Tanzania Health Facility Registry http://hfrportal.ehealth.go.tz Oct 26, 2015 OHIE Conference Call

M&E SI (2010-2015) HSSP III (2009-2015) defined M&E strengthening as a key strategic area – evolved into M&E SI (2010-2015) Reference the M&ESI flyer; Goal: To enhance evidence based decision making in the Tanzanian Health Sector Purpose: To strengthen M&E mechanisms to ensure M&E information is used in the planning process at central, regional and district levels and there is improved access to M&E information.

M&E SI (2010-2015): MFL Integrated plan with multiple donors and implementers Each ‘area’ included MOHSW/GoT lead, individual responsible and lead TA organization/individual Objective 5: Provide technical support and leadership to the health sector to move towards and integrated e‐health infrastructure and enterprise architecture MFL activities include Arrange stakeholder meeting to plan for a master‐facility list and define requirements.. Implement master facility list that meets identified requirements Two activities with budgeted line items identified in the early M&E SI plan Initial funding from the CDC and EKN

BACKGROUND 2009-2010 Drugs and Supplies Human Resources Morbidity / G.I.S. / MAPPING Human Resources Financial and Expenditure Systems Drugs and Supplies Disease Surveillance Regulatory Boards H.I.V. Malaria / Other Programmes SURVEYS / RESEARCH Infrastructure / Equipment Morbidity / Mortality / HMIS

VISION G.I.S. / MAPPING Human Resources Drugs & Supplies Financial and Expenditure Systems Disease Surveillance Regulatory Boards Master Facility List H.I.V. Malaria / Other Programmes SURVEYS / RESEARCH Infrastructure / Equipment Morbidity / Mortality / HMIS

HFR/MFL TIMELINE MFL Req Workshop All regions trained RMO-DMO Meeting MFL WG MFL online Sep Nov 7 Sep 10 Dec 20 2009 2009 2010 2011 2012 2013 2014 2015 2015 MFL WG Formed and Meet Today 5 days 2009 - 2012 16 days UCC develop MFL 2010 - 2012 Jan 2011 – Jul 2015 24 days MESI MFL Plans 17 days Aug-Sep 2012: User Stories Workshop Sep 2012 Oct – Dec 2012: Follow up development of Functional Requirements and data elements specification. Draft paper data collection tool Business owners HMIS and DCS Oct 2012 – Dec 2013: Weekly or bi-weekly stakeholder meetings Nov – Dec 2012: Train 10 regions on GPS and paper tool Feb 2013: Decision to use Resource Map as data management engine Mar-May 2013: Select UCC as local implementation partner May – Dec 2013: Development of Curation Workflow and Curation Tool and enhancements to RM Aug 2013: Pilot testing and refinements Sep 2013: ToT Refresh Oct 2013: Revised final specifications and paper tool Nov 2013 – Feb 2014: Testing Feb 2014: ToT Refresh Mar – Apr 2014: Training all regions on GPS, paper tool and Curation Tool. Entering data from initial 10 regions Apr 2014 - August 2014: Data collection for remaining districts September 2014 – August 2015: Data Cleaning between HFR and DHIS2 to map IDs September 2015 – Public Portal Launch MFL Requirements Workshop Functional/Data Elements Specs 25 days Sep – Dec 2012 MFL WG re-started and Business Owners identified 10 regions trained (GPS, data tool) RM selected; Curation Tool developed Remaining regions trained (GPS,, data tool, curation tool; 10 regions curation tool Ongoing data entry, approval, retraining,; Develop Public Portal

