ALTERNATIVE FINANCING MODELS COUNTRY EXPERIENCES –SRI LANKA November 2014.
HIS country experiences
description
Transcript of 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)– Develop capacity to analyse and use information– Develop capacity to maintain and develop HIS
further, including software development– Focus on districts; local action– Appropriate use of technology
Cuba: early HISP days..
• Pilot in 2002-3• Applied same approach as in South Africa:
– Bottom-up development of essential indicator list– ”Massive” local participation– Trying to decentralize decision-making in a
centralized setting• Did not work well, project closed down by
Cuba
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
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
Health Statistics
District 1
DHT
Facility 1 Facility 2 Facility n
IDSR – Notifiable
Diseases
PMTCT
EPI
STD
Home Based Care
IPMS Nutrition
MASA
MCH
Family Planning
IPT
TBSchool Health
Mental Health
Others …
Facility 3
District 2
DHT
District n
DHT
Health Statistics
Facility 1 Facility 2 Facility n
IDSR – Notifiable
Diseases
PMTCT
EPI
STD
Home Based Care
Nutrition
MASA
MCH
Family Planning
IPT
TBSchool Health
Mental HealthOthers
Facility 3
National HIS
District 1 DHIS District n DHIS
IPMS
District 2 DHIS
Tajikistan: Centralized system, decentralized needs
What is collected?
• Global burden of data collection?• What is collected as routine data?
– South Africa: 500– India: 2000– Botswana: 2000– Cuba: 10 000– Tajikistan: 30 000!
• Is the data collected useful? Who uses it?
Sierra Leone: integration and interoperability
• Started late 2007• 1st revision of reporting forms in 2008• National roll-out od DHIS2 and new forms in
2009• 2nd revision of forms in 2009-2010• Reduced amount of forms. Most forms collected
through DHIS• Pilot for interoperability DHIS-OpenMRS• Future plans: more interoperable subsystems
CHIEFDOM LEAGUE TABLE 2ND QUARTER APRIL – JUNE 2009
20.893.632.4114.34391.4Total
14143.228.3100.038.273.82954.9Bumpeh
12123.738.677.8101.268.02961.1Upper Banta
12123.760.5100.057.453.72671.8Ribbi
884.364.086.689.492.64049.8Kori
884.336.5100.077.693.24580.4Kargboro
884.386.5100.0140.769.73555.6Kamaje
884.332.193.092.4110.33761.4Bagruwa
664.735.6100.0120.8201.64888.3Lower Banta
664.778.2100.046.796.552118.4Kowa
334.833.091.791.7106.846140.3Timidale
334.871.375.093.4162.75590.3Kaiyamba
334.845.9100.086.390.557134.9Dasse
225.048.1100.086.2154.362124.3Fakunya
115.393.386.696.6170.94598.2Kongbora
RankingRankingAverage Score
% Exclusive Breastfeeding
at Penta3
% MMRC Submitted
% 2nd Dose of IPT
% 3rd ANC Visit
% PHU Delivery2nd
Quarter
% FullImmunized 2nd Quarter
Chiefdoms
Figure 2: Increasing institutional delivery rates in Western Area, from the HMN Results Report (2010)
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
Challenges at the international/regional level
• Data definitions:– Are the countries collecting the same? With the
same interval?• How do they report?
– Do they have different software solutions?– What is the output format?
• What are the agendas of the various international actors?
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
Armenia
• Fragmentation• Politics. HIS unit not a ”national level” unit.• Reform pushed by international organizations• Like Cuba and Tajikistan:
– Strong centralist traditions• Urba/Rural divide:
– Yerevan is as modern as it gets. Countryside less so
Evolution of the international scene and HISP
• Development agencies are powerful– UNAIDS
• Millenium Development Goals• HMN since 2005• Global Fund: focus on HIS• PARIS declaration: build upon existing HIS
Evolution of HISP
• HISP since 1994– Essential dataset– Local use, bottom-up development
• Now, more diverse– Many agendas: NGOs, international orgs.
• Technology has changed: from offline to online. Mobile
Discussion
• Similarities and differences– Common themes: ?
• In all countries HISP has been active: very few have come far when it comes to information use: how to achieve this?
TALI
1. The information system is working technically according to its specification
2. Data is analysed, disseminated and used:3. Information from the system used for
planning and evaluation of achievements