HELLEN A. WERE HEALTH ECONOMICS TRACK 2 ND COHORT UNITID FELLOWSHIP PROGRAM 24/05/2011

 Several private health institutions in Kenya use Electronic Medical Registers for data collection, analysis and reporting within their institutions. In government hospitals DHIS 11 is used to collect data from health facilities across the country.  This data is then transferred to the national Health Management Information System office at the ministry of health headquarters for analysis and reporting.

 The DHIS 11 collects data on outpatient, inpatient, morbidity, hospital administrative statistics-daily bed returns, human resource and data specific to health intervention programs e.g TB, HIV/ AIDs, maternal and child care.  It does not however, include financial/ accounting module that compares income and expenditures, costing of clinical procedures, administrative costs and other costs.

 For Health planners in the ministry of health in Kenya to prepare credible plans and budgets they need inputs-data or\ evidence generated from health care institutions. They currently rely on district plans and budgets which barely reflect the true position of the institution because they are stand alones systems that are not directly derived from the DHIS 11.  Due to limitation of funds, Budgetary allocations to health facilities are often prioritised. Evidence is needed when making these ‘priorities.

Literature review (supporting Evidence)  According to a report by IBM Corporation (2009), Financial data can help translate strategic goals into financial targets and—in turn—into specific departmental plans and related revenue and expense drivers, such as labor, supplies, procedures and visits. By translating strategic goals into operational plans and by tracking and measuring performance against plan, leading healthcare organizations are better able to meet or exceed objectives.

 Michael and others(1968) A special Information system that takes into account Objective, quantitative measures of health problems is needed so that meaningful comparisons can be made between effort and achievement and between costs and benefits.  Performance budgeting and accounting are also facilitated, since costs of a set of activities (a program package) can be identified.

 Nyamtema (2008)interviewed 43 health workers in Kilombero district, Tanzania on their knowledge, attitude, practice and factors for change on HMIS and HMIS booklets from these facilities were reviewed for completeness  Results: Of all respondents, 81% had never been trained on HMIS, 65% did not properly define this system, 54% didn’t know who is supposed to use the information collected and 42% did not use the collected data for planning, budgeting and evaluation of services provision. Although the attitude towards the system was positive among 91%, the reviewed HMIS booklets were never completed in 25% - 55% of the facilities.

Conclusion: From the above studies it is clear that;  Health Information Systems play a crucial role in planning budgeting and resource allocation.  lack of HMIS training and knowledge of who is supposed to use the information, leads to non- utilization of the available health information system for planning, budgeting and resource allocation.  Financial/ accounting module needs to be incorporated in the district health system so as to improve the planning process at the national level.

Recommendation  Discussions with the ministry of health top management i.e P.S, Director of medical services and heads of divisions to convince them on the relevance of financial module in DHIS and to get their support.  Meeting with all the stakeholders – Ministry of health Policy and planning division staff, HMIS division, HIS experts, donors, District medical officers needs to be held in order to obtain the specifics on how to go about the integration  Implementation matrix on how to integrate the financial module into the DHIS needs to drawn. This plan will involve the necessary action steps to achieving the goal and a workable time frame. It will also contain the budgetary requirements for the project. THANKS