1. The Blueprint for evolving single National Routine Health Information System (HIS) A Brown Bag Presentation of FHI360/SIDHAS Project Monitoring & Evaluation Directorate @MEMS II Office, Wuse Abuja. 15 th May 2013

2. Outline: Rationale for this presentation USG Health Portfolio structure and the NHSDP (2010 -2015) The evolving National Routine Health data reporting system (DHIS) Things to note Suggested Blueprint Take homes

3. Rationale To discuss the need, plausibility and the blueprint for single routine health Information System (HIS) in Nigeria

4. USAID Public Health Portfolio Structure HIV/AIDS and TB Team:HIV/AIDS and TB Team: is an integrated office that seek to improve access, coverage and sustainable capacity for HIV/AIDS and TB services in Nigeria –Assistance Objective 3: –Assistance Objective 3: Increased Nigerian Capacity for a Sustainable HIV/AIDS and TB Response Health, Population and Nutrition Team:Health, Population and Nutrition Team: is an integrated office that seeks to improve basic health services, HIV/AIDS, child survival, malaria, tuberculosis, population and maternal and child health and nutrition services. –Assistance Objective 4: –Assistance Objective 4: Increased Use of High-Impact Health Interventions The Biggest Assumption: Accurate and timely data to gauge the impact of the national response will be available.

5. CDC Public Health Portfolio Structure Strengthening Public Health Systems:Strengthening Public Health Systems: provides technical leadership and direct assistance to  strengthen epidemiology, surveillance, laboratory, blood safety, operations research, and workforce capacity—essential components for strong, sustainable public health systems.  Institutionalize Nigeria HIVQual (NHIVQual)  Establishment of National EMR Dataware house

6. CDC Public Health Portfolio Structure Development of National Medical Laboratory Strategic PlanDevelopment of National Medical Laboratory Strategic Plan  National and International Accreditation of Medical Laboratories  Establishment of a national reference lab for TB and other diseases Establishment of Nigeria Center for Disease ControlEstablishment of Nigeria Center for Disease Control The Biggest Assumption:The Biggest Assumption: Accurate and timely data to gauge the impact of the national response will be available. 6

7. USG Health Portfolio CSOs, CBO and Private Sector Health Portfolio GoN Health Portfolio

8. What is USG’s Commitment?

9. Data Source: Data Source: 2011 Annual NHMIS Report

10. Analysis of national routine health data reporting Table 1 Health Facilities in Nigeria by Type and Ownership, 2012 Type Ownership Total PublicPrivate Primary218088290 30098 (88%) Secondary9693023 3992 (12%) Tertiary7310 83 (0.002 %) Total228501132334173 PHCs accounts for 88% of the HFs in Nigeria. If all PHCs report complete dataset, 88% national report is met. Reporting from all PHCs is under the control of LGAs HMIS Officers. LGA-led Integrated health data management approach can solve our problem. Data Source: FMoH/DPRS 2012

12. Long History …… Unending Discussion

14. 22miles bridge : The Chinese sea bridge which will cut travel by 200 miles – US Mail Online 20miles: Connect US to China Port

15. 1.To make truly GoN-owned high quality routine health data available (from both the private and public sectors) and 2.To plan for and build sustainable NRHIS around the GoN structures and levels with expert TA and supportive supervision from all in-country-IPs. What is the central purpose of strengthening the National Health Management Information System (NHMIS) ?

16. Principles & Context: : GHI Principles: a new business model aimed at delivering dual objectives: achieving significant health improvements creating an effective, efficient and country-led platform for the sustainable delivery of essential health care and public health programs. ( (HIV/AIDS, Malaria, TB, INMCH, Nutrition, FP/RH, NTDs) Third-Ones Principles: One agreed country level Monitoring and Evaluation System. ) (M&E Framework for the NHSDP )

17. Health Services & Routine Data

18. Overview of Nigerian Health Data Nigerian Health Data Routine Health Data NHMIS Data (including Routine Surveillance) Disease Program Data – e.g. ATM Non-Routine Health Data Surveillance studies, Surveys, Operations Research, e.t.c What are we using Health Data/Information for in Nigeria: Health Program Design & redesign, management Decision Making? Health Policy Formulation and Development? Health Planning and Budgeting? What are we using Health Data/Information for in Nigeria: Health Program Design & redesign, management Decision Making? Health Policy Formulation and Development? Health Planning and Budgeting?

