PRISM: Performance of Routine

Information System Management

PRISM Tools for Assessing,

Monitoring, and Evaluating RHIS
Performance

INDEX
1.

Acknowledgements .................................................................................................. 1-2

1.1.
PRISM Tool version 3.0 .................................................................................. 1-2
1.2.
PRISM Tool version 2.0 .................................................................................. 1-3
2. PRISM Tools Summary ........................................................................................... 2-4
3. RHIS Performance Diagnostic Tool ........................................................................ 3-5
3.1.
Data Quality Assessment at District or Higher level ....................................... 3-5
3.2.
Use of Information Assessment at District or Higher level ............................. 3-5
3.3.
Data Quality Assessment at Facility Level ...................................................... 3-5
3.4.
Use of Information Assessment at Facility Level ............................................ 3-5
4. Information Systems Overview and Resources ..................................................... 4-16
4.1.
Information System Mapping ........................................................................ 4-16
4.2.
Facility/Office checklist ................................................................................. 4-16
5. Management Assessment Tool .............................................................................. 5-23
6. Organizational and Behavioral Assessment Tool .................................................... 6-1

Glossary
PRISM
RHIS
OBAT
MAT

Performance of Routine Information System Management

Routine Health Information System
Organizational and Behavioural Assessment Tool
Management Assessment Tool

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1. Acknowledgements
1.1. PRISM Tool version 3.0
PRISM Framework and its tools applications have expanded since 2004. Now it has been
applied in Pakistan, Uganda, South Africa, Mexico, Paraguay, Honduras, Haiti, China
and Cote dIvore for assessment and evaluation. It has been applied in diverse countries
of Africa, Asia, Latin America and Caribbean continents. While these applications
showed the strengths and appropriateness of PRISM Framework and its tools in
identifying strengths and weaknesses of the routine information systems, they brought
some challenges to attention. First, to make a distinction between RHIS performance
indicators accuracy, timeliness and completeness, from their counterpart processes.
Second, to keep minimum variables in various tools for triangulation of information to
avoid respondents burden of filling the details. Third, better measurement of use of
information. Thus, there was a need to revise the PRISM tools. Uganda PRISM
evaluation in 2007 for testing its reliability and validity also helped to make the revisions.
PRISM tools version 3.0 meets old and new challenges in assessing, monitoring and
evaluation of RHIS. The authors would like to thank and acknowledge the contributions
by the following individuals for revision of PRISM version 2.0.

Drs. Chen Jie, Lu Wei, Zhu Quiying, CDC Guangxi, China

Drs. Lu Lin, Jia Mahong, , Yang Yanling, CDC Guangxi, China
Professor David Hotchkiss, Tulane University, USA
Ramon Martinez Piedra, Pan American Health Organization, USA
Drs. Claudia Risso de Araujo Lima, Vinisius P. Queiroz, Brazil
David Boone (MEASURE Evaluation/JSI)
Leontine Gussonou, Traore Moussa (MEASURE Evaluation/JSI, Cote dIvore)
Lu Yao(MEASURE Evaluation/JSI, China)
Mamadou Alimou BARRY, MEASURE Evaluation

Anwer Aqil, MEASURE Evaluation/JSI

Theo Lippeveld, MEASURE Evaluation/JSI

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1.2. PRISM Tool version 2.0

The authors would like to acknowledge the following individuals and organizations all of
whom contributed significantly towards the development of the PRISM tools:
Mounkaila Abdou (MEASURE Evaluation/JSI)
Edward Abel (MEASURE Evaluation/Constella-Futures)
Tariq Azim (John Snow Inc., Boston MA)
Mary Church (Consultant, Sante Fe, NM)
Juan Eugenio Hernandez, Instituto Nacional de Salud Publica, Cuernavaca,
Mexico
Natasha Kanagat (MEASURE Evaluation/JSI)
Anne Lafond (MEASURE Evaluation/JSI)
Eddy Mukooyo (Ministry of Health of Uganda)
Beatrice Plaza (MEASURE Evaluation/UNC)
Michael Rodriguez (MEASURE Evaluation/JSI)
Norah Stoops (HISP, South Africa)
Timothy Williams (MEASURE Evaluation/JSI)
Randy Wilson (Management Sciences for Health, Boston, MA)
We would like to express gratitude towards the MEASURE Evaluation project and all
our team members for their continued support and encouragements and towards USAID
for providing financial support for this project.
Anwer Aqil, MEASURE Evaluation/JSI
Dai Hozumi, MEASURE Evaluation/JSI
Theo Lippeveld, MEASURE Evaluation/JSI

The development of this toolkit was made possible by the support from the United States
Agency for International Development (USAID) under the terms of Cooperative
Agreement GPO-A-00-03-00003-00. The authors views expressed in this publication do
not necessarily reflect the views of the USAID or the United States Government.

