Health Information Systems Programme HISP

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Health Information Systems Programme (HISP) The
success story of a development project in South
Africa
Norah Stoops, Louisa Williamson, Arthur Heywood,
Calle Hedberg Health Information Systems
Programme, School of Public Health University of
Western Cape Cape Town, South Africa Medinfo200
1 London
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HISP a vision
to support the development of an excellent and
sustainable health information system that
enables all health care workers to use their own
information to improve the coverage and quality
of health services within our communities
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HISP Principles

• Empowerment, democratisation transformation
• Develop an Information Culture at local level
• Action-led District Health Information System
• Integration of health management information
  systems
• Computer software supporting processes, not
  driving them
• Primary focus on district teams, supervisors
  facility managers
• Shift power from IT managers to Health
  managers/workers
• Appropriate training programmes
• Educational programmes (Certificate, Diploma,
  M.Phil, Ph.D) key elements in developing
  professional skills and career paths

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HISP in Short the Pilot Years

• Collaborative Research Development project
  between the Universities of the Western Cape,
  Cape Town, Eduardo Mondlane (Maputo), Oslo
  (Norway) National / Provincial Health
  Departments in SA Mozambique
• 1996 Mitchells Plain baseline survey
• 1997-98 Four Pilot sites - Mitchells Plain,
  Khayelitsha, Blaauwberg, later South Peninsula
• 1997-98 Development of Essential Datasets for
  PHC at National (NHIS/SA) Provincial levels
• 1998-99 Development of computer software tools
  the District Health Information Software (DHIS)
  rolled out in the Western Cape in mid-98,
  Eastern Cape 1999
• 2001 National rollout to all nine provinces

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Information Spaghetti
DNHDP Western Cape
City Health
Births Deaths Notifiable diseases
New /emerging flow of information
City Health Clinic 3
City Health Clinic 1
Groote Schuur Hospital
Outside hospitals
City Health Clinic 2
City Health Clinic 4
School Health
Geriatric Services
PAWC
MOU (Midwife obstetric unit) PAWC
Day Hospital DNHPD
City Health Clinic 5
DNHDP Pretoria
Private hospital 31 medical specialists
Psyciatric hospital PAWC
Environmental office
Dental unit 1 PAWC
54 private medical pract.
RSC
Dental unit 2 PAWC
UWC Oral Health Centre
Dental unit 3 PAWC
23 private dental pract.
Mandalay Mobile clinic RSC
Youth Health Services
12-15 NGOs
12 private pharmacies
Mitchells Plain Baseline Survey (1996)
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DHIS Information flow
Information from other sources, e.g. Birth /
death registers TB register, census data
Higher levels
HEALTH PROGRAMS
Local Government
Nutrition
COMMUNITY STRUCTURES
V E R T I C A L
DISTRICT HEALTH MNG. TEAM
C O M M U N I T Y
TB
Health Welfare Forum
Unions
STD/ AIDS
Health Committees
DISTRICT INFORMATION CENTRE DATABASE
Family planning
CHWs
Special Interest Groups
School Health
Traditional healers
Referrals
Health Centres Clinics
HOSPITALS In and out patients
NGOs (Non-gov. Organisations)
Private Sector
Dental Services
Circumcision Surgeons
Mental Health services
Environmental Health
Maternity/ Munits
NON-GOVERNMENT
GOVERNMENT
HEALTH SERVICES
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National Rollout What does it mean?

• All nine provinces involved
• Integration of datasets from all provinces
  (Immunisation, PHC)
• Creating, cleaning up of datasets and validation
  of data (where possible)
• Implementation of PHC and Hospital datasets
• Computer training and support
• Training courses for both software and Use of
  Information
• Ongoing development of software (Service Release
  2 August 2001)
• Inclusion of alternate structures for all
  facilities (country has been divided into new
  Local Authority structures)
• GIS referencing for all facilities

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DHIS Software

• Based on Microsoft Office Professional (1997
  2000)
• Uses Access for Data Entry and Excel Pivot
  Tables for data extraction, manipulation and
  graphing

• Data sets
• PHC monthly
• Clinic audit annually
• Hospital monthly
• TB quarterly
• Environmental health
• Emergency Medical Services

• Facility list
• Data dictionary
• Data parameter
• Max/min
• Validation rules
• Indicators
• Community data
• Institutional infrastructure
• Finances

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DHIS Software

• Forms (individualised)
• Tick register
• Tally sheets
• Reports
• Monthly data
• Monthly indicators
• Programme reports
• Child health
• Maternal health
• Communicable disease
• General PHC

• Pivot tables
• Multidimensional cross-tabulation of data,
  indicators, facilities, time, classifications
• Datamart
• Flexible tool to identify outlying values of data
  or indicators
• Presentation
• Graphs all types
• Word-processing
• PowerPoint presentation
• GIS
• Spatial data display/mapping

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Monitoring the process of DHIS implementation

• LEVEL 1 Data collected at facilities
• Basic validation use of min/max. ranges
• Data sent to district level
• LEVEL 2 Data converted into information
• Feedback as indicators, graphs/ maps, reports
• Routine discussion at all levels
• LEVEL 3 Information based decisions
• Interpretation use of information
• Indicator driven business plan
• Service delivery contracts based on indicators

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HISP International

• Mocambique (part of original pilot project)
• India 2 districts
• Malawi implemented for PHC and Hospital data
  sets
• Nigeria interest
• Tanzania testing

• School of Public Health
• University of Western Cape
• P Bag X17
• Bellville 7535
• South Africa
• Tel [phone]
• Fax [phone]
• norah_at_mweb.co.za louisaw_at_mweb.co.za
• arthur_at_hisp.org chedbeg_at_mweb.co.za