Integración de los Sistemas de Información Sanitaria en Mozambique
Enfoques Verticales y Horizontales, Impactos y Desafíos Estratégicos
DOI:
https://doi.org/10.4314/academicus.v4i2.1%20Palabras clave:
Sistemas de información sanitaria , Integración de sistemas, MozambiqueResumen
Mozambique enfrenta desafíos significativos en la gestión de la información sanitaria debido a la coexistencia de múltiples sistemas desconectados, lo que compromete la eficiencia de los servicios y la toma de decisiones basada en la evidencia. Objetivo: Analizar los Sistemas de Información Sanitaria en Mozambique, destacando su fragmentación, experiencias de integración y brechas para futuras intervenciones. Metodología: Revisión sistemática basada en el protocolo PRISMA, consultando PubMed/MEDLINE, Scopus, Web of Science, African Index Medicus, documentos MISAU e informes de organizaciones internacionales. Se incluyeron estudios empíricos y documentos técnicos (2010-2024) sobre HIS en Mozambique y se analizaron mediante síntesis temática. Resultados: Se identificaron trece sistemas verticales y catorce horizontales que operan simultáneamente. La fragmentación causa sobrecarga para los profesionales (40% del tiempo dedicado al registro), duplicación de datos (42% entre tuberculosis/VIH) y costos anuales de USD 20 millones. Las experiencias piloto en Sofala redujeron el tiempo de registro en un 35% y mejoraron la exhaustividad en un 20%. Principales barreras: déficit organizativo, técnico y de recursos humanos. Consideraciones finales: La fragmentación compromete la eficiencia y la toma de decisiones basada en la evidencia. Es necesario desarrollar políticas de integración, protocolos armonizados y fortalecimiento de capacidades. Persisten lagunas en la literatura sobre los impactos en la calidad de los servicios y los análisis.
Descargas
Citas
AbouZahr, C., & Boerma, T. (2005). Health information systems: the foundations of public health. Bulletin of the World Health Organization, 83(8), 578–583. https://www.scielosp.org/article/bwho/2005.v83n8/578-583/en/
António, A., Silva, M., & Nhampossa, J. L. (2020). Sistema Integrado de Gestão de Medicamentos em Moçambique: Lições de uma experiência piloto. Revista Moçambicana de Saúde Pública, 7(2), 45-62.
António, A., Wagenaar, B. H., & Gimbel, S. (2021). Towards integrated health information systems in Mozambique: A phased approach model. Global Health Action, 14(1), 1875814.
António, E. et al. Integrating pharmaceutical and vertical program data into the national health information system in Mozambique: successes and challenges. Journal of Global Health Reports, v. 4, p. e2020025, 2020. DOI: https://doi.org/10.29392/001c.12623
Banco Mundial. (2017). Banco Mundial Injecta USD 105 Milhões para Melhorar os Cuidados de Saúde Primários em Áreas Mal Servidas de Moçambique. Recuperado em: https://www.worldbank.org/pt/news/press-release/2017/12/20/world-bank-injects-105-million-to-improve-primary-health-care-in-underserved-areas-of-mozambique
Banco Mundial. (2023). Moçambique expande cobertura de cuidados de saúde primários com mais agentes comunitários. Disponível em: https://www.worldbank.org/pt/results/2023/10/17/mozambique-afe-health-system-doubles-coverage-with-more-frontline-community-workers
Benson, T. (2002). Why general practitioners use computers and hospital doctors do not - Part 1: incentives. BMJ, v. 325, n. 7372, p. 1086-1089,.
Berg, M.; Aarts, J.; Van Der Lei, J. (2003). ICT in health care: sociotechnical approaches. Methods of Information in Medicine, v. 42, n. 4, p. 297-301,
Bertalanffy, L. V. (1968). General system theory: foundations, development, applications. New York: George Braziller.
Braa, J., Hanseth, O., Heywood, A., Mohammed, W., & Shaw, V. (2007). Developing health information systems in developing countries: The flexible standards strategy. MIS Quarterly, 31(2), 381-402.
