Editorial
Journal of the Royal Society of Medicine; 2014, Vol. 107(1S) 6–9
DOI: 10.1177/0141076813512817
The African Health Observatory and national health
observatories as platforms for strengthening health
information systems in sub-Saharan Africa
Derege Kebede, Chris Zielinski, Peter Ebongue Mbondji, Miguel Piexoto,
Wenceslas Kouvividila and Luis Gomes Sambo
World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Congo
Corresponding author: Derege Kebede. Email: kebeded@who.int
Introduction
Health information systems represent a key component of national health systems. However, the capabilities for leveraging information for improved
health are limited and unevenly distributed in the
World Health Organization (WHO) African
Region. Improving such capabilities has been identified as a key priority for the success of reforms of
national health systems through primary healthcare1
and for addressing social determinants of health.2
Ministries of health and their partners have recognised the importance of evidence in shaping policymaking and decision-making in the Region and have
been trying to improve their health information and
research systems for some time.3 The recommendations of both the 2008 Ouagadougou4 and Algiers
Declarations5 to establish an African Health
Observatory (AHO) are based on this recognition.
The idea of a ‘health observatory’ as a comprehensive
one-stop shop for good-quality and reliable information
on human health and institutions of care has gained
growing global popularity since the mid-1970s. Since
then, numerous health observatories have been established throughout the world; for example, a network of
12 public health observatories was set up by the UK
Department of Health to provide knowledge, information and surveillance in public health. The declared
focus is on ‘turning information and data into meaningful health intelligence’ and the UK network has been
developing successfully using a similar model to that
adopted by AHO.6 Apart from AHO, a Global
Health Observatory has been functioning in WHO
headquarters since 2010, and most of the WHO regional
offices also have established observatories.
This report describes AHO and how it could be
useful, working with National Health Observatories
(NHO), to address the issues and challenges of
! WHO Regional Office for Africa 2014
Reprints and permissions: sagepub.co.uk/journalsPermissions.nav
strengthening national health information systems.
In addition, the report proposes a number of actions
that countries should consider taking to use NHOs to
improve national health systems.
The AHO
AHO has been operational since the beginning of
2011. Its prime objective is to act as a tool for improving the availability of data from multiple sources
and facilitating the monitoring and evaluation of
health status and trends, including progress towards
the achievement of major health goals in countries
and the Region. These include the Millennium
Development Goals (MDGs), notably MDGs 4 and
5, and problems being addressed by global health initiatives such as the Global Fund to Fight AIDS,
Tuberculosis and Malaria, and the GAVI Alliance.
As a repository or ‘one-stop-shop’ of the best information available on health, AHO serves as a tool to
monitor achievements in health systems strengthening
in such areas as governance, health financing and
human resources for health. AHO is seen as the core
of a reinforced regional health information system,
interacting with NHOs in member countries to contribute to monitoring and evaluation, data collection and
analysis at national level. Above all, it is an information technology platform designed to facilitate multistakeholder collaboration and partnership in accessing
and using information for strengthening national
health systems and improving health outcomes.
AHO consists of a web portal,a a data statistics
platform, a web-based collaborative space for the production and updating of comprehensive and analytical
country health profiles, a repository of key publications including the quarterly periodical The African
Health Monitor, and a platform for networking.
Work is ongoing in developing its content in country
Kebede et al.
profiles and information products, and creating space
for and supporting regional and subregional networks
on various health themes. Collaboration will continue
with ministries in the Region to review and clear all
data published, and to publish better, more up-to-date
and complete data. At the same time, the analytical
country profiles will be expanded and developed so
that they can serve as key evidence in the monitoring
and evaluation of national policies and plans, within
the national development cycle.
The WHO Regional Office for Africa supports
countries to establish their own NHO web portal,
following the same general structure as used for
AHO. Thus, NHOs provide information technology
platforms that enable national, subnational and institutional stakeholders of national health information
systems to collaborate, bringing data together in a
single place and reducing fragmentation. Using specialized software, NHOs enable each stakeholder to
view the data most relevant to them in tabular, graphic and map formats. They are centres for monitoring progress on subnational, national or international
goals and targets, monitoring performance of priority
health programmes and evaluating outcomes of
health interventions.
