This document summarizes lessons learned from scaling up the Health Management Information System (HMIS) in Ethiopia's Southern Nations, Nationalities, and Peoples' Region (SNNPR). The scale up was led by the Federal Ministry of Health with assistance from John Snow Inc. and other partners. Key lessons included developing strong government ownership from the start, harmonizing support from development partners, and being prepared to adapt to changing information needs during the long scale up process. The strategy involved building regional and local capacity, promoting ownership through training and supportive supervision, encouraging partnerships, and enhancing information technology support. After six months initial results were promising with over 700 health workers trained and the regional health bureau taking the lead role.

1. From Pilot to Scaling-up: Lessons learned from HMIS scale-up in Ethiopia Tariq Azim, Chief of Party Derege Mamo, Director Planning/M&E, FMOH, Ethiopia Theo Lippeveld, Vice President JSI

5. Overall Implementation Principle: Balanced sharing of responsibility Mentoring IT development Level of Responsibility Time JSI RHB Training HMIS data collection, reporting Data Quality Assurance Use of HMIS data for decisions eHMIS use

8. Sensitization of RHB senior staff and development partners in SNNPR Yargalem January 2010 Office of SNNP RHB Head July 2010

10. Training Methodology - participatory model On-site 2 day orientation, 1 day practice, 1 day discussion 23 Master Trainers from RHB, ZHD & WorHO 55 Trainers from 11 WorHOs 11 Master Trainers from Hossana Hospital 50 Coordinators & technical staff from Hospital 185 staff from 37 HC All remaining staff All remaining staff 5 days TOT 4 days training 4 days training Supervisory visits by ZHD, WorHO and Project Staff

14. Supervisory Visit by TWG HMIS Instruments in use Client bringing back his Service ID card

16. HEW Training Involving district administration Mobilizing volunteers HH Numbering Record keeping at Health Post Family Folder FF Filing system HH List

18. Hands-on Training on eHMIS – RHB, ZHD, WorHO

22. DSS maps to compare Zonal DPT 1 performance in SNNPR DPT 1 Coverage in 1995 EC DPT 1 Coverage in 2001 EC