Braa, J., Heywood, A., & Sahay, S. (2012). Improving quality and use of data through data-use workshops: Zanzibar, United Republic of Tanzania. Bulletin of the World Health Organization, 90(5), 379–384. https://doi.org/10.2471/BLT.11.099580
Braa, J.; Hanseth, O.; Heywood, A.; Mohammed, W.; SHAW, V. (2007). Developing health information systems in developing countries: the flexible standards strategy. MIS Quarterly, v. 31, n. 2, p. 381-402.
Braa, J.; Sahay, S. Integrated health information architecture: power to the users. (2012). New Delhi: Matrix Publishers.
Checkland, P. (1981). Systems thinking, systems practice. Chichester: John Wiley & Sons.
Chilundo, B., Sundby, J., & Aanestad, M. (2004). Analysing the quality of routine malaria data in Mozambique. Malaria Journal, 3(1), 3-12.
Chilundo, B.; Aanestad, M. (2005). Negotiating multiple rationalities in the process of integrating the information systems of disease specific health programmes. Electronic Journal of Information Systems in Developing Countries, v. 20, n. 2, p. 1-28,.
Chilundo, B.; Saastamoinen, M.; Antti, K. (2004). Taking health information systems research to the field: “the fieldwork of health information system research”. Health Informatics Journal, v. 10, n. 1, p. 22–34.
Dimaggio, P. J.; powell, W. W. (1983). The iron cage revisited: institutional isomorphism and collective rationality in organizational fields. American Sociological Review, v. 48, n. 2, p. 147-160,.
Fayol, H. (1916). Administration industrielle et générale: prévoyance, organisation, commandement, coordination, contrôle. Paris: Dunod.
Fritz, F., Tilahun, B., & Dugas, M. (2015). Success criteria for electronic medical record implementations in low-resource settings: A systematic review. Journal of the American Medical Informatics Association, 22(2), 479-488.
Garrib, A. et al. (2008). An evaluation of the District Health Information System in rural South Africa. South African Medical Journal, 98(7), 549–552.
Gimbel, S. et al. (2017). System-wide improvement of health information systems: case study of the Mozambique HIS strategy (2009–2014). Health Systems & Reform, v. 3, n. 3, p. 177–186,. DOI: https://doi.org/10.1080/23288604.2017.1345040
Gimbel, S. et al. (2018). Training needs for health information system integration in Mozambique: mixed-methods study. JMIR Human Factors, v. 5, n. 3, e10340, DOI: https://doi.org/10.2196/10340
Gimbel, S., Micek, M., Lambdin, B., Lara, J., Karagianis, M., Cuembelo, F., & Sherr, K. (2017). An assessment of routine primary care health information system data quality in Sofala Province, Mozambique. Population Health Metrics, 15(1), 25.
Gimbel, S., Rustagi, A., Robinson, J., Kouyate, S., Coutinho, J., Nduati, E., ... & Sherr, K. (2018). Evaluation of a systems analysis and improvement approach to optimize prevention of mother-to-child transmission of HIV using the consolidated framework for implementation research. Journal of Acquired Immune Deficiency Syndromes, 72(2), S108-S116.
Health Metrics Network. (2008). Framework and standards for country health information systems (2nd ed.). World Health Organization.
Heywood, A., & Rohde, J. (2001). Using information for action: A manual for health workers at facility level. EQUINET/WHO.
INS – Instituto Nacional de Saúde (2022). Relatório Anual de Indicadores de Saúde de Moçambique 2022. Maputo: INS/MISAU.
Karuri, J. et al. (2014). DHIS2: the tool to improve health data demand and use in Kenya. Journal of Health Informatics in Developing Countries, v. 8, n. 1, p. 38–60,.
Karuri, J., Waiganjo, P., Orwa, D., & Manya, A. (2014). DHIS2: The tool to improve health data demand and use in Kenya. Journal of Health Informatics in Developing Countries, 8(1), 38-60.
