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HIS implementation in Ethiopia: case studies from AAHB Woinshet Abdella PhD Student Department of Informatcs University of Oslo.

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Presentation on theme: "HIS implementation in Ethiopia: case studies from AAHB Woinshet Abdella PhD Student Department of Informatcs University of Oslo."— Presentation transcript:

1 HIS implementation in Ethiopia: case studies from AAHB Woinshet Abdella PhD Student Department of Informatcs University of Oslo

2 CONTENTS  Background •Ethiopia / Health Care System  HISP Ethiopia  DHIS Implementation in Addis & Oromia  Challenges

3 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

4 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

5 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

6 HISP-Ethiopia  Objective •Introducing computer based HMIS in Ethiopia in view of supporting local analysis and use of data

7 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

8 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

9 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.

10 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.

11  Research subjects •managers and planners at different levels of the health structure, the health workers responsible in data collections and analysis. Research Approach & context

12 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

13 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

14 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

15  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.

16 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)

17 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

18 Monthly Routine Data Entry/Edit Form Monthly Morbidity and Mortality Data Entry/Edit Form

19 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

20 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)

21 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)

22 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


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