1. 18.05.2015 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 (emranul.haq@gtz.de)emranul.haq@gtz.de

2. 18.05.2015 Seite 2 Nr. 2 18.05.2015 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 (2005-2011) the government is implementing one of the biggest SWAP Health Nutrition and Population Sector Programme (HNPSP) of estimated 3.5 - 4 Billion USD. Bangladesh HIS Update

3. 18.05.2015 Seite 3 Nr. 3 18.05.2015Bangladesh HIS Update Regional Location

4. 18.05.2015 Seite 4 Nr. 4 18.05.2015 UnitNumber Division6 District64 Upazila (Sub district) 496 (not shown in the map) Union4,490 (not shown in the map) Administrative Distribution Bangladesh HIS Update

5. 18.05.2015 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 1978.  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 18.05.2015 Existing Health System Bangladesh HIS Update

6. 18.05.2015 Seite 6 Nr. 6 18.05.2015 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

7. 18.05.2015 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 18.05.2015 Existing Health System Bangladesh HIS Update

8. 18.05.2015 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 18.05.2015 Current Health Information System Bangladesh HIS Update

9. 18.05.2015 Seite 9 Nr. 9 18.05.2015 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

10. 18.05.2015 Seite 10 Nr. 10 18.05.2015 Use of MIS by type of health facility (Health Facility Survey, 2009) Facility typeMean score (%)N (weighted)Std. Deviation District Hospitals74.6760.16901 Upazila Health Centre82.12413.17528 MCWC34.1397.12539 UnHFWC27.111506.11050 UnHFWC, upgraded28.84924.14025 Union Sub-centre20.571134.13090 Private24.42789.20196 Total30.834923.22166 Bangladesh HIS Update

11. 18.05.2015 Seite 11 Nr. 11 18.05.2015 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

12. 18.05.2015 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 18.05.2015 GTZ Support in HIS Bangladesh HIS Update

13. 18.05.2015 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, 2009.  Critically analyze and identify the need, provide training and capacity building  Phased basis implementation 18.05.2015 GTZ Support in HIS Bangladesh HIS Update

14. 18.05.2015 Seite 14 Nr. 14 18.05.2015 Conceptual Diagram of DMIS Bangladesh HIS Update

15. 18.05.2015 Seite 15 Nr. 15 18.05.2015 Different Phase of DMIS Bangladesh HIS Update

16. 18.05.2015 Seite 16 Nr. 16 18.05.2015Bangladesh HIS Update

17. 18.05.2015 Seite 17 Nr. 17 18.05.2015Bangladesh – 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

18. 18.05.2015 Seite 18 Nr. 18 18.05.2015Bangladesh – 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

19. 18.05.2015 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; 18.05.2015 Present HIS Problem Bangladesh HIS Update

20. 18.05.2015 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 18.05.2015 Existing problems Bangladesh HIS Update

21. 18.05.2015 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 18.05.2015 Existing HIS Problem Bangladesh HIS Update

22. 18.05.2015 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 18.05.2015 Opportunities Bangladesh HIS Update

23. 18.05.2015 Seite 23 Nr. 23 18.05.2015 Thank you all Bangladesh HIS Update