Supporting Iraqi Kurdistan Health Authorities in Post-conflict Recovery: The Development of a Health Monitoring System

Abstract

Background: Iraq has endured several conflicts and socio-political tensions that have disrupted its public health system. Nowadays, because health data are not collected on a routine basis, the country still lacks proper statistics and, consequently, response plans to meet present and future health needs of its population. An international partnership is developing in the Iraqi Kurdistan a Health Monitoring System with the aim of supporting evidence-based health policy decisions. Methods: The pilot phase for assessing the feasibility of the programme was launched in 2015. In 2018 the implementation phase began. The first step was to choose the software platform and the coding system, as well as to identify the public hospitals (PH) and Public Health Centers (PHC) to be included in the e-health system. The technical infrastructure of each PHC or PH was updated. The staff of each center was trained in the use of the e-health system and in disease coding. Several seminars introduced regional and district health managers to the basic concepts of data-driven decision making. A local team of experts was trained to create a highly specialized staff with the objective of "training the trainers" and ensuring the future self-sufficiency of the system. Results: By September 2019, 59 PHC and PH were entering data in the Health Monitoring System, while 258 health operators (medical doctors, administrative staff, nurses, statisticians, IT and public health specialists, pharmacists) have been already trained. Currently, more than 600,000 disease events have been collected. Additionally, further 734 medical doctors, statisticians, and health managers have been trained on the basics of public health practice. The goal during the next 3 years is to reach 120 operative centers within the region, envisaging a subsequent expansion of the system to all Iraq. Emberti Gialloreti et al. Health Monitoring System in Iraq Conclusions: The creation of a functioning health monitoring system is feasible also in regions characterized by socio-political tensions. However, multiple stakeholder partnerships are essential. The provision of an e-health information system, coupled with the establishment of a team of local experts, allows the routinely and timely collection of health information, facilitating prompt responses to present and emerging needs, while guiding the formulation and evaluation of health policies.

Integrating maternal and child health data into the Iraqi Kurdistan health information system

“…However, at present, little is known about the actual implementation plan [16]. The WHO is supporting initiatives in the Eastern Mediterranean region [17] to develop national health information systems so as to improve timely and comprehensive registration of health data [18,19]. Since 2015, WHO has been implementing an Interactive Electronic Reporting System in Jordan [20], trying to integrate an e-health initiative launched in 2000 with the (still to be achieved) goal of connecting public hospitals in the country within three years [21].…”

Ten-Year Mortality Trends and Natural Causes of Death in the Iraqi Kurdistan

“…In line with this approach, the University of Rome Tor Vergata (Italy) and the KRI Ministry of Health -with the financial support of the Italian Agency for Development and Cooperation-have initiated a cooperation project to establish the first Health Information System in the KRI, aimed at gathering data on health determinants, births, deaths and health service performance. This project was commenced in 2015 through a pilot phase [43] and now includes about 60 health centres and hospitals, which routinely record health data using ICD-10. The Health Information System is starting to provide high-quality data, which are needed for national and sub-national planning, policy implementation and monitoring of health outcomes and services.…”

Hospital quality monitoring and evaluation system using linked spreadsheets on Microsoft SharePoint

“…A profound monitoring and evaluation system ought to incorporate mixed research approaches (Bamberger, Rao, and Woolcock 2010). All relevant stakeholders' involvement is necessary in determination of indicators to be tracked (Emberti Gialloreti et al 2020, Malone et al 2014, Diallo et al 2003, Guijt 1999. Participatory monitoring and evaluation involves incorporation of all the stakeholders in all stages and processes of the M&E system, and the engagement helps in determination of the way forward and what modifications are needed for better M&E (Izurieta et al 2011, Estrella et al 2000, Guijt 1999, Estrella and Gaventa 1998.…”

“…The most challenging issue in monitoring and evaluation of indicators in healthcare is the development of a systematic way of measurement and utilization of indicators for improvement, development of such a system which incorporates variance reporting requires concerted effort and inclusion of each team member (Brown and Nemeth 1998). There are myriad challenges towards the design, development, and implementation of an effective M&E system; such as stakeholder buy-in, knowledge gap, time constraints, logical frameworks, resources available, and the validity of data, sampling techniques, and the indicator measurements (Emberti Gialloreti et al 2020, Anderson et al 2019, Mthethwa and Jili 2016, Cameron 1993. Emberti Gialloreti et al (2020) concluded that multiple stakeholder involvement is necessary for a successful and timely system in collection and monitoring of health information.…”

“…There are myriad challenges towards the design, development, and implementation of an effective M&E system; such as stakeholder buy-in, knowledge gap, time constraints, logical frameworks, resources available, and the validity of data, sampling techniques, and the indicator measurements (Emberti Gialloreti et al 2020, Anderson et al 2019, Mthethwa and Jili 2016, Cameron 1993. Emberti Gialloreti et al (2020) concluded that multiple stakeholder involvement is necessary for a successful and timely system in collection and monitoring of health information. Participatory M&E systems promote efficiency, relevant and effective processes leading to an elaborate corrective action (Guijt, 1999).…”