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Health Management Information System in Ethiopia
 

Health Management Information System in Ethiopia

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    Health Management Information System in Ethiopia Health Management Information System in Ethiopia Presentation Transcript

    • Health Management Information System in Ethiopia Ownership Starts on Day One
    • Health Management Information System (HMIS)
      • The purpose of HMIS is to routinely generate quality health information that provides specific information support to the decision-making process at each level of the health system for improving the performance of health system and thereby the health status of the population
    • HMIS in Ethiopia
      • Pivotal role for HMIS within Health Sector’s M&E system
      • FMOH adopted “One Plan, One Report & One Budget” policy
        • HMIS providing the core indicators
      • HMIS reform high in Health Sector Development Program (HSDP) agenda
      • Reformed HMIS designed & pilot tested in 2006-2007, with technical assistance by JSI
    • The USAID-funded HMIS scale-up project
      • In 2009, FMOH invited John Snow Inc. (JSI) to scale-up HMIS in the Southern region (SNNPR)
        • SNNPR: population of 16M
      • Funding by USAID through MEASURE Evaluation
      • Scaling up in other regions with assistance of other development partners
    • This presentation is on HMIS scale-up in Southern Nations, Nationalities and Peoples Region (SNNPR)
      • Administrative structure
        • 15 zones
        • 4 special woredas
        • 156 woredas
        • 22 Town Admin.s
        • 3602 rural kebeles
        • 324 urban kebeles
      • Health facilities (public)
        • 23 Hospitals
        • 591 Health centers
        • 3340 Health posts
    • Ownership matters
      • Regional Ownership is essential for
        • Full implementation of HMIS in the region
        • Sustainability of HMIS in the region
    • The vision: Sustaining HMIS in SNNPR
      • We can say that HMIS is sustainable in SNNPR when the Regional Health Bureau (RHB):
        • Values HMIS & demonstrates desire to have HMIS for health system management
        • Drives the system to get the desired benefits from it; i.e.
          • SNNP RHB maintains production of quality HMIS information to meet the current information needs of the region
          • There is continued use of HMIS information for decision making at all tiers of health system
        • Takes responsibility for its successes and failures
        • Manages & continues to have the capacity to manage the HMIS resources & controls financial decisions for HMIS implementation
    • The Challenge
      • Balancing Regional Ownership and Technical Assistance for implementing HMIS
    • The Strategy: Balanced sharing of responsibility & promoting Regional Ownership from Day One RHB JSI/MEASURE Evaluation Mentoring IT development Level of Responsibility Time Training HMIS data collection, reporting Data Quality Assurance Use of HMIS data for decisions eHMIS use
    • Project’s approach to promoting region’s ownership
      • Advocating regional ownership with RHB in the driving seat
      • Building capacity
      • Encouraging broad-based partnership
      • Enhancing IT support
      • System’s approach: introducing HMIS zone by zone
      • Technical support to address changing priorities
    • … .Advocating region’s ownership
      • Sensitization of Regional Health Bureau
        • RHB Head & senior staff
        • Zonal & District Health Offices heads & HMIS Focal Persons
      • Collaboration and participation
        • All communications for training, supervisory visits, reporting are sent out by the RHB
        • Training activities by facilitators from RHB & ZHDs
        • Joint supervisory visits & review meetings
        • RHB in charge of supply of printed supplies from FMOH
      • Capacity building
        • Facilitation & coaching skills
        • Role modeling use of HMIS information
    • The Approach: Advocating regional ownership with RHB at the driving seat Sensitization of RHB senior management and development partners in SNNPR
    • … .Building capacity
      • Training on HMIS skills
        • Training of Health Managers and staff of Health Centers and Hospitals
        • Training focuses on building skills for
          • Record keeping & reporting using HMIS Instruments
          • Data quality assurance
          • HMIS information use
      • Training on eHMIS
        • RHB IT staff trained on eHMIS application
      • Supportive supervision
    • … .Building capacity - participatory training model On-site training Master Trainers from RHB, ZHD & WorHO 5 Trainers from each WorHO Master Trainers from Hospital 50 Coordinators & technical staff from Hospital 5 Case Team staff from every HC All remaining staff All remaining HC staff 5 days TOT 4 days training 4 days training Supervisory visits by ZHD, WorHO and Project Staff
    • Participatory training on HMIS – Facilitators from Zonal Health Departments conducting training
    • Supervisory Visit by HMIS Technical Working Group HMIS Instruments in use Client bringing back his Service ID card
    • … .TA to address emerging priorities & information needs (typical in long-lasting HMIS scaling up process)
        • New priority : Implementation of Family Folder designed as family-centered information tool for integrated health service delivery by Health Extension Workers
        • Needed operational guidelines for implementation
      • Project provided TA on:
        • Developing operational guidelines & pilot testing of various implementation options
        • Testing procedures for assuring continuity of care for significant health episodes through defaulter tracing
        • Promoting community participation
    • HEW Training Involving district administration Mobilizing volunteers HH Numbering Record keeping at Health Post Family Folder FF Filing system HH List Implementing Community-based HMIS
    • Every HH has a unique number and a Family Folder
    • Family Folder has complete list of every HH member and contains service cards for each member
    • Profile of a kebele served by a Health Post: Data collected during HH registration
    • … .Enhancing IT support – the eHMIS
      • eHMIS features
        • Health System Reference Database (HSRD): provides
          • Population denominators for HMIS indicators – by region, zone, district, sub-district
          • Listing of health admin units and facilities with ID numbers
          • Human resource and assets information
        • Data entry module - manual & using scanning technology
        • Data aggregation module
        • Decision Support System
          • Automated generation of graphs, charts, tables and maps
          • Historic HMIS data migrated to new eHMIS thus ensuring continuity
          • Mobile Executive DSS
    • Hands-on Training on eHMIS – RHB, ZHD, WorHO
    • The Strategy paid off…..
      • Within 1½ years
        • Over 5,200 health managers and staff trained
        • TOT completed for all 615 Health centers & 23 Hospitals in the region
        • 9 / 22 zones implementing reformed HMIS, 6 zones started regular reporting
        • 1737 (44%) Health Posts implementing community HMIS
        • eHMIS installed and functional at RHB
          • Electronic Health Institutions data for all health institutions
          • 6 Zonal Health Departments have eHMIS to access aggregate data and Decision Support System via internet
    • ....strategy paid off
      • RHB is in the lead role and owns the process
        • RHB Planning unit in charge of managing the scale-up
        • RHB IT staff carrying out electronic data entry & quality checks
        • Trained HMIS facilitators from among the staff in every zone, woreda & health facility
          • Anecdote: In one hospital 12 staff replaced by new staff. The hospital authority immediately arranged training of these new staff using the trained facilitators from within the hospital
    • … .RHB in the lead
        • RHB mobilizing other implementing partners to assist in HMIS scale-up and sustainability
          • Mobilized resources for printing, furniture, computers for HMIS
        • RHB organizing regular meetings to review scale-up progress & address bottlenecks
    • Lessons learned
      • Strong visionary leadership & commitment of the region (country) essential for scale-up and sustainability of HMIS
      • Developing government ownership starts on Day One and continues throughout the implementation process
      • Harmonized teaming up of development partners with the government can bring the desired results
      • MEASURE Evaluation is funded by the U.S. Agency for
      • International Development and is implemented by the
      • Carolina Population Center at the University of North
      • Carolina at Chapel Hill in partnership with Futures Group
      • International, ICF Macro, John Snow, Inc., Management
      • Sciences for Health, and Tulane University. The views
      • expressed in this presentation do not necessarily reflect
      • the views of USAID or the United States Government.
      Thank You!