Strengthening Routine Health Information System 2012-2014 January - - PowerPoint PPT Presentation

Strengthening Routine Health Information System 2012-2014

January 13, 2015 January 13, 2015 MIS Auditorium, DGHS

Summary of RHIS Initiatives Undertaken

Strengthening RHIS of DGHS and DGFP by USAID-supported partners (MEASURE Evaluation, icddr,b, MaMoni/HSS, MSH/SIAPS) has been directed to

• support to M&E functions of HPNSDP with particular focus on 6 OPs

(MNC&AH, NNS, CBHC, MCR&AH, CCSDP, and FSDP)

• streamline MIS tools to minimize information gaps and duplication, and

reduce the burden of data collection and compilation

• design and use a supply chain management portal for efficient and effective

logistics management of RMNCH commodities

• improve capacity of MIS Units of DGHS and DGFP to generate reliable

information on time.

• improve use of information at the local level and promote evidence-based

decision

SUPPORT TO M&E FUNCTIONS OF

HPNSDP HPNSDP

Support to M&E functions of HPNSDP

Streamlining of OP indicators by MEASURE/icddr,b includes

• Review of 342 indicators across 32 OPs and development
• f PMP
• Developing indicator reference sheets for 342 indicators
• Developing indicator reference sheets for 342 indicators

with detailed information:

– Definition, Calculation, Unit of measurement, Frequency, Source

• f information, Level of data generation
• Categorized 342 indicators by types (i.e training, service,

facility readiness, drug/logistic, infrastructure, workshop/meeting etc.)

STREAMLINING MIS TOOLS

A Key Focus of A Key Focus of MaMoni/HSS & MEASURE Evaluation/icddr,b

Review of OP indicators and assessment of MIS tools

• 6 priority OPs were reviewed where routine MISs covered
• nly 50% of original OP-level service indicators
• Service providers and field-workers overburdened with

recording and reporting requirements, e.g., 14 registers for FWVs

• 14 registers for FWVs
• 11 key sections in FWA register
• 5 in-patient monthly reports manually aggregated
• 5 (at least) monthly reports by HA
• Inadequate data accessibility as computer-based database

not fully functional

• Inadequate use of RHIS data for local-level decision making

DGHS/MIS DGHS/MIS

MIS tools streamlined

Old system Old system

• No structured HA

register

• No structured CSBA

register Revised system Revised system

• Structured HA & CSBA

registers

• Revised monthly reports
• nline

Revision and development of tools/systems from community to hospital level

Community Community

register

• nline

DGFP/MIS DGFP/MIS

• Paper-based FWA register

has separate pregnant women and birth list and missing a number of OP indicators (i.e ANC, PNC, delivery)

• No structured CSBA

register

• Review of FWA register (in

process) adding missing information + pregnant and birth list replaced by piloted ‘pregnancy registration handbook’

• Online pregnancy registration
• Review of MIS 1 & 2 forms

are in process

• Structured CSBA registers

DGHS/MIS DGHS/MIS

MIS tools streamlined

Old system Old system Paper-based CC service register Revised system Revised system

• Revised paper-based

registers included NNS indicators

• Online reporting formats

Revision and development of tools/systems from community to hospital level

Community Clinics Community Clinics

register

• Online reporting formats
• PW & U5 children

registration system

DGHS/MIS DGHS/MIS

MIS tools streamlined

Old system Old system

• Unstructured general
• utpatient register
• Paper-based disease

profile report Revised system Revised system

• Structured register
• Simplified monthly report

+ online reporting at upazila level Revision and development of tools/systems from community to hospital level

Union Union

profile report upazila level

MIS tools streamlined

Old system Old system Revised system Revised system Revision and development of tools/systems from community to hospital level

Union Union

DGFP/MIS DGFP/MIS

Separate FWV registers for every service, viz. delivery, ANC, PNC, birth, pill, condom, IUD and IUD follow up

• Reduced FWV registers

(MNH, OCP/Pill, IUD) by merging relevant registers

• MIS 3 reporting form is under

revision up revision

Single register for FWV for MNH services (MNH register)

DGHS/MIS DGHS/MIS

MIS tools streamlined

Old system Old system

• Paper-based in-patient

reports Revised system Revised system Online in-patient MIS with ICD-10 classification Revision and development of tools/systems from community to hospital level

Upazila & District Upazila & District

DGFP/MIS DGFP/MIS Existing MIS 4 MIS 4 reporting form is under revision

Implementation of tools/systems

Tools/Systems Nationwide by DGHS-MIS With support from icddr,b and MaMoni Other partners

Directorate General of Health Services (DGHS)

