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Implementation of district health information system

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case of district health information system development in Wonosobo District, Indonesia using PHP MySQL

case of district health information system development in Wonosobo District, Indonesia using PHP MySQL

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    • 1. The role of FOSS for Health Information Systems: Case in Wonosobo District, Central Java, Indonesia
        • Anis Fuad 1 , Lutfan Lazuardi, Hari Kusnanto,
        • 1 Graduate Program of Public Health
        • Faculty of Medicine Gadjah Mada University
        • Yogyakarta
        • Indonesia
    • 2. Indonesia
    • 3. 230 million populations 33 provinces 440 districts (new districts coming) 1.246 hospitals (50% private, 32% districts) 7.540 primary health centers
    • 4. WHO ranking of the world health systems (2000)
      • 1 France
      • 2 Italy
      • 3 San Marino
      • … .
      • 37 USA
      • 49 Malaysia
      • 92 Indonesia
      • … .
      • 190 Myanmar
    • 5. Digital Access Index (2002)
      • Sweden 0.85
      • Denmark 0.83
      • Iceland 0.82
      • Korea (Rep.) 0.82
      • Malaysia 0.57
      • Indonesia 0.34
      High Access Uppper Access Medium Access
    • 6. District Health Management Information Systems: Wonosobo District case
    • 7. Central Java Province consist of 35 Districts with approximately 30 million of population Wonosobo District
    • 8. Wonosobo District
      • Mountainous area (from 50 – 2.000 m above sea level)
      • 264 villages with nearly 700.000 population
      • 60% good cellular signal, 36% limited signal, 4% no signal
      • Village – Central District distance:
      • 0-70 km (0 – 2 hrs)
      • 22 Primary Health Centres in 15 subdistricts
      • 1 district hospital, 1 private hospital, some midwifery clinics
    • 9. Each PHC serves 20.000 – 40.000 populations Led by a doctor or public health officer Funded by the government for operational activities Varies altitudes (from 50 to 2000 m above sea level) Open daily for health services and community outreach
    • 10. Primary Health Centre
      • Gatekeeper of health services in subdistrict level
      • Basic health services:
        • Not all of PCH with doctors
        • Other health staffs: midwife, nurses
      • Community programs:
        • Disease surveillance
        • Maternal and child health
        • Nutrition
        • Environment
    • 11. PRIMARY HEALTH CENTRE DATA MANAGEMENT FRAMEWORK
      • INSTRUMENTAL INPUT:
      • RECORDING &REPORTING FORM
      • COMPUTER: HARDWARE & SOFTWARE
      • HUMAN RESOURCES
      • DATA INPUT:
      • 6 BASIC PROGRAM
      • AUXILIARY PHC
      • MOBILE PHC
      • MATERNITY POST
      • OUTREACH POST
      • PRIVATE CLINIC
      • OTHER SECTOR
      • COMMUNITY:
        • HEALTH CADRE
        • TRADITIONAL BIRTH ATTENDANT
      • DATA MANAGEMENT
      • DATA ENTRY
      • DATA AGGREGATION
      • DATA ANALYSIS
      • INTERPRETATION
      • PRESENTATION
      • DISSEMINATION
      • INFORMATION:
      • DAILY:
      • OUTBREAK
      • MONTHLY REPORT:
      • PHC VISIT
      • PROGRAM COVERAGE
      • MORBIDITY AND MORTALITY
      • LOCAL MONITORING
      • ENVIRONMENTAL
      • DRUG MANAGEMENT
      • ETC
      • YEARLY REPORT
      • EPIDEMIOLOGICAL ANALYSIS
      • ENVIRONMENTAL
      • DRUG MANAGEMENT AND UTILIZATION
      • DEMOGRAPHICS
      • PROGRAM COVERAGE
      • ETC
      • DISTRICT HEALTH OFFICE:
      • PHC REPORT
      • VERTICAL PROGRAM
      • DATA UTILIZATION
      • PLAN OF ACTION
      • PROGRAM EVALUATION
      • SUPERVISION GUIDELINE
      • PHC PROFILE
      • REWARD AND INCENTIVES
      • ETC
    • 12. Why FOSS?
      • Previous failure of E-Gov project:
        • Unfinished project
        • With no IT governance at the district level
        • Unused application
        • Impossible to modify and customize
      • New IT governance:
        • New procurement with open source platform
        • Model of district health management information system for other districts
