1. eRegister NHISSA 6 June 2016 Hans Naude

2. Contents 1.Background 2.Demo 3.Challenges and Resolution of those 4.Outcomes 5.Successful implementation depends on 6.Recommendations

3. Background AGSA audit findings > manual source documents not supporting values reported in APP from DHIS ePHC project > HISP to develop eRegisters eTickregister for facilities with computers in consulting rooms – replace paper register eSummary register for summarising paper registers in offline facilities Must allow for offlline implementation Upload followed by auto-processing into DHIS Pre-pilot in 4 FS facilities followed by pilot in 61 facilities in Gert Sibande in Dec 2015

4. Demo

5. ChallengesResolution of Challenges Absence of/Unstable connectivity/Insufficient allocation of data at the facilities(1G per month) Offline and online eTick registers were implemented to address connectivity challenges. Clinicians were not computer literate or reluctant to use the register District were encouraged to use their skills plan via HRD to train clinicians on basic computer skills Data loss as the clinicians were forgetting to save data when going for lunch breaks Follow-up training. Autosave was shortened and a recommendation made that this should be done by IT during LibreOffice installation. Multiple eTick registers were created for the same facility because clinicians did not understand when to submit data. The eTick registers is being revised to allow only one register on the computer per day per consulting room..

6. ChallengesResolution of Challenges Windows firewall settings if upload of document is disabled the first time HISP created a document which shows how a script to be run to remove the stored firewall setting and trained users to allow the upload of documents. Blockage of FTP protocol by some servers It was established that the FTP protocol which was required to upload the registers is blocked by certain firewalls. Thus the FTP site was replaced with an Owncloud webdav server which is permitted via these firewalls Blockage of eTick register uploads on SITA network The blockage was tested on IP SITA internet and the uploading of eRegisters to the server was cleared. Problems loading eRegisters via MPDoH network After SITA upload was cleared specific tests were done on MPDoH portal to upload the registers. Once the blockage to upload registers via MPDoH firewall was cleared some additional performance issues was experienced with the upload which was related to traffic on the MPDoH network during the day e.g. using PERSAL, BAS, email and other network related resources. Uploading eTickregisters after 3pm proved to enhance the performance of the upload and is thus recommended.

7. ChallengesResolution of Challenges Absence of/Unstable connectivity/Insufficient allocation of data at the facilities(1G per month) Offline and online eTick registers were implemented to address connectivity challenges. The amount of eRegisters are reduced so that ONLY one register per facility will be created from v5 and that will relieve the data use for uploading registers The backup of registers manually copied of the computer not always done The trained procedures to copy files into the Archive folder must be followed Backup of the registers onto another device or onto a server The server where the eRegisters is uploaded is a backup for uploaded registers however, facilities should be enabled to do backups of the necessary folders according to accepted backup procedures

8. Outcomes Analysis eTickregister vs DHIS eRegister and DHIS comparison.xlsxeRegister and DHIS comparison.xlsx The piloting of the eRegisters can be considered a success based on the following outcomes – Clinicians adopted the tool – Saving of time for data collation and capturing – Will reduce the cost of procurement of manual registers. – Use of information for planning at all levels to manage health services is made easier and more timely

9. Successful rollout depend on Stakeholder engagement > ownership Training > Mentoring and support ICT Related issues sorted out beforehand – Provincial Firewalls should be tested that they allow for uploading of eRegisters. – Auto-save to be configured to 3-5 minutes to prevent data loss – Help desk to deal with uncertainty. – Proper backup procedures should be put in place

10. Recommendations It is recommended that the eRegisters are rolled out in all the provinces. That manual registers that have been replaced with the eRegisters be discontinued with but that manual registers should be available as a fallback in case of power failure or other issues eTickregister and eSummary are part of the webDHIS Facility Phase rollout and will be further expanded in other provinces as the Facility Phase of the webDHIS transition plan is implemented. Training on these interventions will form part of the Facility Phase rollout.