1. Tanzania Health Facility Registry
Oct 26, 2015
OHIE Conference Call

2. M&E SI ( )
HSSP III ( ) defined M&E strengthening as a key strategic area – evolved into M&E SI ( )
Reference the M&ESI flyer;
Goal: To enhance evidence based decision making in the Tanzanian Health Sector
Purpose: To strengthen M&E mechanisms to ensure M&E information is used in the planning process at central, regional and district levels and there is improved access to M&E information.

3. M&E SI ( ): MFL
Integrated plan with multiple donors and implementers
Each ‘area’ included MOHSW/GoT lead, individual responsible and lead TA organization/individual
Objective 5: Provide technical support and leadership to the health sector to move towards and integrated e‐health infrastructure and enterprise architecture MFL activities include
Arrange stakeholder meeting to plan for a master‐facility list and define requirements..
Implement master facility list that meets identified requirements
Two activities with budgeted line items identified in the early M&E SI plan
Initial funding from the CDC and EKN

4. BACKGROUND 2009-2010 Drugs and Supplies Human Resources Morbidity /
G.I.S. /
MAPPING
Human
Resources
Financial
and
Expenditure
Systems
Drugs and
Supplies
Disease
Surveillance
Regulatory
Boards
H.I.V.
Malaria / Other
Programmes
SURVEYS /
RESEARCH
Infrastructure /
Equipment
Morbidity /
Mortality /
HMIS

5. VISION G.I.S. / MAPPING Human Resources Drugs & Supplies Financial and
Expenditure
Systems
Disease
Surveillance
Regulatory
Boards
Master
Facility
List
H.I.V.
Malaria / Other
Programmes
SURVEYS /
RESEARCH
Infrastructure /
Equipment
Morbidity /
Mortality /
HMIS

6. HFR/MFL TIMELINE MFL Req Workshop All regions trained RMO-DMO Meeting
MFL WG
MFL online
Sep
Nov 7
Sep 10
Dec 20
2009
2009
2010
2011
2012
2013
2014
2015
2015
MFL WG Formed and Meet
Today
5 days
16 days
UCC
develop MFL
Jan 2011 – Jul 2015
24 days
MESI MFL Plans
17 days
Aug-Sep 2012: User Stories Workshop Sep 2012
Oct – Dec 2012: Follow up development of Functional Requirements and data elements specification. Draft paper data collection tool
Business owners HMIS and DCS
Oct 2012 – Dec 2013: Weekly or bi-weekly stakeholder meetings
Nov – Dec 2012: Train 10 regions on GPS and paper tool
Feb 2013: Decision to use Resource Map as data management engine
Mar-May 2013: Select UCC as local implementation partner
May – Dec 2013: Development of Curation Workflow and Curation Tool and enhancements to RM
Aug 2013: Pilot testing and refinements
Sep 2013: ToT Refresh
Oct 2013: Revised final specifications and paper tool
Nov 2013 – Feb 2014: Testing
Feb 2014: ToT Refresh
Mar – Apr 2014: Training all regions on GPS, paper tool and Curation Tool. Entering data from initial 10 regions
Apr August 2014: Data collection for remaining districts
September 2014 – August 2015: Data Cleaning between HFR and DHIS2 to map IDs
September 2015 – Public Portal Launch
MFL Requirements Workshop
Functional/Data Elements Specs
25 days
Sep – Dec 2012
MFL WG re-started and Business Owners identified
10 regions trained (GPS, data tool)
RM selected; Curation Tool developed
Remaining regions trained (GPS,, data tool, curation tool; 10 regions curation tool
Ongoing data entry, approval, retraining,; Develop Public Portal

