Implementation of district health information system


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

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  • Implementation of district health information system

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