1. Health Resources Availability Mapping System The Darfur Case Study
HeRAMS
SUDAN WHO Country Office
Health Information Service Unit 1

2. Outline What is HeRAMS Contextual Information Health Infrastructures
Health Human Resources
Health Services Availability
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3. What is HeRAMS

4. Background
HeRAMS has been initiated and developed between February and December 2008 in the three States of Darfur, Sudan, to assess and monitor the availability of health sector resources provided by both the international and local response to the humanitarian crisis
Based on this experience, HeRAMS evolved in a generic tool of the Global Health Cluster to be used in the roll out of the health clusters in the countries implementing the cluster approach, in order to assist Health Cluster Coordinators and partners in assessing and monitoring the availability of resources and services provided to population affected by humanitarian crisis. 4

5. What is it
HeRAMS (Health Resources Availability Mapping System) is an interactive software-based information system that aims to rapidly capture and process the information in order to assess and monitor the availability of health resources at health facility level and community levels
HeRA M S
Health Resources Availability; in terms of available health resources infrastructure, personnel, and provided services
Mapping;
in terms of assessment, monitoring, and geo-referencing
System;
in terms of analytical framework and technical support tools
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6. HeRAMS Aim and Objectives
HeRAMS is developed to provide the decision makers with timely, relevant, and reliable information about the available health resources,, in order to support them:
Enhancing coordination & accountability through the monitoring Who is Where, When and doing What
Indentifying and measuring gaps
Support priority settings
Inform strategy development and planning of evidence-based health interventions in humanitarian areas
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7. HeRAMS Database System Summary & Analytical Reports
System Components
Standard Data Gathering Matrix
HeRAMS Database System
Input
Output
Summary & Analytical Reports
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8. Key Information Areas
Health Resources' Availability has been disaggregate in three main information areas:
Health Facility Infrastructure & Mobile Clinics
Health Personnel
Health Services
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9. Health Facility Infrastructure
This part is designed to collect set of information related to the health facility infrastructure, that is:
HF Location: precisely specify the location of the HF to the lowest possible level (i.e., State Locality Administrative Unit Settlement/Village), plus the coordinates of the HF (longitude and latitude).
HF premises: provides information about the
HF type with regards to the PHC classifications (i.e., PHCU, PHCC, RH, etc...),
status of the HF (whether it is functioning or not),
nature of the HF building (whether it is permanent or a temporary building),
service coverage of the HF (whether the HF is serving an IDP camp or a settlement, or both)
inpatient capacity of the HF (number of beds).
Dees the HF reporting under EWARS?
HF Management: indicates the health partners who run the HF, in terms of the main owner and manager of the facility, and the supportive partners, if any.
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10. Health Personnel
This part provides information about the health staff work in the HF against the health staff work in the community with regards to certain facility.
HF based staff: is the medical cadre that run the HF, such as MO (Medical Officer), MA (Medical Assistant), Nurse, etc...
Community based staff: is categorized as voluntarily workers (e.g., Village Volunteers), and paid workers (e.g., Community Health Workers, Village Trained Midwives)
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11. Health Services
Health services are broken into three levels of care, where each one encompasses set of services related to different health sectors; as shown in the diagram below:
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12. Data Quality Assurance: (1)
Many validity checks are performed to ensure consistency and reliability of the data:
Implementing the data collection sheet with:
Standard pre-defined lists for the data types of known parameters; (i.e. ., standard locations list, HF Types,…)
Validation rules for entered data types
Upon importing data from the data collection sheet to the Database system, other validation rules are performed to ensure consistency of data types
Performing local quality control check; coordinated editing and auditing process
Peer reviewing of the collected raw data; conducted by the data gathering team (field PHC officers) and developers,
Appraising & reviewing of generated reports before dissemination
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13. Data Quality Assurance: (2)
Other procedures are applied to ensure quality data:
Collecting data by personally interviewing partners and direct field mission, rather than sending partners a copy of the data collection sheet to be filled
Developing data dictionary for clear definition of data elements; “use of meta-data”
Unifying the reporting channel & maintaining one source of data to avoid duplication of reporting
Providing hands-on training for the system users (i.e., PHC officers); up-to-date
Establishing a mechanism for frequent feedback to those collecting and using data
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14. CONTEXTUAL INFORMATION

