1. Computerized System In Himachal Pradesh Health Management Information System (HMIS)

2. Health Management Information System in Himachal Pradesh Presentation by Ms. Harinder Hira Principal Secretary-Health Govt. of Himachal Pradesh

3. Before:  Data was available but not accessible  Summary of data was calculated by hand and therefore prone to errors  Long delay to produce reports

4. “Data Storage”

5. Need for the New HMIS Reform health information systemReform health information system Transition from reporting system to conscious use of informationTransition from reporting system to conscious use of information Managerial decision makingManagerial decision making Accuracy of DataAccuracy of Data Facility wise performanceFacility wise performance New computerized HIMS is expected to increase coverage & improve quality of servicesNew computerized HIMS is expected to increase coverage & improve quality of services Reform health information systemReform health information system Transition from reporting system to conscious use of informationTransition from reporting system to conscious use of information Managerial decision makingManagerial decision making Accuracy of DataAccuracy of Data Facility wise performanceFacility wise performance New computerized HIMS is expected to increase coverage & improve quality of servicesNew computerized HIMS is expected to increase coverage & improve quality of services

6. Existing MIS Flow Health Workers at SC Level Health Workers at SC Level Form 6 Other Health ProgramForms ProgramForms Reports to PHC Form 7 AA Collects and fills data

7. AA Reports to Block Form 8 Reports to District H.Q. Form 9 Reports to Directorate Monthly Bulletin on Process of Different Districts Monthly Bulletin on Process of Different Districts

8. Today:  Data is accessible at all levels  Reports are produced on time  Reports are used for monitoring and decision support

9. Current Status  A computerised information system (HMIS) has been installed in 10 districts out of 12 districts of Himachal Pradesh.  Monthly Reporting Forms 6, 7 and 8 are entered into the HMIS from all Blocks.  HMIS is on trial basis in remaining district of Sirmaur and Tribal District of Himachal Pradesh.  Data from SC, PHC, CHC and Hospitals is available for reporting, supervision, planning and analysis

10. Computerized HMIS Data Collection at Health Facilities Form 6, 7 and 8) District Computer Unit Block Computer Unit Decision Support System State Directorate Health Managers / Program Officers Through Floppy Through FTP, using phone lines

11. New Computerized HIMS Flow SC, PHC, Block PHC, CHC and Other Health Facility SC, PHC, Block PHC, CHC and Other Health Facility Feedback on Indicators Form 6 Collects and fills data PHC fills additional data On form 7 PHC fills additional data On form 7 Reports to Block Computer Unit Computer Unit Reports to Block Computer Unit Computer Unit Hospitals fill additional data On form 8 Hospitals fill additional data On form 8 Reports to District Computer Unit Computer Unit Reports to District Computer Unit Computer Unit Reports to State Computer Unit Computer Unit Reports to State Computer Unit Computer Unit Compiles data for Decision Making Compiles data for Decision Making Compiles data for Decision Making Compiles data for Decision Making

12. Reports Reports are used at monthly Block meetings Reports help in the monitoring of activities Additional reports can be programmed if needed

13. Health Performance Indicators ServicesPercentage Recorded 1 ANC cases registered 2 Pregnant woman with 3 ANC check-ups 3 Registered pregnant woman receiving all ANC services 4 Registered high risk pregnant woman referred 5 Deliveries conducted by trained health personal 6 Deliveries conducted by TBA 7 Woman received 3 Post Natal Check-ups (PNC) 8 Male sterilization to total sterilization 9 Eligible couples covered by IUD 10 Births notified to Local Registrar 11 Still Births notified to Local Registrar 12 Maternal Deaths notified to Local Registrar 13 Utilization of health facility (O.P.D.) 14 Average per day O.P.D. workload per doctor 15 Infant Mortality Rate (IMR) per 1000 live births 16 Maternal Mortality Rate (MMR) per lakh live births MaleFemale 17 Infant (0 to 1 year) fully immunized out of the eligible infants. 18 Incidence of Measles cases per 1000 population

14. 19 Incidence of Whooping Cough cases per 1000 population 20 Diarrheal cases registered under 5 years per 1000 under 5 years population 21 Birth weight recorded less than 2.5 Kg 22 Birth weight recorded 2.5 Kg or more 23 High risk new born referred 24 Acute Diarrhea Disease under 5 years given ORS 25 Acute Diarrhea Disease cases referred 26 ARI cases treated with Co-trimaxozole 27 ARI cases referred 28 Infant Mortality Rate (IMR) per 1000 live births

15. Data Available in Form 6 (all health facilities) 1.Number of OPD cases 2.Ante Natal Care 3.Natal Care 4.Pregnancy Outcome 5.Post Natal Care 6.Immunization 7.Booster Immunization 8.Childhood Diseases 9.Child / Infant Deaths 10.Contraceptive Services 11.Abortions 12.Communicable Diseases 13.Number of Blind 14.IDD control (Iodine Deficiency) 15.Leprosy Cases 16.Registration of vital events (births, deaths) 17.Interaction with the community

16. Data Available in Form 7 (PHC only ) 1.Post natal care 2.RTI/STI 3.Contraceptive Services 4.Abortions 5.Communicable Diseases 6.Blindness Cases 7.Leprosy Cases 8.School Health 9.Equipment 10.Vacancy Position 11.Inventory of Drugs, Vaccines, Lab consumables and Equipment

17. Data Available in Form 8 (Add. for CHC, CH, Dist. Hops., Zonal Hosp. ) 1.Natal care 2.Post natal care 3.Contraceptive Services 4.Abortions 5.Leprosy Cases 6.Prevention of food adulteration 7.Inventory of Drugs 8.Staff Position

18. General Findings HMIS is their reporting, monitoring and supervision tool Situation with data transfer has improved User refresher training has to be intensified Maintenance of computers not secured Need to change form 6,7 and 8

19. General Findings: Data Analysis HMIS is a rich basis for additional data analysis Data analysis is limited (meaning no trends, correlations, regressions) at the moment

20. CONCLUSION The vision of a new HMIS is that it is simple to operate & valuable to health staff. The system has been designed in such a way that health workers who collect the information must be able to use it also. The forms & formats developed should not be too many, bulky and complicated so as to avoid the temptation of not filling them. The system has been developed & pre-tested in 3 districts for a year.

21. Outlook and Perspectives: Reports Reports have improved, some calculations need to be corrected (in process). Visualisation of data/reports (graphs/charts) is available but has to be improved. Ranking of health services for selected indicators has been programmed and works

22. Outlook and Perspectives: Training and Maintenance Statisticians should be trained in additional software (Excel, Access, Windows). Statisticians are and will be trained in same basic hardware maintenance

23. FRIENDLY REMINDER: The purpose of HMIS is to improve health care delivery through improved monitoring, supervision and planning! HMIS is an essential tool to achieve that purpose

24. Challenge Ahead New Forms in NRHM Integrate HMIS proposed HIS(Health Information System) and other softwares to produce comprehensive reports. To take HMIS up to PHC level.