Curatio International Foundation, 3 Kavsadze St., Office 5, Tbilisi 0179, Georgia.
Medecins Du Monde (France) South Caucasus Regional Program, 3 Elene Akhvlediani Khevi, Tbilisi 0102, Georgia.
Health Policy Plan. 2024 Jan 23;39(Supplement_1):i9-i20. doi: 10.1093/heapol/czad098.
Health management information systems (HMISs) are essential in programme planning, budgeting, monitoring and evidence-informed decision-making. This paper focuses on donor transitions in two upper-middle-income countries, China and Georgia, and explores how national HMIS adaptations were made and what facilitated or limited successful and sustainable transitions. This comparative analytical case study uses a policy triangle framework and a mixed-methods approach to explore how and why adaptations in the HMIS occurred under the Gavi Alliance and the Global Fund-supported programmes in China and Georgia. A review of published and grey literature, key informant interviews and administrative data analysis informed the study findings. Contextual factors such as the global and country context, and health system and programme needs drove HMIS developments. Other factors included accountability on a national and international level; improvements in HMIS governance by establishing national regulations for clear mandates of data collection and reporting rules and creating institutional spaces for data use; investing in hardware, software and human resources to ensure regular and reliable data generation; and capacitating national players to use data in evidence-based decision-making for programme and transition planning, budgeting and outcome monitoring. Not all the HMIS initiatives supported by donors were sustained and transitioned. For the successful adaptation and sustainable transition, five interlinked and closely coordinated support areas need to be considered: (1) coupling programme design with a good understanding of the country context while considering domestic and external demands for information, (2) regulating appropriate governance and management arrangements enhancing country ownership, (3) avoiding silo HMIS solutions and taking integrative approach, (4) ensuring the transition of funding onto domestic budget and enforcing fulfilment of the government's financial commitments and finally (5) investing in technologies and skilled human resources for the HMIS throughout all levels of the health system. Neglecting any of these elements risks not delivering sustainable outcomes.
健康管理信息系统（HMIS）在规划、预算编制、监测和循证决策方面至关重要。本文重点关注两个中等偏上收入国家（中国和格鲁吉亚）的捐助方交接情况，探讨国家 HMIS 调整的情况，以及哪些因素促进或限制了成功和可持续的交接。这项比较分析案例研究使用政策三角框架和混合方法，探讨在加维联盟和全球基金支持的项目下，中国和格鲁吉亚的 HMIS 是如何以及为何进行调整的，以及背后的原因。对已发表和灰色文献的审查、关键知情人访谈和行政数据分析为研究结果提供了信息。全球和国家背景以及卫生系统和项目需求等背景因素推动了 HMIS 的发展。其他因素包括国家和国际层面的问责制；通过为数据收集和报告规则制定国家法规以及为数据使用创造机构空间，改善 HMIS 治理；投资硬件、软件和人力资源，以确保定期和可靠的数据生成；以及使国家参与者有能力在循证决策的基础上使用数据，进行项目和交接规划、预算编制和成果监测。并非所有捐助方支持的 HMIS 举措都得到维持和交接。为了实现成功的调整和可持续的交接，需要考虑五个相互关联且紧密协调的支持领域：（1）将方案设计与对国家背景的深入了解相结合，同时考虑国内和外部对信息的需求；（2）规范适当的治理和管理安排，增强国家自主权；（3）避免 HMIS 孤岛解决方案，采取综合方法；（4）确保资金过渡到国内预算，并强制履行政府的财政承诺；最后（5）在整个卫生系统各级投资于 HMIS 技术和熟练人力资源。忽视这些因素中的任何一个都有可能导致无法实现可持续成果。
