A functional health information system (HIS) is necessary for effective health improvements, including lowering health equalities within a society. Government and community planners as well as individuals need access to socioeconomically disaggregated population health status data as well as information on distributions of determinants of health. However, the countries of sub-Saharan Africa have the weakest HIS’s in the world. This presentation reviews the state of sub-Saharan country HIS’s, and what might be done to improve them. The presentation grows out of the work of the Health Metrics Network (HMN), a WHO-coordinated initiative to strengthen HIS’s around the world. The presentation reviews the current status of collection and access to equity-oriented data in various countries, including surveys, censuses, and registry systems. Next, we review the particular needs in an HIS to capture health inequalities data, and present a set of core data that might be used to quickly and inexpensively improve equity content of HIS’s. Barriers to effective use of information, including technical barriers and challenges to building cultures of equity-oriented decisionmaking are also discussed. The presentation reviews tensions between issues of privacy/confidentiality and the need for disaggregated health information, and how they might be reconciled through technologic and policy solutions. Finally, several country case studies are presented to illustrate more and less successful models of improving collection of and access to equity-oriented data in health information systems. Participants’ thoughts will conveyed back to the HMN for consideration in further planning and implementation for improving equity in health information systems.

One of the primary challenges for improved health in all African countries is to address the inequalities and inequities that persist and are replicated in society. This requires not only effective planning and action but also information on those inequalities, a particular problem in sub-Saharan Africa. This presentation first provides empirical information on health inequalities and inequities in five countries in West, East, and Southern Africa, as well as some of the political, economic social forces that underlie them. The presentation will then relate the experiences of six programs of work in five African countries. These locally generated programs, called Equity Gauges, are part of the Global Equity Gauge Alliance, an international NGO aimed at lowering health inequalities through policy and community action. The Gauges demonstrate how different levels of information as well as technical, political and cultural differences between the countries – including stages of political development; village structures; the magnitude of health and economic challenges; political stability; and global trade trends – affected population health and influenced strategies for research and intervention. Programs in Burkina Faso, Kenya, Zambia, Zimbabwe, and two in South Africa serve as case studies to illustrate a variety of strategies for research, advocacy, community empowerment, and interventions, and how an analysis of specific environments can help shape solutions.