IICD supported project: Development of a Management System for Health Facility - Tanzania

Document Actions

Countries: Tanzania [TZ]
Sectors: health
image: project in state 4

Summary

The project aims to develop a customized Health Management Information System (HMIS) to use in hospitals of the Evangelical Lutheran Church Tanzania (ELCT). The HMIS collects health data to be used by the hospital management, and also to meet the needs of the MTUHA, the government registration system for the health sector. The HMIS is based on open source software. Software includes patient registering, billing, laboratory, pharmacy, stock/inventory, x-ray, doctors’ office and ward management. Within the pilot phase, the project will start in one clinic and, if successful it will be rolled out to other hospitals, health centres and dispensaries. Change management is a key component.

Update

Updated: 2008-05-05

The HMIS has been installed in three hospitals; installation in a fourth hospital is ongoing.

The project team has developed an approach to Change Management. A revised draft of a Change Management guide is under preparation: it is a 14 steps approach.

Part of the project is the development of a generic Tanzanian version of Care2X, an open source HMIS. Hereto ELCT programmers are cooperating with the University Computer Centre (UCC) in Dar es Salaam. The development is supported by the international Open Source movement by Mr. Robert Meggle in Germany. Testing of the first version of the Tanzanian Care2X started early 2008.

Introduction

Health facility management suffers from inefficient management practices due to shortage of staff, high turnover rates and inadequate health utilization data. The quality of information from health facilities does not meet the required standards and takes a lot of time from the staff to collect. The ICT structure in Tanzania has developed to a level where it is realistic to computerize some of the routine processes in hospital management.

Objectives

To make available customized software that is capable to do all standard transaction type encounters in the hospital and produce reports according to the standard specifications, including MTUHA.
To have the required hardware in place in order to have satisfactory operation of the HMIS within the health facility.
To have trained and motivated staff who can use the HMIS system, maintain it and generate reliable results.
To have support services in place that can troubleshoot at distance within half a day.
To generate continuously user feedback (end user and management) and integrate relevant results in the software and ways of operating as to assure user friendliness and improved work processes. A spin off could be ideas for renewal/improvement in the organization and supporting software.
To assure roll-out to 26 health facilities and using a package for introduction including a guideline manual, assistance in organizational change, users training and ICT support and back up services and concluded by a user satisfaction test that has to be above a pre-set level.

Development Impacts

Health facilities follow with interest the pioneering work of ELCT. The Ministry of Health, Regional and district health authorities benefit from this development as they can get better reports, which will be the basis for the computerised district health management system.

The system will reduce considerably the possibilities for corruption and malpractices. Parties who are interested in that will be hurt by the project and will most likely react. Therefore an incentive structure and careful change management are required.

Moreover, the other Managed Health Care Programme (MHCP) partners have a significant interest to see MHCP, indeed, to make a significant impact regarding improving the quality of services. The other interest for them is to the services are accessed by the population for which the program is meant to serve and that the strategy was worth the investment.

Direct users are the hospital staff, who are enabled to work more effectively and professionally. The HMIS will provide timely and accurate information leading to better health care planning; improved diagnosis and more patients can get access to health services. A 30% financial improvement is expected through better revenue collection, better patient flows and use of capacity.

Lessons learned

Hospital management is a very complex field. It entails the development of management skills and a business model for the hospitals. Essential is to have a thorough preparation in terms of awareness raising and training among staff to enable them to take ownership and decide on the HMIS implementation. Also longer term support is required to a hospital to assure trouble shooting and a minimum of down time.

A few examples:

At a certain moment the doctor in charge hid the manual forms and made the health facility shift completely to HMIS.
One department was very reluctant in participating. When they saw the others going ahead, they felt ashamed, joined and made up quickly for the delays.
At a certain moment the billing department indicated they wanted HMIS as ‘people always created an image of them cheating’.