A New Frontier in Strategic...

A New Frontier in Strategic Information:

Strategies and Challenges to Strengthening the

National Health Information System in Lesotho

June 9, 2016

SI Unit Webinar

Tsigereda Gadisa, Chief of Party, Lesotho SI Project

Suzue Saito, Principal Investigator, Lesotho SI Project

Presentation Outline

1. What is Health Information Systems (HIS)

2. Why do we care about strengthening HIS?

3. ICAP experience supporting HIS strengthening

4. Lesotho SI Project

5. Rationale & Objectives

6. The Baseline Assessment

7. Proposed Solution

8. Strategy: Advocate, Educate, and Act

9. Achievements

10. Lessons Learned

11. Next Steps

12. Acknowledgements

What is an HIS?

What is an HIS? Key Component of Health Systems

Source: Everybody business : strengthening health systems to improve health outcomes : WHO’s framework for action. World Health Organization 2007

Anatomy of an HIS

HIS

Resources Indicators

Data

Sources Data

Management

Dissemination

& Use

Health Information System Components

Source: Everybody business : strengthening health systems to improve health outcomes : WHO’s framework for action. World Health Organization 2007

HIS policy,

regulatory

framework

Indicators to

help monitor

programs

Census, health

services

records,

surveys, etc.

Processes/

systems to

collect,

aggregate, and

analyze data

Clearly defined

path to

integrate data

into decision

making

Why HIS Strengthening?

It’s Part of What We Do Best

• ICAP goals:

– Transformative solutions to strengthen health systems

– High performing health systems strengthening initiatives

• Well functioning HIS is essential to ability of health

systems to improve health

Why HIS Strengthening?

We Need Data to Assess Progress

The right

- Things

- Time

- Place

- Way

All imply availability of actionable data

Epidemic Control

to end AIDS

to achieve AIDS-free

generation

ICAP Experience with HIS Strengthening

SI/HIS-focused awards won by ICAP

• Swaziland

• Cameroon

• Kazakhstan, Kyrgyzstan, Tajikistan

• Mali

• Lesotho—Not limited to HIV, all health data

Lesotho SI Project

Strengthening SI Activities in the Kingdom of Lesotho

Rationale

• Health Metric Network Assessment, 2007

• Used a standardized tool to assess the different

components and overall functioning of the

health information system in Lesotho

Rationale: Inadequate HIS

Health Metric Network Assessment, 2007

Objectives: Lesotho SI Project

1. Strengthen HIS, Surveillance Planning, and

Coordination

2. Streamline Data Management and Use

3. Capacity Building for Country Ownership and

Sustainability

The 2014 Baseline Assessment

1. HIS is mainly paper-based and aggregation of data

is a large burden

2. Multiple and competing paper and electronic tools

used to transmit, collate and store reports

3. Existing electronic tools do not effectively

interoperate

Limited actionable

health information

available to decision

makers

Maternal Child Health,

(ANC, Delivery, and Family Planning),

Communicable diseases and NCDS

Expanded Program

of Immunization

Tuberculosis (TB)

HIV Care and Treatment

DISTRICT LEVEL District Health Management

Team (DHMT)

Monthly data entry into

district online DB, no

analysis

Quarterly collection; only a

pass through, no aggregation

Monthly collection and

submission; only a pass

through, no aggregation

Health

Planning and

Statistics

Family Health

Department

National TB Program

International

Health

Monthly Paper

Facility Reports

Aggregate statistical table

created and shared quarterly

Monthly Paper

Facility Reports

Quarterly Paper

Hospital Reports

Monthly Paper

Facility Reports

Monthly Paper

Facility Reports




HIV Testing & Counselling

Notifiable Diseases

Monthly/weekly Paper

Facility Reports

Monthly/weekly collection

and submission; only a pass


STIs, HIV and AIDS

Programme (SHAP)