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2. PRISM Tools Summary

PRISM TOOLS
RHIS Performance Diagnostic Tool
Quality of Data
Module

Use of
Information
Module

RHIS Overview &

Facility/ Office
Checklist

RHIS Management
Assessment Tool

(MAT)

Organizational and
Behavioral Assessment Tool
(OBAT)

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3. RHIS Performance Diagnostic Tool

3.1. Data Quality Assessment at District or Higher level

3.2. Use of Information Assessment at District or Higher level
3.3. Data Quality Assessment at Facility Level
3.4. Use of Information Assessment at Facility Level

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RHIS Performance Diagnostic Tool

Quality of Data Assessment: District Office Form
Name of the district:
Date of Assessment:
Name of the Assessor:
Name and Title of person Interviewed:
Data Transmission
DQ 1
DQ 2
DQ 3

DQ 4
DQ 5
DQ 6

Does the district office keep copies of RHIS monthly reports

sent by health facilities?
What is the number of facilities in the district that are supposed
to be reporting to (enrolled in) RHIS?
What is the number of facilities in the district that are actually
reporting to (enrolled in) RHIS?
Count the number of monthly reports submitted by the facilities
for any two months (of the surveryors choosing)..
What is the deadline for the submission of the RHIS monthly
report by facility?

1.Yes

Does the district office record receipt dates of the RHIS

monthly report?

1.Yes

0.No

a.month

b.month

0.No

If no deadline is
set, write no and
go to DQ8
If receipt dates
are not recorded,
go to DQ8

If DQ6 yes, check the dates of receipts for the two months (DQ7 (the total number of
report received before and after the deadline should be the same as in Q4).
a. Month (specify)
b. Month (specify)
DQ 7

DQ 8

DQ 9

Item

1. Before
deadline

2. After
deadline

3. Before
deadline

Number of facilities
Does the district have a record of people who receive monthly
report data by a certain deadline after receiving monthly reports
from the facilities?
Does the district have a record of submitting data on time to
regional and/or national levels?

4. After
deadline
1.Yes

0.No

1.Yes

0.No

Data Accuracy

DQ 10

Manually count the number of following data items from the RHIS monthly reports
for the selected two months. Compare the figures with the reports from the
computer or paper database.
Item
a. Month (specify)
b. Month (specify)
Manual count
Paper /computer
Manual count Paper/Computer

DQ A
DQ B
DQ C

Data Processing/Analysis
DQ 11

Does a database exist to enter and process

data?

DQ 12
DQ 12A
DQ 12B
DQ 12C
DQ 12D
DQ 12E
DQ 12F

Does the database produce the following?

Calculate indicators for each facility catchment area
Data summary report for the district
Comparisons among facilities
Comparisons with district/national targets
Comparisons among types of services coverage
Comparisons of data over time (monitoring over time)

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0. No

1. Yes, by
paper
database
1.Yes
1.Yes
1.Yes
1.Yes
1.Yes
1.Yes

2. Yes, by
computer
database
0.No
0.No
0.No
0.No
0.No
0.No

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DQ13
DQ 14
DQ 15
DQ 16
DQ 17
DQ 18
DQ 19
DQ 20

Do you think that the RHIS procedure manual is userfriendly?

Do you think that the monthly report form is complex and
difficult to follow?
Do you find the data software to be user-friendly?
Do you find that information technology is easy to manage?
Do you think that information system design provides a
comprehensive picture of health system performance?
Do you think RHIS has information that is also included in
other information system?
Does the RHIS software integrate data from different
information systems?
Does the information technology (Land Area Network LAN
or wireless network ) exist to provides access to information to
all district managers and senior management

1.Yes

0.No

0.yes

1.no

1.Yes
1.Yes
1.Yes

0.No
0.No
0.No

1.Yes

0.No

1.Yes

0.No

1.Yes

2.Yes

partially

completely

0.No

DQ 21
DQ 22
DQ 23
DQ 24
DQ 25

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RHIS Performance Diagnostic Tool

Use of Information District Assessment Form
District:
DU1
DU2
DU3

Name of assessor:
Name of respondent and title:

Date:

RHIS report production

Does this district office compile RHIS Data submitted by facilities?
Does the district issue any report containing RHIS information?

