District Health Information System (DHIS) Design

1. The Study on Improvement of Management Information Systems in Health Sector in the Islamic Republic of Pakistan District Health Information System (DHIS) Design Steering Committee Meeting, Islamabad 29 August 2005

2. Outline of Presentation • Rationale • Objective of DHIS • DHIS Specifications • Pilot testing DHIS

3. Rationale for DHIS • After devolution, decision-making and resource management authority transferred to districts • District responsible for improving health services from 1st and 2nd level facilities & outreach • Strengthening the Districts for managing their health systems is a priority • Thereby, improving HIS to respond to the information needs of the Districts is a priority

4. Objective of DHIS Overall objective: • “To provide information for management and performance improvement of primary and secondary healthcare services provided by the public health sector at district level”

5. Specific objectives: • Provide necessary information for monitoring the performance of district health system by incorporating selected key information from HMIS/FLCF, vertical programs and support-systems at district level • Cater to the important routine health information needs of the federal and provincial levels for monitoring policy implementation

6. DHIS incorporates selected key data from existing HISs Data/information from HMIS/FLCF and 2nd hospital Data/information from VPs-MIS DHIS Data/information from HIS sub-systems

7. System Specification • DHIS is a routine health information system • responds to the information need of the District health system’s performance monitoring function • DHIS provides minimum set of indicators • for monitoring of health services from • First and Secondary level facilities, • Outreach • The DHIS indicators are not an exhaustive list of all possible indicators • Provide readily understandable indication of positive or negative deviances

8. System Specification – DHIS Indicators • DHIS has 79 indicators • The selection process has been consultative using specific criteria like relevance, importance, specificity, feasibility, utility. • Grouped into 8 broad categories • Service delivery: 14 preventive; 38 curative • Utilization: 13 • Financial management: 3 • Logistics: 1 • Human resources: 2 • Capital assets: 6 • Private sector regulation: 1 • Information system performance: 1

9. DHIS 79 indicators (66 similar to those in HMIS/FLCF) Cover both outdoor and indoors, as well as outreach (vertical programs) 1st and 2nd levels with different instruments according to its specialization DHIS from RHC requires to capture140 variables HMIS/FLCF 111 indicators Outdoor and outreach Only 1st level (introduced in 2nd level using same format) HMIS/FLCF required to capture 446 variables Comparison between DHIS and HMIS/FLCF

10. System specification – Data flow and use Data Flow Activity International organizations International review of performance vs. policy standard feedback Information Federal review of performance vs. policy standard Federal feedback feedback Information Province Provincial review of performance vs. policy standard feedback feedback Information District District performance review feedback feedback Information Facility Facility performance review feedback feedback assessment of own performance Data collector (care provider) data

11. System specification- Data Quality Assurance 1 • Quality of data by DHIS • Reduce data burden at collection points • Revision of FLCF data collection and reporting instruments • Upgrade software for data compilation and analysis • ICT unit at district • Introduction of data quality assurance procedures (e.g., LQAS), and data cross check at all levels

12. System specification- Data Quality Assurance 2 Data handling steps Interventions Weaknesses A part of raw data to provincial database Reports to concerned authorities at district Data processing - presentation - analysis (computation) - add to database - data check (LQAS) - data consistency (for data in DHIS and VPs) - data entry 1. Upgrade software; 2. Introduce data quality check; 3. Introduce data cross check Outdated software with limited capacity for flexible data presentation Data transfer facility to district New step to improve accuracy of compilation Data accuracy Data check (LQAS) Complex forms Simplify forms Data compilation Reduce amount of data compiled Data burden Complex procedures Revise FLCF registers Data collection Data coverage limited to FLCF Add hospital registers

13. System Specification- Continuous Use of Information • Strengthening District HMIS cell/ICT unit • Strengthening EDOH functions for performance improvement using DHIS information • Strengthening Facility functions • Enhancing staff/managers’ knowledge and skills (capacity building)

14. DHIS Design Synthesis SYSTEMS FOR DATA QUALITY AT ALL LEVELS (LQAS, CROSS DATA CHECK) Provincial & Federal level Data Review for Monitoring Policy Implementation SYSTEMS FOR CONTINUOUS USE OF INFORMATION Transfer need-based Data for Monitoring Feedback District level Data Review for Performance Monitoring Analyzed Data Presentation Tables, Graphs, Bar Charts Self-improvement of Data Quality (LQAS, Data Cross Check) Substantial Feedback to lower levels for Performance Improvement District ICT Rationalize Collection of Data, Limited Performance Indicators Short Feedback Loop Performance Monitoring RHIS VPs HISs Hospital MIS Sub-systems HISs

15. Benefits of DHIS Design • Caters to management needs of devolved district health system • Enhanced coverage for performance monitoring • FLCF, Secondary Hospitals, Vertical Programs, & HIS sub-systems, viz. logistics, financial, human resource, capital assets MISs • Flexibility to evolve for future information needs • Improved data quality assurance procedures at all levels

16. Benefits of DHIS Design 2 • Continuous use of information at all levels • Strengthening of feedback loops within the districts and at all levels • Problem identification, implementation of solutions for performance improvement • Capacity building of staff on data quality and use of information at all levels • Ownership at all level

17. Pilot Test of DHIS Model • Objectives: • To prove the model DHIS in terms of quality of information and continuous use for the improvement of health management at district level Specific Objectives: • To contribute to the finalization of draft NAP for strengthening of health management capacity through use of DHIS Model • To clarify the cost for expansion across the country during scaling up stage • To transfer relevant skills and technologies to personnel concerned with the DHIS

18. Broad Interventions and Activities • Examining improvement of government support to DHIS • Examining contents and draw up draft DHIS strategy paper for HIS policy • Testing self-evaluation and improvement functions • Periodical review of DHIS activities by PWG • Introduction of DHIS design in selected districts and facilities • Revised and improved DHIS tools and instruments • District computer software and manuals • Manuals and guideline material for feedback reports and review meetings • Instruments and guidelines for requesting data from sub-systems • Examining coordinating mechanism among various sub-systems

19. Broad Interventions and Activities • Strengthening of district HMIS Cell • Establishing district ICT unit and capacity building of relevant staff on IT and data quality assurance systems (LQAS, data cross check etc • Clarification of accountability of ICT unit and HMIS Coordinator • Strengthening of EDOH functions • Introduction of regular review meetings at district level • Capacity building on data quality and use of information • Establishing system for monitoring pilot test • Strengthening of facility functions • Building coordination between facility in-charge and out reach staff for regular review meetings at facility level • Capacity building on data quality assurance and use of data at facility level • Commitment from EDOH and higher tiers for regular facility review meetings

20. Broad Interventions and ActivitiesCapacity building • Implementation of education and training to continuously improve knowledge and skills at all levels • Capacity building of selected staff at pilot districts • Data quality Assurance • Use of information • ICT

21. Establish • Provincial Working Group Meeting • Implement supervision and monitoring for pilot test • Ensuring support (HR, Financial) and commitment from higher levels • Considering draft DHIS Strategy Paper • Recommend further implementation of NAP after pilot test results • Review of training programs and curriculum • New education and training plans for relevant staff • District Working Group Meeting • Examine issues related to strengthening of DHIS at district level through holding review meetings • Introducing periodic DHIS design review and Consideration of draft DHIS Strategy Paper • Recommend improvement of district performance review meetings

22. Thank you! End of presentation