1. Health Management Information System Murali Krishna

2. Frame work Introduction Need of HMIS Subsystems of HMIS Steps of HMIS HMIS –Maharashtra – Sub centre – PHC – District Level – State Level Draw backs References

3. Introduction-Definitions System System - Any collection of components that work together to achieve a common objective. Health System -. Health System - All the activities whose primary purpose is to promote, restore or maintain health. Information Information - Meaningful collection of facts or data. Information System Information System - Systems that provide specific information support to the decision-making process at each level of an organization. Health Information System Health Information System - A set of components and procedures organized with the objective of generating information which will improve health care management decisions at all levels of the health system.

4. HMIS A system which provides a required information to each level of management at the right time, in the right form, covering the desired quantity and quality so that it may form basis for decision making. HMIS: process of – Collection, – Transmission, – Storage retrieval, – Analysis, – Interpretation and preparation for utilization and – Presentation of information which is necessary for decision making for effective management.

5. HMIS- Subsystems Epidemiological surveillance: Identification/notification of diseases and risk factors, Investigation, follow-up, control measures Routine service reporting: Hospital/health center based indicators on performance of the various services Specific program reporting: Various programs in operation in a particular country, topically include; RCH, AIDS, Malaria, TB, Leprosy, Integrated Child health and many other programs under different departments Administrative systems: Account and financial systems Drugs management (procurement, storage and delivery) Personnel management Asset management (equipment/buildings etc) Maintenance system Vital registration: Birth, deaths, migration etc

6. Need of HMIS HIS makes information which is necessary for the following purpose 1.Measurement of Community Health 2.Community Diagnosis 3.Finding solution to health problems 4.Prioritization 5.Planning of interventions 6.Directing and controlling health programmes

7. Need of HMIS 8.Development of procedures, definitions, classification and methods of collection analysis, storage and retrieval of data. 9.Establishing administrative standards 10.Carrying on performance appraisal 11.Determination of met and unmet health needs 12.Monitoring and evaluation of health programmes 13.Carry out IEC activities for community and decision makers 14.Demand social support for health activities 15.Social health Legislation

8. Choice of information Relevant: related to what is being studied and related to the particular programme, activity or service. Sensitive: should change with the changes in the situation under scrutiny Valid: expression of the degree to which information enables a measurement to be carried out of what it purpose to measure Specific: Information should reflect changes only in the variable concerned Sufficiently accurate: Capable of proper analysis and interpretation : Should lend itself for analysis and interpretation Timely

9. Steps involved in HMIS Step 1: Identifying information needs and feasible indicators Step 2: Defining data sources and developing data collection instruments for each of the indicators selected Step 3: Developing a data transmission and processing system Step 4: Ensuring use of the information generated Step 5: Planning for health MIS resources Step 6: Developing a set of organizational rules for health information system management

10. Responsibilities & Flow of Information Sub centre-ANM PHC-Pharmacist, computer(designation of a statistical assistant) District-District statistical officer- health, family welfare Dt. TB, Malaria, Leprosy officers State Level-Dy/Joint director Statistics- Family welfare –Dy/Joint director- Vital statistics Surveillance Unit, SRS Central level: CBHI, Statistics Division Department of Family Welfare, CGHS, Statistics Division- Department of Health SRS- head quarter

11. Subcentre level Sub-center to PHC: The person responsible for maintaining HMIS at sub centre level ANM. – Home-based records: Immunization cards, Growth-monitoring card, Maternal health card – Health worker based records: Pregnancy/birth card, death report form, child records, women’s register, workers work form.(most of times)

12. Records at sub centre 1.Eligible Couple Register including Contraception 2.Maternal and Child Health Register: 1.Antenatal, intra-natal, postnatal 2.Under-five register: 1.Immunization 2.Growth monitoring 3.Births and Deaths Register 4.Drug Register 5.Equipment Furniture and other accessories Register

13. Records at sub centre 6.Communicable diseases/ Epidemic Register 7.Passive surveillance register for malaria cases. 8.Register for records pertaining to Janani Suraksha Yojana 9.Register for maintenance of accounts including untied funds. 10.Register for water quality and sanitation 11.Minor ailments Register 12.Records/registers as per various National Health Programme guidelines (NLEP, RNTCP, NVBDCP, etc.)

