Healthy link

TO ACHIEVE the goal of "Health For Allby AD 2000" through the PrimaryHealth Care Approach, the CentralBureau of Health Intelligence (CBHI)and National Informatics Centre (NIC),technically and financially assisted bythe World Health Organization, haveintroduced a computerbased national HealthManagement InformationSystem (HMIS). Using Sattelite-based computer network (NICNET), over 450 districts in 13 states are cutrentlylinked on this networkin a bid to raise efficiency ofthe country's health sector,reports World Health Forum(Vol 16, No 3, 1995).

The need for an actionoriented Management information System as a supportto the health sector wasidentified as early as 1982.The Bhore Committeereport highlighted the deficiencies in the in-built information systems of vari .oushealth and family welfareprogrammes which includedlack of linkages amongthemselves, ill-coverage,delay in transmission, bulkyand mostly irrelevent information, difficult retrievability, under-milisation of theavailable information andpoor feedback. "The information systems had beenplagued by a tendigeneration of informationfor use at higher levels only, which leadsto gross under-utdisation of the informatioD," elaborates Gautam Bose, technical director, NIC.

As a result, the Hmis was designedand developed during 1986-88 andfield-tested successfully in 1989.Currently, its computer-compatibleversion, called HMLS version 2.0, is beingimplemented. Its aim is to gathermonthly information on family welfare,tuberculosis, malaria, blindness, maternal and child mortality and unimmisation. After compiling it in primaryhealth centres and subsequently at thedistrict level, the information is transmitted to the state and national levelsthrough NICNET.

The Hmis has integrated and synchronised the information flow of various health programmes by eliminatingduplication of information and avoiding unnecessary burden on grassroothealth workers. This could significantlyimprove the efficiency of the country'shealth service by making plans morerational, speeding up their implementation and monitoring their ithe grassroot levels this wouldhealth workers to plan their work amaintain their performance recmthey would not be overburdenedpaper work," adds Gautam Bose.

Nevertheless, the HMIS is fraught with some shortcounspresent. "The HMIS cmvide gross data in a Wrange of fields.' feeIndrayan of the UniviCollege of Medical SckDelhi. Informationimportant diseases I&cliver diseases and typbnot available. Furthenas Indrayan puts it, would not be suffiexpertise and m;the periphery toadditional inforiis suggested thereforeother agencies currecollecting data likeSample Registration Syvwhich gathers vaininformation on mortand fertility," should ahmade accessible to NICNET.

It is also felt health databases shouli strengthened and expas is expected the s is fully OFtional, databases on sifurther indicators can anautomatically. "But inmation on age-specific fiity and many other panters will continue from outside the system," IIndrayan. Moreover, many casesnot recorded by the computer as go to private practitioners or areseen by any physician. This tendmake the incidence and prevalencerates, underestimates.

Nonetheless, major developmentsare underway. The BiomformaticsInformation System of the ministry.Science and technology has establishedinformation centres in some prestigiousby technological institutions, and linkshave developed with internationalarm like databanks on geneticsial. The NIC provides the computeretwork for this system. Meanwhile,r hospitals have computerised theirafions for improving detection andiosis of problems, patients and hosmanagement, and taking prompt@dial action. Such records contrito hospital-based research, easylyrifitted on the national network.4nce all the information is notired at every level, the HMis resortsaracteristic filteration and additionformation at each level. The policys. usually require aggregated datavM at the peripheral levels specific,Wregated data is needed, that tooedixtelv. The Hmis is efficient for allall such records.

Through NICNET, the health manbent information system providesky relevent information, makingaggregated and non-aggregatedrctrievable. "Informatics technologyouki be increasingly employed toeve the functioning of India's hospitalssuggests Indrayan.