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Department of Global Health
Assessment Toolkit
ISHO Assessment
Informatics-Savvy Health Organizations Assessment: Strengthening health systems and public health informatics
Led by Patience Komba, Sonora Stampfly, and Kendi Mburu
Introduction
Public health agencies worldwide face numerous barriers that hinder the effective use and application of digital health technologies and public health informatics. Challenges include limited capacities, such as insufficiently trained professionals, inadequate infrastructure, governance issues, and concerns about privacy, confidentiality, and cybersecurity of personally identifiable information (PII). As the global information revolution progresses, countries must navigate these barriers and better understand the data and technology forces shaping public health practice.
To address these challenges and maximize the benefits of digital technology in public health, countries and organizations are striving to build Informatics-Savvy Health Organizations (ISHOs). An ISHO is characterized by its ability to obtain, use, and securely exchange information electronically to enhance public health practice and outcomes. This involves having an informatics vision, robust policies, governance structures, public health informatics-skilled workforce, and effective information systems.
The ISHO assessment process can be applied to organizations of different types—ranging from a whole country to a national Ministry of Health or even specific departments or units within a broader organization. Systematic maturity assessments help establish a baseline dataset for prioritizing, planning, and monitoring the development of a health information system (HIS) ecosystem, shaping an action-oriented informatics roadmap.
The ISHO Assessment Process
A catalyst for public health informatics transformation
The ISHO Assessment helps public health systems achieve their informatics vision by offering a comprehensive framework to assess readiness for transformation, identify critical gaps, and build stakeholder consensus. This collaborative process develops roadmaps to enhance informatics capabilities at national and sub-national levels.
The ISHO Assessment Toolkit Includes
1. Above Site Assessment Data Entry and Analysis Tool
Can be applied at district, regional, provincial, state, or national levels to assess informatics maturity and track progress over time. This is an Excel-based tool used to record, score, and analyze responses for each Core Essential Element (CEE). The tool includes 31 questions organized under the three ISHO core pillars: Vision, Policy, and Governance (12 questions); Skilled Workforce (7 questions); and Effective Information Systems (12 questions). It automatically generates summary tables and visualizations to support interpretation of findings.
2. Above Site Assessment User Guide
This user guide provides step-by-step instructions for conducting an Above-Site ISHO Assessment. The guide is applicable to countries and organizations planning their first assessment or re-evaluating existing capabilities.
3. Key Informant Interview Guide
This is a short facilitation guide designed to collect in-depth qualitative insights from key stakeholders during the assessment. It provides standardized scripts, facilitation steps, and optional probes to ensure consistency across different interviews, interviewers and assessments.
4. Above Site ISHO Assessment Coversheet
This is a standardized form used to document assessment logistics, such as assessment dates and time, participating institutions, team members, and key contacts to ensure traceability and consistent documentation.
5. Statement of Intent to Maintain Confidentiality
An agreement form for all team members and participants involved in the assessment, underscoring the commitment to maintain confidentiality and safeguard sensitive organizational information.
6. Verbal Consent for Above Site ISHO Assessments
A brief script and documentation form used to obtain verbal consent from assessment participants. It ensures ethical data collection practices and participant understanding of the purpose, scope, and voluntary nature of their participation.
7. Introduction to ISHO and ISHO Assessments
A PowerPoint presentation that introduces the ISHO concept, the purpose of ISHO assessments, and how the toolkit supports public health systems in strengthening informatics capabilities. It is typically used during orientation or stakeholder engagement.
8. ISHO Assessment — Data Collectors Training
A training presentation designed to prepare facilitators and data collectors to implement the Above-Site ISHO Assessment. It provides an overview of the assessment process, key concepts, facilitation techniques, and data quality assurance measures to ensure standardized, high-quality data collection across all sites.
This toolkit focuses on three core capabilities
Each capability is essential for building an informatics-savvy health organization.
1. Vision, policy, and governance
A clear vision, strategy, and governance processes for strategically managing information and information technology as critical resources.
2. Skilled workforce
Availability of adequate staff skilled in using information and information technology tools.
3. Effective information systems
Information systems are thoughtfully designed to support the work of the staff effectively and efficiently.