15. North Darfur - Contextual Map - July 2007
Source : OCHA

16. Humanitarian Space Dynamics Quantitative and qualitative evolution of the Population of Humanitarian Concern (North Darfur – January 07, July 07 & January 08)
Evolution - in absolute numbers - of the Population of Humanitarian Concern (Total Population, IDPs and Resident Population)
Evolution (%) of the Composition of the Population of Humanitarian Concern (IDPs vs Resident Population)
IDPs
January 2007
Resident
population
IDPs
July 2007
Resident
population
IDPs
January 2008
Source : OCHA
Resident
population

17. Humanitarian Space Dynamics Quantitative and qualitative evolution of the Population of Humanitarian Concern (El Fasher Locality – North Darfur - January 07, July 07 & January 08)
Evolution - in absolute numbers - of the Population of Humanitarian Concern (Total Population, IDPs and Resident Population)
Evolution (%) of the Composition of the Population of Humanitarian Concern (IDPs vs Resident Population)
IDPs
January 2007
Resident
population
IDPs
July 2007
Resident
population
IDPs
January 2008
Resident
population

18. HEALTH INFRASTRUCTURES

19. i-HeRAMS – Infrastructure Characterization
Functioning Health Facilities State Profile, North Darfur, March Absolute Numbers, by Health Facility Type, by Locality
* Primary Health Care Centre
** Primary Health Care Unit

20. Functioning Health Facilities State Profile Absolute Numbers, by Type, by Locality North Darfur - March 08
* Primary Health Care Centre
** Primary Health Care Unit
*** Primary Health Facilities (= Sum of RH and PHCCs)

21. Primary Health Care System Composition (%) March 2008
Darfur Region
Comparison across States

22. Primary Health Care System Framework Average # of Persons per type of Health Facility, by State Darfur Region, June 2008 (PHCC: Primary Health Care Centre; PHCU: Primary Health Care Unit)

23. i-HeRAMS – Infrastructure Characterization
PHCC Availability by Locality – (IDPs & Non IDPs) Average Number of Persons per PHCC North Darfur, March 2008
i-HeRAMS – Infrastructure Characterization

24. HeRAMS - PHCC Availability Average Number of Persons per PHCC – by Locality and for Major IDP Camps North Darfur - March 08

25. North Darfur Case Study – Dec 2008
North Darfur: Functioning HFs, by Type, and by managing partner (SMoH versus NGOs)
Total functioning HFs = 206 out of 250 existing
North Darfur Case Study – Dec 2008
Out of the 7 RHs managed by SMoH, 4 (57%) are supported by WHO, UNICEF, & UNFPA
Out of those 44 PHC Centers, 13 ones (30%) are supported by WHO, UNICEF, & UNFPA
Out of those 65 PHC Units, only one is supported by WHO, UNICEF, & UNFPA
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26. Total functioning HFs = 194 out of 253 existing
North Darfur Aug-09
Total functioning HFs = 194 out of 253 existing
Out of the 8 RHs managed by SMoH, 5 (63%) are supported by WHO, UNICEF, & UNFPA
Out of those 45 PHC Centers, 16 ones (36%) are supported by WHO, UNICEF, & UNFPA
Out of those 76 PHC Units, 3 ones (4%) are supported by (2 are WHO, UNICEF, UNFPA), & IRC
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27. North Darfur: Functioning PHCCs, per Locality, by managing partner Dec-08 versus Aug-09
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28. South Darfur Case Study – Dec 08
South Darfur: Functioning HFs, by Type, and by managing partner (SMoH versus NGOs)
South Darfur Case Study – Dec 08
Total functioning HFs = 326 out of 415 existing
Out of the 9 RHs managed by SMoH, 5 are supported by WHO
Out of the 6 PHCCs managed by the SMoH, one is supported by CARE (17%)
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29. South Darfur Case Study – Aug 09
Total functioning HFs = 334 out of 408 existing
50% of the 10 RHs managed by the SMoH are supported by WHO
One out of 12 PHCCs (8%) managed by the SMoH is supported by FRC
3 out of 220 PHCUs (1%) managed by the SMoH is supported by FRC 29
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30. South Darfur: Functioning PHCCs, per Locality, by managing partner Dec-08 versus Aug-09
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31. Total functioning HFs = 167 out of 219 existing
West Darfur: Functioning HFs, by Type, and by managing partner (SMoH versus NGOs)
West Darfur Case Study – Dec 2008
Total functioning HFs = 167 out of 219 existing
Out of the 6 RHs managed by SMoH, 5 are supported by WHO
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32. Total functioning HFs = 165 out of 221 existing
West Darfur Aug-09
Out of the 5 RHs managed by SMoH, 4 are supported by WHO
All those 10 PHCCs are supported by (WHO, UNICEF =9PHCCs), & IARA, CAM
Out of those 38 PHCUs 3 (8%) are supported by WHO & UNICEF, CAM
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33. West Darfur: Functioning PHCCs, per Locality, by managing partner
West Darfur: Functioning PHCCs, per Locality, by managing partner. Dec-08 versus Aug-09
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34. HEALTH HUMAN RESOURCES