DU5

DU5a

DU5b

DU5c

DU5d

DU6
DU7

0.No
0.No

If no , go to
DU4

If yes, please list reports that contain data/information generated through the RHIS.
Please indicate the frequency of these reports and the number of times the reports
actually were issued during the last 12 months. Please confirm the issuance of the report
by counting them and putting the number in column 3.
2.No. of
3. No. of times that
1. Title of the report
times this
report is
supposed to
be issued per
year

DU3a
DU3b
DU3c
DU3d
DU3e
DU4

1.Yes
1.Yes

report are actually

issued for the last 12
months

Did the district office send a feedback report using RHIS

1.Yes 0.No
information to facilities during the last three months?
Display of information
Does the district office display the following data? Please indicate the types of data
displayed and whether the data are updated for the last reporting period.
1.Indicator
2.Type of display (Please tick)
3. Updated
Related to mother health
Table
1.Yes 0.No
Graph/Chart
Map
Related to child health
Table
1.Yes 0.No
Graph/Chart
Map
Facility Utilization
Table
1.Yes 0.No
Graph/Chart
Map
Disease surveillance
Table
1.Yes 0.No
Graph/Chart
Map
Does the office have a map of the catchment area?
1.Yes 0.No
Does the office display a summary of demographic information such 1.Yes 0.No
as population by target group(s)?

3-8

If no go to
DU6

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DU8

DU9

DU9a

DU9b
DU9c
DU9d

DU10
DU11

Is feedback, quarterly, yearly or any other report on RHIS data

1.Yes 0.No
available, which provides guidelines/ recommendations for
actions?
If yes to DU8, what kinds of decisions are made in reports of
RHIS data/information for actions? Please check types of decision
based on types of analysis present in reports.
Types of decisions based on types of analysis
Appreciation and acknowledgement based on number/percentage 1.Yes 0.No
of facilities showing performance within control limits over time
(month to month comparisons)
Mobilization/shifting of resources based on comparison by 1.Yes 0.No
facilities
Advocacy for more resources by comparing performance by areas 1.Yes 0.No
(sub-districts, cities, villages), human resources and logistics
Development and revision of policies by comparing types of 1.Yes 0.No
services
1.Yes 0.No
Discussion and decisions about use of information
Does the district office have routine meetings for reviewing
1.Yes 0.No
managerial or administrative matters?
How frequently is the meeting supposed to take place? Circle appropriate answer
4. weekly
3. After every two weeks
0. no schedule

DU12

2. monthly

1. quarterly

How many times did the meeting take place during the last three months? Circle
appropriate answer
12. 12 times 11. Between 7 and 11
3. 3 times
2. 2 times

6. 6 times 5. either 4 or 5
1. 1 time 0. none

DU13

Is an official record of management meetings maintained?

DU14

If yes, please check the meeting records for the last three months to see if the
following topics were discussed:
1.Yes, observed
Management of RHIS, such as data quality, reporting, or
timeliness of reporting
1.Yes, observed
Discussion about RHIS findings such as patient
utilization, disease data, or service coverage, or medicine
stock out
1.Yes, observed
Have they made any decisions based on the above
discussions?
1.Yes, observed
Has any follow-up action taken place on the decisions
made during the previous meetings?
1.Yes, observed
Are there any RHIS related issues/problems referred to
regional/national level for actions?
Promotion and Use of RHIS information at district/higher level
Did district annual action plan showed decisions based on HIS
1.Yes
information?
Did records of district office of last three months show that
1.Yes
district/senior management issued directives on use of information
Did district/national RHIS office publish newsletter/report in last
1.Yes
three months showing examples of use of information
Does documentation exist showing the use information for various 1.Yes

DU14a
DU14b

DU14c
DU14d
DU14e

DU15
DU16
DU17
DU18

If no
go to
DU10

3-9

1.Yes

0.No

If no, go
to DU15

0. No
0. No

0. No
0. No
0. No

0.No
0.No
0.No
0.No

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types of advocacy?
Does the district staff meeting records show attendance of persons 1.Yes 0.No
in charge of the facilities for discussion on RHIS performance?
DU20: Please describe examples of how the district office uses RHIS information for health system
management
0. No examples 1. Yes (details follows)

DU19

DU21
DU22
DU23
DU24
DU25

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RHIS Performance Diagnostic Tool

Quality of Data Assessment: Health Facility Form
Date of Assessment:

Name of the Assessor:

District

Facility

Name and Title of person

Interviewed:
Type

Data Recording
FQ1

FQ 3

FQ 4

Find the following information in the outpatient register for the selected two months. Compare the
figures with the computer-generated reports.
Item
a. Month (specify)
b. Month (specify)
# from
# from
# from register
# from report
register
report

FQ 2

1.Yes

1.Yes

0.No

If no, go
to FQ5

Does this facility keep copies of the RHIS monthly reports which are
sent to the district office?
Count the number of RHIS monthly reports that have been kept at the
facility for the last twelve months
Does this facility keep an outpatient register?