Core Essential Elements (CEEs)
Core Essential Elements or CEEs and their corresponding definitions have been established for each core capability. Each CEE includes a specific question that allows respondents to rate their organization’s maturity level. The above-site tool contains 31 CEEs.
1. Vision, Policy & Governance
2. Skilled Workforce
3. Effective Information Systems
Stages of Maturity
The ISHO assessment uses the Capability Maturity Model (CMM) as a structured framework to measure informatics maturity. The CMM outlines six stages of progression toward becoming a fully informatics-savvy organization:
(2) Initial
(3) Managed
(4) Defined
(5) Measured
(6) Optimized
This model enables organizations to systematically identify strengths and gaps, set clear goals for progressing through these maturity levels, and develop targeted roadmaps and improvement plans to achieve a more advanced ISHO state.
During an assessment, the team, using available evidence, focus group discussion, and consensus building amongst the participants, determines the best capability maturity level for each CEE and its corresponding question, as shown in the example below.
Expansion and Adaptation of the ISHO Assessment
The ISHO assessment tools have been a valuable resource for public health systems in over 20 countries. Initially supported by PEPFAR through the United States Centers for Disease Control, the tools have enabled these countries to perform either rapid self-assessments or in-depth assessments of their digital health capabilities and develop strategic roadmaps to improve policy and governance processes, capacity building, and health information systems infrastructure for more optimized digital health systems.
Recent tool revisions have expanded its applicability across various health settings and challenges. These enhancements make the ISHO tool more adaptable and comprehensive, providing countries with a more effective and flexible digital health assessment and transformation framework.
The above-site tool has supported strategic planning and targeted digital health investments, enhancing its global relevance for use across digital health solutions supporting various diseases and populations.
“My impression was that everyone in the team liked the tool for multiple reasons — it is nicely structured, covers all essential elements, and it’s not too long.”
User of the Above Site ISHO Assessment Tool
“We were able to conduct the above-site rapid assessment efficiently. It’s encouraging to know that the ISHO tool is now generic and not limited to any specific disease, which is perfect for this national assignment. The results from the rapid assessment are now helping shape the situation analysis and identify key areas for inclusion in the digital health strategy.”
Sam Wambugu
Project Director, Center of Digital and Data Excellence at PATH
“Coming from the MEASURE Eval/RDQA days, congrats to the team for developing one of the most comprehensive tools to date. It really is a beautiful piece of work.” 😊
ISHO Assessment Reviewer
ISHO Assessment Process
Implementing the ISHO assessment involves a collaborative approach that engages stakeholders from the outset. The process typically includes the following steps:
Form an Assessment Leadership Team
This team will oversee the assessment, determine its scope, and select the data collection approach.
Identify Scope and Participants
Decide the entity the assessment will focus on. This could be a national or regional level organization, implementing partner, or National Public Health Institute (NPHI) and select relevant participants.
Data Collection
Use the ISHO tools to gather data on the three core capabilities.
Data Analysis and Consensus Building
Analyze collected data and facilitate focus group discussions to reach a consensus on the organization’s informatics maturity.
Develop a Strategic Informatics Roadmap
Based on assessment findings, create a roadmap to address gaps and guide future informatics development.
Plan for the Future
Set up mechanisms to monitor progress and plan for reassessments.
How might countries benefit from the ISHO Assessments?
The ISHO Assessment Tool offers public health organizations a structured and strategic approach to enhance their informatics capabilities. By identifying strengths and weaknesses and developing actionable roadmaps, the ISHO tools help build resilient health systems that can effectively leverage digital health technologies to improve population health outcomes.
Specifically, ISHO assessments and results:
Provide a clear understanding of current informatics capabilities
Facilitate stakeholder engagement and consensus building
Identify critical gaps and areas for improvement
Guide strategic planning and resource allocation
Support the development of targeted interventions to strengthen health systems
Partner
PATH is a global nonprofit dedicated to health equity. With more than 40 years of experience forging multisector partnerships, PATH develops and scales innovative solutions to the world’s most pressing health challenges.
Want more information about ISHO?
Contact us at digi@uw.edu to learn more about conducting an ISHO assessment for your organization.