The Blueprint for evolving s ingle National Routine Health Information System (HIS)

1. The Blueprint for evolving single National Routine Health Information System (HIS) A Brown Bag Presentation of FHI360/SIDHAS Project Monitoring & Evaluation Directorate @MEMS II Office, Wuse Abuja. 15th May 2013

2. Outline: • Rationale for this presentation • USG Health Portfolio structure and the NHSDP (2010 -2015) • The evolving National Routine Health data reporting system (DHIS) • Things to note • Suggested Blueprint • Take homes

3. Rationale • To discuss the need, plausibility and the blueprintfor single routine health Information System (HIS) in Nigeria

4. USAID Public Health Portfolio Structure • HIV/AIDS and TB Team: is an integrated office that seek to improve access, coverage and sustainable capacity for HIV/AIDS and TB services in Nigeria • Assistance Objective 3: Increased Nigerian Capacity for a Sustainable HIV/AIDS and TB Response • Health, Population and Nutrition Team:is an integrated office that seeks to improve basic health services, HIV/AIDS, child survival, malaria, tuberculosis, population and maternal and child health and nutrition services. • Assistance Objective 4: Increased Use of High-Impact Health Interventions • The Biggest Assumption: Accurate and timely data to gauge the impact of the national response will be available.

5. CDC Public Health Portfolio Structure • Strengthening Public Health Systems: provides technical leadership and direct assistance to • strengthen epidemiology, surveillance, laboratory, blood safety, operations research, and workforce capacity—essential components for strong, sustainable public health systems. • Institutionalize Nigeria HIVQual (NHIVQual) • Establishment of National EMR Dataware house

6. CDC Public Health Portfolio Structure • Development of National Medical Laboratory Strategic Plan • National and International Accreditation of Medical Laboratories • Establishment of a national reference lab for TB and other diseases • Establishment of Nigeria Center for Disease Control • The Biggest Assumption: Accurate and timely data to gauge the impact of the national response will be available.

7. GoN Health Portfolio USG Health Portfolio CSOs, CBO and Private Sector Health Portfolio

8. What is USG’s Commitment?

9. Data Source: 2011 Annual NHMIS Report

10. Analysis of national routine health data reporting • PHCs accounts for 88% of the HFs in Nigeria. • If all PHCs report complete dataset, 88% national report is met. • Reporting from all PHCs is under the control of LGAs HMIS Officers. • LGA-led Integrated health data management approach can solve our problem. Data Source: FMoH/DPRS 2012

12. Long History …… Unending Discussion

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15. What is the central purpose of strengthening the National Health Management Information System (NHMIS) ? • To make truly GoN-owned high quality routine health data available (from both the private and public sectors) and • To plan for and build sustainable NRHIS around the GoN structures and levels with expert TA and supportive supervision from all in-country-IPs.

16. Principles & Context: • GHI Principles: • a new business model aimed at delivering dual objectives: • achieving significant health improvements • creating an effective, efficient and country-led platform for the sustainable delivery of essential health care and public health programs. (HIV/AIDS, Malaria, TB, INMCH, Nutrition, FP/RH, NTDs) • Third-Ones Principles: • One agreed country level Monitoring and Evaluation System. (M&E Framework for the NHSDP)

17. Health Services & Routine Data

18. Overview of Nigerian Health Data • What are we using Health Data/Information for in Nigeria: • Health Program Design & redesign, management Decision Making? • Health Policy Formulation and Development? • Health Planning and Budgeting?

19. Referral Chain Initial Practice 30 HFs ------------- UTHs & FMCs Communities -------------------CHEWs 10 HFs ------------- PHCs 20 HFs ------------- GHs

20. Referral Chain Recent Shift 30 HFs ------------- UTHs & FMCs 20 HFs ------------- GHs Communities --------------- -CVs / CORPs/CBOs 10 HFs ------------- PHCs

21. Routine Health Services Databases

22. Databases: Schematic Overview 2 (Proposed)

23. Hierarchical Organization of the Integrated DHIS Platform TB & TB/HIV dataset SRH/HIV Integration dataset

25. Can DHIS address the bigger picture about NHMIS? • Align USG instance metadata with GoN DHIS instance • Derive PEPFAR-NGIs from the data elements contained in the National MSFs • Integrate Data Management Process at all levels. Legend: IT Programming codes

26. Current challenges: 1. Multiple DHIS platforms and its inter-operability & 2. Complicated data management process National DH&PRS DHIS Instance eNNRIMS DHIS Instance USG DHIS Instance Development partners’ DHIS2.0 platform USG HIV and TB Program routine datasets (mainly PEPFAR-NGIs from 10, 20 and 30 Facilities) National HIV Response routine datasets (mainly from 20 and 30 Facilities) Project-level HIV/TB/Malaria and NHMIS routine datasets (mainly from 10, 20 and 30 Facilities)

27. Solution: Moving towards one national Integrated health data management system • GoN-led and driven data management system (sustainability) 2. Promote integrated health data management 3. One sole source for routine health data @ National, State and LGA-levels 4. Considers all-levels of health care including community. National DH&PRS DHIS Instance LGAs PHCs data 20 HFs data Community –level data 30 HFs data

28. Suggested Blueprints • Confidence-building on GoN System’s ability to deliver timely routine health data if supported by Donors and IPs. • Address Institutional weaknesses and capacity constraints for functional HIS at Community-level, HFs, LGAs, State and National levels • Institutionalize LGAs Data Management team and data entry HUB approach • Strengthen our M&E system for better efficiencies and cost reduction • Advocate for IPs to unify tools, systems and processes for M&E.

29. Deep Reflection! • The problem of M&E systems development in Nigeria is caused by IPs and their Donors! • The fragmentation in terms of M&E systems and processes is as a result of each IPs/Donors’ requirements. • If only M&E processes, systems and tools were unified, we will have a more organized system that produces timely and unified/harmonized program results.

30. What are our fears about having One central HIS for routine health data in Nigeria? FEARS • Delayed access to routine data by stakeholders • Quality of what is coming through the Central HIS • Server Administration and • IT infrastructural capacity requirement (5,000+ Users in one Window) • Resource Coordination (Single funding basket) • Stakeholders’ Representative Data Management Team in place @ National level

31. Is it likely to offer any cost saving measure on the long run? • Yes ! The cost of: • HR need and capacity development for HIS management @ all level. • IT Infrastructure and Maintenance • Uninterrupted power supply • Maintaining streamlined Data Management Systems, Processes and Operations such as: • Data Collection and Data Entry • Data Verification and Data Quality Assurance (DQA) and Change Management Process (CMP)

32. Would this process have a chance for capacity transfer to the Government staff; leading to sustainability on the long run? • Yes! Through the: • Stakeholders’ Representative Data Management Team @ National level • Establishment of Integrated Data Management Team (GoN and IPs) at LGAs and State-level • Initial Joint Routine Supportive supervision and DQAs • Training of M&E practitioners for better results at the State and LGA levels.

33. Thanks for Listening Lets Discuss