Presentation on theme: "HIS implementation in Ethiopia: case studies from AAHB Woinshet Abdella PhD Student Department of Informatcs University of Oslo."— Presentation transcript:
HIS implementation in Ethiopia: case studies from AAHB Woinshet Abdella PhD Student Department of Informatcs University of Oslo
CONTENTS Background •Ethiopia / Health Care System HISP Ethiopia DHIS Implementation in Addis & Oromia Challenges
Ethiopia Population million Area – 1.1 million km 2 Decentralized administrative structure •9 regional states & two city administrations 580 weredas (districts) Regional sates are autonomous Poor literacy, education, health status
Health Care System MOH, Regional health bureaus, Zonal health departments, Wereda/Sub-city health offices, Health Facilities Under developed Health service coverage – 61% MMR – 871/100,000, U5MR – 140/1000 High Infectious & communicable diseases HIS is primarily manual & under developed
HISP-Ethiopia Project Initiation •Through a collaboration of the Department of Information Science, Addis Ababa University (AAU) and the University of Oslo in February Partners •AAU; regional health bureaus of Ethiopia; global HISP
HISP-Ethiopia Objective •Introducing computer based HMIS in Ethiopia in view of supporting local analysis and use of data
HISP-Ethiopia HISP Members •4 PhD students / 7 Masters students (one Norwegian) •5 DHIS facilitators hired by HISP Research Sites for HISP Ethiopia •Addis Ababa, Oromia, Tigray, Amhara, Benishangul-Gumuz DHIS implementation is being carried out •Addis & Oromia – since Jan 04 •Others – since June 04 Different stages of implementation
Case Studies from Addis Research Objective •key research objective is to broadly understand the challenges and opportunities with respect to the integration of existing paper-based HIS with computer- based systems in Ethiopia. Theoretical Perspective •ANT Research Approach & context •PAR AR intervention: HIS implementation Intervention into health organizations (AAHB & OHB) One DHIS facilitator for each region
Research Approach & context Research Site •Addis Ababa health bureau (AAHB), •10 sub-cities (districts) •500 public & private health facilities, •located in Addis Ababa city Administration (Province). •Addis Ababa is the capital city of Ethiopia (540 km2 ) •Population is 3 millions.
Research Approach & context Researcher Role. •The role assumed was an involved researcher through action research. •Qualitative data collection method was employed including photography, observations, interviews, discussions, meetings, workshops, training, action experiments, document analysis, telephone calls, visit related institutions, informal lunch/tea meetings.
Research subjects •managers and planners at different levels of the health structure, the health workers responsible in data collections and analysis. Research Approach & context
DHIS Implementation in Addis Negotiate research access (KK) Situation analysis (Mar 03 – Aug 03) •Visits to Health bureaus & HFs Initiating the Design / implementation process with AAHB/OHB (Dec 03) (Bureau) EPR was just introduced then Prototype system was developed and populated with 9 months own data
DHIS Implementation in Addis Ababa Demonstration of the prototype DHIS Addis (Jan 04) •The experiences gained revealed the problems with the existing HMIS Data duplication, fragmentation, … •Local requirement (Morbidity/Mortality data handling) identified that DHIS does not support efficiently Developing minimum health data set & health indicators was proposed
DHIS Implementation in Addis Ababa Major decisions •The proposal for standardizing data set/health indicators accepted •Adapting DHIS based on new dataset and reporting requirement •Adding module to accommodate M/M data handling •Implementing DHIS to ALL Sub-cities. Team formed
The research team was composed of Bureau level, Bureau level Bureau level •Bureau head; •health service head (leader of the project on the part of the bureau), team leader, and senior expert; •family health head, team leader and expert; •Disease Prevention and Control head; IDSR team leader, TB / Leprosy and HIV/Aids program team leader and senior expert; •IEC expert; •Network administrator; Sub-city Level •two family health experts Facility Level •two health facility managers; And the researcher.
DHIS Implementation in Addis Ababa Two Parallel activities performed •Standardized data set, health indicators, data collection & reporting instruments & procedures (data flow, …) development Draft prepared by the group presented for workshops, comments incorporated, the draft was further developed in a series of long meetings, •Development of Morbidity & Mortality module Iterative / incremental (involved one major revision)
DHIS Implementation in Addis Ababa Use of DHIS as a prototyping tool to better understand user requirements for producing an improved & useful system – which potentially increases data use The standardized data set is implemented in all facilities DHIS adapted, the new module incorporated •(Input Form, DHIS Data Flow, Data Entry (next slide), Pivot Table Report, Standard Report ) Input FormDHIS Data FlowPivot Table ReportStandard Report Input FormDHIS Data FlowPivot Table ReportStandard Report
Monthly Routine Data Entry/Edit Form Monthly Morbidity and Mortality Data Entry/Edit Form
DHIS Implementation in Addis DHIS is implemented •All districts (10 sub-cities) and AAHB initially •Scaled to health facility levels 18/23-Health centers & 5/5-Hospitals (when resource / situation allowed ) Training (DHIS/computer basics) was given to sub-city/bureau/HF health staff / managers / data clerk / DHIS facilitators (with own data) Technical support is being provided by the facilitator Participatory design July 2005, Workshop for evaluating one year experience of the use DHIS
Observations … DHIS Software is well-tested & supports •Data aggregation; data sharing; health structure implementation; easily adaptable for new needs, which is inevitable; rapid set-up of DHIS application for a new setting Complaints from different actors (use of MS Access in DHIS – DHIS 2 is a response)
DHIS Implementation in Oromia Collection/reporting instruments and software prepared for Addis is shared by Oromia & other regions Followed similar approach •Some of the differences The process was slower when compared to Addis The minimum data set prepared for Oromia not yet adopted by the region DHIS implementation status •Some Weredas of East Shewa zone (based on computer availability) •Is being rolled out to the remaining zones (at the zone level only)
CHALLENGES Improving data quality, data analysis and use Reduce / Improve dataset Achieving partnership with MOH Scaling & Sustainability Over burdened health worker Limited resource Negotiating with multiple actors Parallel systems