Making health policy management intersectoral: issues of information analysis and use in less developed countries

There is a growing awareness of the need to approach health problems intersectorally. This has important implications for health policy management, centrally so for the informations systems which should enable 'managers' to monitor performance and also provide feedback to those with broader policy responsibilities. Yet relatively little is being done to adjust the information systems to this new intersectoral awareness: the focus of health information systems remains the collection of health service data. Much of the information collected is not used to provide adequate feedback to planners and managers, and to influence programme implementation. The paper--which focuses on the problems in less developed countries--argues that more attention needs to be paid to analysing the expected links between interventions and outcomes, as well as to cost considerations. Flexible procedures are required to address locally or regionally relevant problems. Thought must be given to making information of interest to health workers by linking it to the outcomes of activities, and by enabling them to discuss the implications of findings. Community members may also be thus involved. Often such processes are wholly neglected. The paper examines institutional and political arrangements that influence the capacity to use information for management and policy making, and which need to be understood if information systems are to be broadened beyond the health sector. The paper ends by discussing the main indicators which have been proposed, and occasionally used, to broaden health monitoring in an intersectoral direction. It argues that much relevant information is being routinely produced by the various departments and discusses briefly how such information can be used to build up gradually an intersectoral information system for health.