If no, go
to FQ5

0.No

Data Accuracy Check

4A
4B
4C
4D
FQ 5

FQ 6

Did you receive a directive in the last three months from the senior management or the
district office to:
1.Yes, Observed
5A Check the accuracy of data at least once in three months?
1.Yes, Observed
5B
Fill the monthly report form completely
1.Yes, Observed
5C
Submit the report by the specified deadline
During the last three months, did you receive a directive from the senior management or
the district office that there will be consequences for not adhering to the following
directives:
1.Yes, Observed
6A if you do not check the accuracy of data
1.Yes, Observed
6B
If you do not fill in the monthly reporting form completely
1.Yes, Observed
6C
If you do not submit the monthly report by the specified
deadline

0. No
0. No
0. No

0. No
0. No
0. No

Data Completeness
FQ 7

FQ 8

How many data items does the facility need to report on in the RHIS monthly
report? This number does not include data items for services not provided by
this health facility.
Count the number of data items that are supposed to be filled in by this facility
but left blank without indicating 0 in the selected months report.

Data Transmission /Data Processing/Analysis

FQ 9
FQ 10
FQ A
FQ B
FQ C
FQ D
FQ 11

1. Yes, Observed
Do data processing procedures or a tally sheet exist?
Does the facility produce the following?
Calculate indicators facility catchment area 1. Yes, Observed
Comparisons with district or national targets 1. Yes, Observed
Comparisons among types of services coverage 1. Yes, Observed
Comparisons of data over time (monitoring over time) 1. Yes, Observed
1. Yes, Observed
Does a procedure manual for data collection (with definitions) exist?

3-11

0. No
0. No
0. No
0. No
0. No
0. No

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FQ 12
FQ 13
FQ 14
FQ 15
FQ 16

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RHIS Performance Diagnostic Tool

Use of Information: Facility Assessment Form
Date:
Facility Name:
Facility Type:
FU1
FU2
FU3

Name of assessor:
Name of respondent and title:
District:
RHIS report production
Does this facility compile RHIS Data?
1.Yes
Does the facility compile any report containing RHIS information?
1.Yes

FU5

FU5a

report actually has

been issued during
the last 12 months

During the last three month, did the facility receive any feedback
1.Yes 0. No
report from district office on their performance?
Display of information
Does the facility display the following data? Please indicate types of data displayed and
whether the data have been updated for the last reporting period.
2. Type of display (Please tick)
1. Indicator
3. Updated
Table
Related to maternal health
1.Yes 0.No
Graph/Chart
Map/other
Table
Graph/Chart
Map/other
Table
Graph/Chart
Map/other
Table
Graph/Chart
Map/other

FU5b

Related to child health

FU5c

Facility Utilization

FU5d

Disease surveillance

FU6
FU7

Does the facility have a map of the catchment area?

Does the office display a summary of demographic information
such as population by target group(s)?
Is feedback, quarterly, yearly or any other report on RHIS data
available, which provides guidelines/ recommendations for actions?

FU8

If no , go to
UI4

If yes, please list reports that contain data/information generated through the RHIS.
Please indicate the frequency of these reports and the number of times the reports
actually were issued during the last 12 months. Please confirm the issuance of the report
by counting them and putting the number in column 3.
2. No. of
3. No. of times this
1. Title of the report
times this
report is
supposed to
be issued per
year

FU3a
FU3b
FU3c
FU3d
FU4

0.No
0.No

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1.Yes

0.No

1.Yes

0.No

1.Yes

0.No

1.Yes
1.Yes

0.No
0.No

1.Yes

0.No

If no go to
FU6

If no go to
FU10

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FU9

FU9a
FU9b
FU9c
FU9d
FU10

FU11

If you answered yes to question DU8, what kinds of action-oriented decisions have been
made in the reports (based on RHIS data)? Please check the boxes accordingly
Types of decisions based on types of analyses
Review strategy by examining service performance target and actual 1.Yes 0.No
performance from month to month
Review facility personnel responsibilities by comparing service targets 1.Yes 0.No
and actual performance from month to month
Mobilization/shifting of resources based on comparison by services 1.Yes 0.No
Advocacy for more resources by showing gaps in ability to meet targets
1.Yes 0.No
Discussion and Decision based on RHIS information
Does the facility have routine meetings for reviewing managerial or
1.Yes 0.No
administrative matters?
How frequently is the meeting supposed to take place?
4. weekly

FU12

3. After every two weeks

2. monthly

1. quarterly 0. no schedule

How many times did the meeting actually take place during the last three months?
12. 12 times
2. 2 times

11. Between 7 and 11

1. 1 time

6. 6 times
0. none

5. Either 4 or 5

3. 3 times

FU13

Is an official record of management meetings maintained?

