Health Information Systems Programme Professor Kristin Braa [email protected] Department of Informatics, University of Oslo
Health Information Systems Programme Professor Kristin Braa
[email protected] 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.