District and sub-district level: Online hospital in- patient system Provided ToT to statisticians and instructed to give in- patient data entry, Developed manual inc. All UHCs and DH of Tangail and Chunarughat UHC and DH of Habiganj (logistics, training and onsite support) + central level monitoring UNICEF: SCANU part of the system in 16 DH Developed manual inc. ICD 10 + central level monitoring by M&E staff Union level: General patient register for SACMO and Monthly progress report (aggregated) in DHIS2 DGHS-MIS developed data entry guideline. Currently, 60 districts reporting in DHIS2 Paper-based register and reporting format, trainings were provided in entire Tangail district and Chunarughat (Habiganj) upazila CC: Online monthly reporting (aggregated) format in DHIS 2 Provided laptops with connectivity, training to CHCP, developed manual ~8,000 CCs reporting Entire Tangail and Chunarughat (Habiganj) upazila (onsite support), central level monitoring by M&E staff

Implementation of tools/systems

Tools/Systems Nationwide by DGHS-MIS With support from icddr,b and MaMoni Other partners

Directorate General of Health Services (DGHS)

CC: Pregnant women and U5 registration system (as part of COIA initiative) Provided ToT, developed manual, Intensive monitoring from central level and workshop at divisional Training and onsite support in 3 upazilas of tangail + ToT to UNICEF + central level monitoring by M&E staff UNICEF: in 3 districts JICA: in Satkhira Plan: in workshop at divisional level Plan: in Dinajpur ++ Household level:

• a. HA register and

reporting tool + online reporting format in DHIS2 DGHS-MIS developed data entry guideline. PHC circulated GO Currently, 62 districts are reporting in DHIS2 Paper-based register and reporting format, trainings were provided in entire Tangail district and Chunarughat (Habiganj) upazila

• b. CSBA register and

reporting tool (both FP and Health) + online reporting format in DHIS2 (health) DGHS-MIS developed data entry guideline. PHC circulated GO Currently, 62 districts are reporting in DHIS2

CARE: in Sunamganj ++ SNL: Kushtia

Implementation of tools/systems

Tools/Systems Nationwide by DGFP-MIS With support from icddr,b and MaMoni Other partners

Directorate General of Family Planning (DGFP)

Sub-district level: Aggregated national reporting form-MIS 4 Revision of MIS4 is done and awaiting for approval Technical assistance in the review process Union level (for FWV):

• Single register for MNH

services

• OCP, Condom and ECP

register

• IUD register
• Facility reporting

format-MIS 3

• Review Committee has

revised and finalized reduced MNH and FP registers for FWV. These registers were piloted in icddr,b and MaMoni areas

• Revision of MIS 3 is

done and awaiting for approval Paper-based register and trainings were provided in entire Tangail and Chunarughat (Habiganj) upazila Technical assistance in the review process of MIS 3

SNL: MNH register in Kushtia

Implementation of tools/systems

Tools/Systems Nationwide by DGFP-MIS With support from icddr,b and MaMoni Other partners

Directorate General of Family Planning (DGFP)

Community level:

• a. Pregnancy

Registration Handbook + online MCH-Services initiated online registration format has been accepted and DGFP-MIS has circulated GO to do online Paper-based handbook, training ,

• nsite support in

entire Tangail and

SNL: Kushtia

Handbook + online registration format circulated GO to do online pregnant women registration entire Tangail and Chunarughat (Habiganj) upazila

• b. FWA register 8th

edition and monthly reporting form - MIS 1 Review committee has revised and finalized 8th edition of FWA register and MIS forms 1 and 2. (Piloted pregnancy registration handbook has been added in 8th edition of FWA register) icddr,b provided technical assistance in the review process Icddr,b in collaboration with GIZ providing technical support to DGFP-MIS to transfer their service statistics (monthly report) into DHIS 2 platform. Initially, new system will be piloted in two districts before national scale up.

Quality of reporting improving

100 120 100 120

Community micro-planning in MaMoni areas: HA-FWA-CV network to share MNH/FP information, update registers and reduce inconsistencies in reporting

20 40 60 80 100 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Number FWA report HA report 20 40 60 80 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Number FWA report HA report

16

Neonatal deaths, Habiganj, 2012 Neonatal deaths, Habiganj, 2013

Real time population level estimate generated through MHN register

70 45 45 64 51 51

17

17 45 45 17

At least 1 ANC visit 4 ANC visits SBA delivery PNC within 48 hours

Poil MIS 2012 Poil MIS 2013

Data source: Poil Union MNH Register, Habiganj

Issues and Challenges

System, connectivity related issues

• Absence of individual client-based tracking system

and not synchronized with community database

• Dual systems (both old and revised) are in place
• No provision for offline entry (both DHIS 2 and

pregnancy registration system of DGFP)

• Report generation or data sorting is limited; scope
• f improving dashboard for different users level
• Frequent power cut and slow internet connection

cause delay in online data recording and reporting

Issues and Challenges

Administrative issues

• Perceived high workload of nurses and senior nurses

are reluctant to use computer

• Several admission registers make it difficult to check

whether all patient in a day have been registered whether all patient in a day have been registered

• Perceived inadequate encouragement from local level

manager to use the new system

• Although registration coverage is good, updating

information is poor

• Security of computers and accessories is a major

concern

DESIGN AND USE A SUPPLY CHAIN

MANAGEMENT PORTAL MANAGEMENT PORTAL

Why LMIS is important?

