Using PRISM to strengthen and

evaluate health information systems

MEASURE Evaluation Fact sheet Overview: The PRISM framework identifies strengths
PRISM: Performance of routine
information system management and weaknesses in RHIS performance and bridges the gaps,
leading to improved health system performance.
At MEASURE Evaluation, we know that improved
analysis and use of data lead to better health pro- Routine health information systems developed by MEASURE Evalua-
gram decision making and, ultimately, improved (RHIS) attempt to produce timely tion and John Snow, Inc., acknowl-
health outcomes. This fact sheet introduces one
and quality information about what edges the broader context in which
is happening in health sector orga- RHIS operate. It emphasizes
of the innovative toolsets created for monitoring
nizations. Ideally, this information is strengthening RHIS performance
& evaluating public health interventions. used to guide day-to-day operations, through better data quality and im-
track performance, learn from past proved information use.
MEASURE Evaluation is funded by the U.S. results, and improve accountability. PRISM broadens the analysis of
Agency for International Development (USAID)
However, the systems designed to RHIS performance to include three
through Cooperative Agreement GPO-A-00-03-
track health data often fall short of key categories of determinants that
00003-00 and is implemented by the Carolina this ideal — data quality may be low, affect performance:
Population Center at the University of North processes for using data other than ■■ Behavioral determinants – the
Carolina in partnership with Constella Futures, sending reports may not exist, or knowledge, skills, attitudes, val-
John Snow, Inc., Macro International Inc., and managers and staff may have limited ues, and motivation of the peo-
understanding of the importance of ple who collect and use data;
Tulane University.
the information and few incentives
to give attention to the management ■■ Technical determinants – data
To learn more about MEASURE Evaluation and
of information system processes. collection forms, processes, sys-
our current activities, visit us on the Web at tems, and methods; and
www.cpc.unc.edu/measure. Traditional assessments only partly
address how to improve RHIS, be- ■■ Organizational determinants
cause they look narrowly at technical – information culture, structure,
issues such as data collection forms, resources, and roles and respon-
methods or information technology. sibilities of key contributors at
each level of the health system.
Performance of Routine Infor-
mation System Management The PRISM conceptual framework
(PRISM), a conceptual framework and tools identify strengths and
weaknesses of RHIS performance,
 PRISM: Strengthening and evaluating RHIS performance FS-07-18 (10/20/08)

and associated factors. The tools can be use to design a new ity checklists can asses the data quality of a single health facility;
system, to evaluate an exi sting system or to evaluate the impact they can also be used by ministries of health or intermediate
of interventions on RHIS. The assessment findings also aid in health departments. Data can be collected from all the facilities
designing and prioritizing interventions to improve RHIS per- of a district or a sample of the facilities. One sampling method,
formance. Improved use of infor- lot quality assurance sampling,
mation for evidence-based deci- uses small sample sizes to assess
sion making in turn improves the whether or not a prescribed target
performance of health systems is achieved. For most districts, us-
and leads to better health care. ing 19 health facilities is recom-
PRISM Tools: The PRISM tool- mended, but in some cases as few
set includes the following data as 12 may be sufficient. District
collection tools and instructions RHIS performance is measured
on how and when to use them: by aggregating data from health
facilities. The diagnostic tool,
■■ Performance Diagnostic MAT, and facility checklist are
Tool: The primary toolset applied through record observa-
component, the performance tion, while the OBAT is a self-
diagnostic tool determines administered tool completed by a
the overall level of RHIS sample of individuals at different
performance, i.e. the level of levels of an organization, from fa-
data quality and use of in- cility staff to senior management.
formation. It captures the technical determinants of RHIS
performance, such as level of complexity of data collection Recent Experience: MEASURE Evaluation has used the
forms and user-friendliness of information technology. OBAT to assess the health information systems in Mexico,
Paraguay, and Honduras. The toolset has been applied in Paki-
■■ Overview and Facility/Office Checklist: This tool ex- stan to reform health information systems and in Uganda to
amines technical determinants, such as the structure and conduct a situation analysis of health management information
design of existing information systems in the health sector, systems. We also provided training in the use of the toolset in
information flows, and interaction between different in- South Africa and Mexico.
formation systems. It allows users to understand the avail-
ability and status of RHIS resources necessary for RHIS We have evaluated the PRISM framework and its tools relaibil-
implementation at the facility and district levels. ity and vailidity in Uganda. PRISM framework is used in Chi-
na for baseline assessment of HMIS focusing on HIV/AIDS
■■ Organizational and Behavioral Assessment Tool information and developing interventions to improve identified
(OBAT): This tool identifies behavioral and organizational gaps.
factors affecting RHIS performance. Behavioral determi-
nants include level of data demand, motivation, confidence, PRISM is part of the Health Metrics Network Information
task competence, and problem-solving skills. Organiza- system framework. It is included in a course on information
tional factors include level of promotion of a culture of in- systems at the Johns Hopkins University Bloomberg School of
formation, merit criteria, and use of RHIS information for Public Health.
performance appraisal. Download the Tools: The PRISM framework and tools are
■■ Management Assessment Tool: This tool is designed to available for free download from the MEASURE Evaluation
take rapid stock of the RHIS management practices and aid Web site, www.cpc.unc.edu/measure.
in developing recommendations for better management.
Health information systems produce data at regular intervals,
and the PRISM diagnostic tool should be used routinely, i.e. at
least quarterly, to observe improvements in data quality and in-
For more Information
creases in the use of information. However, other PRISM tools ■■ Anwer Aqil, MD, MPH, DrPH ([email protected])
should be used in conjunction with the diagnostic tool when
MEASURE Evaluation, Carolina Population Center
the RHIS performance becomes stagnant or shows a downward
trend. University of North Carolina at Chapel Hill
206 W. Franklin St., CB 8120
How to Use the PRISM Tools: The PRISM tools can be used
by any organizational unit of the health system to assess RHIS Chapel Hill, NC 27516
performance, including host-country decision makers, designat- 919-966-7482 http://www.cpc.edu/measure/
ed RHIS program managers, and RHIS specialists. Data qual-