District Health Management Information Systems (D-HMIS) - Tanzania
African Inland Church in Tanzania (AICT), Evangelical Lutheran Church in Tanzania (ELCT), Roman Catholic Church (RCC), Christian Social Services Commission CSSC), CMO
on the ground project
Staff Health facilities,
The implementation of a District Health Management Information System (D-HMIS) aims to improve the ability to collect, store and analyse accurate health data. Implementation of D-HMIS also aims to increase data accuracy and effectiveness of intervention, increase accountability, and improve tracking of health trends in the district. Information on patient registrations, diagnoses, treatments, lab tests, billing and pharmacy records are being digitalised. The D-HMIS is rolled out in eight hospitals and four offices of the City Medical Officer and the faith based organisations. The project includes Information and Communications Technology (ICT) training and change management both at facility and district level.
The project entered in a phase of consolidation. The IY staff has been expanded. The project also supports the MICF project. An expansion with five health clinics is prepared for and budgeted by the municipal council.
During expansion the emphasis is on:
1. To support expansion .
2. Advocacy; to raise awareness with Mwanza City councillors
3. Improved communication through connecting the existing participating facilities in and offices in Mwanza through a wireless network
4. Strengthening trouble shooting and maintenance & power supply as to reach a situation of a maximum down time of 1 hour per week.
5. Strengthening local ICT support capacity as to have a pool of ICT experts able to support DHMIS.
6. Improved use at health facility level as to make data collection and analysis an integrated part of health management practices in the participating facilities
7. Support for data use at district level in order to come to an evidence based district health management planning and monitoring
8. Reducing costs and strengthening robustness and functionality of HMIS in order to reduce the costs by 30% compared to the initial investments of DHMIS per type of facility.
9. To assure the well –functioning of M&E, to set up a quality insurance and extract lessons learnt
The ability to collect, analyse and utilize reliable data is vital for health workers to provide cost-efficient and effective health care to the population. Also, timely and accurate information is crucial for policy makers to be able to make well-informed decisions to improve national health care. Unfortunately, the current situation is far from ideal. Data collected using paper and pencil is prone to transcription errors, loss and damage. Using handwritten data also takes time to enter into databases, which is another process prone to human error. The quality of health services delivery is constrained by the poor quality and high costs of existing communications services. Health institutions have poor access to accurate and timely information and data rarely reach policy makers in time for informed decision making. Lack of access to conventional medical and public health information resources, such as journals is another reason why the quality of health service delivery is constrained.
Read more about IICD’s Tanzania Country Programme.
The project started in February 2006. After a good start it was grounded by a severe and long lasting shortage of electricity. A small emergency project was realized to have inverters installed. By the end of 2006/early 2007 it picked up again, but investments in awareness raising among councillors and some of the training activities had to be repeated. In July 2007 a large two days awareness session was realized with councillors and municipal staff, which was successful. In most hospitals the HMIS is operational and attention now gradually shifts to maintenance of equipment, trouble shooting, data integration and analysis at municipal level.
July 2008, the full integrated national health reporting has been generated automatically. A novelty for Tanzania. Training for health workers and councillors is ongoing. A point of attention is trouble shooting and continuous follow up as to avoid the return of old and less effective working methods.
A focus group session of users expressed satisfaction and empowerment, but attention should be paid to trouble shooting and possible negative spin offs of computer use, including a loss of employment.
The project is expanding through local funds. The City Medical Officer initiates exapansion 5 health clinics. The project works presently on a consolidation plan, including a further reduction of down time to the target of less than 2 hour per month, a sustainability plan for the project office and prepares for further expansion. Experimentation is ongoing with n-computing and the implementation of a wireless network that conects all facilities and allows voice over IP. Within the project a learning environment is created that allows better hospital management and with it, better financial results. el
The broad objective of the project is to use ICT in improving the ability to collect, store and analyse accurate health data at Mwanza district level. This increases the efficiency and effectiveness of health services, increases accountability and improves tracing health trends in the district. Participating organisations in the project are the City Medical Officer (CMO), the African Inland Church Tanzania (AICT), the Evangelical Lutheran Church Tanzania (ELCT) and the Roman Catholic Church (RC).
The specific objectives in order to achieve the broad objective are:
- Implementation of a District Health Management Information System
- Training of HMIS users
- Awareness raising for other stakeholders and related government personnel
- Capacity building of the project organizations’ headquarters
- Installation of Internet Connectivity at AICT, ELCT, RC and CMO. Exchange and improved performance at health facility and district level.
Desired future data stream that allow for a better health reporting and planning are depicted below:
The church health institutions will benefit directly as the D-HMIS will facilitate the daily processes. Patients will benefit from the project through faster and better health service delivery. Policy makers and the Tanzanian nation will benefit as more accurate information will be made available in time for informed decision making.
Read more about IICD’s approach towards Health.
It is important to assure power supply backup for any HMIS, so people can continue to access information in case of a power cut, and to prevent the loss of data. Another lesson learned is that the rapid turn over of staff requires frequent retraining. A lot of health workers have moved from faith based to public, state owned hospitals, where salaries have recently increased. This is a serious threat to the project.
The coordinating organisation is the Evangelical Lutheran Church of Tanzania (ELCT), while the Africa Inland Church Tanzania (AICT) Mwanza and the Roman Catholic Church Mwanza are project partners. The project is planned and implemented with the full cooperation of the City Medical Officer (CMO) of the Municipal Council of Mwanza City, who is responsible for all health related matters within the municipality.
Use of District Health Management Information System in Mwanza, Tanzania.
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