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HIS country experiences

HIS country experiences. Overview. Cuba Botswana Tajikistan Sierra Leone West Africa Others … Evolution of the international HIS scene, and HISP. In general. Involved in many aspects of HIS strengthening : Integrate data sources ( into a dw )

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HIS country experiences

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  1. HIS countryexperiences

  2. Overview • Cuba • Botswana • Tajikistan • Sierra Leone • West Africa • Others… • Evolutionoftheinternational HIS scene, and HISP

  3. In general • Involved in manyaspectsof HIS strengthening: • Integrate data sources (into a dw) • Developcapacity to analyse and useinformation • Developcapacity to maintain and develop HIS further, including software development • Focusondistricts; local action • Appropriateuseoftechnology

  4. Cuba: early HISP days.. • Pilot in 2002-3 • Applied same approach as in South Africa: • Bottom-updevelopmentofessentialindicator list • ”Massive” localparticipation • Trying to decentralizedecision-making in a centralized setting • Did not workwell, projectcloseddown by Cuba

  5. Cuba: HIS in the political landscape • Decentralized healthcare: One Grupo Basico de Trabajo (basic working group: doctor and nurse) per 700 people. • Centralized decision-making: ”the district people don’t know what information they need” • Information as signal and symbol • The ”need to know data”-only approach clashed with philosophy of the political system: socialist centralism

  6. Botswana: unbalanced HIS staff • DHIS implementation started in 2005, as an ”IT-project” (located in IT department) • Medical staff never developed much ownership • IT department had limited knowledge of the health sector • Despite resources, very slow implementation and scaling • Fragmentation at the ministerial level

  7. IDSR – Notifiable EPI Home Based Care MASA Diseases Health Statistics PMTCT STD IPMS Nutrition Family Planning MCH IPT School Health TB Mental Health Others … District 1 DHT District 2 District n DHT DHT Facility 1 Facility 2 Facility 3 Facility n

  8. IDSR – Notifiable MASA Home Based Care EPI Diseases IPMS Health Statistics PMTCT Nutrition Family Planning STD MCH IPT School Health TB National HIS Mental Health Others District 1 DHIS District 2 DHIS District n DHIS Facility 1 Facility 2 Facility 3 Facility n

  9. Tajikistan: Centralized system, decentralized needs

  10. What is collected? • Global burdenof data collection? • What is collected as routine data? • South Africa: 500 • India: 2000 • Botswana: 2000 • Cuba: 10 000 • Tajikistan: 30 000! • Is the data collecteduseful? Who uses it?

  11. Sierra Leone: integration and interoperability • Started late 2007 • 1st revisionofreporting forms in 2008 • National roll-out od DHIS2 and new forms in 2009 • 2nd revisionof forms in 2009-2010 • Reducedamountof forms. Most forms collectedthrough DHIS • Pilot for interoperabilityDHIS-OpenMRS • Future plans: more interoperablesubsystems

  12. Figure 2: Increasing institutional delivery rates in Western Area, from the HMN Results Report (2010)

  13. West African Health Organization: trying to achieve critical mass • Regional organization, local funding • Wants to support all 15 member states in developing better HIS • Experiences from Sierra Leone, and interoperability between DHIS2 and other software are key catalysts • Ghana, Gambia, Liberia, Nigeria, Togo also implementing similar systems • Cape Verde, Mali, Burkina Faso, Guinea, Guinea-Bissau, Senegal, Niger, Benin, Ivory Coast, and WAHO HQ also potential implementers • WAHO will be a centre of excellence – Developing and providing skills • Intra-regional collaboration for sustainability

  14. Challenges at theinternational/regionallevel • Data definitions: • Are thecountriescollectingthe same? With the same interval? • How do theyreport? • Do they have different software solutions? • What is the output format? • Whatarethe agendas ofthevariousinternationalactors?

  15. Zambia: who can use the information? • DHIS v. 1.4 in all 70+ districts. Using DHIS v. 2 as national data warehouse • No clear policy of who has access to data, even if it is now available at intranet at MOH. • All requests had to go through one person • Online system challenging this power structure

  16. Armenia • Fragmentation • Politics. HIS unit not a ”nationallevel” unit. • Reform pushed by internationalorganizations • Like Cuba and Tajikistan: • Strongcentralisttraditions • Urba/Ruraldivide: • Yerevan is as modern as it gets. Countryside less so

  17. Evolutionoftheinternational scene and HISP • Developmentagenciesarepowerful • UNAIDS • MilleniumDevelopment Goals • HMN since 2005 • Global Fund: focuson HIS • PARIS declaration: builduponexisting HIS

  18. Evolutionof HISP • HISP since 1994 • Essentialdataset • Localuse, bottom-updevelopment • Now, more diverse • Many agendas: NGOs, internationalorgs. • Technology has changed: from offline to online. Mobile

  19. Discussion • Similarities and differences • Commonthemes: ? • In all countries HISP has beenactive: veryfew have come far when it comes to informationuse: how to achievethis?

  20. TALI • The information system is working technically according to its specification • Data is analysed, disseminated and used: • Information from the system used for planning and evaluation of achievements

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