HIS country experiences

Overview

• Cuba• Botswana• Tajikistan• Sierra Leone• West Africa• Others…• Evolution of the international HIS scene, and

HISP

In general

• Involved in many aspects of HIS strengthening:– Integrate data sources (into a dw)– Develop capacity to analyse and use information– Develop capacity to maintain and develop HIS

further, including software development– Focus on districts; local action– Appropriate use of technology

Cuba: early HISP days..

• Pilot in 2002-3• Applied same approach as in South Africa:

– Bottom-up development of essential indicator list– ”Massive” local participation– Trying to decentralize decision-making in a

centralized setting• Did not work well, project closed down by

Cuba

Cuba: HIS in the political landscape

• Decentralized healthcare: One Grupo Basico de Trabajo (basic working group: doctor and nurse) per 700 people.

• Centralized decision-making: ”the district people don’t know what information they need”

• Information as signal and symbol• The ”need to know data”-only approach clashed with

philosophy of the political system: socialist centralism

Botswana: unbalanced HIS staff

• DHIS implementation started in 2005, as an ”IT-project” (located in IT department)

• Medical staff never developed much ownership• IT department had limited knowledge of the

health sector• Despite resources, very slow implementation

and scaling• Fragmentation at the ministerial level

Health Statistics

District 1

DHT

Facility 1 Facility 2 Facility n

IDSR – Notifiable

Diseases

PMTCT

EPI

STD

Home Based Care

IPMS Nutrition

MASA

MCH

Family Planning

IPT

TBSchool Health

Mental Health

Others …

Facility 3

District 2

DHT

District n

DHT

Health Statistics

Facility 1 Facility 2 Facility n

IDSR – Notifiable

Diseases

PMTCT

EPI

STD

Home Based Care

Nutrition

MASA

MCH

Family Planning

IPT

TBSchool Health

Mental HealthOthers

Facility 3

National HIS

District 1 DHIS District n DHIS

IPMS

District 2 DHIS

Tajikistan: Centralized system, decentralized needs

What is collected?

• Global burden of data collection?• What is collected as routine data?

– South Africa: 500– India: 2000– Botswana: 2000– Cuba: 10 000– Tajikistan: 30 000!

• Is the data collected useful? Who uses it?

Sierra Leone: integration and interoperability

• Started late 2007• 1st revision of reporting forms in 2008• National roll-out od DHIS2 and new forms in

2009• 2nd revision of forms in 2009-2010• Reduced amount of forms. Most forms collected

through DHIS• Pilot for interoperability DHIS-OpenMRS• Future plans: more interoperable subsystems

CHIEFDOM LEAGUE TABLE 2ND QUARTER APRIL – JUNE 2009

20.893.632.4114.34391.4Total

14143.228.3100.038.273.82954.9Bumpeh

12123.738.677.8101.268.02961.1Upper Banta

12123.760.5100.057.453.72671.8Ribbi

884.364.086.689.492.64049.8Kori

884.336.5100.077.693.24580.4Kargboro

884.386.5100.0140.769.73555.6Kamaje

884.332.193.092.4110.33761.4Bagruwa

664.735.6100.0120.8201.64888.3Lower Banta

664.778.2100.046.796.552118.4Kowa

334.833.091.791.7106.846140.3Timidale

334.871.375.093.4162.75590.3Kaiyamba

334.845.9100.086.390.557134.9Dasse

225.048.1100.086.2154.362124.3Fakunya

115.393.386.696.6170.94598.2Kongbora

RankingRankingAverage Score

% Exclusive Breastfeeding

at Penta3

% MMRC Submitted

% 2nd Dose of IPT

% 3rd ANC Visit

% PHU Delivery2nd

Quarter

% FullImmunized 2nd Quarter

Chiefdoms

Figure 2: Increasing institutional delivery rates in Western Area, from the HMN Results Report (2010)

West African Health Organization: trying to achieve critical mass

• Regional organization, local funding• Wants to support all 15 member states in developing better

HIS• Experiences from Sierra Leone, and interoperability between

DHIS2 and other software are key catalysts• Ghana, Gambia, Liberia, Nigeria, Togo also implementing

similar systems• Cape Verde, Mali, Burkina Faso, Guinea, Guinea-Bissau,

Senegal, Niger, Benin, Ivory Coast, and WAHO HQ also potential implementers

• WAHO will be a centre of excellence – Developing and providing skills

• Intra-regional collaboration for sustainability

Challenges at the international/regional level

• Data definitions:– Are the countries collecting the same? With the

same interval?• How do they report?

– Do they have different software solutions?– What is the output format?

• What are the agendas of the various international actors?

Zambia: who can use the information?

• DHIS v. 1.4 in all 70+ districts. Using DHIS v. 2 as national data warehouse

• No clear policy of who has access to data, even if it is now available at intranet at MOH.

• All requests had to go through one person• Online system challenging this power

structure

Armenia

• Fragmentation• Politics. HIS unit not a ”national level” unit.• Reform pushed by international organizations• Like Cuba and Tajikistan:

– Strong centralist traditions• Urba/Rural divide:

– Yerevan is as modern as it gets. Countryside less so

Evolution of the international scene and HISP

• Development agencies are powerful– UNAIDS

• Millenium Development Goals• HMN since 2005• Global Fund: focus on HIS• PARIS declaration: build upon existing HIS

Evolution of HISP

• HISP since 1994– Essential dataset– Local use, bottom-up development

• Now, more diverse– Many agendas: NGOs, international orgs.

• Technology has changed: from offline to online. Mobile

Discussion

• Similarities and differences– Common themes: ?

• In all countries HISP has been active: very few have come far when it comes to information use: how to achieve this?

TALI

1. The information system is working technically according to its specification

2. Data is analysed, disseminated and used:3. Information from the system used for

planning and evaluation of achievements