From Pilot to Scaling-up: Lessons learned from HMIS scale-up in Ethiopia Tariq Azim, Chief of Party Derege Mamo, Director ...
Background: HMIS reform in Ethiopia <ul><li>HMIS in Ethiopia faced  </li></ul><ul><ul><li>Fragmentation, design complexity...
Scaling up reformed HMIS: Challenges <ul><li>Slow scale-up speed </li></ul><ul><li>Limited funds  </li></ul><ul><li>Issues...
The USAID-funded HMIS scale-up project <ul><li>In 2009, FMOH invited John Snow Inc. (JSI) to scale-up HMIS in the Southern...
Overall Implementation Principle:  Balanced sharing of responsibility Mentoring IT development Level of Responsibility Tim...
Scale-up Strategy in SNNPR <ul><li>Promoting regional ownership </li></ul><ul><li>Building capacity </li></ul><ul><li>Fost...
Promoting ownership <ul><li>Sensitization of Regional Health Bureau </li></ul><ul><ul><li>RHB Head & senior staff </li></u...
Sensitization of RHB senior staff and development partners in SNNPR Yargalem January 2010 Office of SNNP RHB Head July 2010
Building capacity <ul><li>Training on HMIS skills </li></ul><ul><ul><li>Training of Health Managers and staff of Health Ce...
Training Methodology - participatory model On-site 2 day orientation,  1 day practice,  1 day discussion 23 Master Trainer...
 
Fostering mentorship and supportive supervision <ul><li>Trained/skilled facilitators available in each zone/woreda </li></...
Encouraging broad-based partnership in support of scale-up <ul><li>All health managers at regional, zonal, woreda/district...
Supervisory Visit by TWG HMIS Instruments in use Client bringing back his Service ID card
Technical support to address emerging priorities & information needs <ul><li>New priority : family-centered & integrated h...
HEW Training Involving district administration Mobilizing volunteers HH Numbering Record keeping at Health Post Family Fol...
Enhancing IT support – the eHMIS <ul><li>eHMIS features </li></ul><ul><ul><li>Health System Reference Database (HSRD): pro...
Hands-on Training on eHMIS – RHB, ZHD, WorHO
 
 
 
DSS maps to compare Zonal DPT 1 performance in SNNPR DPT 1 Coverage in 1995 EC DPT 1 Coverage in 2001 EC
First Results after six months <ul><li>Scale-up efforts  </li></ul><ul><ul><li>Over 700 health managers from 4 zones and 5...
Lessons learned for HMIS Scaling up <ul><li>Strong visionary leadership and commitment at federal, regional, zonal and dis...
<ul><li>MEASURE Evaluation is funded by the U.S. Agency for  </li></ul><ul><li>International Development and is implemente...
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From Pilot to Scaling-up: Lessons learned from HMIS scale-up in Ethiopia

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“From Pilot to Scale-up: Lessons Learned from HMIS Scaling Up in Ethiopia”

Tariq Azim (MEASURE Evaluation), Presenter. Co-authors: Hailemariam Kassahun (MEASURE Evaluation), Mamo, Theo Lippeveld (MEASURE Evaluation)

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From Pilot to Scaling-up: Lessons learned from HMIS scale-up in Ethiopia