19. Initial Practice Range of Health Services Basic Community Health Services (100%) Basic Health Services (100%) Basic Health Services (30%) Specialized Healthcare Services (70%) Basic Health Services (10%) Specialized Healthcare Services (90%) Range of Data Reporte d Community NHMIS Facility NHMIS Disease Programs Report Facility NHMIS Disease Programs Report Communities ------------------- CHEWs Communities 1 0 HFs ------------- PHCs 1 0 HFs ------------- PHCs 2 0 HFs ------------- GHs 2 0 HFs ------------- GHs 3 0 HFs ------------- UTHs & FMCs 3 0 HFs ------------- UTHs & FMCs Referral Chain

20. Recent Shift Range of Health Services Integrated Basic Health Screening & Services (100%) Integrated Basic Health Services (100%) Decentralized Special Services Integrated Basic Health Services (30%) Specialized & Integrated Healthcare Services (70%) Integrated Basic Health Services (10%) Specialized & Integrated Healthcare Services (90%) Range of Data Reported Integrated Health dataset Community NHMISplus Facility NHMISplus Disease Programs Report Facility NHMISplus Disease Programs Report Communities --------------- -CVs / CORPs/CBOs Communities 1 0 HFs -------------PHCs -------------PHCs 2 0 HFs -------------GHs -------------GHs 3 0 HFs ------------- UTHs & FMCs 3 0 HFs ------------- UTHs & FMCs Referral Chain

21. Routine Health Services Databases

22. Databases: Schematic Overview 2 (Proposed) DHIS 2.0: (Web-based Version ) NHMIS Disease Programs NHMIS INMCH NTDs TB / HIV/AIDS / Malaria NutritionFP/RH

23. Hierarchical Organization of the Integrated DHIS Platform Routine Health Data ATM datasets HIV & AIDS dataset Malaria dataset NHMIS dataset NPI dataset Epid. & Disease Surveillance dataset TB & TB/HIV dataset SRH/HIV Integration dataset

25. Can DHIS address the bigger picture about NHMIS? Align USG instance metadata with GoN DHIS instance Derive PEPFAR-NGIs from the data elements contained in the National MSFs Integrate Data Management Process at all levels. IT Programming codes Legend:

26. Current challenges: 1. Multiple DHIS platforms and its inter-operability & 2. Complicated data management process eNNRIMS DHIS Instance Development partners’ DHIS2.0 platform National DH&PRS DHIS Instance USG DHIS Instance National HIV Response routine datasets (mainly from 2 0 and 3 0 Facilities) Project-level HIV/TB/Malaria and NHMIS routine datasets (mainly from 1 0, 2 0 and 3 0 Facilities) (mainly PEPFAR-NGIs from 1 0, 2 0 and 3 0 Facilities) USG HIV and TB Program routine datasets (mainly PEPFAR-NGIs from 1 0, 2 0 and 3 0 Facilities)

27. Solution: Moving towards one national Integrated health data management system 1.GoN-led and driven data management system (sustainability) 2. Promote integrated health data management 3. One sole source for routine health data @ National, State and LGA-levels 4. Considers all-levels of health care including community. National DH&PRS DHIS Instance Community –level data LGAs PHCs data 2 0 HFs data 3 0 HFs data

28. Suggested Blueprints Confidence-building on GoN System’s ability to deliver timely routine health data if supported by Donors and IPs. Address Institutional weaknesses and capacity constraints for functional HIS at Community-level, HFs, LGAs, State and National levels Institutionalize LGAs Data Management team and data entry HUB approach –Strengthen our M&E system for better efficiencies and cost reduction –Advocate for IPs to unify tools, systems and processes for M&E.

29. Deep Reflection! The problem of M&E systems development in Nigeria is caused by IPs and their Donors! The fragmentation in terms of M&E systems and processes is as a result of each IPs/Donors’ requirements. If only M&E processes, systems and tools were unified, we will have a more organized system that produces timely and unified/harmonized program results.

30. What are our fears about having One central HIS for routine health data in Nigeria? FEARS Delayed access to routine data by stakeholders Quality of what is coming through the Central HIS Server Administration and IT infrastructural capacity requirement (5,000+ Users in one Window) Resource Coordination (Single funding basket) Stakeholders’ Representative Data Management Team in place @ National level

31. Is it likely to offer any cost saving measure on the long run? Yes ! The cost of: –HR need and capacity development for HIS management @ all level. –IT Infrastructure and Maintenance –Uninterrupted power supply – Maintaining streamlined Data Management Systems, Processes and Operations such as: Data Collection and Data Entry Data Verification and Data Quality Assurance (DQA) and Change Management Process (CMP)

32. Would this process have a chance for capacity transfer to the Government staff; leading to sustainability on the long run? Yes! Through the: –Stakeholders’ Representative Data Management Team @ National level –Establishment of Integrated Data Management Team (GoN and IPs) at LGAs and State-level –Initial Joint Routine Supportive supervision and DQAs –Training of M&E practitioners for better results at the State and LGA levels.

33. Thanks for Listening Lets Discuss