FU14

If yes, please check the meeting records for the last three months to see if the following
topics were discussed:
Management of RHIS, such as data quality, reporting, or
1.Yes, observed
0. No
timeliness of reporting
Discussion on RHIS findings such as patient utilization,
1.Yes, observed
0. No
disease data, or service coverage, medicine stock out
Have they made any decisions based on the above
1.Yes, observed
0. No
discussions?
Has any follow-up action taken place regarding the decisions
1.Yes, observed
0. No
made during the previous meetings?
Are there any RHIS related issues or problems that were
1.Yes, observed
0. No
referred to the district or regional level for actions?
Promotion and Use of RHIS information by the district/higher level
Observed facility received annual/monthly planned targets based on
1.Yes 0.No
RHIS information
Do facility records for the last three months show that district/senior
1.Yes 0.No
management issued directives concerning the use of information

FU14a
FU14b
FU14c
FU14d
FU14e

FU15
FU16

If no,
go to
FU15

1.Yes

0.No

FU17

If no,
go to
FU15

Did the facility receive a district or national RHIS office newsletter or

1.Yes 0.No
report in last three months giving examples of use of information
FU18
Does documentation exist showing the use information for advocacy
1.Yes 0.No
purposes?
FU19
Did the person in charge of the facility participate in meetings at district
1.Yes 0.No
level to discuss RHIS performance for the last three months?
FU20: Please give examples of how the facility uses RHIS information for health system management
0. No examples 1. Yes (details follows)

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FU21

FU22
FU23
FU24
FU25
FU26

Supervision by the district health office

How many times did the district supervisor visit your facility during
the last three months? (check the answer)

Did you observe a supervisor having a checklist to assess the data

quality?
Did the supervisor check the data quality?
Did the district supervisor discuss performance of health facilities
based on RHIS information when he/she visited your facility?
Did the supervisor help you make a decision based on information
from the RHIS?
Did the supervisor send a report/feedback/note on the last two
supervisory visits?

0.
1.
2
3.
4. >3
1.Yes

If zero, go to
FU26

0.No

1.Yes
1.Yes

0.No
0.No

1.Yes

0.No

1.Yes

0.No

FU27
FU28
FU29
FU30
FU31

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4. Information Systems Overview and

Resources
4.1. Information System Mapping
4.2. Facility/Office checklist

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Routine Health Information System Overview

Overview of Information Systems in Health Sector
(Interview HIS Manager at district and sub-national level)
Level:

National
Sub-national (district, province, etc)
Name (of district, province, etc) _____________________________

Respondents Name:
Function/Title:
Institution:
Department:
Mapping existing routine information systems in health sector (OPTIONAL)
Using the sheet 1: Information system mapping, list all routine information systems existing
in the country/region/district.
This exercise will help you to understand types of health sector information that are included
(or not included) by information systems. It will also help to identify duplication of
information systems.
1) Write down specific names of the information systems.
2) Identify types of information covered by each system and check relevant boxes. You may
also write comments in the box. For example, an information system for EPI may handle
information on drug supplies but it might be limited to vaccines. You can indicate
vaccine only in the box. Similarly, MCH specific information systems may collect
information on service utilization of MCH services only.
3) Please describe how information from different information systems are shared. For
example, between TB programs and HIV/AIDS programs

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1: Information System Mapping (OPTIONAL)

Types of Information Handled by Each Systems
Type of information
system

Specific name
if any

Service
Utilization

Occurrence of
selected
disease(s)

Disease Outbreak
(Immediate report)

Financial
Information

Drug,
contraceptive
vaccine, stock

Human
resources

Equipment/
Building

Vital
Events

Others

Routine service based

reporting system
Epidemiological
surveillance for notifiable
infectious diseases
Special program reporting
systems
(EPI)
Special program reporting
systems (TB)
Special program reporting
systems (Malaria)
Special program reporting
systems (HIV/AIDS)
Special program reporting
systems (MCH)
Special program reporting
systems (specify)
Special program reporting
systems (specify)
Special program reporting
systems (specify)
Community Base
information system
Administrative system
(Finance)
Administrative system
(human resource)
Administrative system
(Training)
Administrative system
(drugs, contraceptive,
vaccine, logistics)
Administrative system
(Infrastructure,

equipment, transport)
Vital Registration
Other system

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Others

2. Data collection and transmission

Please list all data collection tools/forms that are used at the community/health facility level.
If space is not enough, please add an additional sheet of paper.
Facility-based data collection tools: (such as patient registers)

Comments on tools. Is the form easy to

use? Enough space to record data? Takes
too much time?

Comments on forms. Is the form easy to

use? Enough space to record data? Takes
too much time?

