Implementing District Health Information System (DHIS) in Botswana

1. Implementing District Health Information System (DHIS) in Botswana Omprakash Chandna Dept of Information Technology ochandna@gov.bw

2. Health System in Botswana • Large number of facilities across the country: 3 referral hospitals, 7 district hospitals, 17 primary hospitals, 259 health clinics and 340 health posts • Limited health human resources: ≈ 30 physicians and 262 nurses per 100,000 population (vs. 56 / 471 for South Africa and 229 / 897 for Canada) • Health system is a blend of public and private sector in both service delivery and funding organizations: Botswana spends 4% of GDP on health • HIV / AIDS a key issue

3. AIDS Epidemic – Update on Botswana • 300 000 people are HIV+, which is 17.1 % of the total population, 37.4% of the 15-49 age group infected. • Life expectancy dropped from 62 to 56 years.110 000 need immediate enrollment to Anti Retro Viral Therapy (ARVT), 70 000 on ARVT

4. Current Challenges – Health Information Systems in Healthcare • Manual transcription of data in districts (24); electronic means utilised less frequently • Demand for data from different stakeholders (MOH, MLG, NACA, TB, ARV etc.) in ~ 30 different forms. 1564 data elements being captured • Quality of data captured --- doubtful • Fragmented data sets (18) generated by 9 healthcare programmes like PMTCT, ARV, TB, Nutrition, Home-Based-Care, Family Planning etc. • Essential Minimum Indicator Set at national level and in healthcare programmes last revised in year 2001.

5. Current Challenges: ICT in Healthcare Programmes – contd. • Vertical Systems, various software programmes being used for data analysis requiring training of end-users at districts and national levels (EPI-Info, Excel, IMPS etc.) • Patient level Data collected for some programmes (IPMS, TB) while aggregated data (PMTCT, MCH, Nutrition) in others at the districts • Delayed management reports (months, years); Delayed decision-making • Lack of skilled manpower at districts • Lack of unified approach at district and national levels

6. IPMS Project Brief Clinic 3 Clinic 2 Clinic 1 Clinic 4 Clinic 1 Clinic 2 Clinic 4 Clinic 3 Clinic 3 Clinic 2 Clinic 1 Clinic 4 Clinic 3 Clinic 2 Clinic 1 Clinic 4 Princess Marina Hospital (Gaborone) Nyangabgwe Hospital (F’Town) Dept of Info Technology/GDN Maun Hospital Sekgoma Hospital (Serowe)

7. Health Facilities

8. Current Scenario – contd. ARV IPMS IDSR – Notifiable EPI Home Based Care Diseases Health Statistics PMTCT STD Nutrition Family Planning MCH HIV/AIDS School Health TB Mental Health And more … District - DHT Facility 1 Facility 2 Facility 3 Facility n

9. South Africa Malawi Mozambique Norway Botswana Sweden Tanzania Ethiopia Asian partners European Union - Beanish FP6 Programme DHIS operational in several countries South Africa, Ethiopia, Malawi, Mozambique, India

10. Project funded by EU – BEANISH (Building Europe Africa collaborative Network for applying IST in the Health care sector • The project is an outcome of WITFOR 2005 case study. Agreement reached to implement DHIS by MCST, MOH • Collaborative project involving MOH, MLG, UB and NACA

11. Proposed Solution – BEANISH Initiative 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

12. ? Flow of information and reporting structures MINISTRY OF HEALTH MIN. of LOCAL GOVERNMENT DONORS and PARTNERS ? ? ? Data ? ? ? ? DHT2 DHT3 DHT1 (PS, CHN, Matron, Coordinators) Data Action Clinics, Health Posts, Mobile Stops Patients Community Others

13. DHIS Pilot Project –Lessons Learnt • Felt need for reliable and timely health information and management reports (National, districts, facility-wise) on aggregated. General appreciation of the DHIS application • Current data quality questionable - data collection, capturing need monitoring • IT infrastructure inadequate at districts for a roll-out. Reliable Internet/e-mail connectivity not available at DHTs • Need for regular training programmes and refresher courses. • Technical support on the application needs strengthening

15. DHIS Project –Challenges • Project Steering Committee not in place (MOH, MLG,UB) • Frequent movement and transfers of health personnel in districts and at national levels. Loss of continuity in operations • Project delays. Burn rate of EU funds low

17. DHIS Project – Status • Project Initiation Report (PID) disseminated • S/W Application customised for pilot run • DHIS piloted in 4 health districts; Gaborone, South-East, Kgatleng, Okavango • At the pilot districts, end-Users (CHN, PHS, Matrons, IT Officers in the districts) trained in DHIS • Workshop organised for programme managers and stakeholders at national level • Pilot Project Review report finalised and circulated to all stakeholders

18. DHIS Project – Status • Setting-up of a training facility at MOH • Procurement of additional hardware in tendering stage • 44 Health Info. Officers recruited. Training being conducted at UB from 15 Oct, 2007. • Roll-out in 8 districts by March 2008. End of EU funding. • Roll-out in 16 districts by Dec 2008. PEPFAR funding. • Project reporting to the sponsors – EU-BEANISH done quarterly

20. Questions ?? ?? ?? Thank You ??