Accurate and carefully analyzed data is a valuable tool in meeting the health needs of the men, women, and children whose lives the numbers represent. Even as war and factional fighting raged in Afghanistan, operational health facilities did their best to supply the country's Ministry of Public Health (MOPH) with basic information. Simple, straightforward, one-page tally sheets made their way to Kabul, reporting the number of outpatients seen and the all-too-frequent incidents of morbidity.

But raw data alone is of little help to Afghanistan's public health officials charged with changing such numbers for the better. Developing national strategies and policies and guiding program activities requires the analysis of systematically collected data.

With peace restored, the USAID-funded REACH Program has developed a national Health Management Information System (HMIS) that enables REACH NGO grantees in 13 Afghan provinces as well as in other health facilities throughout the country to gather data at community, health post, clinic, and hospital levels. The resulting information is shared at both provincial and central levels, where its meaningful analysis can help shape both local and national response and improve Afghan health services.

Afghanistan's HMIS data are submitted on a monthly, quarterly, and annual basis from a variety of sources, including census results in areas served by basic and/or comprehensive health centers; pharmaceutical inventories; and pictorial registers, whose icons and symbols, entered by illiterate community health workers, record the use of family planning and immunization services by village households.

All health facilities also provide clinic service statistics, data on training, and information on the rate of communicable disease for entry into the HMIS database. Aggregated data from all provinces are now available to national and all provincial health officials in a specifically designed variant of this database with user-friendly features for analyzing the information.

Another variant of the HMIS database, one designed to handle the electronic transfer of data from the field to higher levels, is already in place at the Afghan MOPH in Kabul. To date, the REACH program has installed this type of HMIS database in four of Afghanistan's 34 provincial public health offices. Electronic transfer of data in other provinces is still being managed by NGO grantees and REACH (on behalf of the Ministry). Once the other provinces have appointed permanent provincial HMIS officers, this Afghan HMIS database will be installed countrywide, enabling the Ministry to manage the flow of information at the provincial level throughout the country. This process is expected to be complete before the end of the REACH program in 2006.

Dr. Ahmad Wali, the REACH Provincial Public Health Advisor for Takhar, Badakhshan, and Baghlan provinces, emphasizes that the HMIS allows information to flow in two directions: "HMIS is at the core of the Central Ministry's support of its provincial offices. It results in top-down feedback, corrections, and training. Without HMIS, we don't know where we are, where we were before, and what we need to do in the future."

REACH has provided HMIS training to designated staff from each NGO grantee delivering the Basic Package of Health Services and is supplying continuous support through customer service visits, which include troubleshooting use of the HMIS. Within 18 months after HMIS implementation, fully 80% of more than 300 REACH-assisted clinics operated by these NGOs are reporting regularly each month.

Dr. Wali reports that the Provincial Health Directors in Afghanistan's 34 provinces have expressed a high degree of acceptance and excitement about the HMIS, endorsing its use and support as a "crucially important and essential tool for making future plans to serve the people." The Afghan MOPH agrees and is now working with REACH on plans to implement the HMIS nationwide. REACH is currently training staff of the Ministry's HMIS unit and making other arrangements to hand over the entire system to the Ministry for implementation by the end of 2005.

Analysis of HMIS data can lead to evidence-based strategies and decisions on the care provided to pregnant women, the targets for an immunization campaign, the drugs in demand at a clinic pharmacy, or even the kinds of health messages most needed in a particular area.

Real lives and a stronger, healthier future—all there, lying in the numbers.

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