Foundational elements of HIS: National client registries, health worker registries, and the HMIS

The Ethiopian Ministry of Health (FMOH) has been using two independent, propriety HMIS systems, covering to different regions within the country. This parallel structure has posed challenge to integrate datasets from different regions, conduct national level analysis without manual data integration, and to implement improvements to the system functionality. Thus, FMOH has decided to transition to DHIS2 to address these challenges, and thus to improve their ability to use health data for decision making, through the introduction of a singular, open-source, government owned HMIS that will harmonize upstream data collection as well as downstream reporting and data use and analysis across all levels of the health sector. Facilitating the transition from the two legacy HMIS systems to a new, singular system, is not without its own challenges. Thus, it was critical to implement a transition strategy that brings minimal disruption to the current processes of data collection and use. The FMOH has accomplished customization of the software to the Ethiopian context and conducted user acceptability and field application tests and successfully achieved legacy data migration. In addition, FMOH has conducted a comprehensive 5-days training for over 7000 health professionals at all levels in the health system. The online and offline version of DHIS2 is deployed at >95% of health facilities. However, the reporting rate varies among regions. Currently, service reporting rate has reached 90% while the disease reporting rate is at 80%. This panel presentation will describe the transition processes to DHIS2 using the systems approach covering the business, data, application, and infrastructure aspects of the transition. Particular focus will be given to the challenges of implementation at scale, localization requirements unique to Ethiopia, the HealthNet infrastructure as enabler to DHIS2 operation, the shift in focus from reporting to visualization and data use, and the DHIS2 governance issues.

Imagine two big rooms within Kenya’s Ministry of Health (MOH) packed with cluttered paperwork. Over 50,000 health worker (HW) personnel files are stacked high – pure chaos for finding information about the health workforce and making it impossible to aggregate data and provide broad perspectives. The result – decisions relating to health workforce planning, hiring, deployment, and training are irrational and not based on evidence. Then this problem got bigger. In 2010, Kenya enacted a new constitution, decentralizing health system management from one national hub to 47 county governments. With devolution, health workers moved haphazardly across counties based on preference. In addition, each county was rapidly hiring more HWs with no functional system to track health workforce growth or movement. Meanwhile, technology was playing an increasingly crucial role in Kenyans’ lives. Families and friends were connecting online, the banking industry had transformed, and virtual learning was taking shape in education institutions. IntraHealth International worked with Kenya’s government to bridge the devolution and technology revolutions and organize and digitize MOH’s personnel files and enter them into its open source integrated human resources information system (iHRIS). IntraHealth trained counties to use the centralized system, enabling each county to independently manage their own HWs. Now all 47 counties and national stakeholders have access to information on more than 67,000 health workers, including their workstations and training. These data are used at county and national levels for planning, budgeting, recruitment, deployment, and training. This session will take the audience through the journey of iHRIS in Kenya, within a changing governance and technological environment. The session will share challenges, lessons learned and, data product utilization, linkage of iHRIS to other systems, and how this has improved workforce management in Kenya.

Lack of reliable client identification significantly impacts the quality and provision of health care services. As a result of the changing epidemiological landscape, chronic diseases are a prevailing cause of hospitalizations. Many developing countries face challenges with uniquely identifying clients so that each time a client accesses health services, his/her health information can be linked to ensure continuity of care. The implementation of the NHCR has the potential to lead to accurate and persistent client identification. The initiative will contribute to HIV care and treatment surveillance and the realization of the 90-90-90 continuum framework. In cooperation with the MoHCDGEC and other partners, TSSP is overseeing the implementation of the NHCR system in Tanzania. The client registry (CR) system is part of the foundational digital health initiatives outlined in the Tanzania eHealth strategy and prioritized by the investment recommendations set for the heath sector.