Lawrence, P. R.; LORSCH, J. W. Organization and environment: managing differentiation and integration. Boston: Harvard Business School Press, 1967.
Lippeveld, T. (2001). Routine health information systems: The glue of a unified health system. MEASURE Evaluation Bulletin, 6, 1–4.
Lippeveld, T., Sauerborn, R., & Bodart, C. (2000). Design and implementation of health information systems. World Health Organization.
Macueve, G. et al. Assessing data quality and use in routine health information systems in Mozambique. Pan African Medical Journal, v. 22, p. 13, 2015. DOI: https://doi.org/10.11604/pamj.2015.22.13.5686
Macueve, G. et al. Barriers to interoperability of health information systems in Mozambique: a stakeholder analysis. Studies in Health Technology and Informatics, v. 257, p. 175–179, 2019.
Macueve, G., Mandlate, F., & Ginger, L. (2015). Mapeamento dos sistemas de informação em saúde em Moçambique: Desafios e oportunidades. In Anais do Congresso Moçambicano de Saúde Pública (pp. 123-135). Associação Moçambicana de Saúde Pública.
Macueve, G., Silva, P., & Nhampossa, J. L. (2019). Barriers to health information systems integration in Mozambique: Lessons from a provincial pilot. African Journal of Information Systems, 11(3), 187-203.
Mavimbe, J. C., Braa, J., & Bjune, G. (2005). Assessing immunization data quality from routine reports in Mozambique. BMC Public Health, 5(1), 108.
Mavimbe, J. C., Muquingue, H., Boua, B., Bjune, G., & Braa, J. (2008). Implementation of a web-based District Health Information Software for health information management in five provinces of Mozambique. African Journal of Reproductive Health, 12(3), 67-78.
Mavimbe, J. C.; Braa, J.; Bjune, G. (2005). Assessing immunization data quality from routine reports in Mozambique. BMC Public Health, v. 5, p. 108, DOI: https://doi.org/10.1186/1471-2458-5-108
Ministério da Saúde (MISAU). (2017). Plano estratégico do sector da saúde PESS 2014-2019. República de Moçambique.
Ministério da Saúde (MISAU). (2019). Política nacional de informação para a saúde*. República de Moçambique.
MISAU - (Ministério da Saúde). (2020). Avaliação do Sistema Nacional de Informação para a Saúde (SNIS): Relatório final. República de Moçambique.
MISAU – (Ministério da Saúde de Moçambique). (2007). Relatório sobre as Boas Práticas do SIS Moçambique. Elaborado por: Drª Ercília de Almeida. Recuperado em: https://www.afro.who.int/sites/default/files/2017-06/moz-sis_bestpractices.pdf
MISAU (Ministério Da Saúde). (2013). Plano estratégico do sector da saúde (PESS) 2014-2019. Maputo: MISAU.
MISAU – Ministério da Saúde (2020). Plano Estratégico do Sistema Nacional de Informação em Saúde 2020–2024. Maputo: MISAU.
mOASIS - Universidade Eduardo Mondlane. (2024). Sistema de Informação de Saúde de Moçambique para Monitoria e Avaliação. Recuperado em: https://moasis.org.mz/projectos-old/sis-ma/
Moon, T. D. et al. (2015). Accuracy of HIV testing data from health facilities in Mozambique. Journal of the International AIDS Society, v. 18, n. 1, p. 20070,. DOI: https://doi.org/10.7448/IAS.18.1.20070
Moon, T. D., Jequicene, T., Blevins, M., José, E., Lankford, J. R., Wester, C. W., ... & Vermund, S. H. (2015). Evaluation of in-hospital care for severe malnutrition in rural Mozambique: treatment outcomes and resource utilization. PLoS One, 10(2), e0118025.
