Health Information Systems Program HISP & DHIS 2

• HISP : global network for HIS development, Open Source Software, education and research

• DHIS 2 open source software : reporting, analysis and dissemination of health data & tracking individuals

• Started in South Africa in the 1990’s - Now 40+ countries using DHIS 2

• DHIS 2: core funding from Norad and PEPFAR

• Partners: WHO, Global Fund, GAVI, UNICEF

South Africa

Nigeria

Tanzania

Vietnam

Burkina Faso

India

Norway

3 components of the HISP ‘Network of Action’

Health Information Systems Integration, standards, architecture

Use of information for action Health management

Free & Open Source Software Distributed DHIS development

– Sharing across the world knowledge & support

Building Capacity, Training, Education, Research

Training of health workers Graduate courses, Masters, PhD

Sharing teaching /courses

Mozambique

Kenya Rwanda

others

Ghana Zimbabwe

Uganda

DHIS 2 (District Health Information Software) Sierra Leone

Bangladesh

• Inequity between blacks & whites, rural & urban,

urban & “peri-urban”, former “homelands”, etc.

• “Equity” main target

– But how to know whether targets are achieved?

• Need standard data from across the country on

Health status & Health services provision

• Districts: Building blocks for new Health System

Integration of health services

• DHIS v1 – District Health Information System

District management & equity across country

– ‘

Background: DHIS developed for South

Africa after apartheid in the 1990’s

Hospital

PAWC

Clinic

RSC

Clinic

RSC

Clinic

PAWC

Private

Private

NGO

Cape Town

RSC

Cape Town

PAWC

Malmesbury

PAWC

DNHPD

Western Cape

Family Planning

MOU

PAWC

School

Health Hospital

Clinic

Private NGO

A) Pre-apartheid centralised, vertical and

fragmented structure in Atlantis (simplified).

School

Health

Clinic

Clinic

A B

B) Decentralised integrated district model

As according to the ANC Health Plan

Database

Info. office

Higher

levels

Health

programs

Mother

Child

South Africa after apartheid

- From fragmentation to integration;

Decentralisation: From central control to local empowerment

HMN architecture (2007) – Integrated National data warehouse:

Data

warehouse

DHIS 2

LMIS

HR EMR

Measles under 1 year coverage by district 2006(Measles doses given to children < 1 year / total population < 1 year)

74.7

81.3 79.0 80.7

89.594.4

80.0 79.9

93.6 93.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Chake

Chake

District

Michew eni

District

Mkoani

District

Wete

District

Central

District

North A

District

North B

District

South

District

Urban

District

West

District

Pemba Zone Unguja Zone

District

An

nu

al m

ea

sle

s c

ov

era

ge

%

Data from

Mobile devises

-Data mart

-Meta data

-Visualising

tools

Dashboard

Graphs

Maps

Getting data in - Data warehousing Getting data out - Decision support

systems – ‘Business intelligence (BI)

Web Portal

Mobile

DHIS2 implementing the HMN architecture

Data

Warehouse

Paper based systems: OPD, EPI, RCH, other programs

Users of primary data & data providers

Electronic Medical Records

HR Management

Logistics & drugs

Mobile reporting

Finance Users of primary data & data providers

Users of processed & integrated data

Integration of technologies, systems, data & health programs

Integrated Health Information Architecture (“Horizontal integration”) - integrating sub-systems, technologies, health services & programs

Performance Based financing reporting

SDMX -HD

Paper reports

Aggregate & indicator data

Integration and interoperability

DHIS : Data

warehouse

Statistical

data

OpenMRS :

Medical records

iHRIS: Human

Resource records

Data transfer

from OpenMRS

To DHIS, e.g.:

#deliveries

@health centre X

for month of May

Data transfer

from iHRIS to

DHIS, e.g.:

#midwifes

@health centre X

for month of May

DHIS is calculating

the indicator:

Deliveries per midwife

Per facility per month

Integration

Interoperability Interoperability

Mobile subscribers per 100 persons, Africa

Source: World Bank

Internet: Total bandwidth of communication cables to Africa South of Sahara

Source: AFRINIC

All devises integrated in

Lightweight Browser

SMS

Android app or browser Tablet

PC/laptop

Improved Internet & mobile network – ‘cloud’ infrastructure

Rapid scaling – from ‘hundreds’ of installations to 1

Example: EAC Regional Data warehouse (East Africa Community)

• Essential indicators from EAC countries

• Cross country analysis and comparison

• ‘Drill down’ to district level

• Cross border disease surveillance

Facility Delivery Rate Coverage In EAC Member States

Facility Delivery Rate Coverage In Tanzania Regions

Facility Delivery Rate Coverage In Arusha District

SCORE CARD

Example: WAHO / West Africa Regional & Country platform

Country:

WAHO (West Africa) Dashboard

Ebola cases; Gunea, Liberia, Sierra Leone

Full CIF

Minimal case line list (Name, Sex, Age, Status,

Location)

Lab result (for diagnosis)

Burial data

Contacts

WWW

WWW

WWW

WWW

WWW

Case Import

WWW

Case Investigation Form

Liberia : Integrated

Ebola

Information System