1. DISTRICT HEALTH INFORMATION MANAGEMENT
DISTRICT HEALTH INFORMATION MANAGEMENT SYSTEM DHIMS II- ADDRESSING THEHEALTH INFORMATION GAPS THE EXPERIENCE OF THE GHANA HEALTH SERVICE
Dr. Frank Nyonator, Dr. Anthony Ofosu , Mr. Dan Osei , Mr. Dominic K Atweam
Ghana Health Service-Policy Planning Monitoring and Evaluation Division

2. Outline of presentation
HMIS Challenges
ICT Solutions
Requirements and Security
Innovation
Lessons learnt
Conclusion

3. HIMS Challenges
Obtaining routine service data (USEFUL DATA) from all health facilities across Ghana has been the single most immediate challenge of the health sector
USEFUL DATA for health managers at all levels for planning, budgeting and decision-making has not been timely or complete.
Difficulty in tracking both reporting and non-reporting facilities
Greater challenge for monitoring and evaluation activities of the sector.
This culminates in the slow response of GHS in addressing potential health emergencies and epidemics and planning based on estimates.
Although upstream activities are well-defined, obtaining routine service data from all health facilities across Ghana has been the single most immediate challenge of the health sector.
GHS relies on routine service data collected and passed on from the facilities at the district level to the regional and then to the national level.

4. ICT Solution
GHS Collaborated with the University of Oslo developed a software called the District Health Information Management System (DHIMS2)
DHIMS2 is a comprehensive HMIS solution for the reporting and analysis needs of district health administrations and health facilities at every level.
It’s been designed to
Provide a comprehensive HMIS solution based on data warehousing principles and a modular structure which can easily be customized to the needs of different health systems - national, regions, districts, and facilities
DHIMS2 is centralized, which enables easy, online updates and deployment of the application.
After and extensive review of our HIMS called DHIMS in 2009, GHS through collaboration with the University of Oslo in Norway, developed a software called the District Health Information Management System (DHIMS2). DHIMS2 is a comprehensive web-based Health Management Information System (HMIS) solution for the reporting and analysis needs of district health administrations and health facilities at every level and is hosted at a central level on a sever in Accra.
The features of the DHIMS2 that made it the preferred choice and appropriate for the project was that it provides comprehensive ICT solution based on data warehousing principles and a modular structure, which can easily be customized to the needs of different health systems and at different user levels - national, regional, district, and facility.
DHIMS2 has data entry alternatives that can be customized to replicate paper forms – to simplify the process of data entry and a dashboard for monitoring and evaluation of health programs that can also be user customised to allow different indicators to be generated and analysed for linking specific health outcomes, with the added functionality of, carrying out data quality analysis
The DHIMS2 offers a very user-friendly interface that is easy to navigate. However, training is still required to equip data entry personnel as well as end-users to utilize DHIMS2 optimally for the desired outcome. This is based on three fundamental premises – knowing what one is looking for (whether data element or indicator), where one requires this data or information from (location- regional, district, sub-district or facility level) and when (period or point) time reference. 

DHIMS2 is accessible in all 170 districts and is being used by health facilities and district health directorates to collect, collate, transmit and analyze routine health service data. All staff in District Health Directorates and health facilities with the required capacity for DHIMS2 management has been registered as secure users on the DHIMS2 server. 
There are currently 5,563 registered users from government, quasi-government, private and faith-based facilities that are submitting their service report each month.

5. ICT Solution-Accessibility
DHIMS2 is accessible in all 170 (216) districts and is being used by health facilities and district health directorates to collect, collate, transmit and analyze routine health service data.
All staff in District Health Directorates and health facilities with the required capacity for DHIMS2 management has been registered as secure users on the DHIMS2 server.
There are currently 5,563 registered users from government, quasi-government, private and faith-based facilities that are submitting their service report each month.
DHIMS2 has facilitated the collection of data from all the districts in the country in real time. To a large extent private , government and faith-based organizations are reporting through the DHIMS2.

