Health Information Systems Programme · Health Information Systems Program District Health Information System - DHIS 2 • HISP a global action research network headed and initiated

Health Information Systems Programme Professor Kristin Braa

kbraa@ifi.uio.no Department of Informatics, University of Oslo

Health Information Systems Program District Health Information System - DHIS 2

• HISP a global action research network headed and initiated at the Dept. of Informatics, University of Oslo since 1994

• DHIS 2 is an open source software for reporting, analysis and dissemination of data for all health programs

• Aggregate and individual records and event captures

• Shared and integrated data warehouse for essential health data: information for action

• Implemented in more than 40 countries, national standard in 15 countries, WHO endorsed

• Joint 3-donor (PEPFAR, Global Fund, Norad) effort to strengthen DHIS 2 use in countries

• UiO Innovation award 2013

Action oriented multidisciplinary research • Strengthening national health information systems – Collaborating with Ministries of Health

• Research theme: Sustainable implementation – Interoperability – Architect(ing) – Scaling

• Open source software development done in a global network • Building capacity locally

– At present 32 PhD students worldwide. 30 graduated – PhD school – 6 international Masters program

• DHIS Academy – East Africa, West Africa, Asia,

Latin America)

• From national level to regional level – ECOWAS (WAHO), East Africa Community (EAC)

Capacity building at scale In addition to the DHIS Academies • Integrating DHIS2 in undergraduate education for all

(from nurses to doctors) • Building up Health Informatics Master program • Rwanda and Malawi

Advanced DHIS 2 Academy, Gisenyi, Rwanda May 2014

6

Present in over 40 countries National standard: Kenya, Ghana, Uganda, Rwanda, Tanzania, Nigeria, Liberia, Sierra Leone, Gambia, Zanzibar, Malawi, Zimbabwe, Zambia, Burkina Faso, Bangladesh, 12 Indian states WHO endorsed

DHIS2 as a platform • Generic and generative platform - supports a wide range

of uses also beyond the health sector • Allows for distributed innovation in a wide network • Flexible configuration and customization for a range of

organizations and use cases • Allows for new functionality through open APIs and app

development

Customization of DHIS2 You can set up a system without being a programmer • Organization hierarchy with any number of levels • Specify any kind of data to be collected • Define any type of indicator to be calculated • User profiles and roles • Management of data • Configure many types of output, including charts, tables,

maps and dashboards • Define analysis and reports along any number of categories

and dimensions • On different devices and….

Apps can be selected from DHIS2 App store …Or be developed We encourage people to make apps generic and share

DHIS2 App development • Web Application Programming Interface (Web API)

provides flexibility to extend the functionality • Current architecture lets you install web apps that use

the API to add functionality to solve specific use cases • Web Apps let you use

the DHIS data model in more flexible and customizable way

• With tailored User Interface

• Can share them with others in the DHIS App store

Web App Future • The long term goal of the DHIS team is to primarily use

web apps for the User Interface (Core apps) • The DHIS core User Interface will be replaced by “core

web apps” : – Events (capture/reports/visualizer) , – Mapping – Pivot – Tracker capture – Visualizer

.

Ebola case tracking in Liberia

Registering symptoms

Including coordinates

PEPFAR

• The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government initiative to help save the lives of those suffering from HIV/AIDS around the world

• PEPFAR will use DHIS2 for reporting from all Implementing Partners in 36 countries

• For example the number of Implementing Partners in Kenya are 400

PEPFAR Approvals use case

• PEPFAR needs to approve lots of data • In the core DHIS2 you can only approve one dataset

at a time • An custom Approvals App supports approval of

multiple datasets at the same time and at different approval levels

• The App supports PEPFAR “funding mechanisms” structure

• The App was developed on the standard DHIS2 API data structure

PEPFAR Approvals (Global level)

PEPFAR Approvals (Country level)

PEPFAR Approvals (Data view)