MFL INITIAL STEPS Requirements Workshop Sep 2012 Identify key MOHSW owners Iterative meetings to refine specifications Identify HFR core team Stakeholders workshop held in September 2012, focused on Process, purpose, and motivation for development of a new and comprehensive Master Facility List (MFL) Date Element definition: Analyzed current 2012 Excel MFL and review of Kenya MFL elements Requirements gathering - gathering User Stories Through iterative meetings, identified 3 key ‘owners’ HMIS ICT Department of Curative Services (responsible for private facilities, and intend to register public facilities) Identified the key stakeholders including these 3 groups as well as NIMR, CDC, RTI (and later added UCC), InSTEDD with RI/CPHI providing TA as needed A small MOHSW team did a learning tour to Rwanda to look at how the HFR is being used The MOHSW agreed to make the UCC system available on the MOHSW website to a restricted group of users Workshop, User Stories and some details from Specifications; and then data collection tool and then rounds of revisions as the core MRL team met and refined

MFL Requirements Gathering (iterative) User Stories Requirements Specification And Study Tour to Rwanda for 3 members of MFL core team Data Elements Specification

MFL initial data collection and harmonization GPS training and paper data collection tool developed (paper tool went thorugh many rounds of changes) and paper tool user guide Using EKN funds, MOHSW purchased 133 GPS devices NIMR prepared the GPS training materials and MOHSW with TA prepared HFR/MFL training materials In Nov-Dec 2012, with NIMR funding, trained 10 regions (2 people/district) on why Tanzania is moving to a HFR/MFL, trained on GPS and the paper form During Dec 2012 – Mar 2013 these districts collected the data on the paper forms and shared the GPS information with NIMR for NIMR to review (shared electronically) With TA, the MOHSW made a technology selection based on the Requirements Specification and technology direction (using draft eHealth strategy guiding principles) Paper data collection continued Enter list of data sources – MOHSW HMIS and DCS, NIMR, NHIF Gap in funding – started to add in funds for UCC to Global Fund

MFL transformed to HFR Tool selection UCC identified as local partner Curation Workflow finalized; Development/testing of the Curation Tool Ongoing harmonization and data cleaning Common agreement that MFL output of the HFR which manages and maintains the HF content OHIE HFR (Resource Map – RM) was selected and approved by the MOSHW as the software system to be used The core team continued to meet, and the MOHSW/TA worked with InSTEDD on discussing the requirements to make updates to RM The eHealth Advisor worked to meet with NBS, NHIF, PMORALG and NIMR to combine some MFL lists and create a single list that could be used to load into RM One gap was identified in the area of curation: RM currently did not have an in built curation workflow process, and the MOHSW wanted to have this functionality The MOHSW selected UCC as the Curation Tool implementer and included this work in GF R9 PII application eHealth strategy noted the need for multiple local partners the MOHSW can work with During May to August 2013, the team worked with RM to upload the facilities and do some early testing/bug fixing Pilot testing occurred for one week during August 2013, and feedback was gathered for prioritized changes needed to RM An initial ToT was conducted during Sep 2013, which focused on the paper data collection form, GPS and the initial RM Tanzania MFL The HFR/MFL team continued to meet periodically, while the Curation Tool was developed and additional RM changes were made (including moving to Open ID server) Test plan development and testing continued in Dec 2013-Jan 2014; with User Guides developed in Feb 2014

Integrated HFR (2014-2015) Remaining regions trained (EKN); Ongoing supervision and support; Data Cleaning and approvals National training on Curation Tool during March/April 2014 Initial DHIS-HFR integration meetings started July 2014 Data entry into the Curation Tool continued during 2014 Data comparison between DHIS2 and HFR started in Dec 2014 Additional data cleaning workshops held during Mar-Jul 2015 Final data cleaning in process during Aug/Sep 2015 Public Portal Launch scheduled for Sep 8, 2015

Integrated HFR TZ HFR Resource Map The main data management engine for the HFR. This provides the application programming interface (API) to other systems, so that they can use the HFR data. Three APIS supported Facility Registry API – The FRED API Health Facility Registry Native API Customer Service Delivery-CSD TZ HFR Curation Tool Supports the MOHSW/PMORALG workflow for facility management, for adding, updating and viewing facilities. TZ HFR Public Portal (ready to launch) This portal is developed and in process of being tested, and will be the place where members of the public, partners go to get the latest facility information, with comprehensive reporting, filtering, including mapping