        • Indonesian Goes Open Source initiative
    • 13. Wireless Wide Area Network Based District Health Information Systems
      • Trigger: “suddenly rich” district, receiving grant from national level (specific allocation fund)
      • Willing to develop a wireless wide area network connecting 21 Primary Health Centers (PHC)
      • Interconnected electronic patient recording at each PHC
      • 3/4 of the budget were for infrastructures
    • 14. Wide area network architecture DHO hospital subdivision PHC LAN (intranet) LAN (intranet) Wide Area Network (WAN) WAN WAN WAN PHC LAN (intranet)
    • 15. District Health Office Primary Health Centers
    • 16. What platform?
      • Web-based application
      • PHP programming (v 5.1)
      • MySQL 5.2.x
      • Distributed server at each PHC
      • Main server at the DHO
    • 17.  
    • 18.  
    • 19. Paper based medical record
      • Based on family folder
      • Each folder contains all members of the families
      • No standard coding of diagnosis, drugs, procedures
    • 20.  
    • 21.  
    • 22. Developmental process
      • Team:
        • 1 systems analyst
        • 3 programmers
      • Prototyping method (December 2006 – June 2007)
      • Working together with the users from the district health office and primary health centers
      • One technical champion from the DHO
      • Part of students thesis research
    • 23. Computer utilization before the program (n=36) Computer utilization others File printing File copying Entertainment Creating map Creating graphic Game Preparing report Preparing letter
    • 24.  
    • 25. Patient registration at PHC
    • 26. Electronic-based patient registration -near real time -change from family patient index to individual patient index -improve double registration -daily registration range 10 – 80 patients -specific module for: -community outreach program -maternal and child health register
    • 27. Patient Registration search from other PHC database individual identifiers from other district
    • 28. Services: -general outpatient -maternal and child health
    • 29. Diagnosis entry
    • 30. procedures selection
    • 31. Recorded diagnosis alteration
    • 32. Patient's database
    • 33. Monthly routine reporting form required by the District Health Office -Incidence & prevalence of each disease -Grouped by new and old cases -Grouped by aged
    • 34.
      • Monthly routine reporting form required
      • by the District Health Office
      • -aggregated data of basic program:
        • -Maternal and child health
        • -Nutrition
        • -School Health programs
        • -Surveillance
        • -Environmental
    • 35. Automatic reporting
    • 36.  
    • 37. Simple map of morbidity
    • 38. Integrated application in the district health office (DHO)
    • 39. Discussion
      • Infrastructures:
        • Scaling up the network for other sector (connecting junior high school, online reporting from subdistrict government to the district)
      • Standard:
        • National health reporting standard vs standard for interoperability
        • Requirement of standard vs available human resources and facilities
        • Still on implementation, waiting to be published on next June
    • 40. Lesson learnt
      • Prototype was started by a DBMS training in Sleman district (in 2003)
      • Wonosobo district scaled this prototype into a broad implementation
      • Application will be implemented into other districts
      • Platform for students research (new modules on MNCH, DHF surveillance, fever-based symtomps diagnosis)
      • Need more collaboration with other district health information projects
      • Advocacy and social marketing with Ministry of Health and the Ministry of Information and Communication
      • Evaluation method and sustainability
    • 41. Recommendation
      • There should be clear role of FOSS developer, implementor and social marketer.
      • There is lack of DHO human resources capabilities to develop and modify FOSS in district level
      • Coordination with universities (or other agents) to fulfill the limited human resources for development.
    • 42. Thank you