FACILITY LEVEL Health Facilities &Hospitals

NATIONAL LEVEL Ministerial Departments




Quarterly Paper

Facility Reports

Entry of monthly facility data into

Epi Info DB

Entry of monthly facility

data into ACCESS DB

Entry of quarterly facility

data into Excel DB


Excel DB

Limited Progress Since 2007

The Proposed Solution: DHIS 2

DHIS 2

• Implemented in 47 countries across 4 continents and

increasingly being adopted as national and

subnational HIS

• Supported by diverse and large donors: PEPFAR,

Global Fund, NORAD, University of Oslo,

The Research Council of Norway

www.dhis2.org/deployments

DHIS 2 Advantages

• Open Source Software

– Free to download, install & modify source code in response to local

needs

– Continuous development and software improvement based on user

feedback

• Can be implemented at all levels of the health system: facility, district,

ministerial departments

• Can house different types of data: population-based data, health

facility data, administrative data

• Designed to serve as reporting tool, archiving tool, and dissemination

tool

Strategy: Advocate, Educate, Act

Full year of advocacy and

education at all levels

• How do we know your system is

going to be different?

• I like the system I am using now

• When you leave how can we

sustain it?

Advocacy target Responsible person Venues/Frequency

Minister of Health, Director General, Principal secretary

Country Director/Chief of Party

Monthly briefing meetings Impromptu meetings

Department Heads Chief of Party/HMIS specialist & HMIS managers

Stakeholder workshop, follow- up meetings, demo

Program Managers HMIS specialist & HMIS managers

Stakeholder workshop, follow- up meetings, demo


DHIS 2 System Support:

US Ambassador providing

tablets to Berea DHMT (above)

Providing the US Ambassador a tour of

DHIS 2 features (below)


• Stakeholder workshop to

collectively define the

need

• Joint dissemination of

baseline assessment results

with MOH

• Demonstration of DHIS 2

carefully tailored to address

needs expressed by

stakeholders

• Consistent efforts for

sustained advocacy/ education

with MOH and USG

Key Achievements: Customization

• A seven-person team, made up of ICAP (3) and

MOH(4) developers, was assembled to customize

the DHIS 2

• Modeled DHIS 2 on the current paper forms

• Imported legacy data for HIV and TB/HIV programs

• Created dashboard using a few HIV and TB/HIV

program indicators for the ART manager

• Organized a half day forum for live demonstration of

DHIS 2

• Scheduled follow up one-on-one meetings

Key Achievements: Data Warehousing

1. Obtain all program

indicators

2. Obtain all reporting forms,

program data files and

paper based records

3. Defined SOPs to

import/enter electronic

and paper based data

Systematic collection of program indicators

and legacy data

Key Achievements:

Dashboard & Validation Rules

• Over 898 dashboards developed and implemented

for program managers at central and district levels

• Data cleaning using validation rules completed for

data for all 8 programs

Key Achievements:

Validation Rules & Dashboards

Key Achievements:

Capacity Building for National Roll-Out

• Developed training manual and data use SOPs

• Trained key staff at Central (32), District (56), and Facility

(173) levels

• Conducted systematic follow-up with each ministerial

department and each DHMT with individualized

mentorship

• Distributed 55 tablets and 10 modems (4G) for use by

DHMT staff

• Distributed 157 tablets for facility use

Timeline of National Roll-Out

February 18, 2015 National HIS

launched

May 2016 Distribution of tablets to

facility staff

October 2015 Distribution of tablets and

modems to DHMTs

February 2015 Training manual and data

use SOPs developed

February 2015 – March 2016 Trained DHMT staff

March – April 2016 Trained facility staff

February 2015 – Present Conducted systematic follow-up with each ministerial department and each DHMT with individualized mentorship

January 2015 – March 2016 Trained Central staff

Key Achievements: Summary

• Customization: Launched the National HIS on

February 18, 2015

• Data Warehousing: Imported legacy data from 2008 –

2015 for 8 health programs with established reporting systems

– over 40 million data values!