35. Community Based Personnel
Health Workers, by type, working in PHCCs and in the communities of their related catchment areas, North Darfur, December 2008
HF Based Personnel
Community Based Personnel
52% of the overall community personnel are SMoH, while 48% are NGOs supported.
Only 2% of the overall community personnel are SMoH, while 98% are NGOs supported.
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36. Community Based Personnel
Health Workers, by type, working in PHCCs and in the communities of their catchment areas, South Darfur, December 2008
HF Based Personnel
Community Based Personnel
Only 6% of the overall community personnel are SMoH, while 94% are NGOs supported.
Only 1% of the overall community personnel are SMoH, while 99% are NGOs supported.

37. Community Based Personnel
West Darfur: Health Workers by Type, working in PHCCs and in the communities of their catchment areas, Dec 08
Number and percentages of health personnel based on HFs and the community workers personnel; supported by NGOs vs. SMoH
HF Based Personnel
Community Based Personnel
25% of the overall community personnel are SMoH, while 75% are NGOs supported.
32% of the overall HF based personnel are SMoH, while 68% are NGOs supported.

38. Community Based Personnel
Health Workers, by type, working in PHCUs and in the communities of their catchment areas, West Darfur, December 2008
HF Based Personnel
Community Based Personnel
32% of the overall community personnel are SMoH, while 68% are NGOs supported.
25% of the overall community personnel are SMoH, while 75% are NGOs supported.

39. HeRAMS - Health Workers, by type, by managing partner
North Darfur, March 2008
Facility Based Staff
Community Based Staff

40. HeRAMS - Health Workers, by type, by type of Health Facility
North Darfur, March 2008
Rural Hospitals vs PHCCs
PHCCs vs PHCUs

41. HeRAMS - Health Workers, by type, by Locality
North Darfur, March 2008
Facility Based Staff
Community Based Staff

42. HEALTH SERVEICES AVAILABILITY

43. Health Services examples
Out of 62 health service monitored through the HeRAMS CHECK LIST, we have selected the following 5 services as examples of the service availability in Darfur 3 states:
Level of Care
Sublevel
Code
Service
Community Care Level
Child Health
C23
Community mobilization for and support to mass vaccination campaigns and/or mass drug administration/treatments
PHC Level
General Clinical Services
P14
Referral Capacity: referral procedures, means of communication, transportation
Maternal & Newborn Health
P62
Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed and/or reported), advise/counsel on nutrition & breastfeeding, self care and family planning, preventive treatment(s) as appropriate
P65
Basic essential obstetric care (BEOC): parenteral antibiotics + oxytocic/ anticonvulsivant drugs + manual removal of placenta + removal of retained products with manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7
P66
Post partum care: examination of mother and newborn (up to 6 weeks), respond to observed signs, support breast feeding, promote family planning

