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The Private not for Profit Health Sector (PNFP):

Use of Information Communication Technology & HMIS to strengthen Management Systems and for Advocacy Africa CHAs 4 th biennial Conference 23 rd to 26 th Feb , 2009 Uganda Kirumira Kizza Charles Assistant Data Management Advisor to UCMB.

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The Private not for Profit Health Sector (PNFP):

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  1. Use of Information Communication Technology & HMIS to strengthen Management Systems and for Advocacy Africa CHAs 4th biennial Conference 23rd to 26th Feb , 2009 Uganda Kirumira Kizza Charles Assistant Data Management Advisor to UCMB

  2. The Private Not For Profit (PNFP) Health Sector in Uganda • The Private not for Profit Health Sector (PNFP): • 52PNFP hospitals (42% of 124 Hospitals in the country) • 45 CHAs Hospitals UCMB & UPMB (36% of 124 ) • 500 functional lower level health units (20% of the total LLUs in the country) • 20 Health Training Institutions (over 60% of the total Training Schools in the country ) • Estimated level of services provided to the population: range between 30-35%.

  3. The Catholic Health Sector • The Catholic Health Sector is coordinated nationally by UCMB and comprises: • 27 Hospital (2 more are registered but not yet accredited) • 241 lower level health units (LLU), • 12 Health Training Institutions – Nursing Training, Midwifery and Laboratory Schools • One of the Major stakeholders in the Uganda national health system

  4. UCMB Network Journey to Current ICT position(2001 to date) • 2001: UCMB realized need for ICT to strengthen operations especially HMIS. • UCMB ensures that all Health Facilities (HF) use HMIS properly • Through a series of short courses in HMIS • Training users in Microsoft Office applications, basic ICT skills and use of ICT equipment. • Targeted: • Records Officers in Hospitals & HCIVs • Diocesan Health Coordinators (DHCs) • Hospital managers

  5. UCMB Journey with ICT and HMIS • 2002: Installing of internet / e-mail facilities • Transmission of data and information from Hospitals & DHO to UCMB data base was effected. • Strengthened timeliness of compilation and feedback • At facility level focus is on performance assessment & utilization of results. • 2004: Financial Accounting software (FIPRO ABC ) was developed by UCMB • Hospitals generate cost by Cost Centre • Able to analyse Economic efficiency of the Hospital • Managers are able to relate input to output on a cost centre .

  6. UCMB Journey with ICT and HMIS • 2007: UCMB developed a Web site (http//www.ucmb.co.ug) • This enabled HF to access managerial, financial, ICDM guidelines and health survey reports. • 2008:Health Training Institution connected • Internet and e-mail • enabled to manage data and information

  7. UCMB Journey with ICT and HMIS • 2008:Web-based HMIS was launched Link: http://fs.ucmb.co.ug/UCMB2/web/index.php • Links UCMB data base to all hospitals (indicators for evidenced decision making). • Each hospital can access its data from UCMB on line and order specific analyses • Compare with locally analyzed information

  8. What have been strengthened as a result? • Governance and Management in general • Use of data for management decisions • Informed Strategic decisions • Finance Management System • Hospitals moving to international accounting standards • Most hospitals using Cost-based accounting (accrual) based on Cost-centre • Timely production of financial reports • Fipro used by 12 hospitals now • It is modular

  9. What have been strengthened as a result? • Analytical outlook of information • Comparison of performance over time • Individual hospital trends • Comparison against others in the network • Human Resources Management and Development • Access to HR guideline on the UCMB web site • Monitor staff attrition & retention regularly • Receive information on Training Scholarship Fund via UCMB web site & e-mail • Information used for: • Planning recruitment • Planning capacity building • Investigating reasons for high turnover • Advocacy

  10. Using the HMIS as a tool for Monitoring & Evaluating Access, Equity, Efficiency, Quality of Health Services

  11. The data source: HMIS • E-reports are then forwarded to UCMB (via e-mail) • stored in a central databank • UCMB hospitals collect data based on the MoH Health Management Information System (HMIS) • from a Summary Annual Report Format (activities and financial information)

  12. The auto-generated information: examples • What is possible with the system is to auto-generate information • graphs or tabular formats • right at health facility level • Make basic trends analysis • Health Facility performance indicators, Epidemiology, Specific indicators to monitor the implementation of the National Health Sector Strategic Plan

  13. The auto-generated information: examples

  14. Hint on Composite Indicators used by Managers • The Standard Unit of Output (SUO)* • SUO is a standardized measure of output that allows comparison • Computation formulae • Hospital – (15*IP)+(1xODP)+(5*DEL)+(0.5*ANC/MCH/NFP)+(0.2* IMM.) • Dioceses - (5*IP)+(1xODP)+(2*DEL)+(0.3*ANC/MCH/NFP)+(0.2* IMM.) • SUO documents/literature available at http://www.ucmb.co.ug/

  15. Cont: Composite Indicators used by Managers • The quality health care* • This composite indicator consists of 7 indicators: • fresh Still birth rate, • maternal Death Rate, • recovery Rate on discharge, • infection rates for caesarean section, • proportion of qualified staff , • patients satisfaction & • drug prescription practices.

