The Blueprint for evolving single National Routine Health Information System (HIS) A Brown Bag Presentation of FHI360/SIDHAS Project Monitoring & Evaluation Directorate @MEMS II Office, Wuse Abuja. 15 th May 2013
The Blueprint for evolving single National Routine
Health Information System (HIS)
A Brown Bag Presentationof
FHI360/SIDHAS Project Monitoring & Evaluation Directorate
@MEMS II Office, Wuse Abuja. 15th May 2013
Outline: • Rationale for this presentation • USG Health Portfolio structure and the
NHSDP (2010 -2015) • The evolving National Routine Health data
reporting system (DHIS) • Things to note • Suggested Blueprint• Take homes
Rationale
• To discuss the need, plausibility and the blueprint for single routine health Information System (HIS) in Nigeria
USAID Public Health Portfolio Structure• HIV/AIDS and TB Team: is an integrated office that seek to
improve access, coverage and sustainable capacity for HIV/AIDS and TB services in Nigeria– Assistance Objective 3: Increased Nigerian Capacity for a
Sustainable HIV/AIDS and TB Response• Health, Population and Nutrition Team: is an integrated office
that seeks to improve basic health services, HIV/AIDS, child survival, malaria, tuberculosis, population and maternal and child health and nutrition services. – Assistance Objective 4: Increased Use of High-Impact Health
Interventions• The Biggest Assumption: Accurate and timely data to gauge
the impact of the national response will be available.
CDC Public Health Portfolio Structure• Strengthening Public Health Systems:
provides technical leadership and direct assistance to strengthen epidemiology, surveillance,
laboratory, blood safety, operations research, and workforce capacity—essential components for strong, sustainable public health systems.
Institutionalize Nigeria HIVQual (NHIVQual) Establishment of National EMR Dataware
house
CDC Public Health Portfolio Structure• Development of National Medical
Laboratory Strategic Plan National and International Accreditation of Medical
Laboratories Establishment of a national reference lab for TB and
other diseases• Establishment of Nigeria Center for Disease
Control• The Biggest Assumption: Accurate and timely
data to gauge the impact of the national response will be available. 6
Analysis of national routine health data reporting Table 1 Health Facilities in Nigeria
by Type and Ownership, 2012
TypeOwnership
TotalPublic
Private
Primary 21808 8290
30098
(88%)
Secondary
969 30233992(12%)
Tertiary 73 1083
(0.002%)
Total 228501132
33417
3
• PHCs accounts for 88% of the HFs in Nigeria.
• If all PHCs report complete dataset, 88% national report is met.
• Reporting from all PHCs is under the control of LGAs HMIS Officers.
• LGA-led Integrated health data management approach can solve our problem. Data Source: FMoH/DPRS 2012
22miles bridge : The Chinese sea bridge which will cut travel by 200 miles – US Mail Online
20miles: Connect US to China Port
1. To make truly GoN-owned high quality routine health data available (from both the private and public sectors) and
2. To plan for and build sustainable NRHIS around the GoN structures and levels with expert TA and supportive supervision from all in-country-IPs.
What is the central purpose of strengthening the National Health Management Information System (NHMIS) ?
Principles & Context:
• GHI Principles:• a new business model aimed at delivering dual objectives:
• achieving significant health improvements• creating an effective, efficient and country-led platform for
the sustainable delivery of essential health care and public health programs.
(HIV/AIDS, Malaria, TB, INMCH, Nutrition, FP/RH, NTDs)
• Third-Ones Principles:• One agreed country level Monitoring and Evaluation System.
(M&E Framework for the NHSDP)
Overview of Nigerian Health Data
Nigerian Health Data
Routine Health Data
NHMIS Data (including Routine
Surveillance)
Disease Program Data – e.g. ATM
Non-Routine Health Data
Surveillance studies, Surveys,
Operations Research,
e.t.c What are we using Health Data/Information for in Nigeria:• Health Program Design & redesign, management
Decision Making? • Health Policy Formulation and Development? • Health Planning and Budgeting?
