Health Management Information Systems Assessment

1. Health Management Information Systems Assessment Final Presentation May 23, 2006 Presented by Andrea Chitouras

2. What is an HMIS? • A System of systems that allows for the collection, storage, compilation, transmission, analysis and usage of health data that assist decision makers and stakeholders manage and plan resources at every level of health service • Information systems transform raw data into useful information through input, processing and output (Management Information Systems, Laudon & Laudon)

3. What’s the HMIS objective? • Ensuring the quality of all health data • Strengthening the ability to analyze and use the data and • Making informed and cohesive decisions can and will positively affect the health and lives of the people of Rwanda

4. What is Information Technology (IT)? IT consists of: • Computer hardware • Computer software • Storage technology • Communications technology • Network

5. How do IT and IS work together? Strategy & Policy Information Architecture i.e. Info Systems Management Knowledge & Coordination Operational level Programs & Projects, HR, Finance Hardware Software Data storage Networks Communications IT Infrastructure Adapted from Management Information Systems, Laudon & Laudon

6. Changing Environment • Assessment conducted in the midst of decentralization reforms • Reduced staff at the central level (from 12 to 1) • Increased staff at the district levels • Newly appointed personnel unsure of their roles, responsibilities or how to perform tasks • New processes and procedures • Uncertainty regarding reporting procedures • Interruption of monthly meetings and supervision

7. Methodology • The HMIS Team of 4 and HMIS specialists (RTI) • Interviews with: • Health center directors • District hospital directors • Heads of Nursing • Chiefs of services • Supervisors (now at hospitals) • District (admin) health directors • District (admin) newly appointed supervisors • Partners • Donors • Review of secondary sources (published and unpublished documents, presentations)

8. Site Visits Reference and District Hospitals Health Centers Dispensaries Districts

9. Number of HMIS Assessment Site Visits by Province and as Percentage of Total Visits

10. HMIS Assessment Sites Visited, by Type

11. Health Facility Routine Reports • Weekly--Epidemiological (maladies d’alertes) • Monthly--TRACnet, SIS, CAMERWA, Contractual Approach, Partner reports • Trimester--Tuberculosis • Annual--Facilities • Monthly SIS reports often take providers up to 3 working days to complete.

12. Current Data Flow (SIS) MINISANTE Reference Hosp. Military Hosp. ? District Hospital District Ex-District Private Disp. Health Centers Community Health Workers (AS) ASC ASC ASC ASC ASC

13. Performance of Health Facilities in Submitting Monthly SIS Reports Data from MoH

14. Key Strengths of Rwanda’s HMIS • GoR has recognized the importance of a strengthened HMIS and has set out ambitious goals for improving it. • Some health centers and district hospital directors and nurses take the initiative to analyze and use data to whatever degree they can. • Health workers expressed a keen interest for more training and better tools to perform analysis and learn how to use transformed data.

15. HMIS Gaps Lack of: • Policies for easy access to data and enforcement of data sharing (while respecting patient privacy). • Coordination with vertical programs • Communication and coordination within, between and amongst GoR, donors and partners. • Communication of current HMIS roles, responsibilities, procedures, reporting • Information systems human and financial resources and management • Important data sources (community, reference hospitals, private health facilities, military)

16. HMIS Gaps (cont.) Lack of: • Training on all levels from computer and software program usage to data entry, quality data, usage of tools, process and procedure guidelines, supervision, analysis, usage, feedback, patient information, and knowledge about how to perform tasks. Additional Issues • GESIS does not reflect the new districts and does not have the capacity to manipulate data and produce necessary reports. • Heavy site level reporting burdens • Logistical challenges in report submission (transportation, communication, electricity)

17. Recommendations:Immediate Implementable Actions • The GoR needs to determine policies that will facilitate the effectiveness of a national HMIS (data access; donor, partner and program involvement and coordination; flow of data and information; roles etc.) • GoR and Donors must devote appropriate resources, staffing and support to improve the national HMIS (coordinators, IT and IS specialists, program developers and training programs) • All stakeholders need to improve communication, coordination and cooperation

