Utilizing international standards

Sometimes it can be difficult to identify or reach agreement on data standards. It is often helpful to identify available international standards to use as a starting point and, ideally, a landing place. (The World Health Organization Minimal Data Set on Health Worker Information, not yet published, will help facilitate regional and cross-country comparison of HRH issues and give countries a starting point as they think about their health worker information systems.) Use of international standards has the added benefit of preparing the data to be aggregated with other country HRH information at the regional or global levels. Work to identify and adopt international standards gets significant support from regional and multilateral organizations because it is of considerable value to their own efforts.

In the HRH arena, there are two types of international standards to consider: 1) those that define standard HRH terminology; and 2) those that define how HRH-related information is accessed and shared. A key example of the former is provided by International Standard Classifications of Occupations (ISCO), which is maintained by the International Labour Organization (2013). The ISCO standards provide a mechanism for establishing workforce classifications. For example, even with identical job duties, a Ministry of Health might call a cadre a midwife, whereas another organization such as a faith-based organization (FBO) might call the same cadre a nurse-midwife, and yet another entity might call the cadre a birthing coach. Software such as iHRIS can map various occupations to the ISCO code, allowing accurate comparisons and aggregation of data across organizations and countries. Excerpts from the ISCO (2008 revisions) are included in Appendix A.

The second type of international standard (defining how HRH-related information is accessed and shared) is most useful for specifying how information systems can communicate with one another to share health worker information across organizations. This is called interoperability or the exchange of information across systems. Several organizations define standards for interoperability. The standards published by Integrating the Health Enterprise (IHE) are noteworthy in that, unlike others, they are open access. Not only are the IHE standards free to download and implement, any organization can freely participate in their ongoing development. The Care Services Discovery profile (IHE International 2013), which defines data models for health workers and the services they provide, was developed with a key requirement that it be applicable in low-resource settings.


iHRIS is an open source HRIS product originally developed by the Capacity Project and currently managed by CapacityPlus. The easy-to-use and customizable iHRIS platform (www.ihris.org) allows countries, ministries, and service delivery organizations to collect and use quantitative and qualitative health workforce characteristics. For example, the iHRIS Manage application makes it possible to track, manage, and map the health workforce. iHRIS Qualify enables professional entities to maintain a database of registered and licensed health professionals to support quality of care. We use examples from iHRIS in this brief, but all of the concepts and strategies that we discuss are equally applicable to other HRH information systems.

At present, 19 countries around the world use iHRIS. The number of health worker records captured by iHRIS surpasses 810,000, although data quality checks reveal that many records are duplicates—the result of poor data quality in the original paper-based records. A well-implemented and maintained electronic HRIS is able to reveal these kinds of problems via automatic reports that identify, compare, and analyze common fields, making it possible to correct double counting and other data quality issues that are more difficult to identify and remedy in paper-based systems.

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