Moon, T. D., Silva, W., Burlison, J., Blevins, M., Shepherd, B. E., Sidat, M., ... & Vermund, S. H. (2019). Lessons learned from a randomized controlled trial of a mobile phone-based intervention for pediatric HIV care in rural Mozambique. AIDS Care, 31(3), 329-336.
Nhampossa, J. L. et al. Experiences with integrating TB and HIV information systems in Sofala Province, Mozambique. Pan African
Medical Journal, v. 29, p. 216, 2018. DOI: https://doi.org/10.11604/pamj.2018.29.216.14158
Nhampossa, J. L. et al. Health information system performance and data use in Mozambique: a cross-sectional study. Global Health Action, v. 10, n. 1, 2017. DOI: https://doi.org/10.1080/16549716.2017.1359922
Nhampossa, J. L., Nhalungo, D., & Sacoor, C. (2017). Health management information systems in Mozambique: A systematic review of the literature. Mozambique Medical Journal, 24(2), 78-87.
Nhampossa, J. L., Sidat, M., & Moon, T. D. (2018). Piloting integration of HIV and tuberculosis health information systems in Mozambique. Global Health Action, 11(1), 1515438.
Nutley, T., & Reynolds, H. (2013). Improving the use of health data for health system strengthening. Global Health Action, 6(1), 20001. https://doi.org/10.3402/gha.v6i0.20001
Nutley, T., & Reynolds, H. W. (2013). Improving the use of health data for health system strengthening. Global Health Action, 6(1), 20001.
Observatório do Cidadão para Saúde, (2021). Budget Dynamics of the Health Sector in Mozambique: Focusing on Financing Sexual & Reproductive Health and HIV and AIDS Programmes. Recuperado em: https://www.observatoriodesaude.org/en/budget-dynamics-of-the-health-sector-in-mozambique-focusing-on-financing-sexual-reproductive-health-and-hiv-and-aids-programmes/
Pacific Prime International. (2024). Seguros de Saúde em Moçambique*. Disponível em: https://www.pacificprime.com/pr/countries/mozambique/
Page, M. J., et al. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Pessoa, C. R. M., & Dos Santos, H. (2012). Sistemas de informação em saúde em Moçambique: Análise situacional. Revista de Saúde Pública, 46(3), 542-549.
Pessoa, R. C.; Santos, E. M. (2012). Fragmentação e sobreposição nos sistemas de informação em saúde em Moçambique: análise geográfica e institucional..
Plsek, P. E.; Greenhalgh, T. Complexity science: the challenge of complexity in health care. BMJ, v. 323, n. 7313, p. 625-628, 2001.
Rádio Moçambique. (2024). Ministro da Saúde defende financiamento que torne o sector mais resiliente aos desafios actuais*. Disponível em: https://www.rm.co.mz/ministro-da-saude-defende-financiamento-que-torne-o-sector-mais-resiliente-aos-desafios-actuais/
Rogers, E. M. Diffusion of innovations. (2003) 5. ed. New York: Free Press,.
SciELO. (2018). Assistência Farmacêutica em Moçambique: a ajuda externa na provisão pública de medicamentos. Recuperado em: https://www.scielo.br/j/csc/a/nZt9hnwDWLDqXGsBgdSsPVR/?lang=pt
Scott, C., et al. (2017). Health information system strengthening: A common agenda for action. Journal of Global Health, 7(1), 010304. https://doi.org/10.7189/jogh.07.010304
Sherr, K. et al. Strengthening integrated primary health care in Sofala, Mozambique. BMC Health Services Research, v. 13, p. S4, 2013. DOI: https://doi.org/10.1186/1472-6963-13-S2-S4
Sherr, K., Cuembelo, F., Michel, C., Gimbel, S., Micek, M., Kariaganis, M., ... & Pfeiffer, J. (2013). Strengthening integrated primary health care in Sofala, Mozambique. BMC Health Services Research, 13(1), 73.
Silva, L. M. da et al. (2019). Avaliação da interoperabilidade dos sistemas de informação em saúde em países de baixa renda: o caso de Moçambique. Revista Brasileira de Informática em Saúde, v. 15, n. 2, p. 23–30,.