Initial Practice
Range of Health Services
• Basic Community Health Services (100%)
• Basic Health Services (100%)
• Basic Health Services (30%)
• Specialized Healthcare Services (70%)
• Basic Health Services (10%)
• Specialized Healthcare Services (90%)
Range of Data Reported
• Community NHMIS
• Facility NHMIS
• Facility NHMIS
• Disease Programs Report
• Facility NHMIS
• Disease Programs Report
Communities-------------------
CHEWs
10 HFs-------------
PHCs
20 HFs-------------
GHs
30 HFs -------------UTHs & FMCs
Referral Chain
Recent Shift
Range of Health Services
• Integrated Basic Health Screening & Services (100%)
• Integrated Basic Health Services (100%)
• Decentralized Special Services
• Integrated Basic Health Services (30%)
• Specialized & Integrated Healthcare Services (70%)
• Integrated Basic Health Services (10%)
• Specialized & Integrated Healthcare Services (90%)
Range of Data Reported
• Integrated Health dataset
• Community NHMISplus
• Facility NHMISplus
• Facility NHMISplus
• Disease Programs Report
• Facility NHMISplus
• Disease Programs Report
Communities--------------- -
CVs / CORPs/CBOs
10 HFs-------------
PHCs
20 HFs-------------
GHs
30 HFs -------------UTHs & FMCs
Referral Chain
Databases: Schematic Overview 2 (Proposed) DHIS 2.0: (Web-based Version)
NHMIS
Disease Program
s
NHMIS
INMCH
NTDs
TB / HIV/AIDS / Malaria
Nutrition FP/RH
Hierarchical Organization of the Integrated DHIS PlatformRoutine
Health Data
ATM datase
ts HIV & AIDS dataset
Malaria dataset
NHMIS dataset
NPI dataset
Epid. & Disease Surveillance dataset
TB & TB/HIV dataset
SRH/HIV Integration dataset
Secondary Facilities Facilities
LGA
State
National
PHCs Tertiary Facilities
Community
Central DHIS Instance
State DHIS Instance
LGA DHIS Data Entry Hub
Can DHIS address the bigger picture about NHMIS?
• Align USG instance metadata with GoN DHIS instance
• Derive PEPFAR-NGIs from the data elements contained in the National MSFs
• Integrate Data Management Process at all levels.
IT Programming codes
Legend:
Current challenges: 1. Multiple DHIS platforms and its inter-operability & 2. Complicated data management process
eNNRIMS DHIS
Instance
Development partners’ DHIS2.0 platform
National DH&PRS
DHIS Instance
USG DHIS Instance
National HIV Response
routine datasets (mainly from 20
and 30 Facilities)
Project-level HIV/TB/Malaria and
NHMIS routine datasets
(mainly from 10, 20 and 30 Facilities)
USG HIV and TB Program routine datasets (mainly
PEPFAR-NGIs from 10, 20 and 30 Facilities)
Solution: Moving towards one national Integrated health data management system
1. GoN-led and driven data management system (sustainability)
2. Promote integrated health
data management
3. One sole source for routine health data @ National, State and LGA-levels
4. Considers all-levels of health care including community.
National DH&PRS DHIS Instance
Community –level data
LGAs PHCs data
20 HFs data
30 HFs data
Suggested Blueprints
• Confidence-building on GoN System’s ability to deliver timely routine health data if supported by Donors and IPs.
• Address Institutional weaknesses and capacity constraints for functional HIS at Community-level, HFs, LGAs, State and National levels
• Institutionalize LGAs Data Management team and data entry HUB approach – Strengthen our M&E system for better efficiencies
and cost reduction– Advocate for IPs to unify tools, systems and
processes for M&E.
Deep Reflection!
• The problem of M&E systems development in Nigeria is caused by IPs and their Donors!
• The fragmentation in terms of M&E systems and processes is as a result of each IPs/Donors’ requirements.
• If only M&E processes, systems and tools were unified, we will have a more organized system that produces timely and unified/harmonized program results.
What are our fears about having One central HIS for routine health data in Nigeria? FEARS
• Delayed access to routine data by stakeholders
• Quality of what is coming through the Central HIS
• Server Administration and • IT infrastructural capacity
requirement (5,000+ Users in one Window)
• Resource Coordination (Single funding basket)
• Stakeholders’ Representative Data Management Team in place @ National level
Is it likely to offer any cost saving measure on the long run?
• Yes ! The cost of: – HR need and capacity development for HIS management @
all level. – IT Infrastructure and Maintenance – Uninterrupted power supply– Maintaining streamlined Data Management Systems,
Processes and Operations such as: • Data Collection and Data Entry • Data Verification and Data Quality Assurance
(DQA) and Change Management Process (CMP)
Would this process have a chance for capacity transfer to the Government staff; leading to sustainability on the long run? • Yes! Through the:
– Stakeholders’ Representative Data Management Team @ National level
– Establishment of Integrated Data Management Team (GoN and IPs) at LGAs and State-level
– Initial Joint Routine Supportive supervision and DQAs – Training of M&E practitioners for better results at the State and
LGA levels.