The development and consolidation of the Brazilian National Health System (Sistema Único de Saúde - SUS) are at the heart of the establishment of Health Information Systems (HIS) nationwide. Although some records predate the SUS, it was based on its structuring that the legal and operational framework for the systematic collection of data evolved, both for administrative purposes and for monitoring diseases and health conditons.¹1. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377(9779):1778-97. doi: 10.1016/S0140-6736(11)60054-8
https://doi.org/10.1016/S0140-6736(11)60... In programmatic terms, HIS data can be the basis for structuring public health actions and planning and evaluating programs; in the academic context, they contribute to the formulation and implementation of research hypotheses.²2. Coelho Neto GC, Chioro A. Afinal, quantos Sistemas de Informação em Saúde de base nacional existem no Brasil?. Cad Saude Publica. 2021;37(7):e00182119. doi: 10.1590/0102-311X00182119
https://doi.org/10.1590/0102-311X0018211... ^),(33. German RR, Lee LM, Horan JM, Milstein RL, Pertowski CA, Waller MN, et al. Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep. 2001;50(RR-13):1-35. HIS in Brazil are an important source of structured data for researchers, as discussed in a recent editorial⁴4. Coeli CM. Ciência de dados populacionais. Epidemiol Serv Saude. 2022;31(3):e2022119. doi: 10.1590/S2237-96222022000300001
https://doi.org/10.1590/S2237-9622202200... of the Epidemiology and Health Services journal (revista Epidemiologia e Serviços de Saúde - RESS) on population data science, which can also be noted by their constant presence in articles published in the journal - there are sixteen such articles in this issue.

The heterogeneous nature of the way these databases are constituted is a challenge for the professionals responsible for their maintenance and management and, moreover, raises research questions for researchers who work with the subject. Evaluation of the quality and sensitivity of Brazilian HIS data is a recurrent object of research published in the RESS and is present in this issue of the journal.⁵5. Mendes MS, Oliveira ALS, Schindler HC. Avaliação da completitude, consistência e não duplicidade dos dados de notificação da hanseníase no Sistema de Informação de Agravos de Notificação, João Pessoa, Paraíba: estudo descritivo, 2001-2019. Epidemiol Serv Saude. 2023;32(2):e2022734. doi: 10.1590/S2237-96222023000200008
https://doi.org/10.1590/S2237-9622202300... ^)-(99. Barbosa JS, Tartaro L, Vasconcelos LDR, Nedel M, Serafini JF, Svirski SGS, et al. Avaliação da incompletude dos registros de óbitos por causas externas do Sistema de Informações sobre Mortalidade no Rio Grande do Sul, 2000-2019. Epidemiol Serv Saude. 2023;32(2):e2022301. doi: 10.1590/S2237-96222023000200006
https://doi.org/10.1590/S2237-9622202300... The importance of producing solid evidence on HIS performance is undeniable; it is however reasonable to ask how much progress has been made in relation to the development of other aspects of these systems.

Before doing so, when attempting to answer an earlier question about the number of nationally based HIS existing in Brazil, Coelho Neto et al. identified fifty-four in operation between 2010 and 2018.²2. Coelho Neto GC, Chioro A. Afinal, quantos Sistemas de Informação em Saúde de base nacional existem no Brasil?. Cad Saude Publica. 2021;37(7):e00182119. doi: 10.1590/0102-311X00182119
https://doi.org/10.1590/0102-311X0018211... Even with this extensive list, it is possible that professionals and researchers still feel the lack of one or more databases with which they work did, which reinforces the authors’ conclusion about the need to promote transparency in the management of information technology policy within the scope of the Ministry of Health in order to achieve effective accountability.²2. Coelho Neto GC, Chioro A. Afinal, quantos Sistemas de Informação em Saúde de base nacional existem no Brasil?. Cad Saude Publica. 2021;37(7):e00182119. doi: 10.1590/0102-311X00182119
https://doi.org/10.1590/0102-311X0018211...