Silva, P., António, A., & Macueve, G. (2019). Technical barriers to health information systems interoperability in Mozambique: A mixed-methods study. Health Policy and Technology, 8(4), 380-388.
SIS-MA - Sistema de Informação de Saúde para Monitoria e Avaliação. (2024). SISMA - Ministério da Saúde. Disponível em: https://sisma.misau.gov.mz/
Stansfield, S. K., Walsh, J., Prata, N., & Evans, T. (2006). Information to improve decision making for health. In D. T. Jamison et al. (Eds.), Disease control priorities in developing countries (2nd ed., pp. 1017-1030). Oxford University Press.
Stansfield, S. K.; Walsh, J.; Prata, N.; Evans, T. Information to improve decision making for health. In: JAMISON, D. T. et al. (Ed.). Disease control priorities in developing countries. 2. ed. Washington: World Bank, 2008. p. 1017-1030.
Tilahun, B., & Fritz, F. (2015). Comprehensive evaluation of electronic medical record system use and user satisfaction at five low-resource setting hospitals in Ethiopia. JMIR Medical Informatics, 3(2), e22.
Tilahun, B.; Fritz, F. (2015). Comprehensive evaluation of electronic medical record system use and user satisfaction at five hospitals in
Ethiopia. JMIR Medical Informatics, v. 3, n. 2, e22,. DOI: https://doi.org/10.2196/medinform.4106
Tomás, C. et al. Desafios da interoperabilidade dos sistemas de informação em saúde em Moçambique: uma análise de políticas públicas. Revista Saúde em Debate, v. 40, n. 109, p. 110–120, 2016.
Tomás, L., Sidat, M., & Moon, T. D. (2016). Information and communication technology infrastructure barriers to telemedicine implementation in Mozambique. Telemedicine and e-Health, 22(7), 575-578.
Wagenaar, B. H. et al. Costs of health information systems in Mozambique: a cross-sectional study. BMC Health Services Research, v. 18, p. 750, 2018. DOI: https://doi.org/10.1186/s12913-018-3551-5
Wagenaar, B. H. et al. Data-driven performance improvement: using health information systems for decision-making in Mozambique. Health Systems & Reform, v. 3, n. 3, p. 183–193, 2017. DOI: https://doi.org/10.1080/23288604.2017.1345043
Wagenaar, B. H., Gimbel, S., Hoek, R., Pfeiffer, J., Michel, C., Manuel, J. L., ... & Sherr, K. (2017). Effects of a health information system data quality intervention on concordance in Mozambique: Time-series analyses from 2009-2012. Population Health Metrics, 15(1), 9.
Wagenaar, B. H., Sherr, K., Fernandes, Q., & Wagenaar, A. C. (2016). Using routine health information systems for well-designed health evaluations in low-and middle-income countries. Health Policy and Planning, 31(1), 129-135.
Wagenaar, B. H.,ततागत, A., Engmann, C., Waiswa, P., Lufesi, N., Alinafe, G., ... & Gupta, S. (2018). Economic evaluation of integrated community case management in rural Mozambique: A cluster randomized trial. The Lancet Global Health, 6(2), e140-e149.
Weber, M. (1947). The theory of social and economic organization. New York: Oxford University Press,.
World Health Organization (2010). Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. WHO Press.
World Health Organization (WHO). (2018). Scorecard on health data systems and capacity, 2018. Geneva: WHO. https://www.who.int/publications/i/item/9789241514645
World Health Organization (WHO). (2012). Management of patient information: Trends and challenges in member states. WHO Press.
World Health Organization (WHO). (2008). Framework and standards for country health information systems. 2. ed. Geneva: WHO.
World Health Organization (WHO). (1978). Primary health care: report of the International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978. Geneva: WHO.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2026 Diamantino Comia; Junior Rafael; Victor Bassiano
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
