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LEARNING MODULE
HEALTH INFORMATION SYSTEM FOR MED LAB SCIENCE
WEEK 5 – HMIS MONITORING AND EVALUATION

HMIS Monitoring & Evaluation measures the effect on both service delivery and use of
services (FP/Immunization Integration Working Group,
A health management information System aims primarily n.d.).
at assisting in the planning and management of a
national health strategy plans; thus, continuous M&E Framework
monitoring and evaluation is necessary for it to be
effective. By definition and function, monitoring and A general framework of M&E of health system
evaluation are complimentary. strengthening (HSS) was developed by various global
• Monitoring refers to the collection, analysis, and partners and countries. Derived from the Paris
use of information gathered from programs for Declaration on aid harmonization and effectiveness and
the purpose of learning from the acquired the International Health Partnership (IHP+), this
experiences, accounting the resources used both framework places health strategy and related M&E
internal and external, and obtaining results and processes of each country at the center. The
making decisions. strengthening of a common country platform for the
• These purposes correspond to three M&E of HSS is the core of the framework. In doing so,
functions: learning, monitoring, and there is better alignment and the monitoring of fundings
steering. Meanwhile, evaluation is the for health systems is easy.
systematic assessment of completed
programs or policies. The objective is to There are four components of the framework as
gauge the effectiveness of the program provided by WHO, namely, the indicator domains, data
so that adjustments can be made in collection, analysis, synthesis, and communication use,
areas that need improvement. intended for achieving greater health impact. For
• An evaluation has both a learning function in monitoring medical services, indicators should be
which the lessons learned need to be tracked to assess processes and results associated with
incorporated into future proposals, and a the various indicator domains. In this way, the strengths
monitoring function which means that the and weaknesses of implementation are provided and can
concerned parties review the implementation of be used for troubleshooting in the system. In terms of
policy based on the objectives and resources. outcomes and impact indicators, the changes may not be
directly caused by service delivery efforts for there are
Purpose of M&E other factors to consider. However, these data are still
A robust monitoring and evaluation (M&E) system is useful in understanding the current health status and
required to assess the effect of integrated service context within a country (FP/Immunization Integration
delivery. Appropriate indicators, data collection systems Working Group, n.d.).
and data analysis to support decision-making help guide
successful implementation of integrated services and


M&E Plan

An M&E plan addresses the components of the
framework and establishes the foundation for regular
reviews during the implementation of the plan for the
national level. Local M&E systems generate information
for global monitoring based on the health sector review
processes which are considered key factors in monitoring
the progress and performance of the entire system.
Medical institutions are monitored and evaluated
through the assessment of reports, surveys, HMIS, and
other evaluation studies.



Specifically, the National Health Mission of India

identifies strategies which help in the successful

implementation of the framework. The framework

should

(1) be localized,

(2) address the needs for multiple users and

purposes,
Table 7.2 provides specific indicators, data sources, and
(3) facilitate the identification of indicators and data
purposes for tracking each indicator for monitoring
sources, and
family planning and immunization service delivery and
(4) be able to use the M&E in disease-specific
assessing the integration of services. This table includes
programs.
a variety of quantitative indicators coupled with

qualitative techniques in order to better understand the

basics of the integration processes and solicit feedback
M&E and HMIS Indicators
on the approach.


An indicator is a variable which measures the value of
the change in units that can be compared to past and
future units. The focus is on a single aspect of a program
such as input, output, among others. HMIS uses various
indicators to monitor key aspects of health system
performance. The United States Agency for International
Development (USAID) classifies these indicators (Table

7.1) into five broad categories, namely, immunization,
reproductive health, disease prevention and control,
resource utilization, and data quality.


monitoring program performance and how it encourages
similar in-depth analysis for all health programs and
services such as maternal survival intervention, child
mortality and child survival intervention, and Stop TB
program.


Maternal Survival Interventions

The fifth millennium development goal targets to reduce
the maternal mortality ratio by 75 percent and to achieve
universal access to reproductive health. Despite this set
goal, none of the maternal survival intervention alone
can reduce the maternal mortality rate. As Campbell and
Graham (2006) explained, the complexity of the country
contexts and maternal health determinants makes it
complicated to choose the best strategies in achieving
this goal. However, they found that packaging of health
facility-oriented interventions is highly effective and has
high coverage of the intended target group.


In order to routinely monitor the progress towards
implementation of a highly effective package of maternal
survival interventions, HMIS is designed to provide some
of the core input, process, and output indicators.

