Module 4
Country assessment, health monitoring, and health information systems
Tool 14: Strengthening health information,
health monitoring and evaluation
Tool overview
Strengthening health information systems
Strengthening national health information systems is key to incorporating refugee and migrant information into a well-functioning system. Whole-of-population care as well as specific care for refugees and migrants are part of the core function of health services and the corresponding information that goes along with those services, such as:
- outbreak and other infectious disease detection, investigation and control
- environmental health programmes
- immunization
- surveillance and control of risk factors for NCDs
- provision and quality of clinical services
- health promotion and education
- maternal and child health services
- emergency preparedness and response.
Information collected on these services can include identifiers for refugees and migrants, feeding into a national health information system to improve monitoring, planning, implementation and evaluation of needs for all the population. Another important source of information is refugee and migrant health records, which contain information on immunizations, communicable diseases and NCDs.
Core indicators to capture refugee and migrant health focus on key variables relating to the migratory status within the determinants of health:
- country of birth
- country of citizenship
- month and year of arrival
- country of birth of both parents.
Additional information to allow further disaggregation of health data by subgroups of migrants could include reasons for migration.
Currently challenges exist that make it difficult to disaggregate health data by migratory status. A core set of variables capturing this and other relevant health and social determinants of health for migrants should be integrated into national health information systems. Efforts to strengthen health information systems in low- and middle-income countries do not occur in isolation but need to integrate with other aspects of core health system functions. The country context and the human element of health-care systems are often considered secondary to technological solutions. Short-term solutions need to be weighed carefully against long-term ones, as well as using monitoring and evaluation components to measure health information system effectiveness and build the evidence for what works.
The principles of humanitarian information management recommended by the Global Health Cluster (Box 1) are relevant to country data collection, particularly in transition or refugee camps and holcentres.
Box 1. Basic principles of information management Confidentiality. Protect sensitive data and information. Accessibility. Apply easy-to-use formats and tools, translating information into common or local languages when necessary and placing information in locations (such as websites) that are easily accessible by relevant partners. Inclusiveness. Ensure data ownership by multiple stakeholders, especially the government. Interoperability. Make sharable data available in formats that can be easily retrieved by relevant stakeholders. Accountability and validity. Use appropriate methods of collection, transformation and analysis to ensure data are credible. Relevance. Collect information that is practical, flexible, responsive and driven by operational needs in support of decision-making throughout all phases of a crisis. Objectivity, neutrality and humanity. Use a variety of sources when collecting and analysing information that are free of political interference to avoid harming or misleading at-risk populations and to respect their dignity. Timeliness and sustainability. Preserve, catalogue and archive current, open-sourced information for analysis and retrieval. |
Strengthening health monitoring and evaluation
Monitoring refugee and migrant health through reliant and relevant data is an important public health strategy. Data for monitoring and promoting the health of refugees and migrants, as well as host populations, should include at a minimum the social determinants of health and the accessibility and utilization of health services.
Health information systems require sound and reliable information for policy development and implementation, governance and regulation, research, health education and training, financing and delivery of services. This information includes individual, health facility and population-level health data and indicators.
While there is a plethora of tools on health monitoring and evaluation, in general there are fewer tools specifically related to health monitoring for refugees and migrants. Examples come primarily from the WHO European Region. The United Nations High Commissioner for Refugees’ Health Information Toolkit includes 73 groupings of tally sheets, health register and reporting forms, guidelines and emergency reporting forms, as well as training materials that can be downloaded and contextually adapted. There is also a health information system evaluation checklist for refugee camp situations.
The WHO Health Equity Assessment Toolkit (HEAT) is a software application that facilitates the assessment of health inequalities within countries. In 2021 WHO launched HEAT Plus, which allows users to upload and work with their own databases. Both toolkits are organized around two main components:
- explore inequality, which enables users to explore the current situation in one setting of interest (e.g. a country, province or district) and the change in inequality over time; and
- compare inequality, which enables users to benchmark (i.e. compare the situation in one setting of interest with the situation in other settings).
Data and indicators
Monitoring and evaluating the health status of populations and subgroups requires timely and quality information. Accurate data are needed to generate action to improve the health status of migrants and refugees.
Traditional (routine) data are available at national level in most countries. Sources include civil registration, vital statistics, population censuses, Demographic and Health Surveys, Living Standards Measurement Studies, health institution records such as national hospital registries, and national epidemiological disease surveillance studies. Vertical disease control programmes for tuberculosis, HIV and malaria collect data on mobile and migrant populations.
Non-traditional data sources on migrant health status include the Migration Integration Policy Index (MIPEX), which measures policies to integrate migrants in 38 countries in Asia, Europe, North America and Oceania and includes information on health-related policies collected through its Health Strand questionnaire. The BioMosaic project created a software application that allows combining and visualizing immigration statistics and health and demographic data.
Drawing upon both traditional and on-tradition data sources maybe a useful way to obtain data on refugees and migrants, as well as vulnerable populations.
Guidance and tools
Health Information Systems
Guidance, training, reports
Tools
Monitoring and evaluation
Guidance, training, reports
Tools
National eHealth Strategy Toolkit
Monitoring emergencies and large influxes of refugees and migrants
Guidance, training, reports
Tools
Additional resources
Related teams