Post on 09-Aug-2020
Strengthening Routine HealthInformation System
2012-2014
January 13, 2015January 13, 2015
MIS Auditorium, DGHS
Summary of RHIS InitiativesUndertaken
Strengthening RHIS of DGHS and DGFP by USAID-supportedpartners (MEASURE Evaluation, icddr,b, MaMoni/HSS,MSH/SIAPS) has been directed to• support to M&E functions of HPNSDP with particular focus on 6 OPs
(MNC&AH, NNS, CBHC, MCR&AH, CCSDP, and FSDP)
• streamline MIS tools to minimize information gaps and duplication, andreduce the burden of data collection and compilation
• design and use a supply chain management portal for efficient and effectivelogistics management of RMNCH commodities
• improve capacity of MIS Units of DGHS and DGFP to generate reliableinformation on time.
• improve use of information at the local level and promote evidence-baseddecision
SUPPORT TO M&E FUNCTIONS OF
HPNSDPHPNSDP
Support to M&E functions of HPNSDP
Streamlining of OP indicators by MEASURE/icddr,bincludes• Review of 342 indicators across 32 OPs and development
of PMP• Developing indicator reference sheets for 342 indicators• Developing indicator reference sheets for 342 indicators
with detailed information:– Definition, Calculation, Unit of measurement, Frequency, Source
of information, Level of data generation
• Categorized 342 indicators by types (i.e training, service,facility readiness, drug/logistic, infrastructure,workshop/meeting etc.)
STREAMLINING MIS TOOLS
A Key Focus ofA Key Focus ofMaMoni/HSS
&MEASURE Evaluation/icddr,b
Review of OP indicators andassessment of MIS tools
6 priority OPs were reviewed where routine MISs coveredonly 50% of original OP-level service indicators
Service providers and field-workers overburdened withrecording and reporting requirements, e.g.,
14 registers for FWVs• 14 registers for FWVs
• 11 key sections in FWA register
• 5 in-patient monthly reports manually aggregated
• 5 (at least) monthly reports by HA
Inadequate data accessibility as computer-based databasenot fully functional
Inadequate use of RHIS data for local-level decision making
DGHS/MISDGHS/MIS
MIS tools streamlined
Old systemOld system
- No structured HAregister
- No structured CSBAregister
Revised systemRevised system
- Structured HA & CSBAregisters
- Revised monthly reportsonline
Revision and development of tools/systems from community to hospital level
CommunityCommunity
register online
DGFP/MISDGFP/MIS
- Paper-based FWA registerhas separate pregnantwomen and birth list andmissing a number of OPindicators (i.e ANC, PNC,delivery)
- No structured CSBAregister
- Review of FWA register (inprocess) adding missinginformation + pregnant andbirth list replaced by piloted‘pregnancy registrationhandbook’
- Online pregnancy registration- Review of MIS 1 & 2 forms
are in process- Structured CSBA registers
DGHS/MISDGHS/MIS
MIS tools streamlined
Old systemOld system
Paper-based CC serviceregister
Revised systemRevised system
- Revised paper-basedregisters included NNSindicators
- Online reporting formats
Revision and development of tools/systems from community to hospital level
Community ClinicsCommunity Clinics
register - Online reporting formats
- PW & U5 childrenregistration system
DGHS/MISDGHS/MIS
MIS tools streamlined
Old systemOld system
- Unstructured generaloutpatient register
- Paper-based diseaseprofile report
Revised systemRevised system
- Structured register
- Simplified monthly report+ online reporting atupazila level
Revision and development of tools/systems from community to hospital level
UnionUnion
profile report upazila level
MIS tools streamlined
Old systemOld system Revised systemRevised system
Revision and development of tools/systems from community to hospital level
UnionUnion
DGFP/MISDGFP/MIS
Separate FWV registers forevery service, viz. delivery,ANC, PNC, birth, pill,condom, IUD and IUD followup
-Reduced FWV registers(MNH, OCP/Pill, IUD) bymerging relevant registers
-MIS 3 reporting form is underrevisionup revision
Single register for FWV for MNH services (MNH register)
DGHS/MISDGHS/MIS
MIS tools streamlined
Old systemOld system
- Paper-based in-patientreports
Revised systemRevised system
Online in-patient MIS withICD-10 classification
Revision and development of tools/systems from community to hospital level
Upazila & DistrictUpazila & District
DGFP/MISDGFP/MIS Existing MIS 4MIS 4 reporting form is
under revision
Implementation of tools/systemsTools/Systems Nationwide by
DGHS-MISWith support fromicddr,b and MaMoni
Otherpartners
Directorate General of Health Services (DGHS)
District and sub-districtlevel:Online hospital in-patient system
Provided ToT tostatisticians andinstructed to give in-patient data entry,Developed manual inc.