An effective logistics management information system is necessary to ensure consistent availability

• f medicines :
• Provide real-time information
• Allow managers to react quickly and efficiently
• Allow managers to react quickly and efficiently

to avoid stock-outs and over-stocks

• Help plan for proper distribution
• Assist in forecasting & supply planning

DGFP Logistics Information Management Systems Flow

National Stock Status of Contraceptives

indicates < 4 months indicates 4-7.9 months indicates >=8 months

Fewer stock-outs (<5%) of IUDs while nearly no stock-

• uts (<1%) of injectables for last two years.

Reference: M G Kibria et.al, 2013, Impact of a Computerized Inventory Management System in Ensuring Commodity Security of Contraceptives in Bangladesh (Presented in the International FP conference, Addis Ababa, Nov 2013))

DGFP SDP Dashboard Module

• Service Delivery Points

(SDP) include Family Welfare Assistants (FWA), Family Welfare Visitors (FWV), NGO etc

• SDP Stock Status is

available in UIMS (which available in UIMS (which is running in 488 sub- districts)

• UIMS data upload to web

(SCMP/ SCIP)

• Dashboard indicate stock

status of individual SDP

DGFP SDP Dashboard Module

Salient experience:

• Contributed to identifying the root causes of stock-
• uts
• Helped to assess the quality of SDP reports and assist

Pilot phase: March-September 2014 Pilot area: 20 Upazilas in Sylhet, Lakshmipur, Gazipur and Bogra

• Helped to assess the quality of SDP reports and assist

in designing supervision plans for low-performing sites

• Reduced the stock-out rate significantly
• Improved decentralized decision making
• Promoted governance and accountability

Next Steps

• Update the DGFP LMIS tools (UIMS, WIMS and

eLMIS) and expand the product list (n=304 items)

• Roll-out national implementation of the SDP
• Roll-out national implementation of the SDP

dashboard module to all Service Delivery Points (~30,000) by July 2015

• Handing-over the tools to the DGFP for

management and maintenance

Challenges

• Prompt actions taken based on information
• Retention of trained staff
• Improving the ICT infrastructure
• Ensuring feedback mechanism from upper

Ensuring feedback mechanism from upper tier/supportive supervision visit

• Thoroughly discussing FP program’s performance

in the district/Upazila monthly meeting

• Staff motivation

Replicating Best Practices (LMIS) in DGHS and NTP

• Formation of Technical Working Group- Done
• Selected a list of Items to tracked on [26 items

including UN commissioned life-saving commodities] in consultation with the TWG

• Map-out and design the Logistics recording and
• Map-out and design the Logistics recording and

reporting systems in collaboration with MaMoni/HSS- in progress [Piloted in Lakshmipur]

• Technological assessment of MOHFW Supply Chain

Management Portal (SCMP) and DHiS2 to integrate the eLMIS- To be started soon

• Work with DGHS/TWG to introduce the DGHS LMIS

IMPROVING CAPACITY

Technical personnel support

M&E manager: Supervision of development team, coordination among stakeholders, developing guidelines, ToT etc. M&E Officers: Monitoring and reporting of MIS activities from the central level. Assisting development of from the central level. Assisting development of tools/guidelines and providing ToT Programmers: Designing online tools, maintenance , troubleshooting of the systems and providing ToT

Technical support in development of RHIS materials

• 1. Training manual for CHCP on computer and
• nline reporting
• 2. Training manual for HA on Tablet PC use
• 2. Training manual for HA on Tablet PC use
• 3. Training Manual on ICD-10
• 4. Indicator book
• 5. Local health bulletin
• 6. Instruction manual on monthly reporting

Technical support to MIS related Meetings/Workshops/Trainings

• 1. Meeting and workshop on COIA
• 2. ToT on ICD-10
• 2. ToT on ICD-10
• 3. ToT on Community clinic reporting
• 4. Workshop on CRVS
• 5. Meeting on nutrition related indicators
• 6. Meeting on SCANU reporting system
• 7. Meeting on HIV/AIDS reporting system

IMPROVING USE OF INFORMATION AT THE LOCAL LEVEL FOR EVIDENCE-BASED DECISION MAKING MAKING

Improve data availability and accessibility

• Online reporting makes data

more easily available at different levels.

• Online entry at/close to
• Online entry at/close to

source reduced chance of compilation errors

• Report generation using

routine data at the local level and presentation at annual MIS conference

Thanks