Mozambican Open Universidade Architectures, Standards and Eduardo Mondlane Information Systems MOASIS and Jembi: a sustainable multi-national PPP for National HMIS development in Mozambique drgs Developing, Sustaining, and Managing a Competent Global Health Workforce April 2014, Dr. Alessandro Campione and Prof. Chris Seebregts
Contents: 1. HIS in Low Resources Setting 2. Jembi and Moasis model (as possible solution) 3. Main achievements
HIS in Low Resource Settings
SOME CHALLENGES OF PUBLIC HEALTH HIS Increased interest in sustainable national HIS at scale Lack of in-country funding for HIS workforce in the MOH Fragmented projects funded by multiple donors Lack of harmonization and standards for multiple projects Too high expectations and lack of visible and early results challenge of implementing technologies without ensuring adequate support/capacity to ensure sustainability
HIS WORKFORCE IN MOZAMBIQUE, A CHALLENGING HR ENVIRONMENT Lack of health IT skills and training BANK SUPP. PATNERS Unpredictable personnel supply and demand Competition in the private sector for scarce personnel, including: Abnormally high salaries and lack of MINING IT benchmarks SPECIA CIALI LIST COMPANIES High turnover of staff Lack of professional commitment and exaggerated importance of the role of developers in HIS MOBILE Dependency on external consultants COMPANIES
HIS WORKFORCE WITHIN THE MOH Uncertainty in the leadership Strong St rong MOH H le leader ershi ship results ults in in: and Health IT specialists • Less s turno nover er of staff unaffordable for the public • Positi sitive envir iron onment ent stim imul ulates es in inve vestm stment ent health system in in HIS IS Planning Big ig im improvem ement ent in in short t tim ime • Governance Regulatory M&E INVOLVED IN Weak MOH H le leader ersh ship p resul ults ts in in: MISAU MOH OPERATION Susp spendi ending ng curre rent nt in init itiat atives es – embargo argo / • INCREASE DEMAND mora ratori orium um ON TECHNOLOGY • Pro rojec ects ts based d on perso sonal nal AND IT COMPLEXITY theorie ories/i s/int nter erests ests High challenging • Pro rojects ects unsust stainable nable, , not reproduci ucible ble or to manage the National scalab able health Information System • Depen ende dent nt on an in indiv ividual ual suppo port
JEMBI AND MOASIS MODEL (AN POSSIBLE AND EFFECTIVE SOLUTION)
JEMBI/MOASIS MODEL RESPOND TO THE NEED OF CRITICAL MASS INSIDE AND OUTSIDE THE GOVERNAMENTAL STRUCTURE N EED TO G UARANTEE C ONTINUIT Y A ND S USTAINABILIT Y I NDEPENDENTLY FO RM T HE L I DERSHIP A ND H R T URNOVER A local PPP, trusted by the MoH, linked to the public, academic and private sector, honest Positive, broker, supported by Int. extended, ORG in a sustainable, locally south th-south south-nor north th owned results collaboration
JEMBI/MOASIS MODEL MOASIS is a non-profit organization of UEM, Living Lab created and supported entirely by JEMBI with support of IDRC, CDC, WHO, Rockefeller and others ORG. We aims to: Strengthen HIS local capabilities involving the public, private and academic sectors reference and link between the MOH and public/private partners JEMBI/MOASIS: 50 PROFESSIONAL IN 4 COUNTRY Employ/develop local HR and build critical mass and network joint team and work plans (gov. & partners) Helps for Project continuity/sustainability Helps to manage expectations Multidisciplinary (IT experts, analyst and developers, public health specialist and epidemiologist) Project Management culture
JEMBI/MOASIS MODEL Country offices (Moasis) focus on deliverables and not on macro planning, fund rising and grant management (Jembi) single organizational infrastructure for all country programs, (Mozambique, South Africa and Rwanda): becoming a REGIONAL e-health HUB Reproduce successful projects and reuse of knowledge Shared senior technical and grant management resources business intelligence system that combines software, communication, persons, well-established methods and procedures and single initiatives full CDC, USAD, WHO, EU compliant