Today, the website of the Health Ministry’s Health and Environmental Surveillance Secretariat has an HIS tab which lists the Live Birth Information System (Sistema de Informações sobre Nascidos Vivos - SINASC), the Notifiable Health Conditions Information System (Sistema de Informação de Agravos de Notificação - SINAN), the e-SUS Notifica system, the Public Health Event Registry - Microcephaly (Registro de Eventos em Saúde Pública - Microcefalia: RESP-Microcefalia) and the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM), which are related to the surveillance of chronic non-communicable diseases.¹⁰10. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde e Ambiente. Vigilância de Doenças Crônicas Não Transmissíveis. Sistemas de informação em Saúde. Sistemas de informação em saúde [Internet]. Brasília: Ministério da Saúde; 2021 [atualizado 2021 Jul 28; citado 2023 Jul 24]. Disponível em: Disponível em: https://www.gov.br/saude/pt-br/composicao/svsa/vigilancia-de-doencas-cronicas-nao-transmissiveis/sistemas-de-informacao-em-saude .
https://www.gov.br/saude/pt-br/composica... In turn, thirty datasets can be found on the openDATASUS webpage, derived from the following systems: e-SUS Notifica, the National Immunization Program Information System (Sistema de Informação do Programa Nacional de Imunizações - SI-PNI), the National Health Establishment Registry (Cadastro Nacional de Estabelecimentos de Saúde - CNES), the Influenza Epidemiological Surveillance Information System (Sistema de Informação da Vigilância Epidemiológica da Gripe - SIVEP-Gripe), the Quality of Water for Human Consumption Surveillance Information System (Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano - SISAGUA), the Food and Nutrition Surveillance System (Sistema de Vigilância Alimentar e Nutricional - SISVAN), the SIM system, the SINASC system, the COVID-19 Platform, Indigenous Health Care Special Secretariat (Secretaria Especial de Saúde Indígena - SESAI), the Indigenous Health Care Information System (Sistema de Informações da Atenção à Saúde Indígena - SIASI), the SINAN system and the Sylvan Health Information System (Sistema de Informação em Saúde Silvestre - SISS-Geo).¹¹11. Ministério da Saúde (BR). Departamento de Informática do SUS. OpenDataSUS [Internet]. Brasília: Ministério da Saúde ; [2023] [citado 2023 Jul 24]. Disponível em: Disponível em: https://opendatasus.saude.gov.br/dataset
https://opendatasus.saude.gov.br/dataset... With the aim of presenting the Brazilian databases of interest for epidemiology, disease surveillance, prevention and control, with effect from 2017 the RESS has published manuscripts in the National Health Database Profile category.¹²12. Silva MM, Mascarenhas MD, Lima CM, Malta DC, Monteiro RA, Freitas MG, et al. Perfil do inquérito de violências e acidentes em serviços sentinela de urgência e emergência. Epidemiol Serv Saude. 2017;26(1):183-94. doi: 10.5123/S1679-49742017000100019
https://doi.org/10.5123/S1679-4974201700... ^)-(1717. Stopa SR, Szwarcwald CL, Oliveira MD, Gouvea ECDP, Vieira MLFP, Freitas MPS, et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol Serv Saude. 2020;29(5): e2020315. doi: 10.1590/s1679-49742020000500004
https://doi.org/10.1590/s1679-4974202000... Additionally, experiences of Brazilian population data centers, in Belo Horizonte, Salvador and Rio de Janeiro, have been recognized for their work with Brazilian HIS, especially for their contribution to linkage between the different databases.¹⁸18. Ali MS, Ichihara MY, Lopes LC, Barbosa GCG, Pita R, Carreiro RP, et al. Administrative data linkage in Brazil: potentials for health technology assessment. Front Pharmacol. 2019;10:984. doi: 10.3389/fphar.2019.00984
https://doi.org/10.3389/fphar.2019.00984...

The initiatives listed above are important, but are insufficient to maintain progress in the area. Making public, and on an ongoing basis, the complete list of available HIS, the associated metadata and access to their anonymized microdata is fundamental for effective accountability.²2. Coelho Neto GC, Chioro A. Afinal, quantos Sistemas de Informação em Saúde de base nacional existem no Brasil?. Cad Saude Publica. 2021;37(7):e00182119. doi: 10.1590/0102-311X00182119
https://doi.org/10.1590/0102-311X0018211... ^),(44. Coeli CM. Ciência de dados populacionais. Epidemiol Serv Saude. 2022;31(3):e2022119. doi: 10.1590/S2237-96222022000300001
https://doi.org/10.1590/S2237-9622202200... ^),(1919. Cunha FJAP, Lázaro CP, Pereira HBB, organizadores. Conhecimento, inovação e comunicação em serviços de saúde. Salvador: Edufba; Rio de Janeiro: Editora Fiocruz; 2014. 240 p. Development efforts for updating and integrating the different systems, so that they take into account the speed of health responses, as well as the establishment of rules that minimize inconsistencies in the databases, are also necessary forms of progress. More in-depth analyses of the systems’ various attributes, such as usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, representativeness, timeliness, and stability, are equally important.³3. German RR, Lee LM, Horan JM, Milstein RL, Pertowski CA, Waller MN, et al. Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep. 2001;50(RR-13):1-35.

Over the years the HIS managed by the Brazilian Ministry of Health have become internationally recognized for their robustness and reliability. However, during the COVID-19 pandemic, lack of timeliness in accessing information contributed to these systems taking a secondary role, so that media vehicles and researchers began to seek other sources to achieve timely disclosure of cases and deaths, with the latter even being accessed by civil registries. In the same period, the Ministry of Health launched an information system to meet the response needs of the pandemic. In this context, the establishment of a coordinated and continuous set of actions that promote HIS transparency and accountability can collaborate with the continuing evolution of these systems, so that they are more sensitive for detecting changes in the behavior of diseases and health conditions, in addition to contributing to addressing new pandemics.

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