Barriers and facilitators to health information exchange in low- and middleincome country settings: a systematic review protocol

Introduction

Health information has been defined as the ‘foundation’ for better health, the ‘glue’ for sticking and holding health systems together and the ‘oil’ lubricating these systems to keep them running.1 Health information is the information about people’s health that describes the occurrence, prevalence and causes of major illnesses, diseases and infections along with the availability, use and effectiveness of remedial actions.2 The availability of standardised reliable health information is indispensable for observing, measuring and monitoring the coverage, quality and outcomes of health services. Likewise, the timely capture and analysis of data obtained through surveillance of health threats and epidemics informs strategies for their prevention and containment.3 Providing the infrastructures and technologies that can enable data to be accurately collected, exchanged and analysed in a timely manner can thus aid in the management of individual patients and strengthen the governance and effectiveness of health systems and improve population health.4

The World Health Organization (WHO)’s Framework for Action has identified health information as one of the six essential building blocks of effective health systems.5 The other five are health workforce, leadership and governance, service delivery, financing, and medical products, vaccines and technologies. According to Health Information for All 2015 (HIFA 2015), the availability and use of appropriate and reliable health information is essential to the achievement of Millennium Development Goals (MDGs). HIFA was founded in 2006 with the aim of ensuring that every person in the world will have access to an informed health care provider (see www.hifa2015.org). Furthermore, the United Nations’ (UN’s) High Level Panel on the post-2015 Development Agenda recently called for a ‘data revolution’ for sustainable development, with a new global initiative, Global Partnership on Development Data, to improve the quality of information and statistics available to diverse interested stakeholders – people, government, international organisations, foundations and the private sector.6

These goals will only be achieved when interested stakeholders are prepared and able to participate in health information exchange (HIE) across health providers, organisations and systems. Such stakeholders include doctors, nurses, health workers, pharmacists, managers and patients in order to support the delivery of optimum quality of health care at the community, district and national levels. For example, information is required at individual and community levels to meet the needs of the local population; at the district level, to help health managers and planners to make judgements and decisions regarding the health system and the effectiveness of health facilities; and at the national level, to make strategic decisions about resource allocation.7 Moreover, co-operation is required among a wide variety of specialists including health care providers, researchers and policy makers for the development of robust systems that can provide reliable, relevant and usable information to support delivery of effective health care services.8

Sound information is also indispensable for monitoring public health outcomes and actions such as planning, programming, policy making and monitoring. Similarly, it is required to ensure accountability of resources and to evaluate the progress of nations against global objectives such as the MDG, which can be improved through strengthening information management at all levels of countries’ health systems. 9,10 Better data and statistics can enable governments to track progress in a timely fashion.6 Accurate health information can empower stakeholders to identify the neediest, for example malaria or human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) patients, and determine whether they are receiving required essential services and facilities. The absence of relevant and reliable health information is a major contributor to preventable deaths and sufferings.11

According to the World Bank (WB), a developing country is one in which the majority of the inhabitants live on low wages, with far fewer public services available to them than those available in the highly industrialised nations.12 Gross national income (GNI) is the main criterion used by the WB to classify economies into low- and middle-income countries (LMIC), which sometimes are also known as developing economies.13 These developing economies are divided into different groups, with respect to GNI per capita, for example (1) low income: $1035 or less; (2) lower middle income: $1036–$4085; and (3) upper middle income: $4086–$12,615. Developed or high-income countries, on the other hand, have a per capita income of $12616 or more.

Lack of access to health information makes it unlikely that LMIC will be able to realise the goals of truly ‘informed health care’ in the near future, as has been envisaged for higher income regions.14 Because many LMIC are unable to generate reliable, complete and timely information about patient health, disease, care and outcomes, their progress in meeting key heath indicators such as the MDG cannot be easily established. Such data are often incomplete and there are frequent significant time lags between data collection periods. 15 For example, over 40 LMIC are incapable of tracking progress on extreme poverty and hunger due to insufficient data.16 Many national authorities are not able to report reliable health-related information to international organisations and donors such as UN and WHO due to poor information capture and management.

Studies on health information systems (HISs) in LMIC have identified a range of barriers to various types of health information exchanged and shared between suppliers/producers, consumers and users.2,17–20 Fragile HISs are increasing dissatisfaction and frustration among producers and users of health data. The introduction of technology and the provision of finance for strengthening weak health systems do not address all of these problems, as there are other technical, structural and sociotechnical barriers that also need to be considered.21–23 For example, HIE at the provincial or national level can only be useful if connectivity and exchange of health information exist at the individual, community or district levels in the first instance.

Given these challenges, there is a pressing need to better comprehend the barriers and facilitators to HIE at individual, provider, community, district, provincial and national levels, especially in LMIC. An appreciation of the barriers and facilitators to accessing, sharing and exchanging health information in different LMIC will allow stakeholders to better understand possible solutions to tackling the problem currently experienced with HIE.

Systematic reviews can be useful for informing the development of evidence-based strategies to address the problems faced by LMIC.24 This systematic review seeks to capture, appraise and synthesise the existing empirical evidence documenting challenges and facilitators to HIE in LMIC. It has the potential to inform guidelines for international donor agencies, national authorities and global health organisations, such as the WHO, the UN and the WB, wishing to develop effective strategies for investment in the design and implementation of HIE.

Methods

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