PUBLIC, ACADEMIC AND PRIVATE SECTOR For MoH support as honest broker and risk taker: Assessments, ToR, Requirements, Evaluations, Procurements, project and contract management, development of innovations/pilot projects and deployment/maintenance For academic sector support: Support the training of future Mozambicans and e-health software and system engineers Develop and maintain curriculum in HIS trainings Training/lectures in various branches (IT, clinicians, nurse, statisticians, HIS technicians etc.) Publication and conferences For private sector support: Reference and repository of HIS information Management of public projects and resource mobilization in non competitive way
MITIGATE HIGHLY COMPETITIVE WORK FORCE ENVIRONMENT Human Resources: Pairing technical and program staff Redundancy across country offices Core Jembi Senior Staff supporting every nodes: epidemiologist, specialist in Public health and HIS, grant and projects management constant on the job/formal training and mentoring Share the most expensive HR Governance: Diplomacy, deep knowledge of local culture and dynamics Create a critical mass and network to support the PPP technical advising /oversight for other Organizations Responsive to governance needs and crises
DEVELOP THE NATIONAL HIS NETWORK CRITICAL MASS AND NETWORK NGO AND • Moasis supported by Jembi PRIVATE NATIONAL SECTOR Jembi supported by CDC building • INSTITUTE MINISTR OF Y OF network STATISTIC HEALTH • Inter-ministerial • Inter-institutional mOASIS • National NGO/ORG International community • MINISTR MINISTRY OF Y OF HONEST BROKER INTERIOR JUSTICE UNIVERSI TY Facilitate partners negotiation • EDUARDO MONDLANE • Convening/coordinating (UEM) stakeholders • Not deciding, support the decision National International • Catalize resurces for PPP NGO/ORG NGO/ORG Not focus on specific products but • on process and tangible outcome
MITIGATE PROJECT CHALLENGES Year 1 Year 1 Year 1 • Frustrating ? One main/major project • Expensive • Possibility of with public sector inactive time • Possibility of ONE BIG FAILURE • Sustainable • More results in short time • Learning process MANY SIMPLE • Success and failures PROJECTS IN • Rational use of PARALLEL team • MESURABLE AND TANGIBLE OUTCOME
SPECIFIC HIS KNOWLEDGE AND FOCUS ON THE RIGHT PROBLEM OF HIS JEMBI/MOASIS FOCUS ON THE WHOLE SYSTEM NEED TRAINING REQUIREMENTS ASSESSMENT DATA QUALITY PUBLICATION MANY FOCUS HERE AND USE IT PROBLEM & TECHNOLOGY PROJECT, CLINIC/PUB MAINTENANCE SUPPORT AND LIC HEALTH AGREEMENTS DEPLOYMENT DEVELOPMENT PROBLEM SUSTAINABILITY FUNDRISING INTEGRATION COMMITMENT
Main achievements (23 projects at national level) Mortality system (SIS-ROH) and VITAL STATISTIC reform National M&E system (SIS-MA) Individual based electronic system (SIBI) national Master Facility List
MORTA TALITY REGISTRAT ATION IN MOZAMBIQUE Mortality data before 2006: census, surveys/ad hoc studies only Support of WHO and CDC: 2008 2008 - 2013 2007 - 2008 2008 2013-2014 14 • Set up of ELEC ECTRON ONIC IC ICD-10 • Expansion to Intra ra- adopted 75% % as hospi pital HOSPIT SPITALS national mortal tality y standard regist ister er (SIS (SIS- • extra-hospital FULL AND ROH) deaths REDUCED Expansion LIST • Training >300 STAFF • Update of First national on ICD-10 analysis - Analysis of death and death mortality • SIS-ROH Expansion to certification process registration analysis based APPLICATION 60% of all - New national regulation on routinely VERSION 2.0 hospitals - New death certificate collected data
SIS-ROH DATA 30000 25000 Other causes 20000 15000 10000 5000 0 2009 2009 2010 2010 2011 2011 2012 2012 HIV not specified 1.1% 25000 > 8 80,000 records 0.4% HIV + TB 20000 0.3% HIV + multiple 0.2% infections 0.4% 15000 HIV + encephalopathy 71.9% 2.5% HIV + bacterial 10000 2.9% 4.2% infections HIV + Kaposi sarcoma 5.0% 5000 HIV + mycotic 11.2% infections 0 HIV + Burkitt lynphoma 2008 2009 2010 2011 2012 HIV + other malignant neoplasm Intr ntra-hosp -hospital tal Ext xtra ra-hos -hospi pita tal
CRVS REFORM IN MOZAMBIQUE cooperation with STAT-SA STATSA active member of WHO-FIC community Inter-institutional Vital Statistics WHO-FIC CONFERENCE Working Group (MoU) Members: MOH, MOJ, UEM/MOASIS, INE In-depth assessment of CRVS and plan of action for CRVS Reform in Mozambique
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