ICAP Tanzania’s Experiences Implementing an Aggregate Database: District Health Information System (DHIS) Joshua Chale, Data Manager July 28, 2010

Why DHIS? Prior to implementing DHIS, NACP used multiple systems at district level i.e MS Access and EPI info. Data most commonly submitted to regional and national level with excel spreadsheets. In 2008, University of Dar es Salaam (UDSM) received funding from JICA and technical support from University of Oslo to pilot DHIS as a component of the Health Information System Program (HISP) Pilot launched in Coast region with 2 program areas: STIs and VCT. In 2009, a 3rd program area PMTCT was added and ICAP was invited to a meeting to review initial pilot results (as HIV implementer for this region) As of the end of June 2010, UDSM rolled out DHIS to 27 of 122 districts. Currently DHIS contains the following program areas PMTCT, VCT, MTUHA (HMIS), EPI, population data

DHIS Benefits Can run as a web-based and as an offline application. Relatively easy to learn and adapt (does not require high level of programming knowledge) Allows multiple levels of organization units to be entered and data can be aggregated accordingly (POS (dept) →Site → District → Region → National level) Incorporates data checks during data entry and after data collection

DHIS Benefits Cont…. Facilitates data analysis within DHIS or with reporting tools such as iReport, Birt, or pivot tables Maintains Security through defining user levels Allows user to tailor indicators Streamlines data and site census management because all program areas data are kept in one place Facilitates data use because all staff can access data at any time from office

Sample charts from DHIS 2 (iReports)

ICAP DHIS Implementation to Date ICAP customized DHIS to include: PEPFAR and ICAP NY indicators and disaggregations not in national system Data entry screens consistent with data indicators Customized reports in line with data tables for QR Points of service within facility (for HTC) Data checks in line with URS Export files for submission of data to NY Phased Roll Out: December 2009: HTC; data entry in 2 regions March 2010: HTC +TB/HIV; data entry in 2 regions + central data entry for 2 additional regions June 2010: HTC, TB/HIV, PMTCT; data entry at regional level by all 4 regions Training: All M&E staff were brought together and trained in DHIS basics Data managers receiving advanced training in system upgrades, reports, import/export and Installation Care and treatment data will be added for Q1, 2011 (post-APR hurdle)

MOHSW Implementation Challenges Limited: computer skills & infrastructure culture of data use technical support Feedback of data to site Weak M&E systems; worker overload Poor data quality Poor guidelines for DHIS use

ICAP-TZ Challenges in adopting DHIS Training offered by UDSM for TZ pilot focused on data entry for district level users; training isn’t targeted for local adaptation or customization UDSM did not receive training in how to adapt or program DHIS, therefore there is limited support for ICAP in our customization Developing reports with BIRT is complex; iReport just added is easy to use Importing historical data from old databases (TB, PMTCT, and VCT) into DHIS is challenging Setting up multiple points of service for HTC for one facility is time consuming. Terminology used in DHIS is not always intuitive

Additional training needs For users Understanding the database components Using data checks, and checking data completeness Data import/export and analysis Pivot tables and iReport For developers Training on the understanding of database schema JAVA- So that one can have capability to modify the database

Lessons learned DHIS 2 is a flexible, easy, system to adapt for local data collection tools Despite limited support UDSM is able to provide, it is helpful to have a local firm to assist in problem solving and troubleshooting DHIS has been adapted in numerous countries around the world and there are several online communities and resources for additional information exchange

How will DHIS help promote high quality care? DHIS will save time, facilitate reporting, freeing up M&E to spend more time on supervision and mentoring DHIS will help M&E team communicate results better to clinical team DHIS facilitates feedback to sites for program improvement

Way Forward/Next Steps With advanced knowledge of DHIS (through ICAP adaptation and use) ICAP is poised to support districts in roll out Can focus ICAP support on routine feedback to DHMT and sites rather than data collection Can help District mgmt teams focus supervision visits on sites with weaker programs and facilitate information use in supportive supervision

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