  1. 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
  2. 2. Background: HMIS reform in Ethiopia <ul><li>HMIS in Ethiopia faced </li></ul><ul><ul><li>Fragmentation, design complexity, data quality, reporting timeliness issues, limited information use </li></ul></ul><ul><li>HMIS reform high in Health Sector Development Program (HSDP) agenda </li></ul><ul><li>Guiding principles of reform </li></ul><ul><ul><li>Simplification </li></ul></ul><ul><ul><li>Standardization </li></ul></ul><ul><ul><li>Harmonization </li></ul></ul><ul><ul><li>IT support </li></ul></ul><ul><li>Reformed HMIS designed pilot tested in 2006-2007 </li></ul>
  3. 3. Scaling up reformed HMIS: Challenges <ul><li>Slow scale-up speed </li></ul><ul><li>Limited funds </li></ul><ul><li>Issues of ownership and sustainability </li></ul><ul><li>Concomitantly addressing emerging or re-emerging priorities and information needs </li></ul><ul><li>Need for expertise in organizing scale-up activities </li></ul>
  4. 4. The USAID-funded HMIS scale-up project <ul><li>In 2009, FMOH invited John Snow Inc. (JSI) to scale-up HMIS in the Southern region (SNNPR) </li></ul><ul><ul><li>SNNPR: population of 16M; > 4,000 health facilities </li></ul></ul><ul><li>Funding by USAID through MEASURE Evaluation </li></ul><ul><li>Scaling up in other regions with assistance of other development partners </li></ul><ul><li>This presentation is on lessons learned from the HMIS scale-up in Southern Region (SNNPR) </li></ul>
  5. 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
  6. 6. Scale-up Strategy in SNNPR <ul><li>Promoting regional ownership </li></ul><ul><li>Building capacity </li></ul><ul><li>Fostering mentorship and supportive supervision </li></ul><ul><li>Encouraging broad-based partnership </li></ul><ul><li>Enhancing IT support </li></ul><ul><li>System’s approach: introducing HMIS zone by zone </li></ul><ul><li>Technical support to address changing priorities </li></ul>
  7. 7. Promoting ownership <ul><li>Sensitization of Regional Health Bureau </li></ul><ul><ul><li>RHB Head & senior staff </li></ul></ul><ul><ul><li>Zonal & District Health Offices heads </li></ul></ul><ul><ul><li>HMIS Focal Persons </li></ul></ul><ul><li>Collaboration and participation </li></ul><ul><ul><li>All communications for training, supervisory visits, reporting are sent out by the RHB </li></ul></ul><ul><ul><li>Training activities by facilitators from RHB & ZHDs </li></ul></ul><ul><ul><li>Joint supervisory visits & review meetings </li></ul></ul><ul><ul><li>RHB in charge of supply of printed supplies from FMOH </li></ul></ul><ul><li>Capacity building </li></ul><ul><ul><li>Facilitation & coaching skills </li></ul></ul><ul><ul><li>Use of HMIS information </li></ul></ul>
  8. 8. Sensitization of RHB senior staff and development partners in SNNPR Yargalem January 2010 Office of SNNP RHB Head July 2010
  9. 9. Building capacity <ul><li>Training on HMIS skills </li></ul><ul><ul><li>Training of Health Managers and staff of Health Centers and Hospitals </li></ul></ul><ul><ul><li>Training focuses on building skills on </li></ul></ul><ul><ul><ul><li>Record keeping & reporting using HMIS Instruments </li></ul></ul></ul><ul><ul><ul><li>Data quality assurance </li></ul></ul></ul><ul><ul><ul><li>HMIS information use </li></ul></ul></ul><ul><li>Training on eHMIS </li></ul><ul><ul><li>RHB IT staff trained on eHMIS application </li></ul></ul><ul><li>Supportive supervision </li></ul>
  10. 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
  11. 12. Fostering mentorship and supportive supervision <ul><li>Trained/skilled facilitators available in each zone/woreda </li></ul><ul><li>Mentoring visits to health centers during on-site orientation of the staff </li></ul><ul><li>Follow-up supportive supervisory visits to review implementation and address misconceptions, if any, among the staff </li></ul>
  12. 13. Encouraging broad-based partnership in support of scale-up <ul><li>All health managers at regional, zonal, woreda/district and health facility levels involved </li></ul><ul><li>Coordination through RHB Technical Working Group </li></ul><ul><ul><li>TWG constituted by RHB and other development partners in SNNPR </li></ul></ul><ul><li>Support to HMIS scale-up by development partners </li></ul><ul><ul><li>Supporting training </li></ul></ul><ul><ul><li>Supply of IT components at zonal and woreda offices </li></ul></ul><ul><ul><li>Shelves and MPI boxes for hospitals </li></ul></ul>