7. MFL INITIAL STEPS
Requirements
Workshop
Sep 2012
Identify key MOHSW owners
Iterative meetings to refine specifications
Identify HFR core team
Stakeholders workshop held in September 2012, focused on
Process, purpose, and motivation for development of a new and comprehensive Master Facility List (MFL)
Date Element definition: Analyzed current 2012 Excel MFL and review of Kenya MFL elements
Requirements gathering - gathering User Stories
Through iterative meetings, identified 3 key ‘owners’
HMIS
ICT
Department of Curative Services (responsible for private facilities, and intend to register public facilities)
Identified the key stakeholders including these 3 groups as well as NIMR, CDC, RTI (and later added UCC), InSTEDD with RI/CPHI providing TA as needed
A small MOHSW team did a learning tour to Rwanda to look at how the HFR is being used
The MOHSW agreed to make the UCC system available on the MOHSW website to a restricted group of users
Workshop, User Stories and some details from Specifications; and then data collection tool and then rounds of revisions as the core MRL team met and refined

8. MFL Requirements Gathering (iterative)
User Stories
Requirements Specification
And Study Tour to Rwanda for 3 members of MFL core team
Data Elements Specification

9. MFL initial data collection and harmonization
GPS training and paper data collection tool developed (paper tool went thorugh many rounds of changes) and paper tool user guide
Using EKN funds, MOHSW purchased 133 GPS devices
NIMR prepared the GPS training materials and MOHSW with TA prepared HFR/MFL training materials
In Nov-Dec 2012, with NIMR funding, trained 10 regions (2 people/district) on why Tanzania is moving to a HFR/MFL, trained on GPS and the paper form
During Dec 2012 – Mar 2013 these districts collected the data on the paper forms and shared the GPS information with NIMR for NIMR to review (shared electronically)
With TA, the MOHSW made a technology selection based on the Requirements Specification and technology direction (using draft eHealth strategy guiding principles)
Paper data collection continued
Enter list of data sources – MOHSW HMIS and DCS, NIMR, NHIF
Gap in funding – started to add in funds for UCC to Global Fund

10. MFL transformed to HFR Tool selection UCC identified as local partner
Curation Workflow finalized; Development/testing of the Curation Tool
Ongoing harmonization and data cleaning
Common agreement that MFL output of the HFR which manages and maintains the HF content
OHIE HFR (Resource Map – RM) was selected and approved by the MOSHW as the software system to be used
The core team continued to meet, and the MOHSW/TA worked with InSTEDD on discussing the requirements to make updates to RM
The eHealth Advisor worked to meet with NBS, NHIF, PMORALG and NIMR to combine some MFL lists and create a single list that could be used to load into RM
One gap was identified in the area of curation: RM currently did not have an in built curation workflow process, and the MOHSW wanted to have this functionality
The MOHSW selected UCC as the Curation Tool implementer and included this work in GF R9 PII application
eHealth strategy noted the need for multiple local partners the MOHSW can work with
During May to August 2013, the team worked with RM to upload the facilities and do some early testing/bug fixing
Pilot testing occurred for one week during August 2013, and feedback was gathered for prioritized changes needed to RM
An initial ToT was conducted during Sep 2013, which focused on the paper data collection form, GPS and the initial RM Tanzania MFL
The HFR/MFL team continued to meet periodically, while the Curation Tool was developed and additional RM changes were made (including moving to Open ID server)
Test plan development and testing continued in Dec 2013-Jan 2014; with User Guides developed in Feb 2014

11. Integrated HFR ( )
Remaining regions trained (EKN); Ongoing supervision and support; Data Cleaning and approvals
National training on Curation Tool during March/April 2014
Initial DHIS-HFR integration meetings started July 2014
Data entry into the Curation Tool continued during 2014
Data comparison between DHIS2 and HFR started in Dec 2014
Additional data cleaning workshops held during Mar-Jul 2015
Final data cleaning in process during Aug/Sep 2015
Public Portal Launch scheduled for Sep 8, 2015

12. Integrated HFR
TZ HFR Resource Map
The main data management engine for the HFR. This provides the application programming interface (API) to other systems, so that they can use the HFR data.
Three APIS supported
Facility Registry API – The FRED API
Health Facility Registry Native API
Customer Service Delivery-CSD
TZ HFR Curation Tool
Supports the MOHSW/PMORALG workflow for facility management, for adding, updating and viewing facilities.
TZ HFR Public Portal (ready to launch)
This portal is developed and in process of being tested, and will be the place where members of the public, partners go to get the latest facility information, with comprehensive reporting, filtering, including mapping

