HIS IMPLEMENTATION IN ZANZIBAR

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HIS IMPLEMENTATION IN ZANZIBAR 

• Juma Lungo
• jumal_at_ifi.uio.no
• University of Oslo
• 13th April 2007

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Motivation

• Routine health delivery services
• Basic health services at community level, health
  posts, dispensaries, health centres, and
  hospitals
• Decision-making and health planning take place
  at the top (Ministry, and provincial levels)

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Why HIS?

• Health planner at the Ministry
• of Health,
• ah! the number of clients has increased this
  year. The health facility needs one more Nurse

• Patients/clients at a remote
• health facility.
• How does health planners at the Ministry of
  Health plan for these health facility clients

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Introduction

• Zanzibar Health Sector has a number of
  sub-systems for collecting and reporting data
• Expanded Programme on Immunization (EPI),
• Schistosomiasis/ Helmenthisis Control Programme,
• Nutrition Unit,
• Reproductive and Child Health (RCH),
• TB and Leprosy,
• Zanzibar AIDS Control Programme (ZACP) and
• Malaria Control Programmes.
• All these vertical programmes have introduced
  their own specific forms for data collection.

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Introduction

• As a result the Primary Health care Units and
  hospitals ended to have different forms (from
  handwritten pages to printed forms), for data
  collection and reporting
• At the end of 2004, a HMIS review revealed that
  the HMIS in Zanzibar is fragmented and does not
  support data driven decision-making

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Objectives

• A roadmap towards development of HMIS was agreed
  as follows
• Developing essential indicator and data sets
• Streamline the data collection tools
• Develop and implement a computer database to
  assist the process of storage and analysis of
  heath data.

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Methodology

• HISP contracted to re-design the HMIS
• Action Research

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Action Research

• Action research has been typified as a way to
  build
• theory,
• knowledge, and
• practical action
• by engagement with the world in the context of
  practice itself

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Action Research

• Is a research approach, which has the dual aims
  of action and research
• action to bring about change in some community or
  organisation or program
• research to increase understanding on the part of
  the researcher or the client, or both

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Action Research

• Action research aims to contribute both to the
  practical concerns of people in an immediate
  problematic situation and to the goals of social
  science by joint collaboration within a mutually
  acceptable ethical framework

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Essence of Action Research

• Diagnostic Stage
• Analysis of the social situation by the
  researcher and the subject of the research
• Theories are formulated concerning the nature of
  the research domain
• Therapeutic Stage
• Involves collaborative change experiment
• Changes are introduced and the effects are
  studied

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Phases of Action Research

• The most prevalent description of action research
  details a five phase, cyclical process which can
  be described as an ideal exemplar of the
  original formulation of action research

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Phases of Action Research

• This ideal approach first requires the
  establishment of a client-system infrastructure
  or research environment
• Then, five identifiable phases are iterative
• (1) diagnosis,
• (2) action planning,
• (3) action taking,
• (4) evaluating, and
• (5) specifying learning

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Phases of Action Research
DIAGNOSING Identifying or Defining a Problem
ACTION PLANNING Considering alternative courses
of action
CLIENT SYSTEM INFRASTRUCTURE Specification and
agreement that constitutes the research
environment
SPECIFYING LEARNING Identifying general findings
EVALUATING Studying the outcomes of an action
ACTION TAKING Implementing a course of action
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Implementation of HIS in Zanzibar

• HMIS taskforce to foresee and implement the HMIS
  was created
• HISP was contracted as a technical implementation
  team to work together with the taskforce and
  other stakeholders
• Initially started to work in Four districts in
  Zanzibar
• Micheweni, Chakechake, North A, and North B

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ACTION RESEARCH CYCLE

• Establishment of a client-system infrastructure
  or research environment
• HISP contract signed
• The taskforce was a team of health officers
  working under the MOHSW,
• HISP Zanzibar is a team of hired software
  developers,
• Masters and PhD students registered at the
  University of Oslo were also involved

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ACTION RESEARCH CYCLE
Phase Specific Activities
Diagnosing Semi-structured interviews with health staff Observations on health data collection and analysis Use of checklists by inspecting data registers, analysis tools, and health workers staffing level Assessing available computers and computer programs A kickoff workshop between HISP team and Taskforce
Action planning Acquiring DHIS Software from HISP network Developing strategies for importing baseline data to DHIS Acquiring sample health indicators
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ACTION RESEARCH CYCLE
Phase Specific Activities
Action taking Mapping of data elements to indicators Reviewing health data collection forms DHIS database setup and Data importation Designing new health data collection forms Training health workers on Computer Literacy Training health workers on Health data analysis
Evaluation Group Discussions with health workers DHIS demonstration Testing newly designed data collection forms Calculating indicators Comparative with baseline data Retrospective testing
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ACTION RESEARCH CYCLE
Phase Specific Activities
Specifying learning Presentations and Fieldwork reports Publications Theses and Scientific papers
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Comparative with baseline data
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Opportunities and Challenges

• Developing effective, need based and indicator
  driven datasets
• aligning the interests of various stakeholders to
  agree that a particular data element should be
  dropped and so to adopt new forms was a big
  challenge
• it is easy for stakeholders to add more health
  data elements than dropping one

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Opportunities and Challenges

• Training of district officers in managing
  computer database in the context of poor computer
  literacy
• Most of the health workers are not conversant
  with computers
• computers are strange talking machines which
  scares illiterate computer users, a health
  officer told us
• The challenge was to train health workers to
  operate computers and then to update and manage
  large database of health data

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Opportunities and Challenges

• Gradually improve the quality of data and use of
  information for management
• The challenge here is to change the attitude of
  senior health officers to rely on health data to
  make sensible decisions

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Project Outcomes

• Essential datasets and indicators have been
  developed
• Reporting routines from one level to another has
  been established
• Health data collection forms are successfully
  electronically mimicked in the DHIS and that the
  DHIS is installed and being used in all
  districts, the zonal offices, and at the HMIS
  unit

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Concluding Remarks

• The main achievement in this project is
• to be able to combine the interest of many
  stakeholders (especially the vertical programs)
  and point them to single source of data, the
  DHIS.
• this paved the way to concentrate on the
  technical side of implementing and training users
  to use the software (DHIS) instead of struggling
  with political and administration barriers.

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Thanks

• The End

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