Perceptions of health managers on the current facility based health management information system

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Effective health system management requires a well functioning Health Management Information System (HMIS) to generate relevant information for evidence-based decision-making. However, as World Health Organization has observed, in most of the countries health information systems have been woefully inadequate in providing the needed management support due to various reasons. Numerous attempts to strengthen HMIS have not proved very fruitful, one of the reasons being not taken into consideration the perceptions of the stakeholders. Owing to the importance of HMIS as a decision making tool and the dependency for its effectiveness on the field-managers who are the key stake holders, this qualitative research was planned to explore, understand, and describe the perceptions (lived experience) of health managers regarding HMIS within their organizational setting and in the context of the phenomenon of decentralization in Pakistan. In this study, the respondents identified various strengths and concerns related to HMIS and suggested improvements as well. However, from a phenomenological perspective the investigator came across the people who were aggrieved by the system where values are deteriorating, frustrations are surging, and, distrust on the system and hopelessness is prevailing. Devolution did not bring immediate positive effects on the existing HMIS, rather it was associated with loss of certain achievements gained over time such as reporting regularity. The planned HMIS reforms as verbally shared by federal level managers and as claimed by them, present in PC1, may bring improvement in the information systems at the district level but currently some provincial HMIS offices are experiencing severe difficulties, such as acute shortage of staff, after devolution. It is evident from the responses that no well thought interim plan existed for the HMIS functioning or had it been conceived, it was not implemented during the replacement of the old system with the new one. The politico economic perspectives that emerged out of this study indicate that mistrust exists in the design and implementation of HMIS. The influence of the donors has been pointed out at various levels with much emphasis. There are also feelings that the new devolution system is heavily under the local political pressure that may prevent the use of information for the evidence-based decision-making From policy and practical domains, certain suggestions have been made for consideration that point towards organizational development and institutional strengthening initiatives. These include defining the structure of organization; specifying the roles, responsibilities and eligibility criterion of various cadres; defining a career structure; managing resources; overhauling the training activity, right from needs assessment to evaluation; creating sense of responsibility; motivating the staff; giving incentives for good work and inculcating work ethics etc.

This document is available in the relevant AKU library