The HMIS indicators are related to the following:
1. pregnancy care interventions
• 1st antenatal care attendances
• 4th antenatal care attendances
• Cases of abnormal pregnancies attended at out-
patient departments (OPD) of health facilities
• Institutional cases of maternal morbidity and mortality
HMIS Indicators and Health Programs due to antepartum hemorrhage (APH), hypertension and
This section explains the relationship of HMIS indicators edema reported by in-patient departments (IPD) of
and some of the health programs on communicable and health facilities
non-communicable diseases. These disease data provide • Cases of abortion attended at health facilities
an in-depth understanding of how HMIS can be used for


• Cases of medical (safe) abortions conducted at health The Philippine government through DOH launched
facilities various strategies to help ensure good health of the
Filipino children by the year 2025:
2. intrapartum care 1. CHILD21 - Child 21 or the Philippine National
• Deliveries by skilled attendants (at health facilities) Strategic Framework for Plan Development for
• Deliveries by health extension workers (HEW) (at home Children 2000 to 2025 serves as a framework for
of health posts) policymaking and program planning and as a
• Institutional cases of maternal morbidity and mortality roadmap for interventions aimed at
due to obstructed labor safeguarding the welfare of the Filipino children.
This is part of the Philippines’ commitment to
3. postpartum care the United Nations Convention on the Rights of
• 1st postnatal care attendance the Child (UN CRC).
• Institutional cases of maternal morbidity and mortality 2. Children's Health 2025 - This is a subdocument
due to postpartum hemorrhage (PPH) and puerperal of Child 21 which focuses on the development of
sepsis the Filipino children and the protection of their
rights by utilizing the life cycle approach.
4. interpartum period 3. Integrated Management of Childhood Illness
• Family planning method acceptors (new and repeat) (IMCI) - IMCI is a strategy that aims to lower
• Family planning methods issued by type of method child mortality caused by common illnesses.
4. Enhanced Child Growth - This is an intervention
aimed to improve the health and nutrition of the
The Child Mortality and Child Survival Interventions Filipino children by operating community-based
The leading cause of under-5 child mortality in the health and nutrition posts all throughout the
Philippines as reported by the Department of Health country.
(DOH) in their Top (10) Leading causes of child mortality
report (2010) was Pneumonia with 2,051 reported cases. The STOP TB Program
Figure 7.1 shows data reported which includes other
causes of child mortality: Diarrheas and gastroenteritis, Envisioning a tuberculosis-free world, the goal of the
congenital anomalies, septicemia, other diseases of the Stop TB Program (STP) is to dramatically reduce the
nervous system, accidental drowning or submersion, global burden of tuberculosis (TB) by 2015. This is in line
dengue fever and dengue hemorrhagic fever, chronic with the WHO’s millennium development goals and the
lower respiratory diseases, meningitis and leukemia. Stop TB Partnership which aims to push TB up the world
political agenda. One of the main objectives of the
program is to achieve universal access to high-quality
care (i.e., universal access to high quality diagnosis and
patient-centered treatment) for all people with TB
(including those co-infected with HIV and those with
drug-resistant TB).


health, immunization, disease prevention and
TB case detection and successful completion of the control, resources utilization, and data quality.
treatment/cure of the TB remains at the core of the Stop ü HMIS is a source of routine data necessary for
TB Strategy. Thus, by 2050, one of the targets of the monitoring different aspects of various health
strategy is to reduce the prevalence of and deaths due to programs implemented in a country. The HMIS
TB by 50 percent compared with the 1990 baseline. indicators should be carefully selected to meet
the essential information necessary for
monitoring the performance of various health
The HMIS indicators to monitor stop TB Program are programs and services and to present an
• TB patients on DOTS (Number of new smear- overview of the available health resources.
positive pulmonary TB cases enrolled in the
cohort)
• TB case detection (Number of new smear-
positive pulmonary TB cases detected, number
of new smear-negative pulmonary TB cases
detected, number of new extra-pulmonary TB
cases detected)
• HIV-TB co-infection (Proportion of newly
diagnosed TB cases tested for HIV)
• HIV+ new TB patients enrolled in DOTS
• TB treatment outcome (Treatment completed
PTB+, Cured PTB+, Defaulted PTB+, Deaths PTB+)

KEY POINTS TO REMEMBER:
ü Monitoring and evaluation (M&E) is a core
component of current efforts to scale up for
better health. Global partners and countries
have developed a general framework for M&E of
health system strengthening (HSS).
ü The primary aim of HMIS is to have a strong M&E
and review system in place for the national
health strategic plan that comprises all major
disease programs and health systems.
ü There are different HMIS indicators which can be
used in monitoring the key aspects of the health
system performance. These are from among the
five broad categories, namely, reproductive