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HIS country experiences

This overview explores the evolution and challenges of Health Information Systems (HIS) across various countries, including Cuba, Botswana, Tajikistan, and Sierra Leone. It highlights unique local experiences, implementation strategies, and the pivotal role of decentralized decision-making. Insights into data utilization, integration, and technology application underline efforts to enhance HIS effectiveness. By analyzing both successes and setbacks, the document sheds light on how these lessons can foster the development of sustainable healthcare systems in diverse political and cultural contexts.

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HIS country experiences

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  1. HIS countryexperiences

  2. Overview • Cuba • Botswana • Tajikistan • Sierra Leone • West Africa • Others… • Evolutionoftheinternational HIS scene, and HISP

  3. In general • Involved in manyaspectsof HIS strengthening: • Integrate data sources (into a dw) • Developcapacity to analyse and useinformation • Developcapacity to maintain and develop HIS further, including software development • Focusondistricts; local action • Appropriateuseoftechnology

  4. Cuba: early HISP days.. • Pilot in 2002-3 • Applied same approach as in South Africa: • Bottom-updevelopmentofessentialindicator list • ”Massive” localparticipation • Trying to decentralizedecision-making in a centralized setting • Did not workwell, projectcloseddown by Cuba

  5. Cuba: HIS in the political landscape • Decentralized healthcare: One Grupo Basico de Trabajo (basic working group: doctor and nurse) per 700 people. • Centralized decision-making: ”the district people don’t know what information they need” • Information as signal and symbol • The ”need to know data”-only approach clashed with philosophy of the political system: socialist centralism

  6. Botswana: unbalanced HIS staff • DHIS implementation started in 2005, as an ”IT-project” (located in IT department) • Medical staff never developed much ownership • IT department had limited knowledge of the health sector • Despite resources, very slow implementation and scaling • Fragmentation at the ministerial level

  7. IDSR – Notifiable EPI Home Based Care MASA Diseases Health Statistics PMTCT STD IPMS Nutrition Family Planning MCH IPT School Health TB Mental Health Others … District 1 DHT District 2 District n DHT DHT Facility 1 Facility 2 Facility 3 Facility n

  8. IDSR – Notifiable MASA Home Based Care EPI Diseases IPMS Health Statistics PMTCT Nutrition Family Planning STD MCH IPT School Health TB National HIS Mental Health Others District 1 DHIS District 2 DHIS District n DHIS Facility 1 Facility 2 Facility 3 Facility n

  9. Tajikistan: Centralized system, decentralized needs

  10. What is collected? • Global burdenof data collection? • What is collected as routine data? • South Africa: 500 • India: 2000 • Botswana: 2000 • Cuba: 10 000 • Tajikistan: 30 000! • Is the data collecteduseful? Who uses it?

  11. Sierra Leone: integration and interoperability • Started late 2007 • 1st revisionofreporting forms in 2008 • National roll-out od DHIS2 and new forms in 2009 • 2nd revisionof forms in 2009-2010 • Reducedamountof forms. Most forms collectedthrough DHIS • Pilot for interoperabilityDHIS-OpenMRS • Future plans: more interoperablesubsystems

  12. Figure 2: Increasing institutional delivery rates in Western Area, from the HMN Results Report (2010)

  13. West African Health Organization: trying to achieve critical mass • Regional organization, local funding • Wants to support all 15 member states in developing better HIS • Experiences from Sierra Leone, and interoperability between DHIS2 and other software are key catalysts • Ghana, Gambia, Liberia, Nigeria, Togo also implementing similar systems • Cape Verde, Mali, Burkina Faso, Guinea, Guinea-Bissau, Senegal, Niger, Benin, Ivory Coast, and WAHO HQ also potential implementers • WAHO will be a centre of excellence – Developing and providing skills • Intra-regional collaboration for sustainability

  14. Challenges at theinternational/regionallevel • Data definitions: • Are thecountriescollectingthe same? With the same interval? • How do theyreport? • Do they have different software solutions? • What is the output format? • Whatarethe agendas ofthevariousinternationalactors?

  15. Zambia: who can use the information? • DHIS v. 1.4 in all 70+ districts. Using DHIS v. 2 as national data warehouse • No clear policy of who has access to data, even if it is now available at intranet at MOH. • All requests had to go through one person • Online system challenging this power structure

  16. Armenia • Fragmentation • Politics. HIS unit not a ”nationallevel” unit. • Reform pushed by internationalorganizations • Like Cuba and Tajikistan: • Strongcentralisttraditions • Urba/Ruraldivide: • Yerevan is as modern as it gets. Countryside less so

  17. Evolutionoftheinternational scene and HISP • Developmentagenciesarepowerful • UNAIDS • MilleniumDevelopment Goals • HMN since 2005 • Global Fund: focuson HIS • PARIS declaration: builduponexisting HIS

  18. Evolutionof HISP • HISP since 1994 • Essentialdataset • Localuse, bottom-updevelopment • Now, more diverse • Many agendas: NGOs, internationalorgs. • Technology has changed: from offline to online. Mobile

  19. Discussion • Similarities and differences • Commonthemes: ? • In all countries HISP has beenactive: veryfew have come far when it comes to informationuse: how to achievethis?

  20. TALI • The information system is working technically according to its specification • Data is analysed, disseminated and used: • Information from the system used for planning and evaluation of achievements

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