All UHCs and DH of Tangailand Chunarughat UHC andDH of Habiganj (logistics,training and onsite support)+ central level monitoring
UNICEF:SCANU part ofthe system in16 DH
Developed manual inc.ICD 10
+ central level monitoringby M&E staff
Union level: Generalpatient register forSACMO and Monthlyprogress report(aggregated) in DHIS2
DGHS-MIS developeddata entry guideline.Currently, 60 districtsreporting in DHIS2
Paper-based register andreporting format, trainingswere provided in entireTangail district andChunarughat (Habiganj)upazila
CC: Online monthlyreporting (aggregated)format in DHIS 2
Provided laptops withconnectivity, training toCHCP, developedmanual~8,000 CCs reporting
Entire Tangail andChunarughat (Habiganj)upazila (onsite support),central level monitoring byM&E staff
Implementation of tools/systemsTools/Systems Nationwide by
DGHS-MISWith support fromicddr,b and MaMoni
Otherpartners
Directorate General of Health Services (DGHS)
CC: Pregnant womenand U5 registrationsystem (as part of COIAinitiative)
Provided ToT,developed manual,Intensive monitoringfrom central level andworkshop at divisional
Training and onsite supportin 3 upazilas of tangail + ToTto UNICEF + central levelmonitoring by M&E staff
UNICEF: in 3districtsJICA: inSatkhiraPlan: inworkshop at divisional
levelPlan: inDinajpur ++
Household level:a. HA register andreporting tool + onlinereporting format inDHIS2
DGHS-MIS developeddata entry guideline.PHC circulated GOCurrently, 62 districtsare reporting in DHIS2
Paper-based register andreporting format, trainingswere provided in entireTangail district andChunarughat (Habiganj)upazila
b. CSBA register andreporting tool (both FPand Health) + onlinereporting format inDHIS2 (health)
DGHS-MIS developeddata entry guideline.PHC circulated GOCurrently, 62 districtsare reporting in DHIS2
CARE: inSunamganj++SNL: Kushtia
Implementation of tools/systemsTools/Systems Nationwide by
DGFP-MISWith support fromicddr,b and MaMoni
Otherpartners
Directorate General of Family Planning (DGFP)
Sub-district level:Aggregated nationalreporting form-MIS 4
Revision of MIS4 isdone and awaiting forapproval
Technical assistance in thereview process
Union level (for FWV):- Single register for MNHservices- OCP, Condom and ECPregister- IUD register- Facility reportingformat-MIS 3
-Review Committee hasrevised and finalizedreduced MNH and FPregisters for FWV.These registers werepiloted in icddr,b andMaMoni areas- Revision of MIS 3 isdone and awaiting forapproval
Paper-based register andtrainings were provided inentire Tangail andChunarughat (Habiganj)upazila
Technical assistance in thereview process of MIS 3
SNL: MNHregister inKushtia
Implementation of tools/systemsTools/Systems Nationwide by DGFP-MIS With support
from icddr,b andMaMoni
Otherpartners
Directorate General of Family Planning (DGFP)
Community level:a. PregnancyRegistrationHandbook + online
MCH-Services initiated onlineregistration format has beenaccepted and DGFP-MIS hascirculated GO to do online
Paper-basedhandbook, training ,onsite support inentire Tangail and
SNL: Kushtia
Handbook + onlineregistration format
circulated GO to do onlinepregnant women registration
entire Tangail andChunarughat(Habiganj) upazila
b. FWA register 8th
edition and monthlyreporting form - MIS 1
Review committee has revisedand finalized 8th edition ofFWA register and MIS forms 1and 2.(Piloted pregnancy registrationhandbook has been added in8th edition of FWA register)
icddr,b providedtechnical assistance inthe review process
Icddr,b in collaboration with GIZ providing technical support to DGFP-MIS to transfer their servicestatistics (monthly report) into DHIS 2 platform. Initially, new system will be piloted in two districtsbefore national scale up.
Quality of reporting improving
100
120
100
120
Community micro-planning in MaMoni areas: HA-FWA-CVnetwork to share MNH/FP information, update registersand reduce inconsistencies in reporting
0
20
40
60
80
100
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Nu
mb
er
FWA report HA report
0
20
40
60
80
Jan
Feb
Mar
Ap
r
May Jun
Jul
Au
g
Sep
Oct
No
v
Dec
Nu
mb
er
FWA report HA report
16Neonatal deaths, Habiganj, 2012 Neonatal deaths, Habiganj, 2013
Real time population level estimategenerated through MHN register
70
45 45
64
51 51
17
17
45 45
17
At least 1 ANC visit 4 ANC visits SBA delivery PNC within 48 hours
Poil MIS 2012 Poil MIS 2013
Data source: Poil Union MNH Register, Habiganj
Issues and Challenges
System, connectivity related issueso Absence of individual client-based tracking system
and not synchronized with community database
o Dual systems (both old and revised) are in place
o No provision for offline entry (both DHIS 2 andpregnancy registration system of DGFP)
o Report generation or data sorting is limited; scopeof improving dashboard for different users level
o Frequent power cut and slow internet connectioncause delay in online data recording and reporting
Issues and Challenges
Administrative issueso Perceived high workload of nurses and senior nurses
are reluctant to use computer
o Several admission registers make it difficult to checkwhether all patient in a day have been registeredwhether all patient in a day have been registered
o Perceived inadequate encouragement from local levelmanager to use the new system
o Although registration coverage is good, updatinginformation is poor
o Security of computers and accessories is a majorconcern
DESIGN AND USE A SUPPLY CHAIN
MANAGEMENT PORTALMANAGEMENT PORTAL
Why LMIS is important?
