Presentation on theme: "HIS implementation in Ethiopia: case studies from AAHB"— Presentation transcript:
1HIS implementation in Ethiopia: case studies from AAHB Woinshet AbdellaPhD StudentDepartment of InformatcsUniversity of Oslo
2CONTENTS Background HISP Ethiopia Ethiopia / Health Care SystemHISP EthiopiaDHIS Implementation in Addis & OromiaChallenges
3Ethiopia Population - 72+ million Area – 1.1 million km2 Decentralized administrative structure9 regional states & two city administrations580 weredas (districts)Regional sates are autonomousPoor literacy, education, health status
4Health Care SystemMOH, Regional health bureaus, Zonal health departments, Wereda/Sub-city health offices, Health FacilitiesUnder developedHealth service coverage – 61%MMR – 871/100,000, U5MR – 140/1000High Infectious & communicable diseasesHIS is primarily manual & under developed
5HISP-Ethiopia Project Initiation Partners Through a collaboration of the Department of Information Science, Addis Ababa University (AAU) and the University of Oslo in February 2003.PartnersAAU; regional health bureaus of Ethiopia; global HISP
6HISP-Ethiopia Objective Introducing computer based HMIS in Ethiopia in view of supporting local analysis and use of data
7HISP-Ethiopia HISP Members Research Sites for HISP Ethiopia 4 PhD students / 7 Masters students (one Norwegian)5 DHIS facilitators hired by HISPResearch Sites for HISP EthiopiaAddis Ababa, Oromia, Tigray, Amhara, Benishangul-GumuzDHIS implementation is being carried outAddis & Oromia – since Jan 04Others – since June 04Different stages of implementation
8Case Studies from Addis Research Objectivekey 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 PerspectiveANTResearch Approach & contextPARAR intervention:HIS implementation Intervention into health organizations (AAHB & OHB)One DHIS facilitator for each region
9Research Approach & context Research SiteAddis 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.
10Research Approach & context Researcher Role.The role assumed was an involved researcher through action research.Qualitative data collection method was employed includingphotography, observations, interviews, discussions, meetings, workshops, training, action experiments, document analysis, telephone calls, visit related institutions, informal lunch/tea meetings.
11Research Approach & context Research subjectsmanagers and planners at different levels of the health structure, the health workers responsible in data collections and analysis.
12DHIS Implementation in Addis Negotiate research access (KK)Situation analysis (Mar 03 – Aug 03)Visits to Health bureaus & HFsInitiating the Design / implementation process with AAHB/OHB (Dec 03) (Bureau)EPR was just introduced thenPrototype system was developed and populated with 9 months own data
13DHIS Implementation in Addis Ababa Demonstration of the prototype DHIS Addis (Jan 04)The experiences gained revealed the problems with the existing HMISData duplication, fragmentation, …Local requirement (Morbidity/Mortality data handling) identified that DHIS does not support efficientlyDeveloping minimum health data set & health indicators was proposed
14DHIS Implementation in Addis Ababa Major decisionsThe proposal for standardizing data set/health indicators acceptedAdapting DHIS based on new dataset and reporting requirementAdding module to accommodate M/M data handlingImplementing DHIS to ALL Sub-cities.Team formed
15The research team was composed of 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 Leveltwo family health expertsFacility Leveltwo health facility managers;And the researcher.
16DHIS Implementation in Addis Ababa Two Parallel activities performedStandardized data set, health indicators, data collection & reporting instruments & procedures (data flow, …) developmentDraft prepared by the group presented for workshops, comments incorporated, the draft was further developed in a series of long meetings,Development of Morbidity & Mortality moduleIterative / incremental (involved one major revision)
17DHIS Implementation in Addis Ababa Use of DHIS as a prototyping toolto better understand user requirements for producing an improved & useful system – which potentially increases data useThe standardized data set is implemented in all facilitiesDHIS adapted, the new module incorporated(Input Form, DHIS Data Flow, Data Entry (next slide), Pivot Table Report, Standard Report )
18Monthly Routine Data Entry/Edit Form Monthly Morbidity and Mortality Data Entry/Edit Form
19DHIS Implementation in Addis DHIS is implementedAll districts (10 sub-cities) and AAHB initiallyScaled to health facility levels18/23-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 facilitatorParticipatory designJuly 2005, Workshop for evaluating one year experience of the use DHIS
20Observations … 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 settingComplaints from different actors (use of MS Access in DHIS – DHIS 2 is a response)
21DHIS Implementation in Oromia Collection/reporting instruments and software prepared for Addis is shared by Oromia & other regionsFollowed similar approachSome of the differencesThe process was slower when compared to AddisThe minimum data set prepared for Oromia not yet adopted by the regionDHIS implementation statusSome Weredas of East Shewa zone (based on computer availability)Is being rolled out to the remaining zones (at the zone level only)
22CHALLENGES Improving data quality, data analysis and use Reduce / Improve datasetAchieving partnership with MOHScaling & SustainabilityOver burdened health workerLimited resourceNegotiating with multiple actorsParallel systems