HEALTH FACILITY REGISTRY (HFR) DEFINITION STAKEHOLDERS Health Facility Registry (HFR) is an online tool used to provide public access to a database of approved information about all health facilities in Mainland Tanzania. HFR contains Master Facility List, which is the official source of health facilities information for the health care sector. HFR PMORALG MDAs Partners Public

BENEFITS OF HFR Latest facility information – Updated list Foundation of integrated HIS at all levels –used as basis of all system and surveys Resource saving – No need for stakeholders to maintain their own facility list Promote efficiency – Single source of updated list

HFR BENEFICIARIES Get Facility list Statistical report Get location and direction to the facility Give feedback Know facility type, ownership, service offered Get nearest facility PUBLIC Get Statistical report Facility list Get Geographic coordinates Capability to integrate with other systems STAKEHOLDERS

REPORTS PRODUCED Detailed report Summary report Number of Health Facilities by Service offered Type Ownership Administrative division Map view Facility list by Service offered Type/ Level Ownership Administrative division

HFR/DHIS INTEGRATION PROCESS HFR List DHIS HF List Mapped HFR/DHIS IDs Comparison of HFR/DHIS list was necessary Checked if facilities has similar name, type, ownership, operating status, administrative div. Common differences found after comparison work was: different names of facilities e.g facility name in HFR is Faith while in DHIS is Amani, facility type i.e Health centre in DHIS while HFR is DISP, ownership e.g. Public in DHIS while FBO in HFR. Three workshop for data cleaning was conducted to resolve these differences and update the changes in HFR. HFR Changes HFR DHIS FRED API

HFR INTEGRATION VISION Drug Registry Health Professional Registry   Health Facility SHR Terminology Services Patient Registry Data Warehouse (Health resources) eLMIS   Interoperability Layer   EMRs/HoMIS Insurance System i.e. NHIF, CHF, etc. Epicor, PlanRep Other point of service applications (i.e. HRHIS, etc.) iHMS

CURRENT STATUS HFR portal launched (10-Sept) HFR/DHIS integration is in progress and finalizing HFR/DHIS mapping IDs Ongoing data collection tool review Continue to improve data quality in HFR i.e. Services offered (can this replace some facility surveys?) Geographic Administration change challenges Getting remaining GPS codes that are missing (852: Priv 243, Publ 609) Mapping HFR services to the HMIS reports Make sure the updates and approval process for facilities is rapid Other facilities types providing Health care services i.e. Social Welfare, Pharmacy, Funeral homes,etc

LESSONS LEARNED 2 original MFL main activities in M&E SI did not reflect the actual MRL/HFR complexity Joint ownership within the MOHSW takes more time to meet multiple owners expectations and leadership buy-in Harmonizing lists with deletions/merging of HF difficult to track through API with deleted IDs Need to move the DCS approvals into their routine work and allocate funds

PARTNERS

INFORMATION CAPTURED Facility registered name Geographic location Name and location Zone-Region-District-Council-Ward-Village/Street Administrative division Unique generated per facility Does not change Facility Identifier Number Common facility name- Registration number- CTC ID- MSD ID-MTUHA Code Identification Postal address-Phone-Fax-Email-Website-Facility In charge details Contact information

INFORMATION CAPTURED.. Location description-Service area-Catchment area-Population Physical Location Facility type-Ownership-Registration status-Operation status Classification Number of rooms and beds- Transport-Water-Mobile networks-Toilet facility-Waste management -Sterilization and Infection control Infrastructure Clinical service-Therapeutics-Prosthetics and Medical devices-Diagnostics services-RCH-Growth monitoring /Nutrition Surveillance-Oral Health Services (Dental)-ENT Services-Emergency preparedness-Support services Service Offered