An effective logistics management informationsystem is necessary to ensure consistent availabilityof medicines :
• Provide real-time information
• Allow managers to react quickly and efficiently• Allow managers to react quickly and efficientlyto avoid stock-outs and over-stocks
• Help plan for proper distribution
• Assist in forecasting & supply planning
DGFP Logistics Information Management Systems Flow
National Stock Status of Contraceptives
indicates < 4 monthsindicates 4-7.9 monthsindicates >=8 months
Fewer stock-outs (<5%) of IUDs while nearly no stock-outs (<1%) of injectables for last two years.
Reference: M G Kibria et.al, 2013, Impact of a Computerized InventoryManagement System in Ensuring Commodity Security of Contraceptivesin Bangladesh (Presented in the International FP conference, AddisAbaba, Nov 2013))
DGFP SDP Dashboard Module• Service Delivery Points
(SDP) include FamilyWelfare Assistants (FWA),Family Welfare Visitors(FWV), NGO etc
• SDP Stock Status isavailable in UIMS (whichavailable in UIMS (whichis running in 488 sub-districts)
• UIMS data upload to web(SCMP/ SCIP)
• Dashboard indicate stockstatus of individual SDP
DGFP SDP Dashboard Module
Salient experience:
• Contributed to identifying the root causes of stock-outs
• Helped to assess the quality of SDP reports and assist
Pilot phase: March-September 2014Pilot area: 20 Upazilas in Sylhet, Lakshmipur, Gazipur and Bogra
• Helped to assess the quality of SDP reports and assistin designing supervision plans for low-performingsites
• Reduced the stock-out rate significantly
• Improved decentralized decision making
• Promoted governance and accountability
Next Steps
• Update the DGFP LMIS tools (UIMS, WIMS andeLMIS) and expand the product list (n=304items)
• Roll-out national implementation of the SDP• Roll-out national implementation of the SDPdashboard module to all Service DeliveryPoints (~30,000) by July 2015
• Handing-over the tools to the DGFP formanagement and maintenance
Challenges
• Prompt actions taken based on information
• Retention of trained staff
• Improving the ICT infrastructure
• Ensuring feedback mechanism from upperEnsuring feedback mechanism from uppertier/supportive supervision visit
• Thoroughly discussing FP program’s performancein the district/Upazila monthly meeting
• Staff motivation
Replicating Best Practices (LMIS) inDGHS and NTP
• Formation of Technical Working Group- Done
• Selected a list of Items to tracked on [26 itemsincluding UN commissioned life-saving commodities] inconsultation with the TWG
• Map-out and design the Logistics recording and• Map-out and design the Logistics recording andreporting systems in collaboration with MaMoni/HSS-in progress [Piloted in Lakshmipur]
• Technological assessment of MOHFW Supply ChainManagement Portal (SCMP) and DHiS2 to integrate theeLMIS- To be started soon
• Work with DGHS/TWG to introduce the DGHS LMIS
IMPROVING CAPACITY
Technical personnel support
M&E manager: Supervision of development team,coordination among stakeholders, developingguidelines, ToT etc.
M&E Officers: Monitoring and reporting of MIS activitiesfrom the central level. Assisting development offrom the central level. Assisting development oftools/guidelines and providing ToT
Programmers: Designing online tools, maintenance ,troubleshooting of the systems and providing ToT
Technical support in development ofRHIS materials
1. Training manual for CHCP on computer andonline reporting
2. Training manual for HA on Tablet PC use2. Training manual for HA on Tablet PC use3. Training Manual on ICD-104. Indicator book5. Local health bulletin6. Instruction manual on monthly reporting
Technical support to MIS relatedMeetings/Workshops/Trainings
1. Meeting and workshop on COIA2. ToT on ICD-102. ToT on ICD-103. ToT on Community clinic reporting4. Workshop on CRVS5. Meeting on nutrition related indicators6. Meeting on SCANU reporting system7. Meeting on HIV/AIDS reporting system
IMPROVING USE OF INFORMATION
AT THE LOCAL LEVEL FOR
EVIDENCE-BASED DECISION
MAKINGMAKING
Improve data availability andaccessibility
• Online reporting makes datamore easily available atdifferent levels.
• Online entry at/close to• Online entry at/close tosource reduced chance ofcompilation errors
• Report generation usingroutine data at the local leveland presentation at annualMIS conference
Thanks