14. Report to PHC Frequency: Monthly (The report has to be sent to PHC by 3 rd of month, during the monthly visit to PHC in format provided consisting of 16 pages-rather a book ) Performance report – report on all aspects of performance Family planning, immunization, Diarrheal diseases, Malaria, leprosy, Blindness, Deaths of all types Inventory report – Malaria drugs, Family planning, vaccines, ORS, Basic drugs and others. it has column on consumption, balance and whether it is sufficient or not Basic equipment facilities –It shows the list of 20 basic equipment and in case they are out of order from a particular date-quarterly

15. Contents of Report Safe motherhood:  ANC registration  Anemia (IFA distributed)  ANC  Treated of complicated pregnancies  Pregnancy outcome  Order of live Birth  Birth weight, Low birth weight babies,  PNC  RTI/STI  Janani Suraksha Yojana  Expenditure of JSY Family planning  Family planning method  Cu T Insertions  Other FP methods  Information regarding newly married couple (one Year)  Stock of Important Medicine Child care  Vaccination  Vitamin A  IFA  Surveillance of Vaccine preventable Diseases  Neonate and infant deaths and reasons New Sanjeevani Yojana  Financial assistance to mothers  Dai Meetings  Check up of children  Malnourished children check up  Changes in grades of Malnourishment  Nutritional Status of Neonate and infants IEC NVBDCP

16. Primary Health centre The data thus obtained from the sub centre’s and from the PHC are compiled at PHC in the provided format for PHC Entered online on http://phd.nic through Block computer operator (In Wardha all 8 blocks have been provided with computers with internet and Block supervisor, who got a training of one day at district level).http://phd.nic Every PHC is provided with an ID and a password for this purpose. The data has to be entered by 6 th or 7 th of the month.

17. PHC If the data entry is delayed it is discussed in the monthly Medical officers meeting at district level on 8 th 9 th or 10 th. The persons responsible for MIS at PHC level are – Medical officer – computer (designation of a statistical assistant), – Pharmacist

18. Contents of report Safe motherhood:  ANC visits  Prevention and treatment of Anemia  Pregnancy beyond 28 weeks – caste and religion wise  Treatment of complicated pregnancies  Caesarian deliveries  Outcome of pregnancies  Order of Live births  Birth weight  Low Birth weight babies  Home visits during PNC  MTP  RTI/STI  Wet Mount Test  JSY  Financial assistance and expenditure under JSY  Maternal Deaths  Reasons of maternal deaths  Family Planning-methods, Age wise, sex wise surgeries, deaths, Cu T follow up

19. Contents of report Child care Vaccination Vitamin A Morbidity of Under Five Neonate, infant under Five deaths Reasons of deaths Adolescent care /health services Health campe arranged Reports of Ashram School check up Stock of Important Medicines Dai Meetings Nutrition: Health check up malnourished children Changes in grades of malnourished children Sanitation: Water sample exam Administrative details Vehicles IEC National programmes NLEP RNTCP IDDCP NVBDCP Epidemic if any

20. Contents of report Equipment, stock, Material Minimum Need programme Report of Communicable and Identified non communicable diseases Report of Snake Bite Birth / Death registration details

21. Data quality The degree to which the data or statistics measure what was intended to be measured when the data collection system was designed – Inappropriate data collection – Failure to report data – Unintentional recording and reporting of inaccurate data – Intentional recording and reporting of false data – Errors in processing data - Editing, Coding, Data entry, Tabulating

22. Monitoring mechanism (IPHS) Monitoring Internal mechanisms: 1.Supportive supervision and Record checking at periodic intervals by the Male and Female Health supervisors from PHC (at least once a week) and by 2. MO of the PHC (at least once in a month) etc. as per check list for Sub-centre. External mechanism: Village health and sanitation committee, Evaluation (by an independent external agency, client satisfaction survey etc. by NGOs)

23. District to state HQ The persons responsible for HMIS at District level is District statistical officer- health, family welfare Dt. TB, Malaria, Leprosy, Blindness officers etc., Each program sends a summary of program statistics District Statistical officer: (Mr. Sanjay Rathod for Wardha) trained at Pune for two days. He ensures that all PHC level data entry and also the district level data for various programmes. The data from the district should be completed by 15 th of month.. He also generates a district level report Every month. Every Month a meeting is held at DHS, Mumbai of all the District Statistical officers.

24. State level State level: Dy/Joint director Statistics- Family welfare – Dy/Joint director- Vital statistics Surveillance Unit Sample Registration system

25. Advantages of Computerization – More speedy communication of data – At national, state & district levels, processing can be done for valuable information Obtaining coverage levels for various activities – Age-specific & area-specific figures – Check suspect data from PHCs – Identification of problems requiring research – Prompt reporting of results – Achieve data standards – Data for comparative purposes

26. September report is already available http://maha-arogya.gov.in/hmis/default.htm Drawbacks of HMIS 1.Exhaustive report 2.Not utilized at local level 3. poor quality of data collected 4.Poor utilization of data at all levels

27. References Epidemiology and Management for all: PV Sathe and AP Sathe URL: http://maha-arogya.gov.in/ Mrs. M kataria : Strengthening of health Management information system 1995- 96:NIHFW Ranganayakulu Bodavala:Evaluation of Health Management Information System in India: Need for Computerized Databases in HMIS. Harvard School of Public Health