It should be stressed that AHO is a platform that
provides a workspace in which all relevant activities
and programmes may operate. As such, it is not a new
initiative requiring extensive inputs, training or
restructuring. Rather it provides a web-based mechanism to conduct work collaboratively, reducing fragmentation and enabling standardization of data. The
development of partnerships is considered to be a key
role for AHO. It offers a forum with supporting technology (e.g. lists, web pages, conferencing) for kindred
programmes and partners. The AHO model, extended
to national and subnational levels, provides a backbone to reinforce national health information systems.
Issues and challenges
In strengthening their national health information
system, countries face three major issues that they
must address:
. Fragmentation of national and subnational initiatives
or efforts on health information across sectors, levels,
programmes, projects, disciplines and specialtiesb
. Availability of information: the limitation of capabilities for the timely generation, analysis of and
access to relevant information, and to ensure its
availability in sufficient quantity and quality
. Weak capabilities for sharing, translation or application of available information for policy-making
and decision-making
7
Fragmentation of stakeholders’ initiatives is a
major issue for countries. Dealing with this issue successfully would minimize the extra burden on national
authorities and health workers resulting from the need
for additional data or reporting to partners.7
Fragmentation is evident not only in responding
to external initiatives and partners but also among
similar services within the national health systems,
impeding the resources of multiple stakeholders to
strengthen national health information systems.
Addressing this issue requires innovative ways to
improve the participation and collaboration of multiple stakeholders, such as the platforms and tool for
networking and collaboration offered by NHOs.
Availability of information is another key issue.
Countries need to have the capacity to generate relevant information in a timely fashion and in sufficient
quantity and quality. To do this, they need to
strengthen data and information resources and
enhance the national capacity for data management
and generation of evidence. The collective knowledge
and resources of multiple stakeholders, including academic and research institutions, need to be harnessed.
The availability of information is also dependent on
the capacity to acquire existing local and global information and making the best use of information technology. NHOs could work to improve capabilities in
online searching, filtering and retrieval of information,
and storage, indexing and sharing of information.8
A pervasive issue throughout health systems is
weak capability for sharing, translation or application of available information for policy-making and
decision-making. This is frequently related to the lack
of a collaborative workspace where data and other
evidence are available and analysis can take place,
and the lack of a platform where evidence from a
wide range of relevant stakeholders can be marshalled. Strengthened capacity to format, package
and share information in such a way that it is readily
accessible by users is key to ensure that policy-makers
or decision-makers value or accept the evidence presented to them. Improving such capacity requires networking and collaborative facilities, such as those
offered by NHOs, to enable users (e.g. policymakers) and producers of information (e.g. researchers) to collaborate in the various stages of development of evidence.
NHOs offer an innovative information technology-based solution to address the major issues
described above. They offer platforms for multi-stakeholder collaboration (through networking and
creating communities of practice involving such participants as academics, researchers, policy-makers
and public health practitioners), serve as repositories
of the best available information, and provide tools
8
to strengthen the monitoring of health status and
trends.
What countries can do to establish NHOs
When establishing NHOs, countries should consider
constituting a country-wide, multisectoral and multidisciplinary group involving all key stakeholders to
coordinate their efforts.c This could be an ad hoc,
interim mechanism. Ideally, a secretariat with sufficient capacity should be established and located
within the department of health information in the
ministry of health.
A national review and mapping of stakeholders,
including national and subnational institutions dealing with health information, should be undertaken as
part of the process of developing NHOs. Such institutions would form the base network of the NHO
and be entrusted with coordinating a specific function, depending on their respective strengths and
mandates. The identification and engagement of further relevant partners in the country and externally
should be actively pursued.
The top leadership in the health sector should publicly demonstrate their strong backing for NHOs by
investing internal and external resources in them, supporting necessary actions to raise the awareness of
relevant stakeholders, and promoting the establishment and strengthening of NHOs. International partners should also be encouraged to fund NHOs and
ensure that their support is aligned with country
efforts. WHO country offices should provide technical
support to NHOs, particularly to their secretariat.
