Health Management Information System in Ethiopia


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Health Management Information System in Ethiopia

  1. 1. Health Management Information System in Ethiopia Ownership Starts on Day One
  2. 2. Health Management Information System (HMIS) <ul><li>The purpose of HMIS is to routinely generate quality health information that provides specific information support to the decision-making process at each level of the health system for improving the performance of health system and thereby the health status of the population </li></ul>
  3. 3. HMIS in Ethiopia <ul><li>Pivotal role for HMIS within Health Sector’s M&E system </li></ul><ul><li>FMOH adopted “One Plan, One Report & One Budget” policy </li></ul><ul><ul><li>HMIS providing the core indicators </li></ul></ul><ul><li>HMIS reform high in Health Sector Development Program (HSDP) agenda </li></ul><ul><li>Reformed HMIS designed & pilot tested in 2006-2007, with technical assistance by JSI </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 </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>
  5. 5. This presentation is on HMIS scale-up in Southern Nations, Nationalities and Peoples Region (SNNPR) <ul><li>Administrative structure </li></ul><ul><ul><li>15 zones </li></ul></ul><ul><ul><li>4 special woredas </li></ul></ul><ul><ul><li>156 woredas </li></ul></ul><ul><ul><li>22 Town Admin.s </li></ul></ul><ul><ul><li>3602 rural kebeles </li></ul></ul><ul><ul><li>324 urban kebeles </li></ul></ul><ul><li>Health facilities (public) </li></ul><ul><ul><li>23 Hospitals </li></ul></ul><ul><ul><li>591 Health centers </li></ul></ul><ul><ul><li>3340 Health posts </li></ul></ul>
  6. 6. Ownership matters <ul><li>Regional Ownership is essential for </li></ul><ul><ul><li>Full implementation of HMIS in the region </li></ul></ul><ul><ul><li>Sustainability of HMIS in the region </li></ul></ul>
  7. 7. The vision: Sustaining HMIS in SNNPR <ul><li>We can say that HMIS is sustainable in SNNPR when the Regional Health Bureau (RHB): </li></ul><ul><ul><li>Values HMIS & demonstrates desire to have HMIS for health system management </li></ul></ul><ul><ul><li>Drives the system to get the desired benefits from it; i.e. </li></ul></ul><ul><ul><ul><li>SNNP RHB maintains production of quality HMIS information to meet the current information needs of the region </li></ul></ul></ul><ul><ul><ul><li>There is continued use of HMIS information for decision making at all tiers of health system </li></ul></ul></ul><ul><ul><li>Takes responsibility for its successes and failures </li></ul></ul><ul><ul><li>Manages & continues to have the capacity to manage the HMIS resources & controls financial decisions for HMIS implementation </li></ul></ul>
  8. 8. The Challenge <ul><li>Balancing Regional Ownership and Technical Assistance for implementing HMIS </li></ul>
  9. 9. The Strategy: Balanced sharing of responsibility & promoting Regional Ownership from Day One RHB JSI/MEASURE Evaluation Mentoring IT development Level of Responsibility Time Training HMIS data collection, reporting Data Quality Assurance Use of HMIS data for decisions eHMIS use
  10. 10. Project’s approach to promoting region’s ownership <ul><li>Advocating regional ownership with RHB in the driving seat </li></ul><ul><li>Building capacity </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>
  11. 11. … .Advocating region’s 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 & 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>Role modeling use of HMIS information </li></ul></ul>
  12. 12. The Approach: Advocating regional ownership with RHB at the driving seat Sensitization of RHB senior management and development partners in SNNPR
  13. 13. … .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 for </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>
  14. 14. … .Building capacity - participatory training model On-site training Master Trainers from RHB, ZHD & WorHO 5 Trainers from each WorHO Master Trainers from Hospital 50 Coordinators & technical staff from Hospital 5 Case Team staff from every HC All remaining staff All remaining HC staff 5 days TOT 4 days training 4 days training Supervisory visits by ZHD, WorHO and Project Staff
  15. 15. Participatory training on HMIS – Facilitators from Zonal Health Departments conducting training
  16. 16. Supervisory Visit by HMIS Technical Working Group HMIS Instruments in use Client bringing back his Service ID card
  17. 17. … .TA to address emerging priorities & information needs (typical in long-lasting HMIS scaling up process) <ul><ul><li>New priority : Implementation of Family Folder designed as family-centered information tool for integrated health service delivery by Health Extension Workers </li></ul></ul><ul><ul><li>Needed operational guidelines for implementation </li></ul></ul><ul><li>Project provided TA on: </li></ul><ul><ul><li>Developing operational guidelines & pilot testing of various implementation options </li></ul></ul><ul><ul><li>Testing procedures for assuring continuity of care for significant health episodes through defaulter tracing </li></ul></ul><ul><ul><li>Promoting community participation </li></ul></ul>
  18. 18. HEW Training Involving district administration Mobilizing volunteers HH Numbering Record keeping at Health Post Family Folder FF Filing system HH List Implementing Community-based HMIS
  19. 19. Every HH has a unique number and a Family Folder
  20. 20. Family Folder has complete list of every HH member and contains service cards for each member
  21. 21. Profile of a kebele served by a Health Post: Data collected during HH registration
  22. 22. … .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 module - manual & using scanning technology </li></ul></ul><ul><ul><li>Data aggregation module </li></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><ul><ul><ul><li>Mobile Executive DSS </li></ul></ul></ul>
  23. 23. Hands-on Training on eHMIS – RHB, ZHD, WorHO
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  28. 28. The Strategy paid off….. <ul><li>Within 1½ years </li></ul><ul><ul><li>Over 5,200 health managers and staff trained </li></ul></ul><ul><ul><li>TOT completed for all 615 Health centers & 23 Hospitals in the region </li></ul></ul><ul><ul><li>9 / 22 zones implementing reformed HMIS, 6 zones started regular reporting </li></ul></ul><ul><ul><li>1737 (44%) Health Posts implementing community HMIS </li></ul></ul><ul><ul><li>eHMIS installed and functional at RHB </li></ul></ul><ul><ul><ul><li>Electronic Health Institutions data for all health institutions </li></ul></ul></ul><ul><ul><ul><li>6 Zonal Health Departments have eHMIS to access aggregate data and Decision Support System via internet </li></ul></ul></ul>
  29. 29. ....strategy paid off <ul><li>RHB is in the lead role and owns the process </li></ul><ul><ul><li>RHB Planning unit in charge of managing the scale-up </li></ul></ul><ul><ul><li>RHB IT staff carrying out electronic data entry & quality checks </li></ul></ul><ul><ul><li>Trained HMIS facilitators from among the staff in every zone, woreda & health facility </li></ul></ul><ul><ul><ul><li>Anecdote: In one hospital 12 staff replaced by new staff. The hospital authority immediately arranged training of these new staff using the trained facilitators from within the hospital </li></ul></ul></ul>
  30. 30. … .RHB in the lead <ul><ul><li>RHB mobilizing other implementing partners to assist in HMIS scale-up and sustainability </li></ul></ul><ul><ul><ul><li>Mobilized resources for printing, furniture, computers for HMIS </li></ul></ul></ul><ul><ul><li>RHB organizing regular meetings to review scale-up progress & address bottlenecks </li></ul></ul>
  31. 31. Lessons learned <ul><li>Strong visionary leadership & commitment of the region (country) essential for scale-up and sustainability of HMIS </li></ul><ul><li>Developing government ownership starts on Day One and continues throughout the implementation process </li></ul><ul><li>Harmonized teaming up of development partners with the government can bring the desired results </li></ul>
  32. 32. <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!