The Study on Improvement of Management Information Systems The Study on Improvement of Management Information Systems in Health Sector in the Islamic Republic of Pakistanin Health Sector in the Islamic Republic of Pakistan

District Health Information District Health Information System (DHIS) DesignSystem (DHIS) Design

Steering Committee Meeting, Islamabad

29 August 2005

Outline of PresentationOutline of Presentation

Rationale Rationale

Objective of DHISObjective of DHIS

DHIS SpecificationsDHIS Specifications

Pilot testing DHISPilot testing DHIS

Rationale for DHISRationale for DHIS

After devolution, decision-making and resource After devolution, decision-making and resource management authority transferred to districtsmanagement authority transferred to districts

District responsible for improving health services District responsible for improving health services from 1st and 2nd level facilities & outreachfrom 1st and 2nd level facilities & outreach

Strengthening the Districts for managing their Strengthening the Districts for managing their health systems is a priorityhealth systems is a priority

Thereby, improving HIS to respond to the Thereby, improving HIS to respond to the information needs of the Districts is a priorityinformation needs of the Districts is a priority

Objective of DHISObjective of DHIS

Overall objective:Overall objective:

““To provide information for management To provide information for management and performance improvement of primary and performance improvement of primary and secondary healthcare services and secondary healthcare services provided by the public health sector at provided by the public health sector at district level”district level”

Specific objectives:Specific objectives:

Provide necessary information for monitoring the Provide necessary information for monitoring the performance of district health system by performance of district health system by incorporating selected key information from incorporating selected key information from HMIS/FLCF, vertical programs and support-HMIS/FLCF, vertical programs and support-systems at district levelsystems at district level

Cater to the important routine health information Cater to the important routine health information needs of the federal and provincial levels for needs of the federal and provincial levels for monitoring policy implementation monitoring policy implementation

DHIS incorporates selected key data DHIS incorporates selected key data from existing HISsfrom existing HISs

Data/information from VPs-MIS

Data/information from HMIS/FLCF

and 2nd hospital

Data/information from HIS sub-systems

DHIS

System Specification System Specification

DHIS is a routine health information systemDHIS is a routine health information system

– responds to the information need of the District health responds to the information need of the District health system’s performance monitoring functionsystem’s performance monitoring function

DHIS provides minimum set of indicatorsDHIS provides minimum set of indicators

– for monitoring of health services fromfor monitoring of health services from

First and Secondary level facilities,First and Secondary level facilities,

OutreachOutreach

The DHIS indicators are not an exhaustive list of all The DHIS indicators are not an exhaustive list of all possible indicatorspossible indicators

– Provide readily understandable indication of positive or Provide readily understandable indication of positive or negative deviancesnegative deviances

System Specification – DHIS IndicatorsSystem Specification – DHIS Indicators

DHIS has 79 indicatorsDHIS has 79 indicators– The selection process has been consultative using specific The selection process has been consultative using specific

criteria like relevance, importance, specificity, feasibility, criteria like relevance, importance, specificity, feasibility, utilityutility..

– Grouped into 8 broad categoriesGrouped into 8 broad categories

Service delivery: 14 preventive; 38 curativeService delivery: 14 preventive; 38 curative

Utilization: 13Utilization: 13

Financial management: 3Financial management: 3

Logistics: 1Logistics: 1

Human resources: 2Human resources: 2

Capital assets: 6Capital assets: 6

Private sector regulation: 1Private sector regulation: 1

Information system performance: 1Information system performance: 1

Comparison between DHIS and HMIS/FLCFComparison between DHIS and HMIS/FLCF

DHISDHIS

– 79 indicators (66 similar to 79 indicators (66 similar to those in HMIS/FLCF)those in HMIS/FLCF)

– Cover both outdoor and Cover both outdoor and indoors, as well as outreach indoors, as well as outreach (vertical programs)(vertical programs)

– 11stst and 2 and 2ndnd levels with different levels with different instruments according to its instruments according to its specializationspecialization

– DHIS from RHC requires to DHIS from RHC requires to capture140 variablescapture140 variables

HMIS/FLCFHMIS/FLCF

– 111 indicators111 indicators

– Outdoor and outreachOutdoor and outreach

– Only 1Only 1stst level level (introduced in 2(introduced in 2ndnd level level using same format)using same format)

