THE UNITED REPUBLIC OF TANZANIA HEALTH INFORMATION SYSTEMS (HIS): HERMES SOTTER RULAGIRWA Presented at 2017 PEPFAR data and systems applied learning Summit September 18-21, 2017

ABOUT TANZANIA 50+ Million (NBS, 2017) Total Area: 883,600 sq km Life Expectancy: 61.8 years Health Facilities: 7,616 Mobile Penetration: 79% Internet Penetration: 45% 100% of National, Zonal, Specialized and Regional Hospitals connected to National ICT backbone Districts connected to National ICT backbone: 85% National Data Centers

Benefits of Digital Health HIS Increased revenue collection Cost Efficiencies Improved Quality of Health at HF Patient Satisfaction The Ministry through its ongoing health sector reforms aims at Improving the quality of healthcare Improving operational effectiveness and efficiency Improving resource utilization (e.g. costs) Implementation of HSSP III has produced many positives, however realizing the best health outcomes requires a fundamental transformation. The role of ICT in supporting such a transformation has widely been accepted across the globe, but the challenge is how to do this well!

Benefits Cont The use of eHealth shown positive impact within health sector. E.g. At the National Hospital revenue collection increased by 350% At one of the Zonal Hospital (Mbeya) revenue increased by 300% Some Regional Referral Hospital revenue increased by 150% Record keeping at the National Hospital has improved from 70 personal files lost per day, to 15personal files lost per week. However during computerization period physical files lost, but the information is still available. Appointment cancelation were 150/day now its down to 15/day. Average waiting time to get appointment was 7 weeks, now is 1.4 weeks Today No Record Loss, Appointments are made by the Doctors right away.

Tanzania Digital Health Strategies Health policy 0f 2007, now under review National ICT Policy 2016, HSSP IV 2015 - 2020 eHealth Strategy 2013-2018 An Integrated Health Facility Electronic Management System (iHFeMS)-2016 ICT policy guideline specific for health sector Digital Health Investment Roadmap – 2017-2023, recently launched on 2016 M&E strategy ALL documents available in the MoH and eGA Website (www.moh.go.tz and www.ega.go.tz)

Tanzania Digital Health Strategies

Overview HIS DHIS2 Journey began since 2007 MoHCDGEC working with multiple stakeholders (eg. Global Fund, NORAD, CDC, USAID, Netherlands, UN Agencies) Technical support from University of Oslo and University of Dar es Salaam (HISP) The actual implementation started in 2010 after agreeing on implementation approach National Rollout was completed in 2013 Integration with Vertical Programs Initiative started in 2014

Integrated programs Data needs within DHIS2 HMIS Data (OPD, IPD etc.) RCHS Data HIV/AIDS and PMTCT Program data Malaria Program Data TB and Leprosy Data Result based Financing (RBF)

Information flow Data aggregation MOHCDGEC Regional Medical Office (RMO/RHMT) IPs Programmes National DHIS 2 Database District Medical Office (DMO/CHMT) Facility Data aggregation Patient/Client Client recording form

Electronic Systems Integration eLMIS/VIMS HRHIS DHIS2 (HMIS) eIDSR HFR CTC2 eLIS (Viral Load) CTC3

Facility Level Data Systems Program quality, Clinical monitoring Reporting CTC Card CTC3 CTC2 Aggregate Client Level HTC Register National Report Count test RDE Pharmacy TB ERR (TB) Lab New CTC2 Introduces automated reporting from CTC2 to CTC3 Automated reporting to DHIS2 via CTC3 HTC Now integrated to CTC2 RCH ?

Data Quality Assessment Frequency of Data Quality National – at least once annually for selected indicators Regional Level – semi annually. District level – Quarterly Data Quality Methods Spot Checking Cross checking DHIS2 is used to assist DQA teams to identify gaps.

Data Use and Dissemination Program specific Dashboards within DHIS2 Dissemination of data to public through HMIS portal (hmisportal.moh.go.tz) Result based Financing Module (RBF) Performance monitoring of different interventions e.g. Score cards App Quantification Process (e.g. Quantification of ARV drugs and HIV commodities) Tracking of availability of health commodities (e.g. essential medicine)

Achievements Linkage to online Health Facility Registry (HFR) Improved data availability at all levels to support evidence based decision making. Single source of Health data. Integration of vertical programs One to One Integration eg. DHIS2-HRHIS, HFR-DHIS2, HFR-CTC3 etc.

Achievements Cont. More than 1,400 Health Facilities already implementing EMR & ERP at different stages (Fully computerized, partial and ongoing) Health Facility Registry, DHIS2 (as data warehouse), HRHIS/TIIS, eLMIS, VIMS, TIMR all web based centralized at National Level Report of quality of care from citizen, Wazazi nipendeni 15001 code Pregnancy mother Registration eIDSR/DHIS2 85% reporting from HF using mobile across the country Infrastructure: 100% of National, Zonal and specialized hospitals, 93% (26 out of 28) regional hospitals connected in the national backbone, 85%

Achievements: Data We Have

We know which commodities are available at HF (DHIS2/eLMIS)

Challenges Inadequate computing infrastructure at health facility level Track patients for Referral cases at different HFs Inadequate ICT infrastructure for easy scaling of HIS Inadequate ICT expertize/staff especially at Regional/and Districts Hospitals and Health Centres

Way forward Computerisation at primary health care Implementation of EMR – Ongoing Implementation of Health Information Exchange (HIE) Capacity building at all levels Performance Contracts at all levels Continue implementation of Digital Health Investment Recommendation Roadmap

Health Information Exchange Conceptual Model

Road map This slide shows how we have grouped the investment recommendations into foundational, high impact and quick win. It also shows us the timing and costing of all the recommendations in one place Main menu

Asante Sana &