44. Availability of selected Health Services at PHCCs, North Darfur, December 08
Maternal & Newborn Health
Services provided at Primary Health Care Level
Child Health Service provided at community care level
General Clinical Service provided at Primary Health Care Level
To interpret the graph; Antenatal care service example:
13% of the service is provided by the PHC Centers managed by the NGOs, while 64% of the service is provided by SMoHs. The overall percentage of the PHCCs providing the service out of the total functioning centers is 37%

45. Availability of selected Health Services at PHCCs, South Darfur, December 08
General Clinical Service provided at Primary Health Care Level
Maternal & Newborn Health
Services provided at Primary Health Care Level
Child Health Service provided at community care level
To interpret the graph; Antenatal care service example:
9% of the service is provided by the PHC Centers managed by the SMoH, while 57% of the service is provided by NGOs. The overall percentage of the PHCCs providing the service out of the total functioning centers is 65%

46. Availability of selected Health Services at PHCCs, West Darfur, December 08
Please refer to slide#20 to have the services related to this codes
Service provided at Primary Health Care Level
Service provided at community care level
To interpret the graph; Antenatal care service example:
5% of the service provided by the PHC Units managed by the SMoH, while 56% of the service provided by NGOs. The overall percentage of the PHCUs providing the service out of the total functioning units is 61%

47. Trend Analysis example
West Darfur: provision of Maternal & Newborn service at PHCCs
PHC Level
P62
Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed and/or reported), advise/counsel on nutrition & breastfeeding, self care and family planning, preventive treatments) as appropriate
P63
Skilled care during childbirth for clean and safe normal delivery
P65
Basic emergency obstetric care (BEmOC): parenteral antibiotics + oxytocic/ anticonvulsivant drugs + manual removal of placenta + removal of retained products with manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7
P66
Post partum care: examination of mother and newborn (up to 6 weeks), respond to observed signs, support breast feeding, promote family planning
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48. HeRAMS - Availability of Health Services to address STI & HIV/AIDS by managing partner, North Darfur, March 2008

49. HeRAMS - Availability of Health Services to address STI & HIV/AIDS at PHCCs, PHCUs, and Rural Hospitals, North Darfur, March 2008
Rural Hospitals
PHCCs & PHCUs

50. HeRAMS - Availability of Health Services to address Sexual Violence at PHCCs, by managing partner, North Darfur, March 2008

51. HeRAMS - Availability of Health Services to address Sexual Violence at PHCCs, by Locality, North Darfur, March 2008

52. i-HeRAMS – Health Sub Sectors and Key Services Gap Analysis
Identification of Gaps* in the provision of Key Services & Sub Sectors at the level of Administrative Units
Sexual Violence
Package monitored :
- Clinical Management of Rape Survivors
- Emergency Contraception
- PEP for STI & HIV Infections
* None of the Primary Care Facilities of the Admin Unit in red provides the package of services to address sexual violence.

53. HeRAMS - Availability of Health Services to address Maternal & Newborn Health
by managing partner, North Darfur, March 2008

54. at PHCCs, PHCUs, and Rural Hospitals, North Darfur, March 2008
HeRAMS - Availability of Health Services to address Maternal & Newborn Health
at PHCCs, PHCUs, and Rural Hospitals, North Darfur, March 2008
Rural Hospitals
PHCCs & PHCUs

55. HeRAMS - Availability of Health Services to address Maternal & Newborn Health
at PHCC, by Locality, North Darfur, March 2008

56. i-HeRAMS – Gap Analysis of Basic Emergency Obstetric Care,
by Locality, North Darfur, March 2008
Maternal & Newborn Health
Service monitored: BEmOC
* None of the Primary Care Facilities of the Admin Units in red provides the Basic Emergency Obstetric Care Service

57. i-HeRAMS – Gap Analysis of CHild Health Key Service, by Admin Unit,
North Darfur, March 2008
Child Health
Service monitored: EPI
* None of the Primary Care Facilities of the Admin Unit in red provides routine EPI

58. South Darfur
Provision of Key Services – Proportion of PHF providing Key Services (%), March 2008

59. South Darfur
Provision of Key Services – Proportion of PHF providing Key Services (%), March 2008

60. South Darfur
Provision of Key Services – Proportion of PHF providing Key Services (%), March 2008