1. RWANDA INTERGRATED HEALTH MANAGEMENT INFORMATION SYSTEM Ministry of Health

2. Rwanda’s Health System Tertiary hospitals ~ 250 ~ 255, 000 National (~ 12 m) Health care delivery system Av. Catchment area pop Health centers Health posts No. of public facilities / CHWs 484 380 45,011 District hospitals ~ 23 000 Type of service offered ▪ Specialized hospitals serving the entire country ▪ Medical training ▪ Provide government defined “minimum package of activities at the peripheral level (MPA) ▪ This includes complete and integrated services such as curative, preventive, promotional, and rehabilitation services ▪ Supervise health posts and CHWs operating in their catchment area Community-based : Prevention, screening and treatment of malnutrition Integrated Management of Child Illness (CB-IMCI) Provision of family planning Maternal Newborn Health (C-MNH) DOT HIV, TB and other chronic illnesses Behavior change and communication Provinces (5) Sector (416) District (30) ▪ Provide government defined “Complementary package of activities (CPA) (C-section, treatment of complicated cases,.. ▪ Provide care to patients referred by the primary health centers ▪ Carry out planning activities for the health district and supervise district health personnel 36 7 ▪ Services provided are similar, albeit reduced from, that by Health Centers. ▪ Established in areas which are far from health centers, ▪ Services include curative out-patient care, certain diagnostic tests, child immunization, growth monitoring for children under five years, antenatal consultation, family planning, and health education Village (14,837) Cell (2148) Administrative structure Community Health Workers 80% of burden of disease addressed at this level 4

3. Intergarted tools for reporting (At facility level)  Patient file  Registers  Reporting forms http://moh.gov.rw/index.php?id=135http://moh.gov.rw/index.php?id=135  Standard Operating Procedures http://moh.gov.rw/index.php?id=154 http://moh.gov.rw/index.php?id=154  Metadata Dictionary where all indicators are defined. http://moh.gov.rw/index.php?id=139 http://moh.gov.rw/index.php?id=139  Publication of routine data like Annual Statistical booklet 2008-2014 http://moh.gov.rw/index.php?id=156http://moh.gov.rw/index.php?id=156

4. Reporting tools review to reduce workload by removing unused data New HMIS (based on DHIS-2) Old (GESIS) Size ( pages)12 DH46 DH 11 HC26 HC New sections added IMCI (Under 5 years)There was none before or section was expanded Neonatal Nutrition screening Physiotherapy GBV (Violence basee sur le genre) Mental Health Blood bank Simplified age groups Minimal and only on applicable data elements (most diseases are = 5 years) They were too many which made data recording a burden ICD-10 and disease definitions Matched diseases with ICD-10 classification and improved case definitions

5. R-HMIS reporting modules  Modules designed in R-HMIS (DHIS2)  HMIS reporting forms (DH, HC, Referals, Private facilities)  Rwanda Integrated Disease Surveillance  TB Quarterly report and ETB  CHW monthly Report (SISCOM)  HIV Module  Neonatal and child death report  Weekly child mortality report  Annual reports  Maternal Death audit reports

6. Contribution of Community Health Workers 1 male 1 female 1 Female in charge of maternal Health 3 CHWs/ village

7. Infant and Under-five Mortality from the RDHS/RIDHS, 2005, 2007-08, 2010, and 2014-15

8. Maternal Mortality Ratio form the RDHSs 2000, 2005, 2010, and 2014-15 1071 750 476 210 Maternal mortality also dropping steadily

9. Rwanda Data Warehouse & Dashboard Data Ware- house Data Ware- house Periodic Reports Formatted reports Indicator Trend Graphs Pivot tables Thematic Maps INPUTS OUTPUTS GESIS Trac Net Trac Net Interoperability layer Data Dictionary Data Dictionary Data export Other DB Other DB Facility Registry IDSR

10. Main Challenges & Plans to address them ChallengesNext steps to address them 1Population growth- Increase accessibility to FP services through multisectoral approach 2Shortage of skilled health professionals (especially doctors) -In country training for health professionals through HRH Program (doctors, nurses, midwives and Hospital managers) with US Universities -Increase the intake in the medical school (x2) -Encourage private sector to invest in the medical education 3 Financial sustainability of health facilities - Framework for public hospitals to generate money through creation of private wings - Partnership with private sector in expanding care for Primary health care (PPCP framework for Health posts) -Strengthening community health workers cooperatives in generate more incomes Quality of data -Mechanisms are in place like ISS/DQA, Coordination meeting, data review by services before submission, data review and validation by Programs before use and feedback from HMIS central level.

11. Thank You More Focused Decision Making saves much resources and time