Countries should select appropriate technologies
and solutions to be used by NHOs within their specific environments, bearing in mind the current state
of information technology infrastructure in the country. These include a choice of database management
system, visualisation tools for the analysis and rendering of data, a content management system for
their profiles and information products, and networking software (for lists, conferencing, etc.). The technologies chosen must interoperate seamlessly with
any existing ministry websites and with the data
warehouse solution selected for the national health
information system, so that the NHO can act as the
core of the national health information system. It is
also recommended that countries consider ensuring
that these technologies are interoperable with those
of the AHO and other regional NHOs. The Regional
Office is able to support NHOs with generic template
observatories and the basic content for analytical
national profiles.
Countries should facilitate the role of NHOs in
continuing education by developing and providing
Journal of the Royal Society of Medicine 107(1S)
appropriate training materials for collaborative
learning, eLearning or traditional forms of learning
for ongoing professional development. Appropriate
mechanisms and processes, such as working groups,
standing committees and online networking should
be put in place to encourage involvement of local
and external academics, researchers and experts in
these efforts.
Conclusions
Improving the capabilities for leveraging information
for health is a key priority for the success of reforms
of national health systems through primary healthcare and for addressing priority health problems.
Strengthening of national health information systems
through the creation of NHOs would enable multistakeholder participation and strengthen capabilities
to generate, acquire, share and apply information. It
is recommended that each Member State reinforces
or initiates its efforts to establish a platform that
could serve as an NHO. A clear road map and timeline should be established for this process by individual countries.
Declarations
Competing interests: None declared
Funding: WHO Regional Office for Africa
Ethical approval: Not required
Guarantor: DK
Contributorship: DK and CK co-wrote the paper, PSLD
provided support and overall leadership.
Acknowledgements: None
Provenance: Not commissioned; editorial review
Notes
a. See http://www.aho.afro.who.int.
b. Some examples: sectors and levels (health/non-health;
public/private; urban/rural, local/international; academia/civil service); programmes and projects (routine
health management information systems /disease control programmes); disciplines and specialties (public
health/medical/statistics/economics).
c. Depending on the specificity of each country, the group
should include representatives from: the producers and
users of information; national, subnational and district
levels; public health, medical and social sciences; science
and technology, including information technology;
quantitative and qualitative disciplines; health and
non-health sectors; public and private sectors; civil society and faith-based groups; academic, research and
public health centres; and external partners.
9
Kebede et al.
References
1. World Health Organization. The World Health Report
2008: Primary Health Care Now More Than Ever.
Geneva: World Health Organization, 2008.
2. Commission on Social Determinants of Health. Closing
the Gap in a Generation: Health Equity through Action on
the Social Determinants of Health. Final Report of the
Commission on Social Determinants of Health. Geneva:
World Health Organization, 2008.
3. Regional Committee documents on health information
(2004-AFR/RC54/R3), on research (2006-AFR/RC54/
R3), on knowledge management (2006-AFR/RC56/16)
and Algiers Declaration (2009-AFR/RC59/5). See
http://www.afro.who.int/en/who-in-the-african-region/
regional-committee-for-africa.html (last checked 24
March 2012).
4. World Health Organization. Ouagadougou Declaration
on Primary Health Care and Health Systems in Africa
5.
6.
7.
8.
2008: Achieving Better Health for Africa in the New
Millennium. Brazzaville: World Health Organization
Regional Office for Africa, 2008.
World Health Organization. The Algiers Declaration:
Ministerial Conference on Research for Health in the
African
Region.
Brazzaville:
World
Health
Organization Regional Office for Africa, 2009.
Public Health England web portal. See http://www.
apho.org.uk/ (last checked 7 May 2012).
World Health Organization. Framework and Standards
for Country Health Information Systems. 2nd edn.
Geneva: World Health Organization/Health Metrics
Network, 2008.
Landry R, Amara N, Pablos-Mandes A, Shademani R
and Gold I. The knowledge value chain: a conceptual
framework for knowledge translation in health. Bull
World Health Organ 2006; 84: 597–602.