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The cutting edge in ICT RHIS thinking<br />Norah Stoops<br />HISP South Africa<br />4th International RHINO Conference Mex...
Use of DHIS in Africa <br /> I have worked in the following countries<br />Myanmar<br />Liberia<br />Swaziland<br />Namibi...
Common features<br />Inappropriate use of Excel spread sheets<br />Use of rigid databases – unable to change<br />Collecti...
Introduction of DHIS<br />Standardised clinic/facility list<br />Standardised data elements and definitions<br />Country s...
Used only for TB data<br />
Myanmar<br />Required a system for quarterly TB data<br />Able now to make own changes to database in terms of facilities,...
Zimbabwe<br />Was using a non linked database<br />Very limited reporting abilities<br />Able to import all historical dat...
Liberia<br />Excel being used for all programmes!!!!!<br />Able to develop a National Essential Indicator Dataset<br />Abl...
Democratic Republic of Congo<br />Used for 1 project<br />Use of both English and French in one database<br />MOH interest...
The ability to switch languages for data element names<br />
South Sudan<br />New state<br />LOTS of INGOs and M&E staff<br />Have NO system for routine data<br />Disease surveillance...
Results<br />Ownership of system by all staff<br />Encourage local staff to make alterations/adaptations<br />Allows staff...
The cutting edge in RHIS(or how to move RHIS into the 21 century)<br />Norah Stoops<br />HISP South Africa<br />4th Intern...
Characteristics of a failed RHIS<br />‘Ownership’ of the data belonging to the HIS Unit<br />Interpretation of data/inform...
Factors hindering a functional RHIS<br />Applying research methodology in RHIS environment<br />Data collection/tools  (PM...
Defining an Essential Dataset. . . determine “must know” information needs<br />Must Know<br />Dangerous to know<br />Shou...
The fewer resources a country has – the more determined they are to waste them<br />Collecting ‘Dangerous to know’ informa...
Aim of a Routine Health Information System<br />Health management strives to translate health policy into practice<br />He...
High<br />Detail in Data<br />Low<br />Information System<br />Low<br />Low<br />Resources(time, people, h/w, s/w)<br />St...
There are obstacles to a functional RHIS<br />
Sometimes you pick up free riders <br />You may have to ‘dump’ some things (going nowhere)<br />
Sometimes you are not sure how something got into the system<br />Occasionally you are given a warning that this road is n...
Sometimes you are doing well and just need a bit of panel beating to be fully functional<br />
How do you get to be the best<br />Be pro-active, out in front and responsive to changing information needs<br />Make frie...
30<br />Ancient wisdom says that when you discover you are riding a dead horse, the best strategy is to dismount.<br />In ...
31<br />5.  Arranging a visit to other sites to see how they ride dead horses.<br />6.  Appointing a committee to revive t...
32<br />12.  Buying a computer program to enhance dead horse performance.13.  Declaring a dead horse less costly to mainta...
We have a RHINO baby on the way<br />
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Information Communication Technology in Routine Health Information Systems

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Information Communication Technology in Routine Health Information Systems

