HIS country experiences

Overview Cuba Botswana Tajikistan Sierra Leone West Africa Others… Evolution of the international HIS scene, and HISP

In general Involved in many aspects of HIS strengthening: – Integrate data sources (into a dw) – Develop capacity to analyse and use information – Develop capacity to maintain and develop HIS further, including software development – Focus on districts; local action – Appropriate use of technology

Cuba: early HISP days.. Pilot in Applied same approach as in South Africa: – Bottom-up development of essential indicator list – ”Massive” local participation – Trying to decentralize decision-making in a centralized setting Did not work well, project closed down by Cuba

Cuba: HIS in the political landscape Decentralized healthcare: One Grupo Basico de Trabajo (basic working group: doctor and nurse) per 700 people. Centralized decision-making: ”the district people don’t know what information they need” Information as signal and symbol The ”need to know data”-only approach clashed with philosophy of the political system: socialist centralism

Botswana: unbalanced HIS staff DHIS implementation started in 2005, as an ”IT-project” (located in IT department) Medical staff never developed much ownership IT department had limited knowledge of the health sector Despite resources, very slow implementation and scaling Fragmentation at the ministerial level

Health Statistics District 1 DHT Facility 1Facility 2Facility n IDSR–Notifiable Diseases PMTCT EPI STD Home Based Care IPMSNutrition MASA MCH Family Planning IPT TBSchool Health Mental Health Others … Facility 3 District 2 DHT District n DHT

Health Statistics Facility 1Facility 2Facility n IDSR–Notifiable Diseases PMTCT EPI STD Home Based Care Nutrition MASA MCH Family Planning IPT TB School Health Mental Health Others Facility 3 National HIS District 1 DHISDistrict n DHIS IPMS District 2 DHIS

Tajikistan: Centralized system, decentralized needs

What is collected? Global burden of data collection? What is collected as routine data? – South Africa: 500 – India: 2000 – Botswana: 2000 – Cuba: – Tajikistan: ! Is the data collected useful? Who uses it?

Sierra Leone: integration and interoperability Started late st revision of reporting forms in 2008 National roll-out od DHIS2 and new forms in nd revision of forms in Reduced amount of forms. Most forms collected through DHIS Pilot for interoperability DHIS-OpenMRS Future plans: more interoperable subsystems

Figure 2: Increasing institutional delivery rates in Western Area, from the HMN Results Report (2010)

West African Health Organization: trying to achieve critical mass Regional organization, local funding Wants to support all 15 member states in developing better HIS Experiences from Sierra Leone, and interoperability between DHIS2 and other software are key catalysts Ghana, Gambia, Liberia, Nigeria, Togo also implementing similar systems Cape Verde, Mali, Burkina Faso, Guinea, Guinea-Bissau, Senegal, Niger, Benin, Ivory Coast, and WAHO HQ also potential implementers WAHO will be a centre of excellence – Developing and providing skills Intra-regional collaboration for sustainability

Challenges at the international/regional level Data definitions: – Are the countries collecting the same? With the same interval? How do they report? – Do they have different software solutions? – What is the output format? What are the agendas of the various international actors?

Zambia: who can use the information? DHIS v. 1.4 in all 70+ districts. Using DHIS v. 2 as national data warehouse No clear policy of who has access to data, even if it is now available at intranet at MOH. All requests had to go through one person Online system challenging this power structure

Armenia Fragmentation Politics. HIS unit not a ”national level” unit. Reform pushed by international organizations Like Cuba and Tajikistan: – Strong centralist traditions Urba/Rural divide: – Yerevan is as modern as it gets. Countryside less so

Evolution of the international scene and HISP Development agencies are powerful – UNAIDS Millenium Development Goals HMN since 2005 Global Fund: focus on HIS PARIS declaration: build upon existing HIS

Evolution of HISP HISP since 1994 – Essential dataset – Local use, bottom-up development Now, more diverse – Many agendas: NGOs, international orgs. Technology has changed: from offline to online. Mobile

Discussion Similarities and differences – Common themes: ? In all countries HISP has been active: very few have come far when it comes to information use: how to achieve this?

TALI 1.The information system is working technically according to its specification 2.Data is analysed, disseminated and used: 3.Information from the system used for planning and evaluation of achievements