Data transmission/reporting forms

3. Information flowchart
Using the chart provided on the next page, illustrate the flow of information from community to health facility,
health facility to district level, district level to regional level, regional level to the central/national level. For each
level, please indicate specific departments/job titles which should receive and process information received from
a lower level.
This exercise will help you to clarify information flows in existing information systems and identify potential
problems, which affect the performance of the information systems.
1) If some levels, e.g. community level and regional level are not relevant to systems that you are examining,
please omit them from the exercise.
2) Please be as specific in identifying information sources and data transmission points as possible. For
example, if different types of facilities have different reporting units at district level, you will want to indicate
these different paths of information.
3) Add more than one information system to see interactions between information systems and how
complicated or simple information flows are in your health system. You can see how basic routine health
information systems information flow interacts with special program information systems such as EPI,
HIV/AIDS, and Malaria.
4) You can be creative in indicating different information flows in different colors. For example, you can
indicate the data aggregation process in red and the information feedback process in blue color. Or General
RHIS in green and EPI in pink, etc.

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Information flowchart
Information Flow Sheet

Community
information
system

Administrative
system
(Finance)

Contraceptive

MCH

HIV/AIDS

Malaria

TB

EPI

Types of Information Systems

HMIS

Levels

Central/national
Level

Regional Level
(Province)

District Level

Facility Level

Community
Level

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Facility/Office Checklist
(Interview Facility Manager or person in charge of RHIS at the office)
Person Interviewed (name, title, organization)
Facility/Office Name
Facility/Office Address
Facility Type (Hospital/Clinic/District office/Region office/Ministry RHIS unit, etc.)
Ownership (Public/Private/Mixed)

(Interviewer: Please verify if the following equipment is available in the facility)

1. Equipment
How many are in working
condition?

Hardware Equipment
a. Computer

Total Quantity

b. Data Back-up Unit (e.g. floppy, CD, zip)

0. No

1. Yes

0. No

1. Yes

c. Printers
d. Modems
e. UPS
f. Generators
g. Regular telephone
h. Radio telephone
i. Access to the internet
j. Calculator

2. Utilities
a. Is there a continuous electricity supply?
0.No
1. Yes
b. How often is the electricity supply interrupted?
0. Never/occasionally 1. Once a month 2. Twice a month
3. Weekly
c. Is the room, where the computer hardware is kept, air-conditioned?
0.No
1. Yes
d. Is running water available in the facility?
0.No
1. Yes

4. Daily

3. Availability of registers, forms

Type of record, report or register
a.

Have you run out of this form in the past 12 months? If so, why?

b.

0.No 1. Yes

c.

0.No 1. Yes

d.

0.No 1. Yes

e.

0.No 1. Yes

0.No 1. Yes

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B. Organization of the health facility

B.1. Please describe total number of persons under each category below: (Adapt according to the country
situation)
B.2. Title/ post
Number
Number
1. Medical officer

10. Health educator

2. Comprehensive nurse registered

11. Health inspector

3. Comprehensive nurse enrolled

12. Laboratory technician

4. Nursing Assistance

13. Public health dental assistant

5. Clinical officer

14. Anesthetic officer

6. Laboratory Assistant

15. Midwife

7. Health Assistant

16. Support staff

8. Dispenser

17. Other (specify)

9. Health information assistant

B.3. Who fills in the HMIS monthly reports? Specify the codes from Q B.2.
B.4. List those staff members who received any training in the recording, processing, or reporting of health
information during the last two years, the number of trainings received, and the year of the latest training.
B.4.d. Subjects of last training:
1. data collection
B.4.b. How many
2. data analysis
trainings
B.4.c.
3. Data display/report
B.4.a. Title or Post
courses/sessions did
Year of last
4. 1&2
(Coding from QB.2)
this person received
training?
5. 1&3
in the past three
6. 2&3
years?
7. 1,2 & 3
8. other (specify)
1.
2.
3.
4.
5.

BB1. Only for Staff at District or Higher level

Staffing
BB.1 Total number of persons working in district HMIS office including sub-districts?
BB.2 Total number of persons working in district HMIS office excluding sub-districts?
BB.3 Total number of district and sub-district staff in district HMIS office trained to collect,
verify and analyze information?

