The health management information system of Pakistan under devolution: health managers' perceptions.

Devolution implies that use of data for decision making starts at the level of data generation. However under a newly decentralized system, managers may face different hurdles in utilizing the preexisting Health Management Information System (HMIS). This qualitative research explores the perceptions of health managers regarding HMIS under the devolution reforms enacted in 2001 in Pakistan. The study was carried out by interviewing 26 managers at various levels in seven selected districts in all provinces. There was general dissatisfaction and confusion over roles and responsibility: respondents reported that the overall atmosphere was characterized by the reluctance of provincial managers to release data under their authority, the absence of prerequisite human resources, and conflicts of interests between political and administrative leadership. The devolution didn't bring immediate good effects for the HMIS. Treated as a least priority area, staff was distributed from provincial HMIS cells, causing overburdening of remaining staff and jeopardizing data analysis. Reporting regularity from the districts was also compromised secondary to political interference and loss of provincial control. The present HMIS is in need of redesigning so that it may keep pace with the devolved system. The HMIS reforms are needed to improve information systems at the district level, capacity building of district managers, political commitment, and administrative ownership of the system and to earmark and make available resource and promote evidence-based decision making. Change in the public administration culture towards encouraging initiative taking at lower levels, introduction of performance incentives, inculcating work ethics, encouraging local accountability, and good governance are all essential.