Development of Management System for Health Facility - Tanzania

The Health Management Information System (HMIS) was set up in 2006 to use in hospitals of the Evangelical Lutheran Church Tanzania (ELCT). By using the HMIS software, hospitals can easily collect, store and analyse data on patient registration, billing, laboratory, pharmacy, stock/inventory, x-ray and ward management. The project starts in one clinic and, if successful it is rolled to other hospitals, health centres and dispensaries. Change management is a key component. 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.

The programme is gradually expanding in number of facilities and scope.

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.

Read more about IICD’s Tanzania Country Programme.

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 to adapt the software to Mfumo wa Taarifa za Uendeshaji wa Huduma za Afya (the Swahili name for HMIS), the government health registration system.

The HMIS system is installed in four hospitals and a guide for change management has been drafted: it is a 14 steps approach. The open sourse software Care2x is functional.

The programme is expanded to also include telemedicine and accounting software (WebERP). An interface has been built to the the DHIS2 software that makes aggregation of data of health facilities possible, data warehousing & data mining and official Management and Information reporting to the national health authorities. CORDAID and FELM finnace an expansion of the programme.

• 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, incl. 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

Health facilities follow with interest the pioneering work of ELCT.

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.

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.

Read more about IICD’s approach towards Health.

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’.

Owner of the HMIS project is the Evangelical Lutheran Church (ELCT). ELCT owns and manages 20 hospitals, 5 paramedical institutions, over 160 dispensaries and health centres and various projects and programmes, which is about 15% of the national health services in Tanzania. The project is closely linked to another project with the ELCT on telemedicine.