18. Key Recommendations (cont.) 4. Develop long-term HMIS strategy tomeet short and long term needs of GoR, donors, partners and ultimately inform decisions to improve the overall healthcare system 5. Modify existing GESIS program to reflect the newly defined districts with correct health centers linked to them as an interim fix 6. Reinforce capacity for Information Systems (IS) and Information Technology (IT)

19. Policy • Align data standards, data collection tools, measurement methods, content, feedback, and technology for all districts • Develop policies for easy and efficient access to health information to avoid individual organizations having to create parallel systems (which increases the burden on the health care provider) • Adopt International Classification of Disease data and Current Procedural Terminology

20. Communication and Coordination • Clarify and communicate roles and responsibilities (written guidelines, trainings) • Communicate current correct reporting procedures to district supervisors, district admin. health directors, health center directors and nurses etc. • Re-establish Monthly Coordination meetings at the district level • Assign sufficient and capable staff to HMIS systems coordination • Coordinate HIV/AIDS vertical systems

21. Capacity Building: Training and Education • Train Supervisors & health facility Directors in: • Data verification, supervision and offering feedback • Data analysis and usage • Emphasize and Use feedback • Train staff in computer and software usage • Train health staff in the use of International Classification of Disease Data coding and Current Procedural Terminology (can be done in phases)

22. Develop and Support Data Analysis and Utilization skills strengthening • Train data collectors, compilers and users in the importance of data analysis and utilization and increase their ability to use these tools • Incorporate data analysis and utilization into educational/training programs: KIST, KHI, ICT & IT schools and training centers, schools of nursing and management, implementing partner programs

23. Develop Feedback policy and skills (reporting and transfers) MINISANTE Reference Hosp. Military Hosp. District Admin & Hosp. Private Disp. Health Centers Community Health Workers (ASC) ASC ASC ASC ASC ASC

24. Modifications and System Development • Align GESIS with new districts • Integrate community-based data, private sector, military and referral hospitals • Develop systems to record and use patient information • Integrate International Classification of Disease (ICD) data and Current Procedural Terminology (CPT) into the new system.

25. A National HMIS • An ideal system needs to provide useful information to users at all levels • The whole point of such a system is for people to be able to get useful, timely and accurate data easily. The system needs to be able to: • Exchange data with other data systems • Have capacity to store and manipulate necessary data • Produce graphs and charts • Produce regular and custom reports • Easy accessibility to: • Enter data • Already transformed data

26. Steps for designing a new or partially new system Thoroughly understand the organizational procedures and processes Get input from all levels of the information system to make sure the system responds to the needs of users. Commission information systems specialists to design a system which incorporates either all or part of the existing system, or design a completely new system based on the new organizational procedures and processes and reporting needs.

27. How to be Part of the Solution GoR/MoH: • Policy determination (data access, data sharing, roles and responsibilities, reporting, including data analysis and usage into curricula) • Hire capable coordinators,IS, IT specialists at the all levels of the health pyramid • Clearly communicate policies to all stakeholders Donors and GoR: • Provide the necessary financial and human resources to implement the next steps for the national HMIS

28. How to be Part of the Solution(cont.) Donors and GoR: • Identify liaisons to communicate, coordinate, harmonize and share information re: programs Implementing Partners • Coordinate and cooperate with other partners working on HMIS programs to reduce duplication of effort and resources and to ensure data quality and usage • Include training for data collection, analysis and utilization etc. in all health systems related projects

29. MURAKOZE CYANE!THANK YOU ! Sincere thanks to the Ministry of Health and GoR, USAID, staff at health centers, districts, district hospitals, donors, and partners organizations for their cooperation and collaboration in conducting the HMIS Assessment.