6. Requirement & Security
The only requirements for the user is to have a web browser installed on a computer and have an Internet connection.
To access DHIMS2 you do not need any software to be installed on your computer. It works independent of the operating system on your personal computer.
Data is encrypted , SSL certficate authentication
Requires strict user guide line
Data Is Protected
GHS DHIMS2 uses advanced, industry-recognized safeguards and procedures, such as password-protected login, the toughest commercially available encryption technology and firewall protected servers.
Password Protected Access
Each DHIMS2 user has online account created unique password.
GHS controls who accesses GHS data and what they can see and do. Once you set up a user, only trusted Data Center operational staff access GHS data.
DHIMS2 offer multiple permission levels that let us limit the access privileges of each user.
Encrypted Transmission of Data
Districts data travels between your computer and GHS server it is encrypted by a technology called Secure Sockets Layer (SSL) using 128-bit encryption.
This is the same technology used by banks and offers the highest level of encryption currently supported by commercial Web browsers.
The lock icon in the bottom of your browser window indicates that your data is shielded from unauthorized access while in transit.

7. Personalized Dashboard that Managers can track their service data of interest
Every user on DHIMS2 has his or her own personalized dashboard. This depends on what service area you are interested in

8. Quick reports for managers
Figures and graphs can be generated from DHIMS for reports and presentations

9. INNOVATION
GHS ensured in-house capacity building and development of DHIMS2 application .
All modifications done on the DHIS2 platform to adapt it for GHS use as DHIMS2 were accomplished by our own staff, trained by a TA ‘s from the University Of Oslo.
We have accomplished a nationwide implementation of a web-based data collation and reporting system involve private, quasi government and government facilities without an initial pilot project.
Enumerate the role of CHIM-PPMED , CDC, Oslo HISP, etc. The key advantage of our approach is that low cost of roll-out, as we are using in-house capacity

10. Implementation
GHS to date has trained 5 health workers in each of the 170(216) districts (850 health workers), 180 system administrators across the 10 Regional Health Directorates and all 170(216) District health directorates to support the use of DHIMS2 in collecting and collating health service data.
Senior Managers at the headquarters level, Regional and district level have also been trained and all now use DHIMS2 to monitor the service utilization and inputs as well as to generate their own reports due to the real time data on DHIMS2
Enumerate the role of CHIM-PPMED , CDC, Oslo HISP, etc

11. LESSONS LEARNED
When routine health service data is visible, easily available and accessible on a common platform for all managers it leads to improvement in Data Quality.
Dealing with the Human Factor and Change management are the most important challenges to overcome when putting in a technology to address service delivery bottlenecks
there are constructive critiques on what the typical trends of specific indicators should look like versus what anomalies are being recorded to prompt further inquiry.
This leads to continuous discussions on how to improve upon reporting rates, data completeness, accuracy and internal consistencies of the routine health service data.
This also helps to draw the true pattern of service utilization against the knowledge of the interventions that are being put into the health care service delivery system across the various districts
Human beings are complex and to succeed you need to manage the change well

12. CONCLUSION
Introducing DHIMS2 into the Health Sector has so far been successful in mitigating the challenges with service data collection and reducing the information transmission bottlenecks and timeliness. .
Prior to the creation and introduction of DHIMS2, the information systems and sub- systems within these defined levels were mostly spreadsheet-based.
This made the data management process prone to many errors with the knock on effect of many local level managers distrusting their own data, hence rarely using it in decision-making or predicting trends.
In turn data collation and aggregation at central level was made even more difficult. This resulted in heavy reliance on international estimates

13. Integrated architecture of interoperable systems
Integrated architecture of interoperable systems and infrastructures (paper, computers, internet, mobiles telephones
Replicated at each administrative level:
National
Regional
District
Reports, GIS, Pivot, Graphs etc
DHIS2
Data from/to mobile
phones
Data Warehouse
Data capture from
Paper reports
DHIS2/NBIT
Import e data
Household Tracking
Monthly summary Reports
This is the way forward for the GHS an integrated interoperable system for health information which will make use of mobile phones, computers to provide information for managers to take critical decisions
Export e summary data
Medical Records
Logistics MIS
Human Resource Records
Open MRS
Telephone
Open LMIS
iHRIS
Register pregnant women and immunization