Health Management Information System

1. Overview of Urban Health MIS Health Management Information System Second Urban Primary Health Care ProjectLocal Govt. Division, Ministry of LGRD&C www.uphcp.org Zia HoqueMIS & Data Management Officer

2. Urban Health MISLegacy System • The first Urban Health Management Information System of Bangladesh was established in 1998 • UHMIS was started as truly paper based system • Routine data recorded in registers. • Analyzing data, Quarterly Performance Report was prepared by PA NGOs and sent to UPHCP HQ for compilation • UPHCP HQ compiled all together and produced QPRs www.uphcp.org Continued . . .

3. Urban Health MISProblem with Data • There was no uniform framework upon which all NGOs & development partners can collect, analyze, report & use health data • This makes inter-partner and even inter cost-center (intra partner) comparison of health progress difficult • Development partners seriously feel this limitation for monitoring progress of the achievement, particularly of MDGs www.uphcp.org Continued . . .

4. Urban Health MISProblem with Data • Due to huge problems with data quality development partners noticed several times within the 9 years life time of the legacy system about lack of consistency among variables. Few are following: • Timelinessin data acquisitions, transportation, process and analysis as well as dissemination • Dissimilar rateson same variable between organizations were common • Poor reliabilityof data discouraged policy makers & managers to use health information for decision making www.uphcp.org Continued . . .

5. Urban Health MISHMIS in UPHCP-II • There were a provision to recruit a 1.2 million USD budgeted heavy weight consulting firm for HMIS development & Implementation • Unfortunately the recruitment was dropped in the mid way • At this stage there were no single penny budgetary provision for any changes in HMIS • But still then huge pressure remained from development partners to furnish HMIS to increase availability, reliability, timeliness …… ….. and so on … www.uphcp.org Continued . . .

6. Urban Health MISWeb-based HMIS • In this scenario, still there was no budget for any improvements of HMIS in UPHCP. • By an alternate way we took an initiative to pool a marginal fund and looked for the most cost effective IT enabled solution (Software as Service, i.e. a rental system) • The firstweb based Health Management Information System of Bangladesh was established in late 2007 in this way www.uphcp.org Continued . . .

7. Urban Health MISWeb-based HMIS • A web based Health Management Information System with integrated data approval mechanism has been developed and deployed. • This is the starting point of a new era in the establishment of automated Health Management Information System in Bangladesh. • This HMIS for UPHCP-II is a managed hosted application with basic objective to enhance data acquisition, approval and publishing process. It allows data to be route, verified and approved to PMU in a transparent manner. www.uphcp.org Continued . . .

8. Urban Health MISWeb-based HMIS • Established a full functional web based HMIS • Automated data cross-checking & validation mechanism has been introduced • A successful e-Governance application has been integrated for data verification, approval and publication • Current scope of the system is Services Statistics • We are able to publish regular QPRs (Quarterly Performance Reports) within 21 days after a quarter passed. www.uphcp.org Continued . . .

9. Urban Health MISFine tuning • The UHMIS was then equipped with the web based HMIS in front layer and a paper based data recording system in the background • Still then the paper based data record keeping system was not uniformed in 24 PAs. They developed their own data recording system. • UPHCP started working on developing Unified Record Keeping System (URKS) from 2008. www.uphcp.org Continued . . .

10. Urban Health MISFine tuning • The Unified Record Keeping System (URKS) Development and Implementation Committee was formed consisting of • Representative of Director (MIS), DGHS • Representative of Director (MIS), DGFP • Representatives from NGOs and Consulting Firms • Representatives from PIU and PMU • URKS developed in line with the national requirements. www.uphcp.org Continued . . .

11. Urban Health MISFine tuning • URKS is now finalized, approved and in use. • Therefore UHMIS is now equipped with the web based HMIS in front layer and the URKS in the background • URKS is developed in a way that UPHCP might switch over to a 100% automated system in no time • Hopefully by its third phase UPHCP might be able to develop and implement the automation by a sophisticated HMIS www.uphcp.org Continued . . .