  16. Applications : a Monitoring System used by Managers. • The electronic HMIS system developed by UCMB • Uses HMIS information to monitor Annual Health Units’ performance • Based on • ACCESSIBILITY: using indicator called Standard Unit of Output (SUO)* • EQUITY: using as indicator Values of Fees charged per SUO • EFFICIENCY: using as indicator Number of SUO per Staff and Cost per SUO produced • Quality of Health Care (Hospitals): using 7 indicators* • These are composite indicators / indices

  17. Applications : a Monitoring System used by Managers. • Managers can analyse data at source • But can also access tabulated data and graphs on the web by logging onto UCMB data server and running some queries • The next 5 slides show trends of these composite indicators / indices used to measure how UCMB network remains faithfulness to its Mission Statement • Using box-whisker plot • Show individual trend and trend against the rest in the network • Trends are used for management decisions and informing governance

  18. Monitoring Access:Composite Activity Indicator: Hospital Trend of SUO op (blue line) against UCMB network (box-plot graphs)

  19. Monitoring Equity:Level of patients’ fees: Hospital Trend of Fees values (blue line) against UCMB network (box-plot graphs)

  20. Monitoring Efficiency:Total Cost per Output: Hospital Trend of Cost per SUO values (blue line) against UCMB network (box-plot graphs)

  21. Monitoring Efficiency:Staff Productivity: Hospital Trend of SUO OP per Staff values (blue line) against UCMB network (box-plot graphs)

  22. Monitoring Quality:Quality of health care: Hospital Trend of Quality of services (blue line) against UCMB network (box-plot graphs)

  23. HMIS as a tool for accountability • The system’s application has been used as tool • for internal accountability: managers to the Board • Report to boards on trend annually is mandatory • for external accountability: other stakeholders in Health Sector (Ministry of Health, Development Partners, Donors…) • For self-appraisal and performance analysis of hospitals and diocesan health departments

  24. Using HMIS Information for Advocacy

  25. Internal Advocacy –UCMB Network • For equitable charges in all hospitals & LLUs (Fees /SUO) on behalf of users (esp. the poor) • Based on trends of fee / SUO compared to that of access, cost and productivity • For consolidation instead of unnecessary expansion / scale ups • Due to macro-economic challenges • To provoke efficiency measures • Based on trends of efficiency (economic and staff productivity) • To guide recruitment and management of HR

  26. Advocacy – Outside the UCMB network • Together with UPMB and UMMB • Produced “Facts and figures of PNFP” and shared with • Ministry of Health • Members of Parliament • Development Partners (including CORDAID, AVSI, IICD, CUAMM, etc) • Also shared with ARHAP • Feb 2008: Made presentation to members of Parliamentary Social Services Committee – advocating for more government support

  27. Advocacy – Outside the UCMB network • Include report on PNFP in the Annual Health Sector Performance report (AHSPR) • Analyses showing the difference in remuneration between Govt & PNFP Health workers– advocacy for support to HR • Advocate for PHC–Wage grant for PNFP Health workers • In May 2005: Religious leaders used information to advocate to government for more support to PNFP

  28. Advocacy at International fora • Relationship between Church Health Services (CHSs) and respective governments • WHO-NGO Consultation Sept. 2008 Geneva (Br. Dr. Daniel Guiste-UCMB.) • C.C.I.H. June 2006 Annual Conference –U.S.A – • Addressing the human resource in Health crisis. (Marieke Verhallen-UCMB.) • Uganda Catholic Bishops appealed to CIDSE to  influence decisions at the revision of the Paris Declaration to enable more funding to CSO (Accra – Ghana 2008) • Annually share information with Cordaid • Carry out advocacy where possible

  29. Conclusion • The Uganda National HMIS provides enough data to perform basic & trend analysis at the HF • to help managers to take decision ( based on sound information) • ICT applications have been very helpful • analysis easier at Health Facility levels (periphery) • the system auto-generates information • and connectivity and applications enable data transfer and report viewing right at the periphery

  30. Conclusion • Trends analysis can be done at the periphery • Does not require “high expertise levels” • Just look at the graphs and draw conclusion. • Consolidated sector analysis done at the center • as it requires the aggregation of the complete data set and higher levels of “expertise” ( only possible with IT ) • Punctual feed-back mechanisms were enabled at the centre. • Generated information is being used to strengthen various aspects of management and governance

  31. CONCLUSION • UCMB has also used HMIS information for advocacy • Internally • Within the catchment's area of the health facilities to influence health seeking behaviour. • At Diocesan Level • At Hospital • National level • International level

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