Key Achievements: Summary

• Defined Validation Rules & Dashboards: Developed and implemented 77 validation rules for data quality

control, developed custom dashboards for each program, and

trained users to develop their own dashboards – over 898

dashboards created!

• National Roll-out: 7 Departments, 10 Districts, and a

total of 462 users have access to the system


(ANC, Delivery, and Family Planning),

Communicable diseases and NCDS

Expanded Program

of Immunization

Tuberculosis (TB)


DISTRICT LEVEL District Health Management

Team (DHMT)

Monthly data entry into

district online DB, no

analysis

Quarterly collection; only a

pass through, no aggregation




Health

Planning and

Statistics

Family Health

Department

National TB Program

International

Health

Monthly Paper

Facility Reports

Aggregate statistical table

created and shared quarterly

Monthly Paper

Facility Reports

Quarterly Paper

Hospital Reports

Monthly Paper

Facility Reports

Monthly Paper

Facility Reports





Notifiable Diseases

Monthly/weekly Paper

Facility Reports

Monthly/weekly collection

and submission; only a pass


STIs, HIV and AIDS

Programme (SHAP)

FACILITY LEVEL Health Facilities &Hospitals

NATIONAL LEVEL Ministerial Departments




Quarterly Paper

Facility Reports


Epi Info DB

Entry of monthly facility

data into ACCESS DB

Entry of quarterly facility

data into Excel DB


Excel DB


Epidemiology and Family Planning

Communicable

diseases and NCDS

Tuberculosis (TB)


DISTRICT LEVEL

District Health Management Team (DHMT)

Data Entry,

Analysis,

Feedback

and Use

in DHIS 2

Family Health Department

Health Planning and Statistics

National TB Program

International

Health

Monthly Paper

Facility Reports

Monthly Paper

Facility Reports

Quarterly Paper

Facility Reports

Monthly Paper

Facility Reports

Monthly Paper

Facility Reports


Notifiable Diseases

Monthly Paper

Facility Reports

STI, HIV and AIDS Programme

(SHAP)

FACILITY LEVEL

Health Facilities &Hospitals

NATIONAL LEVEL

Ministerial Departments

Quarterly Paper

Hospital Reports


Epidemiology and Family Planning

Communicable

diseases and NCDS

Tuberculosis (TB)


DISTRICT LEVEL

District Health Management Team (DHMT)

Data Entry, Analysis,

Feedback and Use in

DHIS 2

Family Health Department

Health Planning and Statistics

National TB Program

International

Health


Notifiable Diseases

STI, HIV and AIDS Programme

(SHAP)

FACILITY LEVEL

Health Facilities &Hospitals

NATIONAL LEVEL

Ministerial Departments

Lessons Learned:

Essentials for Success • Securing MOH Commitment from the highest level critical to

create a system that “sticks”

− Leadership change at MOH meant that we had to redo

advocacy/education work

• A highly skilled locally-based informatics and data management

staff fundamental

− Timely and sustained solutions have to be developed and implemented

locally

• Being responsive to expressed needs and identifying gaps in

the current system collaboratively is important

• Data need to be comprehensive and high quality

− Need to systematically query and address issues indicator by indicator

Next Steps for Continued Success

• Institutionalize program analysis and data use by

provision of tailored dashboards

− DHIS 2 must continue to replace paper/existing systems

• Continued advocacy, education at all levels

• Develop additional validation rules to further

improve data quality

• Continued capacity building at national, district and

facility levels, with particular emphasis on data use

• Teboho Koma, Tlohang Moeketse, Haroon Seruli, Pheletso Tau

• Lesotho Ministry of Health

• Tsele Moloeli, Rethabile Selebalo, Monaheng Maoeng, Kamohelo

Mokhesi

• Health Planning and Statistics Department (Mahlape Ramoseme,

Masebeo Koto)

• Program Leads

• PEPFAR/CDC Lesotho

• HISP South Africa

• Miriam Rabkin

• Blanche Pitt

• Kieran Hartsough

• Piku Patnaik

Acknowledgements

A New Frontier in Strategic...

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