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5.Management Assessment Tool

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RHIS Management Assessment Tool

(Observation at facility and higher levels)

Questions under grey areas are not for the facility level
MAT1. Name of the facility

MAT2. Name of the Assessor

MAT3. Name of the district

MAT4: date of assessment

MATG1

Presence of RHIS Mission displayed at prominent position(s)

MATG2

Presence of management structure for dealing with RHIS related

strategic and policy decisions at district and higher levels
Presence of an updated (last year) district health management
0 No 1 Yes
organizational chart, showing functions related to RHIS/health
information
Presence of distribution list and documentation of RHIS past
0 No 1 Yes
monthly/quarterly report distribution at district or higher level
Presence of RHIS situation analysis report less than 3 year old
0 No 1 Yes
Presence of RHIS 5 year plan at district or higher level
0 No 1 Yes
Presence of RHIS targets at facility and higher level
0 No 1 Yes
Presence of a copy of RHIS standards at district or higher levels
0 No 1 Yes
Presence of a copy of RHIS standards at facility
0 No 1 Yes
Presence of performance improvement tools (flow chart, control
0 No 1 Yes
chart etc.) at the facility
Does facility/district have a RHIS training manual?
0 No 1 Yes
Presence of mechanisms for on-job RHIS training (see
0 No 1 Yes
documentation)
Presence of schedule for planned
0 No
1. Yes, for 2. Yes, 2 years or
training
one year
more
Presence of RHIS supervisory checklist
0 No 1 Yes
Presence of schedule for RHIS supervisory visit
0 No 1 Yes
Presence of supervisory reports
0 No 1 Yes
Presence of RHIS related expense register
0 No 1 Yes
Presence of mechanisms for generating funds for RHIS
0 No 1 Yes
Presence of RHIS monthly/quarterly financial report
0 No 1 Yes
Presence of long term financial plan for supporting RHIS
0 No 1 Yes
activities

MATG3

MATG4
MATP1
MATP2
MATP3
MATQ1
MATQ2
MATQ3
MATT1
MATT2
MATT3
MATS1
MATS2
MATS3
MATF1
MATF2
MATF3
MATF4

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0 No
0 No

1 Yes
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6. Organizational and Behavioral

Assessment Tool

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Organizational and Behavioural Assessment Tool

(To be filled by staff and management at all levels)

Introduction
This survey is part of the_____________________, to improve Management Information
systems in the health sector. The objective of this survey is to help develop interventions for
improving information system and use of information. Please express your opinion honestly.
Your responses will remain confidential and will not be shared with anyone, except for
presented table forms. We appreciate your assistance and co-operation in completing this
study.
Thank you.
___________________________________________________

IDI.

Name of facility

ID2.

District

DD1. Title of the person filling the questionnaire (circle answer)

(Make these categories appropriate to the host country)
1. Provincial DG
2. Provincial HMIS focal person
3. District HO
4. District HMIS focal person
5. Facility in charge
6. Other facility staff (specify) -------------------DD2.

Age of the person

----------------------

DD3.

Sex

DD4.

Education
1. 10 years 2. Intermediate (11-12) 3. Bachelor (13-14) 4. Master
5. Professional diploma/degree (specify)----------6. Other (specify) --------------------------------------.

DD5.

Years of employment

1. Male

2.Female

-----------------------

DD6. Did you receive any training in HMIS related activities in last six months? 0. No 1.Yes

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We would like to know your opinion about how strongly you agree with certain activities carried out
by _______________. There are no right or wrong answers, but only expression of your opinion on a
scale. The scale is about assessing the intensity of your belief and ranges from strongly disagree (1)
to strongly agree (7). You have to determine first whether you agree or disagree with the statement.
Second decide about the intensity of agreement or disagreement. If you disagree with statement then
use left side of the scale and determine how much disagreement that is strongly disagree (1),
somewhat disagree (2) or disagree (3) and circle the appropriate answer. If you are not sure of the
intensity of belief or think that you neither disagree nor agree then circle 4. If you agree with the
statement, then use right side of the scale and determine how much agreement that is agree (5),
somewhat agree (6) or strongly agree (7) and circle the appropriate answer. Please note that you
might agree or disagree with all the statements and similarly you might not have the same intensity of
agreement or disagreement and thus variations are expected in expressing your agreement or
disagreement. We encourage you to express those variations in your beliefs.
This information will remain confidential and would not be shared with anyone, except presented as
an aggregated data report. Please be frank and choose your answer honestly.

Strongly
disagree

disagree

Somewhat
Disagree

Neither
disagree
nor agree
4

Somewhat
Agree

agree

Strongly
agree

To what extent, do you agree with the following on a scale of 1-7?

