Developing and implementing national health identifiers in resource limited countries: why, what, who, when and how?

Many resource-limited countries are scaling up health services and health-information systems (HISs). The HIV Cascade framework aims to link treatment services and programs to improve outcomes and impact. It has been adapted to HIV prevention services, other infectious and non-communicable diseases, and programs for specific populations. Where successful, it links the use of health services by individuals across different disease categories, time and space. This allows for the development of longitudinal health records for individuals and de-identified individual level information is used to monitor and evaluate the use, cost, outcome and impact of health services. Contemporary digital technology enables countries to develop and implement integrated HIS to support person centred services, a major aim of the Sustainable Development Goals. The key to link the diverse sources of information together is a national health identifier (NHID). In a country with robust civil protections, this should be given at birth, be unique to the individual, linked to vital registration services and recorded every time that an individual uses health services anywhere in the country: it is more than just a number as it is part of a wider system. Many countries would benefit from practical guidance on developing and implementing NHIDs. Organizations such as ASTM and ISO, describe the technical requirements for the NHID system, but few countries have received little practical guidance. A WHO/UNAIDS stake-holders workshop was held in Geneva, Switzerland in July 2016, to provide a 'road map' for countries and included policy-makers, information and healthcare professionals, and members of civil society. As part of any NHID system, countries need to strengthen and secure the protection of personal health information. While often the technology is available, the solution is not just technical. It requires political will and collaboration among all stakeholders to be successful.

Evaluation of a non-name-based HIV reporting system in San Francisco.

OBJECTIVE: To develop and evaluate a non-name-based HIV reporting system. METHODS: A population-based study of the accuracy of a set of non-name codes and a prospective study of a laboratory-initiated HIV surveillance system conducted at a county hospital (site 1) and a health maintenance organization (site 2). Participants were persons reported with AIDS in San Francisco and patients with a positive test result for HIV antibody, p24 antigen, viral load, or a CD4 count at the study sites. RESULTS: Proper match rate was 95% for records with complete codes and records with at least 50% of the codes. Proper non-match rate was 99% for records with all code elements and 96% for records with at least 50% of the elements. Completeness of reporting was 89% (site 1) and 87% (site 2). Median number of days between test and receipt of test report at the health department was 9 days at site 1 and 7 days at site 2. During 1999, 78% of HIV-infected patients at site 1 and 87% at site 2 had an HIV-specific laboratory test. CONCLUSIONS: A non-name-based laboratory reporting system for HIV is feasible.