Seite 1 Bangladesh Health Information System 2 nd IFHRO SEAR Conference Perth, Australia, Tuesday, October 13, 2009 GTZ Health Programme Muhammed Emranul Haq, M&E Advisor

Seite 2 Nr Background Bangladesh is located in the northeastern part of South Asia with land area of 147,570 square kilometers. Population of about 150 million, more than 920 persons per square kilometer. Administratively, the country is divided into 6 divisions, 64 districts, and 496 upazilas (sub districts). Currently ( ) the government is implementing one of the biggest SWAP Health Nutrition and Population Sector Programme (HNPSP) of estimated Billion USD. Bangladesh HIS Update

Seite 3 Nr Bangladesh HIS Update Regional Location

Seite 4 Nr UnitNumber Division6 District64 Upazila (Sub district) 496 (not shown in the map) Union4,490 (not shown in the map) Administrative Distribution Bangladesh HIS Update

Seite 5 Nr. 5  Significant progress in recent times in many of its social development indicators particularly in health.  Achieved important gains in providing primary health care since the Alma Ata Declaration in  Infant, maternal and under-five mortality rates have all decreased over the last decades, with a marked increase in life expectancy at birth.  Due to a good health infrastructure and dedicated workers it has been possible to make those successes Existing Health System Bangladesh HIS Update

Seite 6 Nr Ministry of Health and Family Welfare (MOHFW) Director General of Health Services (DGHS) Director General of Family Planning (DGFP) National Nutrition Program me (NNP) Directorate of Drug Administra tion (DDA) Directorate of Nursing Services (DNS) 38 Line directors for programmes implementation 64 District Level Facilities 469 Upazila Level Facilities Union and Community Services and Facilities Civil Surgeon Upazila Health Officer Director General Bangladesh HIS Update

Seite 7 Nr. 7 The Public Sector  Primary: Upazila Health Complex (UHC) at sub-district level which works as a health-care hub.  Secondary: Responsible for preventive healthcare services  Tertiary: Above sub district are district hospitals, medical colleges, providing secondary care and national tertiary level care facilities. The Private Sector  Both specialized and general hospital, clinic, diagnosis facilities are provided Existing Health System Bangladesh HIS Update

Seite 8 Nr. 8 Mostly vertical data collection, less integration, no quality control, lack of regular dissemination, less utilization for decision making Logical flow of data and availability is fairly absent Whereas, in other places, it needs attention Current Health Information System Bangladesh HIS Update

Seite 9 Nr HMIS Assessment using the HMN approach Overall assessment of Data Sources Data SourceOverall Score Census66%Adequate Vital Registration77%Highly Adequate Population-based surveys65%Adequate Health and disease records (incl. surveillance) 46%Present but not adequate Health service records25%Present but not adequate Resource record28%Present but not adequate TOTAL51%Adequate Bangladesh HIS Update

Seite 10 Nr Use of MIS by type of health facility (Health Facility Survey, 2009) Facility typeMean score (%)N (weighted)Std. Deviation District Hospitals Upazila Health Centre MCWC UnHFWC UnHFWC, upgraded Union Sub-centre Private Total Bangladesh HIS Update

Seite 11 Nr Existing MISs in Health Sector National HIS NNPDGHSDGFP MIS of Directorate General Health Services (DGHS) MIS of Directorate General Family Planning (DGFP) MIS National Nutrition Program (NNP) Bangladesh HIS Update

Seite 12 Nr. 12  Realizing the need currently GTZ is providing support to bridge the gap  Through building a national data warehouse  Following a participatory process  Increased inter collaboration within the system  Meet the need to the policy makers level  Create a model for future HIS  Supporting the existing M&E Unit under the MOHFW GTZ Support in HIS Bangladesh HIS Update

Seite 13 Nr. 13  “Data Management and Information System (DMIS) is a technical support to Ministry of Health and Family Welfare (MOHFW) which has started its activities on the 1st of March,  Critically analyze and identify the need, provide training and capacity building  Phased basis implementation GTZ Support in HIS Bangladesh HIS Update

Seite 14 Nr Conceptual Diagram of DMIS Bangladesh HIS Update

Seite 15 Nr Different Phase of DMIS Bangladesh HIS Update

Seite 16 Nr Bangladesh HIS Update

Seite 17 Nr Bangladesh – MOHFW – M&E Framework Remaining weaknesses / challenges  Lack of coordination between Departments, Programmes, and Directorates  Multitude of reporting forms and requirements  Focus on activity (input) reporting  Lack of ownership (at service / facility level) and consequently poor quality of data  Limited use of indicators (percentage, rate or ratio with a clearly defined denominator, allowing for setting targets and eventually performance measurement with regard to outputs and outcomes) Bangladesh HIS Update

Seite 18 Nr Bangladesh – MOHFW – M&E Framework Leading to…  Programme and sector M&E mainly based on non routine (e.g. survey) data  Non availability of data for (comprehensive and continuous) M&E of programme activities and results  Lack of use of data and information in decision making process at all levels Bangladesh HIS Update

Seite 19 Nr. 19  Use of large numbers of forms and data elements, slow down processes and reduce data quality  Manual data compilation at District and below levels and centralised entry into the data base is a main source for errors  Training in data management and analysis is almost absent across all MISs; Present HIS Problem Bangladesh HIS Update

Seite 20 Nr. 20  Lack of understanding or reluctant about ICT among the most of the health professionals  Less use of data for policy decision  Lots of computer and related equipments have been procured but there is no presence of an efficient system  Acute shortage of IT efficient technical Human Resources both at operator and specialized level Existing problems Bangladesh HIS Update

Seite 21 Nr. 21  Manual data collection mechanism is predominant  Even data is collected but those are not properly analyzed as per need or requirement  Weakness of national sector programme not be able to indicate specifically about the ICT in Health sector  Individual or donor level interests are not well coordinated or facilitated by the high level decision makers Existing HIS Problem Bangladesh HIS Update

Seite 22 Nr. 22  Commitment from the present democratic government to implement “Digital Bangladesh” vision by 2021  Increased global network e.g. HMN, PHIN, HIMAA, IFHRO, e-Health etc.  Interest among the donor community e.g. DMIS initiative, WHO’s mandate  Data demand from the highest policy makers  Present development of ICT in local market & availability of skilled manpower  World class system have been introduced by several private Hospital level, who are eager to collaborate  Increased motivation of data use Opportunities Bangladesh HIS Update

Seite 23 Nr Thank you all Bangladesh HIS Update