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ORGANIZING AN INFORMATION NETWORK ON HEALTH CONDITIONSAs part of the process of building democracy and promoting sustained human development, the Federal Constitution of 1988 provided for the organization of a "Unified Health System" (UHS) as a Brazilian health reform mechanism. This constitutional goal has implied major changes in attitudes about health and citizenship issues, both in terms of sector responsibilities and of the key factors that influence or determine health status. This type of approach is complicated even further by the size of Brazil and the enormous disparities in economic and social development, combined with significant economic constraints and the context of the globalization movements that have characterized the 1990s. To overcome the problems inherent in any rapid process of adaptation and change, efforts to set up the UHS should obviously be grounded in strategic planning principles that reconcile growing social needs and aspirations with current limitations in resources and nationwide implementation capabilities. Major problems associated with the administration of this new system include the need to organize regularly updated databases to provide management information to UHS decisionmakers at the three levels of government: federal, state and local. Existing information systems are disjointed, inaccurate, and out moded, resulting in a decision-making and management process that does not take full advantage of available information. The seriousness of this matter is further heightened by the lack of regular health situation analysis and trend assessment which could provide critical supporting data for system administration and technical management efforts. A survey conducted in 1993 revealed large numbers of databases and information systems operated by agencies within the public sector, without regular reporting by these agencies that would contribute to the formulation of health policy and corresponding initiatives. Likewise, countless government agencies, academic institutions, and nongovernmental organizations are engaged in gathering data and producing specific studies of interest to the health sector, but such information is generally used only in academic circles. It is well-known that the Brazilian health system lacks needed coordination mechanisms to take full advantage of the country's extensive technical and institutional resources. This situation is also reflected in the problems faced by the Pan American Health Organization (PAHO) in fulfilling its responsibilities, namely its attempts to monitor, study, document, and report changes and progress in health conditions in its Member Countries. Diverse initiatives in the country to overcome these obstacles have been unsuccessful, despite the efforts of their promoters. The main problem lies in the absence of coordination mechanisms to bolster interagency cooperation efforts which are generally difficult to manage. These efforts depend on sustained decision-making at the sectoral level, supported by assistance from international organizations such as PAHO and specialized national agencies such as the Instituto Nacional de Geografia e Estatística (IBGE) [National Bureau of Geography and Statistics]. In search of a possible solution to a problem of this importance and magnitude, the PAHO Representative Office in Brazil has joined forces with that country's Ministry of Health, with critical backing from PAHO's senior management, to frame a proposal to set up an integrated information system designed to ensure the regular production of timely baseline data, the monitoring of selected health status indicators, the production of specific reports containing data analyses, health situation assessments, applied bibliographic literature databases, and the regular publication of indicators and reports on national health conditions and trends. The proposal calls for the organization of a network of information producers through a joint enterprise consisting of selected agencies and organizations that are not only devoted to producing information, but are equally interested in exploring health-related issues in greater depth. Network operations will be designed to bolster policy-making and evaluation efforts as well as government health initiatives by supplying pertinent assessments and analyses. They would also monitor trends in problems whose management falls within the purview of PAHO itself and its Member Governments. The design of this network is predicated on a commitment by all interested parties to ensure and maintain a dynamic, regular flow of analytical data--insofar as possible, transmitted electronically--on health problems and initiatives, as well as on overall economic, social, and political conditions that determine or affect health conditions. The anticipated increase in interagency cooperation in information-sharing should provide the necessary foundation for maximizing the use of important technical and scientific databases and the nation's cadre of professionals. Once the integrated network is officially in place, the next steps would be the signature of working agreements with each participating agency and organization on project implementation and management issues; the collection, updating, and analysis of data and indicators; and the performance of health situation analyses. Participating agencies and organizations would be organized into interdisciplinary, interagency committees according to the needs and the dynamics required by the information network, to perform specific tasks aiming at the improvement and strategic formulation of health policies. These committees would be responsible for: (i) evaluating the importance, uses, and limitations of health indicators; (ii) identifying ways and means of collecting the respective baseline data; (iii) facilitating the coordination efforts of interested agencies; (iv) evaluating the supply of analytical data of interest to the network; and, (v) recommending bibliographic references for data production purposes. This project will lay the necessary groundwork for linking PAHO with the Ministry of Health and network agencies and organizations in all operations carried out in Brazil by establishing a coordinated, integrated information system to bolster sector planning and programming efforts and vest the health sector with the capacity for joint action within the framework of the government policies that have a bearing on health conditions. The Brazilian proposal is an integral part of ongoing efforts by PAHO-Headquarters to collaborate with Member Countries to create or maintain a system of core data, which began with the publication of the pamphlet entitled Health Situation in the Americas: Basic Indicators 1995. The proposal is being framed and implemented under the aegis of an ad hoc working party comprised of representatives from the Brazilian Ministry of Health and the PAHO Representative Office whose work is being coordinated by the Executive Secretariat of the country's Ministry of Health. It has already made progress in identifying and defining a set of basic indicators for health situation analysis and trend assessment, in framing proposals for disaggregating these indicators into analytical categories, and in identifying the major national information sources, as well as the most prominent agencies and organizations working in each specialized area. The next step will be to discuss the proposal with these agencies and organizations and to hold a technical meeting at the country level to finalize the organizational structure of the integrated information network.
References
Source: Brazil, Executive Secretary, Ministry of Health; PAHO/Brazil.
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