HIS implementation in Ethiopia: case studies from AAHB

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HIS implementation in Ethiopia case studies from
AAHB

• Woinshet Abdella
• PhD Student
• Department of Informatcs
• University of Oslo

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CONTENTS

• Background
• Ethiopia / Health Care System
• HISP Ethiopia
• DHIS Implementation in Addis Oromia
• Challenges

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Ethiopia

• Population - 72 million
• Area 1.1 million km2
• Decentralized administrative structure
• 9 regional states two city administrations
• 580 weredas (districts)
• Regional sates are autonomous
• Poor literacy, education, health status

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Health Care System

• MOH, Regional health bureaus, Zonal health
  departments, Wereda/Sub-city health offices,
  Health Facilities
• Under developed
• Health service coverage 61
• MMR 871/100,000, U5MR 140/1000
• High Infectious communicable diseases
• HIS is primarily manual under developed

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HISP-Ethiopia

• Project Initiation
• Through a collaboration of the Department of
  Information Science, Addis Ababa University (AAU)
  and the University of Oslo in February 2003.
• Partners
• AAU regional health bureaus of Ethiopia global
  HISP

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HISP-Ethiopia

• Objective
• Introducing computer based HMIS in Ethiopia in
  view of supporting local analysis and use of data

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HISP-Ethiopia

• HISP Members
• 4 PhD students / 7 Masters students (one
  Norwegian)
• 5 DHIS facilitators hired by HISP
• Research Sites for HISP Ethiopia
• Addis Ababa, Oromia, Tigray, Amhara,
  Benishangul-Gumuz
• DHIS implementation is being carried out
• Addis Oromia since Jan 04
• Others since June 04
• Different stages of implementation

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Case Studies from Addis

• Research Objective
• key research objective is to broadly understand
  the challenges and opportunities with respect to
  the integration of existing paper-based HIS with
  computer-based systems in Ethiopia.
• Theoretical Perspective
• ANT
• Research Approach context
• PAR
• AR intervention
• HIS implementation Intervention into health
  organizations (AAHB OHB)
• One DHIS facilitator for each region

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Research Approach context

• Research Site
• Addis Ababa health bureau (AAHB) ,
• 10 sub-cities (districts)
• 500 public private health facilities,
• located in Addis Ababa city Administration
  (Province).
• Addis Ababa is the capital city of Ethiopia (540
  km2 )
• Population is 3 millions.

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Research Approach context

• Researcher Role.
• The role assumed was an involved researcher
  through action research.
• Qualitative data collection method was employed
  including
• photography, observations, interviews,
  discussions, meetings, workshops, training,
  action experiments, document analysis, telephone
  calls, visit related institutions, informal
  lunch/tea meetings.

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Research Approach context

• Research subjects
• managers and planners at different levels of the
  health structure, the health workers responsible
  in data collections and analysis.

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DHIS Implementation in Addis

• Negotiate research access (KK)
• Situation analysis (Mar 03 Aug 03)
• Visits to Health bureaus HFs
• Initiating the Design / implementation process
  with AAHB/OHB (Dec 03) (Bureau)
• EPR was just introduced then
• Prototype system was developed and populated with
  9 months own data

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DHIS Implementation in Addis Ababa

• Demonstration of the prototype DHIS Addis (Jan
  04)
• The experiences gained revealed the problems with
  the existing HMIS
• Data duplication, fragmentation,
• Local requirement (Morbidity/Mortality data
  handling) identified that DHIS does not support
  efficiently
• Developing minimum health data set health
  indicators was proposed

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DHIS Implementation in Addis Ababa

• Major decisions
• The proposal for standardizing data set/health
  indicators accepted
• Adapting DHIS based on new dataset and reporting
  requirement
• Adding module to accommodate M/M data handling
• Implementing DHIS to ALL Sub-cities.
• Team formed

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• The research team was composed of
• Bureau level,
• Bureau head
• health service head (leader of the project on the
  part of the bureau), team leader, and senior
  expert
• family health head, team leader and expert
• Disease Prevention and Control head IDSR team
  leader, TB / Leprosy and HIV/Aids program team
  leader and senior expert
• IEC expert
• Network administrator
• Sub-city Level
• two family health experts
• Facility Level
• two health facility managers
• And the researcher.

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DHIS Implementation in Addis Ababa

• Two Parallel activities performed
• Standardized data set, health indicators, data
  collection reporting instruments procedures
  (data flow, ) development
• Draft prepared by the group presented for
  workshops, comments incorporated, the draft was
  further developed in a series of long meetings,
• Development of Morbidity Mortality module
• Iterative / incremental (involved one major
  revision)

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DHIS Implementation in Addis Ababa

• Use of DHIS as a prototyping tool
• to better understand user requirements for
  producing an improved useful system which
  potentially increases data use
• The standardized data set is implemented in all
  facilities
• DHIS adapted, the new module incorporated
• (Input Form, DHIS Data Flow, Data Entry (next
  slide), Pivot Table Report, Standard Report )

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Monthly Routine Data Entry/Edit Form
Monthly Morbidity and Mortality Data Entry/Edit
Form
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DHIS Implementation in Addis

• DHIS is implemented
• All districts (10 sub-cities) and AAHB initially
• Scaled to health facility levels
• 18/23-Health centers 5/5-Hospitals (when
  resource / situation allowed)
• Training (DHIS/computer basics) was given to
  sub-city/bureau/HF health staff / managers / data
  clerk / DHIS facilitators (with own data)
• Technical support is being provided by the
  facilitator
• Participatory design
• July 2005, Workshop for evaluating one year
  experience of the use DHIS

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Observations

• DHIS Software is well-tested supports
• Data aggregation data sharing health structure
  implementation easily adaptable for new needs,
  which is inevitable rapid set-up of DHIS
  application for a new setting
• Complaints from different actors (use of MS
  Access in DHIS DHIS 2 is a response)

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DHIS Implementation in Oromia

• Collection/reporting instruments and software
  prepared for Addis is shared by Oromia other
  regions
• Followed similar approach
• Some of the differences
• The process was slower when compared to Addis
• The minimum data set prepared for Oromia not yet
  adopted by the region
• DHIS implementation status
• Some Weredas of East Shewa zone (based on
  computer availability)
• Is being rolled out to the remaining zones (at
  the zone level only)

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CHALLENGES

• Improving data quality, data analysis and use
• Reduce / Improve dataset
• Achieving partnership with MOH
• Scaling Sustainability
• Over burdened health worker
• Limited resource
• Negotiating with multiple actors
• Parallel systems

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THANK YOU!