Java SMS Android PC/laptop/tablet Browser

Community / Villages

Community Health Workers

Clinics Districts / Hospitals

Extending the DHIS reach through mobiles

Data warehouse

DHIS 2

LMIS

HR EMR

Measles under 1 year coverage by district 2006(Measles doses given to children < 1 year / total population < 1 year)

74.781.3 79.0 80.7

89.594.4

80.0 79.9

93.6 93.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

ChakeChakeDistrict

Michew eniDistrict

MkoaniDistrict

WeteDistrict

CentralDistrict

North ADistrict

North BDistrict

SouthDistrict

UrbanDistrict

WestDistrict

Pemba Zone Unguja Zone

District

Annu

al m

easl

es c

over

age

%

Data from Mobile devises

-Data mart -Meta data -Visualising tools

Dashboard

Graphs

Maps

Getting data in - Data warehousing Getting data out - Decision support systems

Web Portal

Mobile

The importance of backbone for scaling

Collect

Analyze Use

Information for action

• Kenya – First mover, cloud

• Ghana – Fast moving learning from Kenya

• Uganda – Maternal and neonatal death audits – Tracking of pregnant women

• Rwanda – Tracker, ANC, sophisticated integration

• Zambia – 600 mobiles for malaria incidence reporting

• Malawi – Browser vs app

• Nigeria – Building an SMS infrastructure for any project

• Indian states – Mobile HIS reporting, 6000 health workers

Punjab, Himachal Pradesh

Learning through network of action: National online HIS using mobile internet

Tracking HIV positive mothers through pregnancy and birth

Covering simple and advanced interfaces

Uganda: ePMTCT – SMS Reporting • Goal: Elimination of mother to child transmition of HIV • Scaled to all facilities Option B+ implementing service outlets

pmtct a.400. b.359. c.50. d.98. e.10. f.50. g.0. h.n. i.y

eMTCT Real-time Reporting

Measles under 1 year coverage by district 2006(Measles doses given to children < 1 year / total population < 1 year)

74.781.3 79.0 80.7

89.594.4

80.0 79.9

93.6 93.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

ChakeChakeDistrict

Michew eniDistrict

MkoaniDistrict

WeteDistrict

CentralDistrict

North ADistrict

North BDistrict

SouthDistrict

UrbanDistrict

WestDistrict

Pemba Zone Unguja Zone

District

Annu

al m

easl

es c

over

age

%

Dashboard

Graphs

Maps Mobile

Send to 8989

ePMTCT Real-time Reporting

At a facility - Aggregate data - Enter data - phone (sms) - Send to DHIS2 central

server - Receive Automatic

feedback At a District - Validate report - Approve reports

(Completeness) - Follow-up on missing report

At a National - League tables - Follow-up on missing report and

query data - Further aggregation and

analysis

National DHIS

Database

In search of the missing data: Uganda ”Saving Mothers Giving Life”

• Project in 4 districts in Uganda • National DHIS2-based infrastructure is used for reporting

SMS reporting by Village Health Teams (CHWs)

03.10.2014 29

SMS Broadcast Messages

Results

Results

SMS Broadcast to Village Health Teams and Beneficiaries

From SMGL: Dear VHT member, Encourage all pregnant mothers to attend antenatal care at least four times during pregnancy

Leverage on the social network

Mobile = communicate and share

• The mobile is primarily a communication tool! • Don’t forget to improve communication, even if it is

the secondary goal of a specific mHealth project • Community features help create sustainability • Example: Closed User Group makes people

positive about project and acts as an attractor

Improving data quality through social media

Interpretations

• Charts, reports, maps can be shared with other users of DHIS 2

• Discussion forum open to all users to comment on the data

• Fostering communities of data use

High tech – low resource – big impact

www.dhis2.org

More Apps (PEPFAR)

• To fit all the PEPFAR use cases after Approvals there will be three more apps

• Deduplication of data • User management apps that simplifies creating

users within the pepfar hierachy – Adding users to usergroups, copying permissions etc.

• Maintenance/Config app that simplifies the process of creating “Funding Mechanisms” within the system – This will create usergroups / category options / Categories /

Category option combinations etc all by using one form.