12. Urban Health MISDMIS Support • The Data Management Information System (DMIS) support to MoHFW was working under the Planning Wing, Ministry of Health & Family Welfare • The aim of DMIS is to develop the central Data Warehouse for HMIS of Bangladesh • However, DMIS was unable to customize the DHIS2 for UPHCP-II. But still UPHCP is providing data to DMIS in regular interval. www.uphcp.org

13. System Entities and Activities www.uphcp.org

14. Data Flow of UPHCP-II 1st working day of following month 2nd to 3rd working day of following month 4th to 7th working day of following month Data recording and monthly compilation by CRHCC, PHCC, Satellite, PECC, VCCT, DOTS Counselor Paramedic Field Supervisor Clinic In-Charge PA HQ for Entry, Edit and Validation MIS Officer | Data Entry Project Manager | Approval PIU for Collation and vetting (S)MEO | Review Project Officer | Approve Forward for approval/ Feedback Send Hardcopy Feedback Forward for approval/ Feedback 8th to 13th working day of following month Review Feedback PMU for Approval,processingand compilation SMQAO | Review MIS&DMO | Approve DPD (Tech) | Approve, Publish Review Feedback Approved and Published over web-based HMIS HMIS Shared with stakeholders/ Feedback LGD, ADB, DFID, SIDA, UNFPA, ORBIS, PPME Firm DPs, LGD, MoHFW, DGHS, DGFP, PAs, PIUs, PMU etc. Quarterly Progress Report Preparation & Publication www.uphcp.org

15. Purpose for Developing a HMIS • To initiate automation for a complex and challenging project with widely distributed locations • To utilize the technological advantages offered by internet for data communication • To provide an effective tool for data management, dissemination and storage. • To act as a pilot for a comprehensive HMIS. This one is the first web-based HMIS of Bangladesh. www.uphcp.org

16. System Characteristics • A quantum improvement on quality, volume and accuracy for report generation • Attempts to meet the information requirements of the executing and donor agencies by producing improved and comprehensive QPRs • Authenticity and acceptability of MIS reports. • It is a substantially cost-effective solution for creating a distributed networked system in terms of investment on cost of equipment, development, manpower requirement and training. • Ease of implementation and operation • Effective means of introducing computer culture among the participating agencies. www.uphcp.org

17. Current Status As per the the scope of the system, only services statistics has been automated fromPA level. All partners are uploading their center-wise monthly performance record to the central website. Core advantage of this application can be summarized as follows: • PAs are able to enter center-wise monthly data in a central database • Stakeholders at higher levels (PIU/PMU Officials) are able to review, forward or return documents, submitted by the lower formations. • Donor representatives/Consultant firms can keep track of the information flow. • Centralized System is administered by Project Management Unit of UPHCP-II • Status of a specific document is visible/transparent to all relevant users. • Effective for monitoring & supervision of the project. www.uphcp.org

18. Strength • Ready availability i.e. web based system • Logical validity checks • Reviewed and approved by PIU • Speeded up the report preparation. • Improved data quality due to cross verification between database and physical registers during monitoring visits by PIU and PMU officials as well as ISI conducted by PPM&E. • Flexibility in report generation. • Availability of legacy data from inception i.e. July 2005. www.uphcp.org

19. Limitations/Constraints • Data coverage confined to only services statistics. There are scope for introducing many other modules. • Data entry is from PA level. It may be extended up to center level and even in some extend up to satellite level. • Data accuracy still suffers due to inadequate monitoring at the field level. • DMIS was not able to provide the technical support as per requirement. • Recruitment of HMIS firm has been dropped. In the absence of budget it is impossible to develop a sophisticated MIS. • Though we are talking about Urban HMIS, there are a lot of different type players are in the same field. All should come under one umbrella to depict the actual scenario of Urban Health. www.uphcp.org

20. Screen Shot HMIS Gateway (www.uphcp.org) HMIS www.uphcp.org

21. Index Page (www.uphcp.org) Screen Shot Review Report Center Operation (data entry) www.uphcp.org

22. Screen Shot Data Entry Screen (www.uphcp.org) Age group wise client info Medicine Error Message Service Head-wise Patient info Sub-Component-wise Record www.uphcp.org

23. Eye Care Data Entry Screen (www.uphcp.org) Screen Shot www.uphcp.org

24. Quick Review Panel (www.uphcp.org) Screen Shot www.uphcp.org

25. Screen Shot Output Panel (www.uphcp.org) www.uphcp.org

26. Output List cntd (www.uphcp.org) Screen Shot www.uphcp.org

27. Sample Output (www.uphcp.org) Screen Shot www.uphcp.org

28. Sample Output cntd (www.uphcp.org) Screen Shot Summary Info (Auto generated) Audit Trial (Action Log with date-time and Note) www.uphcp.org

29. Screen Shot Eye Care Output Panel (www.uphcp.org) www.uphcp.org

30. Screen Shot Sample Eye Care Output (www.uphcp.org) www.uphcp.org

31. Open Session • Question & Answer • Thanks for all Zia Hoque MIS & Data Management Officer ziamcsd@gmail.com www.uphcp.org