  1. 1. The cutting edge in ICT RHIS thinking<br />Norah Stoops<br />HISP South Africa<br />4th International RHINO Conference Mexico<br />March 2010<br />
  2. 2. Use of DHIS in Africa <br /> I have worked in the following countries<br />Myanmar<br />Liberia<br />Swaziland<br />Namibia<br />DRC<br />South Sudan<br />Zimbabwe<br />South Africa<br />
  3. 3. Common features<br />Inappropriate use of Excel spread sheets<br />Use of rigid databases – unable to change<br />Collecting LOTS of data – poor reporting rates<br />Unable to use almost all of the collected data<br />Not collecting data that is really needed<br />Vertical parallel programmes – no communication with anyone else<br />HIS (sometimes) seen as not effective<br />Very poor analysis of data<br />Poor data quality – unable to run data quality checks<br />
  4. 4.
  5. 5. Introduction of DHIS<br />Standardised clinic/facility list<br />Standardised data elements and definitions<br />Country staff involved in customisation<br />Able to see links between data elements/indicators and population in Pivot tables – see coverage rates<br />Communication between various programmes<br />Integration of parallel reporting systems<br />‘Why have we taken so long to introduce the DHIS’<br />Revision of reporting systems and data flow<br />
  6. 6. Used only for TB data<br />
  7. 7. Myanmar<br />Required a system for quarterly TB data<br />Able now to make own changes to database in terms of facilities, population figures<br />Able to view TB data over time instead of just for 1 year<br />
  8. 8.
  9. 9. Zimbabwe<br />Was using a non linked database<br />Very limited reporting abilities<br />Able to import all historical data<br />MOH responsible for customisation of DHIS with off site support<br />
  10. 10.
  11. 11. Liberia<br />Excel being used for all programmes!!!!!<br />Able to develop a National Essential Indicator Dataset<br />Able to integrate ALL vertical programmes into 1 database<br />Lots of training in definitions<br />Lots of training in using the DHIS – capacity and skills transfer to local staff<br />
  12. 12.
  13. 13. Democratic Republic of Congo<br />Used for 1 project<br />Use of both English and French in one database<br />MOH interested in roll out in whole country<br />MOH system unable to integrate provincial data files into 1 system – no country picture available<br />
  14. 14. The ability to switch languages for data element names<br />
  15. 15.
  16. 16. South Sudan<br />New state<br />LOTS of INGOs and M&E staff<br />Have NO system for routine data<br />Disease surveillance in Excel<br />Have LOTS of registers – BUT not printed<br />Desperate for a comprehensive solution<br />DHIS will be rollout in 4 states <br />
  17. 17. Results<br />Ownership of system by all staff<br />Encourage local staff to make alterations/adaptations<br />Allows staff at lowest levels to analyse and use own information to improve health status and health service management. <br />
  18. 18. The cutting edge in RHIS(or how to move RHIS into the 21 century)<br />Norah Stoops<br />HISP South Africa<br />4th International RHINO Conference Mexico<br />March 2010<br />
  19. 19. Characteristics of a failed RHIS<br />‘Ownership’ of the data belonging to the HIS Unit<br />Interpretation of data/information done by HIS (reports prepared without input of managers)<br />Vertical programme management recording & reporting (duplicate data collection)<br />Inflexibility of system to adapt to changes in information needs (paper forms/software)<br />Demanding data without considering resources available<br />Extensive use of Excel spreadsheets<br />Use of databases that are not relationship based (i.e. tables not linked)<br />
  20. 20. Factors hindering a functional RHIS<br />Applying research methodology in RHIS environment<br />Data collection/tools (PMTCT)<br />Longitudinal registers<br />Donor demands (PEPFAR indicators)<br />EVERYTHING is thrown into the Routine system<br />No consideration of other data collection methods i.e.<br />Record review, sentinel surveillance, surveys etc<br />Data from different facility types not integrated – unable to determine the full district picture<br />
  21. 21. Defining an Essential Dataset. . . determine “must know” information needs<br />Must Know<br />Dangerous to know<br />Should Know<br />Nice to Know<br />
  22. 22. The fewer resources a country has – the more determined they are to waste them<br />Collecting ‘Dangerous to know’ information<br />
  23. 23. Aim of a Routine Health Information System<br />Health management strives to translate health policy into practice<br />Health management information systems provide the mechanisms needed to monitor the translation of health policy into practice – this cascades down from ministry through provinces/regions/county/district and facility levels<br />The RHIS enables counties to assess whether the goals, objectives, indicators and targets, based on both strategic & operational plans are being achieved<br />
  24. 24. High<br />Detail in Data<br />Low<br />Information System<br />Low<br />Low<br />Resources(time, people, h/w, s/w)<br />Staff Capacity<br />High<br />High<br />
  25. 25. There are obstacles to a functional RHIS<br />
  26. 26. Sometimes you pick up free riders <br />You may have to ‘dump’ some things (going nowhere)<br />
  27. 27. Sometimes you are not sure how something got into the system<br />Occasionally you are given a warning that this road is not the right one<br />
  28. 28. Sometimes you are doing well and just need a bit of panel beating to be fully functional<br />
  29. 29. How do you get to be the best<br />Be pro-active, out in front and responsive to changing information needs<br />Make friends with all the programme managers<br />Develop a ESSENTIAL INDICATOR DATA SET (indicators are analysed data – consist of numerator and denominator – this defines what you collect)<br />Definitions for all data elements and indicators<br />MDGs/National Objectives – have you included the most basic input, process, output, outcome, impact indicators that you need to measure these<br />Say NO – donors/managers<br />Rethink your M&E plan<br />Plan for regular changes<br />Appropriate computer software application – DHIS works<br />Training, training and more training<br />
  30. 30. 30<br />Ancient wisdom says that when you discover you are riding a dead horse, the best strategy is to dismount.<br />In organizations, however, we often try many other strategies, including the following:<br />1.  Changing riders.2.  Buying a stronger whip.3.  Falling back on. "This is the way we've always ridden."4.  Appointing a committee to study the horse.<br />
  31. 31. 31<br />5.  Arranging a visit to other sites to see how they ride dead horses.<br />6.  Appointing a committee to revive the dead horse.7.  Creating a training session to improve riding skills.8.  Hiring an outside consultant to show how a dead horse can be ridden.9.  Harnessing several dead horses together to increase speed.10.  Increasing funding to improve the horse's performance.<br />11.  Doing a study to determine if outsourcing will reduce the cost of riding a dead horse. <br />
  32. 32. 32<br />12.  Buying a computer program to enhance dead horse performance.13.  Declaring a dead horse less costly to maintain than a live one.14.  Forming a work group to find uses for dead horses.15.  Promoting the dead horse to a supervisory position.<br />Is your RHIS a dead horse?<br />
  33. 33. We have a RHINO baby on the way<br />

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