PEPFAR/SA M&E ALL PARTNERS MEETING

1. PEPFAR/SA M&E ALL PARTNERS MEETING Presentation on DHIS by HISP-SA and NDoH 21 June 2012

2. Overview of Presentation • Current role of DHIS • How will it relate to the other health management information systems • DHIS data flow process and PEPFAR partners’ access to DHIS Data • Challenges and possible solutions • Future: Version 2.0

3. Current Role of DHIS • Nationally adopted system for aggregated anonymised routine data • Aggregated: sum of services rendered by facilities • Anonymised: not patient specific • Routine: could be daily (in-patient days), weekly (HCT campaign, notifiable medical conditions), monthly (NIDS), quarterly (TB, HIV data), annually (DHER reviews) • Data warehouse for integrating data from a variety of sources • ETR.net, Tier.net • BAS (and Persal) • (Laboratory data) • Survey data such as Annual ANC HIV/AIDS-Syphilis Sero-surveillance data, DHS data • Facility infrastructure (from Basic Audit Survey just undertaken) • Core standards and measures • Project management tool • Feeding into the web-reporting system

4. Important Characteristics of the DHIS:1. Customisable Organisational Hierarchy • Ability to report against multiple hierarchies • South Africa – Old and New administration systems • Project/Partner Hierarchy and NDoH Hierarchy • Namibia – MoHSS and PACT Hierarchy of Partners • Alignment between the DHIS OU hierarchy and that used in other systems is critical for interoperability

5. Important Characteristics of the DHIS:2. Customisable Data Element, Indicators, Validation Rules • Ability to add data elements • Increase disaggregation of existing DE • Add new data element • Merge/Remove duplicate data elements • Alignment of DE/Indicators between systems is critical for interoperability

6. Important Characteristics of the DHIS:3. Other considerations HISP Supported Sites Around the World 2012 • FOSS, being developed through a participatory and incremental development strategy • International development team building on multi-country sharing of experiences • DHIS is used to capture data related to over 1 billion people in Africa and Asia

7. Relationship to other Information Systems Specialist systems Patient specific IS: ETR.net, TIER.net, EPR systems Specialist reporting system Legacy management IS: PERSAL, BAS Electronic data exchange with National HMIS Other IS: Laboratory, specialised surveys DHS, BA, etc Web-based Integrated Reporting Export into SQL Server database and web-based data presentation

11. DHMIS Policy

12. Data Flow and DHMIS Policy 60 days (45) Health facility NDoH

13. NIDS Review Process • The Director-General has approved the review of the NIDS in accordance with DHIMS Policy • The HIS Task Team established by the D-G in August 2010 will lead the NIDS review process as of April 2012. • Composition of the HIS task team: national, provincial and partners • Participants from Clusters in National DoH • Guidelines for inclusion, removal or selection of indicators will developed. • Provincial Consultations as per DHMIS policy • NIDS Review to be completed by September 2012

14. Current PEPFAR Reporting Record of patients seen Record of patients seen Summary of key information Summary of key information Data analysis and use Data analysis and use ? ? Data entry into other systems Data entry into other systems Web-based data entry into National HMIS Partner systems Partner systems Data entry into National HMIS Data entry into PIMS Data entry into PIMS

15. Ideal Situation • PEPFAR reporting as a subset of the NIDS • Additional PEPFAR data elements collected through sentinel sites, surveys, or with additional funding • Ideally partner IS will allow electronic data exchange with DHIS

16. Example 1: “Ideal-Ideal” Situation • Khusela PMTCT project (PATH) in ECape: • Khusela used DHIS as their database (restricted OU hierarchy, restricted data elements) • Allowed smooth interchange of data with the district DHIS • Manual re-capture in PIMS

17. Example 2 • I-ACT Project with SAP in ECape: • Basic Care Package indicators developed in DHIS • Successfully used in ECape • Currently being explored for use nationally

18. “Value add” of this approach • In each of these two examples, the projects are contributing in a small way to the national system in use • Improving capacity of IO’s • Strengthening data quality • Strengthening departmental data comparisons and use • Use of a standardised database facilitates data management from projects over time • Without some form of standardisation amongst partners, it can become a “free-for-all” with a multitude of disparate systems being developed (or not developed) • See next slide

19. Example 3 • Sub-partners report on “protected” excel sheets • Data is imported electronically from excel into DHIS • DHIS manipulated to provide PEPFAR data as requested • PACT provides sub-contracts to local NGOs and needs to collate PEPFAR data from them, and to report to USAID by partner and by geographic region

20. DHIS2 and data flow Monthly report sent to Sub-district office Monthly report for mobile transmission Facility Data capture and validation into DHIS2 database on national or provincial server Sub-district 7-20 days Mobile data transmission by-passes the usual channels and speeds up data availability Data validation District Province Data validation National Data (?import and) validation

21. Ideas about DHIS2 deployment • Will facilitate • Quicker access to data at all levels • Management of NIDS dataset • Management of OU hierarchy • Will require: • New strategies for feedback as normal levels are by-passed • Will not improve: • Reprinting and management of data collection tools after NIDS revisions • Access issues to the National data • DHIS2 being used for HCT campaign data, ART subset, and outreach teams, National Data Dictionary (DE and OU hierarchy) • Possibly use for • I-ACT Database • Notifiable Medical Conditions reporting • In provinces where access to internet is fairly uniform • Gradual introduction in parallel to existing system because: • Limited internet access/band-width in some areas • Functionality in DHIS2 is not as sophisticated as that in DHIS14 (so need to develop this functionality – esp. latest changes introduced to accommodate AG)

22. DHIS2 and PEPFAR Partner Reporting • It is important to recognise the links between databases to support “Partner Data”, and that used for “Facility and District” reporting • Up to now, partners have not had a standardised tool for collecting, collating and reporting on their projects – they only have a system for data capture for onward reporting to OGAC • Ideally, partner data and that used at facility, and district level will be closely integrated so as to ensure that • Data collection is efficient and of a high quality • DQ is improved at source (facility level) • The same values are reported (by partners and by districts).

23. Some Ideas for an “Ideal World” • PEPFAR Partners will co-ordinate their information needs based on: • Essential reporting to Congress • Existing needs in SA • This will be used to feed into the NIDS Review process • The process will accommodate 90% of PEPFAR reporting requirements, and the balance will be addressed through additional data collection systems

24. Thank you