  13. 14. Supervisory Visit by TWG HMIS Instruments in use Client bringing back his Service ID card
  14. 15. Technical support to address emerging priorities & information needs <ul><li>New priority : family-centered & integrated health service delivery by Health Extension Workers </li></ul><ul><ul><li>Comprehensive package of MCH, immunization, diarrhea, pneumonia, malaria, TB & HIV/AIDS care, and HH environmental health services </li></ul></ul><ul><ul><li>Family Folder designed as family-centered information tool </li></ul></ul><ul><ul><ul><li>Includes birth and death registration </li></ul></ul></ul><ul><li>Need for operational guidelines for implementation </li></ul><ul><ul><li>Project provided TA on operational guidelines & pilot testing of various implementation options </li></ul></ul>
  15. 16. HEW Training Involving district administration Mobilizing volunteers HH Numbering Record keeping at Health Post Family Folder FF Filing system HH List
  16. 17. Enhancing IT support – the eHMIS <ul><li>eHMIS features </li></ul><ul><ul><li>Health System Reference Database (HSRD): provides </li></ul></ul><ul><ul><ul><li>Population denominators for HMIS indicators – by region, zone, district, sub-district </li></ul></ul></ul><ul><ul><ul><li>Listing of health admin units and facilities with ID numbers </li></ul></ul></ul><ul><ul><ul><li>Human resource and assets information </li></ul></ul></ul><ul><ul><li>Data entry & aggregation –manually & using scanning technology </li></ul></ul><ul><ul><ul><li>Scanning provides a fast, state-of-art technology minimizing data entry errors and making data readily available for decision making </li></ul></ul></ul><ul><ul><li>Decision Support System </li></ul></ul><ul><ul><ul><li>Automated generation of graphs, charts, tables and maps </li></ul></ul></ul><ul><ul><ul><li>Historic HMIS data migrated to new eHMIS thus ensuring continuity </li></ul></ul></ul>
  17. 18. Hands-on Training on eHMIS – RHB, ZHD, WorHO
  18. 22. DSS maps to compare Zonal DPT 1 performance in SNNPR DPT 1 Coverage in 1995 EC DPT 1 Coverage in 2001 EC
  19. 23. First Results after six months <ul><li>Scale-up efforts </li></ul><ul><ul><li>Over 700 health managers from 4 zones and 50 district & health staff from 142 Health Centers and 5 Hospitals trained </li></ul></ul><ul><ul><li>Initial slow start but gaining pace because more & more skilled staff / facilitators available within the region </li></ul></ul><ul><li>RHB is now in the lead role and owns the process </li></ul><ul><ul><li>Project staff is mainly there for TA and facilitation </li></ul></ul><ul><li>Pragmatic approach by FMOH and TA team in responding to new information needs in an evidence-based and collaborative manner </li></ul>
  20. 24. Lessons learned for HMIS Scaling up <ul><li>Strong visionary leadership and commitment at federal, regional, zonal and district levels very important for scale-up and sustainability of HMIS </li></ul><ul><li>Developing government ownership starts from day one and continues throughout scaling up process </li></ul><ul><li>Harmonized teaming-up of development partners with the government can bring the desired results </li></ul><ul><li>Be prepared to respond to new information needs during long scaling up period </li></ul>
  21. 25. <ul><li>MEASURE Evaluation is funded by the U.S. Agency for </li></ul><ul><li>International Development and is implemented by the </li></ul><ul><li>Carolina Population Center at the University of North </li></ul><ul><li>Carolina at Chapel Hill in partnership with Futures Group </li></ul><ul><li>International, ICF Macro, John Snow, Inc., Management </li></ul><ul><li>Sciences for Health, and Tulane University. The views </li></ul><ul><li>expressed in this presentation do not necessarily reflect </li></ul><ul><li>the views of USAID or the United States Government. </li></ul>Thank You!

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