Performance of Routine Information System Management (PRISM) Series

Using data to make evidence-informed decisions is still weak in most low- and middle-income countries. Especially neglected are data produced by routine health information systems (RHIS)—the data collected at public, private, and community-level health facilities and institutions. When routine data are lacking, or are not used, the results can be lower-quality services, weak infection prevention and control responses, lack of skilled health workers available where they are needed, and weak supply chains for drugs and equipment. These factors contribute to poor health outcomes for people.

Through MEASURE Evaluation, funded by the United States Agency for International Development (USAID), JSI has provided technical and financial assistance to strengthen RHIS for more than 15 years, contributing to best practices at the global level and to the strengthening of RHIS data collection, quality, analysis, and use at the country level.

MEASURE Evaluation developed the Performance of Routine Information System Management (PRISM) framework and suite of tools in 2011 for global use in assessing the reliability and timeliness of a RHIS, in making evidence-based decisions, and in identifying gaps in a RHIS so they can be addressed and the system can be improved. The framework acknowledges the broader context in which RHIS operates. It also emphasizes the strengthening of RHIS performance through a system-based approach that sustains improvements in data quality and use. PRISM broadens the analysis of RHIS performance to cover three categories of determinants that affect performance: 

  • Behavioral determinants: The knowledge, skills, attitudes, values, and motivation of the people who collect, analyze, and use health data
  • Technical determinants: The RHIS design, data collection forms, processes, systems, and methods
  • Organizational determinants: Information culture, structure, resources, roles, and responsibilities of key contributors at each level of the health system
PRISM Technical Determinants image

With USAID’s support, JSI staff working for MEASURE Evaluation Phase IV revised the PRISM Tools and developed other elements, based on the PRISM framework, to create a broad array of materials: the “PRISM Series.” This new, more comprehensive PRISM Series is useful for designing, strengthening, and evaluating RHIS performance and developing a plan to put the results of a PRISM assessment into action.

It has the following components:


The revised PRISM Tools are the PRISM Series’ core document. The PRISM tools can be used together to gain an in-depth understanding of overall RHIS performance, to establish a baseline, and to rigorously evaluate the progress and effectiveness of RHIS strengthening interventions every five years, contributing to the national RHIS strategic planning process. Each PRISM tool can also be used separately for in-depth analysis of specific RHIS performance areas and issues.

The second toolkit, the PRISM Tools for Community Health Information Systems, constitutes an adaptation of the PRISM conceptual framework and its associated tools for designing, strengthening, and evaluating RHIS performance in the community health information system (CHIS) context. PRISM Tools for CHIS are specifically intended for evaluating the performance of a CHIS.

Both sets of tools offer six data collection instruments: a RHIS/CHIS Overview Tool, a Performance Diagnostic Tool, an Electronic RHIS/CHIS Functionality and Usability Assessment Tool, a Management Assessment Tool, a Facility/Office or Resource Checklist, and an Organizational and Behavioral Assessment Tool.


To support the use of the PRISM Tools, a User’s Kit was developed, which consists of four manuals. The User’s Kit guides all aspects of a PRISM assessment.

The first manual (Preparing and Conducting a PRISM Assessment) provides details on designing, preparing, and conducting an assessment. The process has three phases: designing a PRISM assessment, preparing a PRISM assessment, and collecting PRISM data.

The second manual (Using SurveyCTO to Collect and Enter PRISM Assessment Data) provides guidance for new and returning users of SurveyCTO interested in using the software for a PRISM assessment. Eight Excel-based form definition files for use on SurveyCTO are associated with this manual.

The third manual (Analyzing Data from a PRISM Assessment) provides indicator breakdowns, step-by-step instructions, calculation tables, and an answer guide to the problem-solving questions of the Organizational and Behavioral Assessment Tool —including graphic representations and open-ended questions—for analysis of all PRISM data into indicators and scores.

The fourth manual (Moving from Assessment to Action) supports the effort of strengthening a RHIS by developing and reinforcing a country’s long-term planning for an integrated health information system, which includes all data sources, health metrics, and tools.


To support the use of the PRISM Tools, MEASURE Evaluation developed a Training Kit. 

The Facilitator’s Manual presents the learning objectives for each session, as well as the topics covered; a session plan (including session duration); the teaching method to use; materials needed for the session; and activities, such as group work. A curriculum of nine training sessions, outlined in this manual, is supported by nine PowerPoint slide decks

The Participant’s Manual contains a glossary, the training schedule, a brief overview of each training session and its key slides and graphics, group exercises, and a training evaluation form.


This Excel-based PRISM Analysis Tool (PAT) supports the analysis of PRISM survey data. Users must configure the tool’s key elements (periods, indicators, and tolerance range) as appropriate. The PAT provides basic instructions on using its modules, guiding the user through the steps of PRISM data importation from the SurveyCTO and Open Data Kit servers into the PAT, in order to conduct the basic analysis. However, the second and third User’s Kit manuals are essential companion documents to the PAT as they provide further step-by-step guidance on data collection, importation, and analysis.

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