– HMIS/FLCF required to HMIS/FLCF required to capture 446 variablescapture 446 variables

System specification – Data flow and useSystem specification – Data flow and use

dataData collector (care provider)

assessment of own performance

Facility performance reviewFacility

District performance reviewDistrict

Provincial review of performance vs. policy standard

Province

Federal review of performance vs. policy standard

Federal

International organizations

feedback

feedback

feedback

feedback

feedback

International review of performance vs. policy standard

Information

Information

Information

feedback

feedback

feedback

Information

feedback

Data FlowData Flow ActivityActivity

System specification- Data Quality Assurance 1System specification- Data Quality Assurance 1

Quality of data by DHISQuality of data by DHIS

– Reduce data burden at collection pointsReduce data burden at collection points

– Revision of FLCF data collection and reporting Revision of FLCF data collection and reporting instruments instruments

– Upgrade software for data compilation and analysisUpgrade software for data compilation and analysis

– ICT unit at districtICT unit at district

– Introduction of data quality assurance procedures Introduction of data quality assurance procedures (e.g., LQAS), and data cross check at all levels (e.g., LQAS), and data cross check at all levels

System specification- Data Quality Assurance 2System specification- Data Quality Assurance 2

Data handling steps Interventions Weaknesses

Revise FLCF registers Complex procedures

Simplify forms Complex forms

Reduce amount of data compiled

Data burden

New step to improve accuracy of compilation

Data compilation

Data collection

fac

ility to

dis

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at d

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1. Upgrade software; 2. Introduce data quality check;3. Introduce data cross check

Outdated software with limited capacity for

flexible data presentation

Data check (LQAS)

Data transfer

A part of raw data to provincial database

Reports to concerned authorities

Data processing- presentation

- analysis (computation) - add to database

- data check (LQAS)- data consistency

(for data in DHIS and VPs)- data entry

Data accuracy

Add hospital registers Data coverage limited to FLCF

System Specification- Continuous Use of System Specification- Continuous Use of InformationInformation

Strengthening District HMIS cell/ICT unitStrengthening District HMIS cell/ICT unit

Strengthening EDOH functions for Strengthening EDOH functions for performance improvement using DHIS performance improvement using DHIS informationinformation

Strengthening Facility functionsStrengthening Facility functions

Enhancing staff/managers’ knowledge and Enhancing staff/managers’ knowledge and skills (capacity building)skills (capacity building)

DHIS Design SynthesisDHIS Design Synthesis

RHIS

District level Data Review for Performance Monitoring

VPs HISs

District ICT

Sub-systems HISsHospital MIS

Rationalize Collection of Data, Limited Performance IndicatorsShort Feedback Loop Performance Monitoring

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Analyzed Data Presentation Tables, Graphs, Bar ChartsSelf-improvement of Data Quality (LQAS, Data Cross Check)

Substantial Feedback to lower levels for Performance Improvement

Provincial & Federal level Data Review for Monitoring Policy Implementation

Transfer need-based Data for Monitoring Feedback

Benefits of DHIS DesignBenefits of DHIS Design

Caters to management needs of devolved Caters to management needs of devolved district health systemdistrict health system

Enhanced coverage for performance monitoringEnhanced coverage for performance monitoring

– FLCF, Secondary Hospitals, Vertical Programs, & HIS FLCF, Secondary Hospitals, Vertical Programs, & HIS sub-systems, viz. logistics, financial, human resource, sub-systems, viz. logistics, financial, human resource, capital assets MISscapital assets MISs

– Flexibility to evolve for future information needsFlexibility to evolve for future information needs

Improved data quality assurance procedures at Improved data quality assurance procedures at all levelsall levels

Benefits of DHIS Design 2Benefits of DHIS Design 2

Continuous use of information at all levelsContinuous use of information at all levels

– Strengthening of feedback loops within the Strengthening of feedback loops within the districts and at all levelsdistricts and at all levels

– Problem identification, implementation of Problem identification, implementation of solutions for performance improvementsolutions for performance improvement

Capacity building of staff on data quality Capacity building of staff on data quality and use of information at all levelsand use of information at all levels

Ownership at all levelOwnership at all level

Pilot Test of DHIS ModelPilot Test of DHIS Model

Objectives:Objectives:– To prove the model DHIS in terms of quality of To prove the model DHIS in terms of quality of

information and continuous use for the improvement of information and continuous use for the improvement of health management at district levelhealth management at district level

