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HIS implementation in Ethiopia: case studies from AAHB. Woinshet Abdella PhD Student Department of Informatcs University of Oslo. CONTENTS. Background Ethiopia / Health Care System HISP Ethiopia DHIS Implementation in Addis & Oromia Challenges. Ethiopia. Population - 72+ million

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His implementation in ethiopia case studies from aahb l.jpg

HIS implementation in Ethiopia: case studies from AAHB

Woinshet Abdella

PhD Student

Department of Informatcs

University of Oslo

Contents l.jpg

  • Background

    • Ethiopia / Health Care System

  • HISP Ethiopia

  • DHIS Implementation in Addis & Oromia

  • Challenges

Ethiopia l.jpg

  • Population - 72+ million

  • Area – 1.1 million km2

  • Decentralized administrative structure

    • 9 regional states & two city administrations

      • 580 weredas (districts)

  • Regional sates are autonomous

  • Poor literacy, education, health status

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Health Care System

  • MOH, Regional health bureaus, Zonal health departments, Wereda/Sub-city health offices, Health Facilities

  • Under developed

  • Health service coverage – 61%

  • MMR – 871/100,000, U5MR – 140/1000

  • High Infectious & communicable diseases

  • HIS is primarily manual & under developed

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  • Project Initiation

    • Through a collaboration of the Department of Information Science, Addis Ababa University (AAU) and the University of Oslo in February 2003.

  • Partners

    • AAU; regional health bureaus of Ethiopia; global HISP

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  • Objective

    • Introducing computer based HMIS in Ethiopia in view of supportinglocal analysis and use of data

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  • HISP Members

    • 4 PhD students / 7 Masters students (one Norwegian)

    • 5 DHIS facilitators hired by HISP

  • Research Sites for HISP Ethiopia

    • Addis Ababa, Oromia, Tigray, Amhara, Benishangul-Gumuz

      • DHIS implementation is being carried out

        • Addis & Oromia – since Jan 04

        • Others – since June 04

      • Different stages of implementation

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Case Studies from Addis

  • Research Objective

    • key research objective is to broadly understand the challenges and opportunities with respect to the integration of existing paper-based HIS with computer-based systems in Ethiopia.

  • Theoretical Perspective

    • ANT

  • Research Approach & context

    • PAR

  • AR intervention:

    • HIS implementation Intervention into health organizations (AAHB & OHB)

    • One DHIS facilitator for each region

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Research Approach & context

  • Research Site

    • Addis Ababa health bureau (AAHB) ,

    • 10 sub-cities (districts)

    • 500 public & private health facilities,

    • located in Addis Ababa city Administration (Province).

    • Addis Ababa is the capital city of Ethiopia (540 km2 )

    • Population is 3 millions.

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Research Approach & context

  • Researcher Role.

    • The role assumed was an involved researcher through action research.

    • Qualitative data collection method was employed including

      • photography, observations, interviews, discussions, meetings, workshops, training, action experiments, document analysis, telephone calls, visit related institutions, informal lunch/tea meetings.

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Research Approach & context

  • Research subjects

    • managers and planners at different levels of the health structure, the health workers responsible in data collections and analysis.

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DHIS Implementation in Addis

  • Negotiate research access (KK)

  • Situation analysis (Mar 03 – Aug 03)

    • Visits to Health bureaus & HFs

  • Initiating the Design / implementation process with AAHB/OHB (Dec 03) (Bureau)

  • EPR was just introduced then

  • Prototype system was developed and populated with 9 months own data

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DHIS Implementation in Addis Ababa

  • Demonstration of the prototype DHIS Addis (Jan 04)

    • The experiences gained revealed the problems with the existing HMIS

      • Data duplication, fragmentation, …

    • Local requirement (Morbidity/Mortality data handling) identified that DHIS does not support efficiently

  • Developing minimum health data set & health indicators was proposed

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DHIS Implementation in Addis Ababa

  • Major decisions

    • The proposal for standardizing data set/health indicators accepted

    • Adapting DHIS based on new dataset and reporting requirement

    • Adding module to accommodate M/M data handling

    • Implementing DHIS to ALL Sub-cities.

  • Team formed

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  • The research team was composed of

  • Bureau level,

    • Bureau head;

    • health service head (leader of the project on the part of the bureau), team leader, and senior expert;

    • family health head, team leader and expert;

    • Disease Prevention and Control head; IDSR team leader, TB / Leprosy and HIV/Aids program team leader and senior expert;

    • IEC expert;

    • Network administrator;

  • Sub-city Level

    • two family health experts

  • Facility Level

    • two health facility managers;

  • And the researcher.

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DHIS Implementation in Addis Ababa

  • Two Parallel activities performed

    • Standardized data set, health indicators, data collection & reporting instruments & procedures (data flow, …) development

      • Draft prepared by the group presented for workshops, comments incorporated, the draft was further developed in a series of long meetings,

    • Development of Morbidity & Mortality module

      • Iterative / incremental (involved one major revision)

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DHIS Implementation in Addis Ababa

  • Use of DHIS as a prototyping tool

    • to better understand user requirements for producing an improved & useful system – which potentially increases data use

  • The standardized data set is implemented in all facilities

  • DHIS adapted, the new module incorporated

    • (Input Form, DHIS Data Flow, Data Entry (next slide), Pivot Table Report, Standard Report )

  • Slide18 l.jpg

    Monthly Routine Data Entry/Edit Form

    Monthly Morbidity and Mortality Data Entry/Edit Form

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    DHIS Implementation in Addis

    • DHIS is implemented

      • All districts (10 sub-cities) and AAHB initially

      • Scaled to health facility levels

        • 18/23-Health centers & 5/5-Hospitals (when resource / situation allowed)

    • Training (DHIS/computer basics) was given to sub-city/bureau/HF health staff / managers / data clerk / DHIS facilitators (with own data)

    • Technical support is being provided by the facilitator

    • Participatory design

    • July 2005, Workshop for evaluating one year experience of the use DHIS

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    Observations …

    • DHIS Software is well-tested & supports

      • Data aggregation; data sharing; health structure implementation; easily adaptable for new needs, which is inevitable; rapid set-up of DHIS application for a new setting

    • Complaints from different actors (use of MS Access in DHIS – DHIS 2 is a response)

    Dhis implementation in oromia l.jpg
    DHIS Implementation in Oromia

    • Collection/reporting instruments and software prepared for Addis is shared by Oromia & other regions

    • Followed similar approach

      • Some of the differences

        • The process was slower when compared to Addis

        • The minimum data set prepared for Oromia not yet adopted by the region

        • DHIS implementation status

          • Some Weredas of East Shewa zone (based on computer availability)

          • Is being rolled out to the remaining zones (at the zone level only)

    Challenges l.jpg

    • Improving data quality, data analysis and use

    • Reduce / Improve dataset

    • Achieving partnership with MOH

    • Scaling & Sustainability

    • Over burdened health worker

    • Limited resource

    • Negotiating with multiple actors

    • Parallel systems