Strongly
disagree

Somewhat
disagree

disagree

Neither
disagree nor
agree

Agree

Somewhat
agree

Strongly
agree

In health department, decisions are based on

D1. Personal liking

D2. Superiors directives

D3. Evidence/facts

D4. Political interference

D5. Comparing data with strategic

health objectives

D6. Health needs

D7. Considering costs

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Strongly
disagree

Somewhat
disagree

disagree

Neither
disagree nor
agree

Agree

Somewhat
agree

Strongly
agree

S1. Seek feedback from

concerned persons

S2. Emphasize data quality in

monthly reports

S3. Discuss conflicts openly

to resolve them

S4. Seek feedback from

concerned community

S5. Use HMIS data for

setting targets and monitoring

S7. Provide regular feedback to their staff through

regular report based on evidence
1
2
3

S8. Report on data accuracy regularly1

In health department, superiors

S6. Check data quality at the facility and

higher level regularly
1

In health department, staff

P1. Are punctual

P2. Document their activities

and keep records

P3. Feel committed in improving

health status of the target population

P4. Set appropriate and doable

target of their performance

P5. Feel guilty for not accomplishing

the set target/performance

P6. Are rewarded for good work

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Strongly
disagree

Somewhat
disagree

disagree

Neither
disagree nor
agree

Agree

Somewhat
agree

Strongly
agree

P8. Display data for monitoring

their set target

P9. Can gather data to find the root

cause(s) of the problem

P10. Can develop appropriate criteria for selecting

interventions for a given problem
1
2

P11. Can develop appropriate outcomes

for a particular intervention
1

P12. Can evaluate whether the targets

or outcomes have been achieved

P13. Are empowered to

make decisions

colleagues for demands/decisions

not supported by evidence

P15. Are made accountable for

poor performance

education and mobilization

P17. Admit mistakes for taking

corrective actions

BC1. Collecting information which is not used for

decision making discourages me
1
2

BC2. Collecting information

makes me feel bored

In health department, staff

P7. Use HMIS data for day to day

management of the facility

and district

P14. Able to say no to superiors and

P16. Use HMIS data for community

Personal

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Strongly
disagree

Somewhat
disagree

disagree

Neither
disagree nor
agree

Agree

Somewhat
agree

Strongly
agree

BC3. Collecting information is

meaningful for me

BC4. Collecting information gives

me the feeling that data is needed
for monitoring facility performance

BC5. Collecting information give me the

Feeling that it is forced on me
1

BC6. Collecting information is appreciated by

Co-workers and superiors
1

U1.Describe at least three reasons for collecting data on monthly basis on the followings:
U1A. Diseases
1.
2.
3.
U1B. Immunization
1.
2.
3.
U1C. Why is population data of the target area needed?
1.
2.
3.

U2. Describe at least three ways of checking data quality.

1.
2.
3.
Dr. Akram, EDO Health, read a recent district report which showed that the data quality was 40%
and felt very disturbed by it. I need to take actions, he said aloud. He paced back and forth
thinking about his next steps to improve data quality. After some time, he calmed down and wrote
his action plan. Please describe how Dr. Akram defined the problem and what major activities Dr.
Akram must have included in his action plan for improving data quality
PSa. Definition of the problem

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PSb. Major activities

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

SELF-EFFICACY
This part of the questionnaire is about your perceived confidence in performing tasks related to
health information systems. High Confidence indicates that person could perform the task, while
low confidence means room for improvement or training. We are interested in knowing how
confident you feel in performing HMIS-related tasks. Please be frank and rate your confidence
honestly.

Please rate your confidence in percentages that you can accomplish the HMIS activities.

Rate your confidence for each situation with a percentage from the following scale
0

10

20

30

40

50

60

SE1. I can check data accuracy

0
SE2. I can calculate percentages/rates correctly 0
SE3. I can plot data by months or years
0
SE4. I can compute trend from bar charts
0
SE5. I can ex plain findings & their implications0
SE6. I can use data for identifying gaps
and setting targets
0
SE7. I can use data for making various types of
decisions and providing feedback
0

70

10
10
10
10
10

20
20
20
20
20

80

30
30
30
30
30

40
40
40
40
40

90

50
50
50
50
50

60
60
60
60
60

70
70
70
70
70

100

80
80
80
80
80

90
90
90
90
90

100
100
100
100
100

10 20 30 40 50 60 70 80 90 100
10 20 30 40 50 60 70 80 90 100

We would like you to solve these problems about calculating percentages, rates and plotting and
interpreting information.
C1. The estimated number of pregnant mothers is 340. Antenatal clinics have registered 170
pregnant mothers. Calculate the percentage of pregnant mothers in the district attending antenatal
clinics.

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C2.The full immunization coverage for 12-23 month-old children were found 60%, 50%, 30%,
40%, 40% for years 1997, 1998, 1999, 2000 and 2001 respectively.
C2a. Develop a bar chart for coverage percentages by years

C2b. Explain the findings of bar chart

C2c. Did you find a trend in the data? If yes or no, explain reason for your answer

2d. Provide at least one use of above chart findings at:

UD1. Facility level

UD2. District level

UD3. Policy Level

UD4. Community level

C3. A survey in a district found 500 children under five years old that were malnourished. The
total population of children less than five years old was 5000. What is the malnutrition rate?

C4. If the malnutrition rate in children less than 2 years old was 20% and the number of total
children less than 2 years old was 10,000, then calculate number of children who are
malnourished.

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