13. HEALTH FACILITY REGISTRY (HFR)
DEFINITION
STAKEHOLDERS
Health Facility Registry (HFR) is an online tool used to provide public access to a database of approved information about all health facilities in Mainland Tanzania.
HFR contains Master Facility List, which is the official source of health facilities information for the health care sector.
HFR
PMORALG
MDAs
Partners
Public

14. BENEFITS OF HFR
Latest facility information – Updated list
Foundation of integrated HIS at all levels –used as basis of all system and surveys
Resource saving – No need for stakeholders to maintain their own facility list
Promote efficiency – Single source of updated list

15. HFR BENEFICIARIES Get Facility list Statistical report
Get location and direction to the facility
Give feedback
Know facility type, ownership, service offered
Get nearest facility
PUBLIC
Get
Statistical report
Facility list
Get Geographic coordinates
Capability to integrate with other systems
STAKEHOLDERS

16. REPORTS PRODUCED Detailed report Summary report
Number of Health Facilities by
Service offered
Type
Ownership
Administrative division
Map view
Facility list by
Service offered
Type/
Level
Ownership
Administrative division

17. HFR/DHIS INTEGRATION PROCESS
HFR List
DHIS HF List
Mapped HFR/DHIS IDs
Comparison of HFR/DHIS list was necessary
Checked if facilities has similar name, type, ownership, operating status, administrative div.
Common differences found after comparison work was: different names of facilities e.g facility name in HFR is Faith while in DHIS is Amani, facility type i.e Health centre in DHIS while HFR is DISP, ownership e.g. Public in DHIS while FBO in HFR. Three workshop for data cleaning was conducted to resolve these differences and update the changes in HFR.
HFR
Changes
HFR
DHIS
FRED API

18. HFR INTEGRATION VISION
Drug Registry
Health Professional
Registry
Health Facility
SHR
Terminology Services
Patient Registry
Data Warehouse
(Health resources)
eLMIS
Interoperability Layer
EMRs/HoMIS
Insurance System i.e. NHIF, CHF, etc.
Epicor, PlanRep
Other point of service applications (i.e. HRHIS, etc.)
iHMS

19. CURRENT STATUS HFR portal launched (10-Sept)
HFR/DHIS integration is in progress and finalizing HFR/DHIS mapping IDs
Ongoing data collection tool review
Continue to improve data quality in HFR i.e. Services offered (can this replace some facility surveys?)
Geographic Administration change challenges
Getting remaining GPS codes that are missing (852: Priv 243, Publ 609)
Mapping HFR services to the HMIS reports
Make sure the updates and approval process for facilities is rapid
Other facilities types providing Health care services i.e. Social Welfare, Pharmacy, Funeral homes,etc

20. LESSONS LEARNED
2 original MFL main activities in M&E SI did not reflect the actual MRL/HFR complexity
Joint ownership within the MOHSW takes more time to meet multiple owners expectations and leadership buy-in
Harmonizing lists with deletions/merging of HF difficult to track through API with deleted IDs
Need to move the DCS approvals into their routine work and allocate funds

21. PARTNERS

22. INFORMATION CAPTURED Facility registered name Geographic location
Name and location
Zone-Region-District-Council-Ward-Village/Street
Administrative division
Unique generated per facility
Does not change
Facility Identifier Number
Common facility name- Registration number- CTC ID- MSD ID-MTUHA Code
Identification
Postal address-Phone-Fax- -Website-Facility In charge details
Contact information

23. INFORMATION CAPTURED..
Location description-Service area-Catchment area-Population
Physical Location
Facility type-Ownership-Registration status-Operation status
Classification
Number of rooms and beds- Transport-Water-Mobile networks-Toilet facility-Waste management -Sterilization and Infection control
Infrastructure
Clinical service-Therapeutics-Prosthetics and Medical devices-Diagnostics services-RCH-Growth monitoring /Nutrition Surveillance-Oral Health Services (Dental)-ENT Services-Emergency preparedness-Support services
Service Offered