Specific Objectives:Specific Objectives:

– To contribute to the finalization of draft NAP for To contribute to the finalization of draft NAP for strengthening of health management capacity through strengthening of health management capacity through use of DHIS Model use of DHIS Model

– To clarify the cost for expansion across the country To clarify the cost for expansion across the country during scaling up stageduring scaling up stage

– To transfer relevant skills and technologies to personnel To transfer relevant skills and technologies to personnel concerned with the DHIS concerned with the DHIS

Broad Interventions and ActivitiesBroad Interventions and Activities

Examining improvement of government support to DHISExamining improvement of government support to DHIS– Examining contents and draw up draft DHIS strategy paper for HIS Examining contents and draw up draft DHIS strategy paper for HIS

policypolicy

Testing self-evaluation and improvement functionsTesting self-evaluation and improvement functions– Periodical review of DHIS activities by PWGPeriodical review of DHIS activities by PWG

Introduction of DHIS design in selected districts and Introduction of DHIS design in selected districts and facilitiesfacilities– Revised and improved DHIS tools and instrumentsRevised and improved DHIS tools and instruments

– District computer software and manualsDistrict computer software and manuals

– Manuals and guideline material for feedback reports and review Manuals and guideline material for feedback reports and review meetingsmeetings

– Instruments and guidelines for requesting data from sub-systemsInstruments and guidelines for requesting data from sub-systems

– Examining coordinating mechanism among various sub-systemsExamining coordinating mechanism among various sub-systems

Strengthening of district HMIS CellStrengthening of district HMIS Cell– Establishing district ICT unit and capacity building of relevant staff on Establishing district ICT unit and capacity building of relevant staff on

IT and data quality assurance systems (LQAS, data cross check etcIT and data quality assurance systems (LQAS, data cross check etc

– Clarification of accountability of ICT unit and HMIS CoordinatorClarification of accountability of ICT unit and HMIS Coordinator

Strengthening of EDOH functionsStrengthening of EDOH functions

– Introduction of regular review meetings at district levelIntroduction of regular review meetings at district level

– Capacity building on data quality and use of informationCapacity building on data quality and use of information

– Establishing system for monitoring pilot testEstablishing system for monitoring pilot test

Strengthening of facility functions Strengthening of facility functions – Building coordination between facility in-charge and out reach staff for regular Building coordination between facility in-charge and out reach staff for regular

review meetings at facility levelreview meetings at facility level

– Capacity building on data quality assurance and use of data at facility levelCapacity building on data quality assurance and use of data at facility level

– Commitment from EDOH and higher tiers for regular facility review meetingsCommitment from EDOH and higher tiers for regular facility review meetings

Broad Interventions and ActivitiesBroad Interventions and Activities

Broad Interventions and ActivitiesBroad Interventions and Activities Capacity buildingCapacity building

Implementation of education and training to continuously Implementation of education and training to continuously improve knowledge and skills at all levelsimprove knowledge and skills at all levels

Capacity building of selected staff at pilot districtsCapacity building of selected staff at pilot districts– Data quality AssuranceData quality Assurance

– Use of informationUse of information

– ICT ICT

EstablishEstablish

Provincial Working Group MeetingProvincial Working Group Meeting

– Implement supervision and monitoring for pilot testImplement supervision and monitoring for pilot test

– Ensuring support (HR, Financial) and commitment from higher levelsEnsuring support (HR, Financial) and commitment from higher levels

– Considering draft DHIS Strategy PaperConsidering draft DHIS Strategy Paper

– Recommend further implementation of NAP after pilot test resultsRecommend further implementation of NAP after pilot test results

– Review of training programs and curriculumReview of training programs and curriculum

– New education and training plans for relevant staffNew education and training plans for relevant staff

District Working Group MeetingDistrict Working Group Meeting– Examine issues related to strengthening of DHIS at district level Examine issues related to strengthening of DHIS at district level

through holding review meetingsthrough holding review meetings

– Introducing periodic DHIS design review and Consideration of draft Introducing periodic DHIS design review and Consideration of draft DHIS Strategy PaperDHIS Strategy Paper

– Recommend improvement of district performance review meetingsRecommend improvement of district performance review meetings

End of presentationEnd of presentation

Thank you!Thank you!