1. Implementing District Health Information System (DHIS) in Botswana Omprakash Chandna Dept of Information Technology ochandna@gov.bw

2. Large number of facilities across the country: 3 referral hospitals, 7 district hospitals, 17 primary hospitals, 259 health clinics and 340 health posts Limited health human resources: ≈ 30 physicians and 262 nurses per 100,000 population (vs. 56 / 471 for South Africa and 229 / 897 for Canada) Health system is a blend of public and private sector in both service delivery and funding organizations: Botswana spends 4% of GDP on health HIV / AIDS a key issue Health System in Botswana

3. 300 000 people are HIV+, which is 17.1 % of the total population, 37.4% of the 15-49 age group infected. Life expectancy dropped from 62 to 56 years.110 000 need immediate enrollment to Anti Retro Viral Therapy (ARVT), 70 000 on ARVT AIDS Epidemic – Update on Botswana

4. Current Challenges – Health Information Systems in Healthcare 1.Manual transcription of data in districts (24); electronic means utilised less frequently 2.Demand for data from different stakeholders (MOH, MLG, NACA, TB, ARV etc.) in ~ 30 different forms. 1564 data elements being captured 3.Quality of data captured --- doubtful 4.Fragmented data sets (18) generated by 9 healthcare programmes like PMTCT, ARV, TB, Nutrition, Home-Based- Care, Family Planning etc. 5.Essential Minimum Indicator Set at national level and in healthcare programmes last revised in year 2001.

5. Current Challenges: ICT in Healthcare Programmes – contd. 6.Vertical Systems, various software programmes being used for data analysis requiring training of end-users at districts and national levels (EPI-Info, Excel, IMPS etc.) 7.Patient level Data collected for some programmes (IPMS, TB) while aggregated data (PMTCT, MCH, Nutrition) in others at the districts 8.Delayed management reports (months, years); Delayed decision-making 9.Lack of skilled manpower at districts 10.Lack of unified approach at district and national levels

6. Nyangabgwe Hospital (F’Town) Maun Hospital Clinic 3 Sekgoma Hospital (Serowe) Princess Marina Hospital (Gaborone) Clinic 2 Clinic 1 Clinic 4 Clinic 1 Clinic 2 Clinic 3 Clinic 4 Clinic 3 Clinic 2 Clinic 1 Clinic 4 Clinic 3 Clinic 2 Clinic 1 Dept of Info Technology/GDN IPMS Project Brief

7. Health Facilities

8. Health Statistics District-DHT Facility 1Facility 2Facility n IDSR–Notifiable Diseases PMTCT EPI STD Home Based Care Nutrition MCH Family Planning HIV/AIDS TBSchool Health Mental Health And more … Facility 3 IPMS ARV Current Scenario – contd.

9. FP6 Programme DHIS operational in several countries South Africa, Ethiopia, Malawi, Mozambique, India South Africa Botswana Mozambique Tanzania Malawi Sweden Ethiopia Norway Asian partners European Union - Beanish

10. 10 Project funded by EU – BEANISH (Building Europe Africa collaborative Network for applying IST in the Health care sectorProject funded by EU – BEANISH (Building Europe Africa collaborative Network for applying IST in the Health care sector The project is an outcome of WITFOR 2005 case study. Agreement reached to implement DHIS by MCST, MOHThe project is an outcome of WITFOR 2005 case study. Agreement reached to implement DHIS by MCST, MOH Collaborative project involving MOH, MLG, UB and NACACollaborative project involving MOH, MLG, UB and NACA

11. Health Statistics Facility 1Facility 2Facility n IDSR–Notifiable Diseases PMTCT EPI STD Home Based Care Nutrition MASA MCH Family Planning IPT TB School Health Mental Health Others Facility 3 National HIS District 1 DHIS District n DHIS IPMS District 2 DHIS Proposed Solution – BEANISH Initiative

12. Action Clinics, Health Posts, Mobile Stops DHT 1 (PS, CHN, Matron, Coordinators) Data MINISTRY OF HEALTH MIN. of LOCAL GOVERNMENT DONORS and PARTNERS DHT 2 DHT 3 ? Patients ? ? ? ? ? ? Community ? Data Others Flow of information and reporting structures

13. Felt need for reliable and timely health information and management reports (National, districts, facility-wise) on aggregated. General appreciation of the DHIS application Current data quality questionable - data collection, capturing need monitoring IT infrastructure inadequate at districts for a roll- out. Reliable Internet/e-mail connectivity not available at DHTs Need for regular training programmes and refresher courses. Technical support on the application needs strengthening 13 DHIS Pilot Project –Lessons Learnt

15. Project Steering Committee not in place (MOH, MLG,UB) Frequent movement and transfers of health personnel in districts and at national levels. Loss of continuity in operations Project delays. Burn rate of EU funds low 15 DHIS Project –Challenges

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17. Project Initiation Report (PID) disseminated S/W Application customised for pilot run DHIS piloted in 4 health districts; Gaborone, South-East, Kgatleng, Okavango At the pilot districts, end-Users (CHN, PHS, Matrons, IT Officers in the districts) trained in DHIS Workshop organised for programme managers and stakeholders at national level Pilot Project Review report finalised and circulated to all stakeholders DHIS Project – Status

18. Setting-up of a training facility at MOH Procurement of additional hardware in tendering stage 44 Health Info. Officers recruited. Training being conducted at UB from 15 Oct, 2007. Roll-out in 8 districts by March 2008. End of EU funding. Roll-out in 16 districts by Dec 2008. PEPFAR funding. Project reporting to the sponsors – EU- BEANISH done quarterly DHIS Project – Status

20. Questions ?? Thank You