pdf • AeHIN GIS Lab Workshop_Topic 3 - The ArcGIS Platform.pdf • AeHIN GIS Lab Workshop_Topic 2 - Use location to transform health and human services.pdf • AeHIN GIS Lab Workshop_Topic 1_the geographi
CONFERENCE ON MEASUREMENT AND ACCOUNTABILITY FOR UNIVERSAL HEALTH COVERAGE IN THE ASIA PACIFIC AND AeHIN 4th GENERAL MEETING
Prepared by: United Nations Conference Centre Bangkok, Thailand Portia Fernandez-Marcelo, MD, MPH (editor) with Charisse Orjalo and Kristin Pascual Secretariat of the Asia eHealth Information Network National Telehealth Center, University of the Philippines – Manila Manila, Philippines The proceedings of the Conference on Measurement and Accountability for Universal Health Coverage in the Asia Pacific and AeHIN 4th General Meeting is prepared by the Udayana University in Bali, Indonesia, the local organizer of the events. This is edited by the AeHIN Secretariat (Manila). This is intended for participants of the Conference and others interested in theory and applications of digital health / eHealth, health information systems (HIS) strengthening, e-Governance, regional peer-networks, country and development partner interactions towards health and social development. This centers on how the three-day conference unfolded, and captures the highlights of each session. Whereas participants actively joined specially in the panel discussions through the Pigeonhole, only the questions were captured. The participants joined a halfday visit to health facilities in Bali province to observe how ICTs are enabling Indonesia’s HIS. Four post-conference workshops were held as well. Participants and organizers’ evaluation are captured as well. These are just briefly described in the Annexes.
Prepared by: United Nations Conference Centre Bangkok, Thailand Portia Fernandez-Marcelo, MD, MPH (editor) with Charisse Orjalo and Kristin...