developing health management information systems who library cataloguing in publication data...

WORLD HEALTH ORGANIZATIONREGIONAL OFFICE FOR THE WESTERN PACIFIC

DevelopingHealth ManagementInformation Systems

A PRACTICAL GUIDE FORDEVELOPING COUNTRIES

ii

WHO Library Cataloguing in Publication Data

Developing health management information systems: a practical guide fordeveloping countries

1. Management information systems 2. Guidelines 3. Developing countries

ISBN 92 9061 1650 (NLM Classification: WA 26.5)

© World Health Organization 2004All rights reserved.

The designations employed and the presentation of the material in this publication do not imply theexpression of any opinion whatsoever on the part of the World Health Organization concerning the legalstatus of any country, territory, city or area or of its authorities, or concerning the delimitation of itsfrontiers or boundaries. Dotted lines on maps represent approximate border lines for which there maynot yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they areendorsed or recommended by the World Health Organization in preference to others of a similar naturethat are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguishedby initial capital letters.

The World Health Organization does not warrant that the information contained in this publication iscomplete and correct and shall not be liable for any damages incurred as a result of its use.

Publications of the World Health Organization can be obtained from Marketing and Dissemination,World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax:+41 22 791 4857; email: [email protected]). Requests for permission to reproduce WHO publications,in part or in whole, or to translate them – whether for sale or for noncommercial distribution – should beaddressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]).For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressedto Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932,1000, Manila, Philippines, Fax. No. (632 521-1036, email: [email protected]).

The named author/s alone is/are responsible for the views expressed in this publication.

Acknowledgements

The WHO Regional Office for the Western Pacific acknowledges the contributions made

by Dr Ophelia Mendoza, WHO Consultant, and Dr Y.C. Chong, Regional Adviser in

Health Information.

iii

Acknowledgements . . . . . . . . . . . ii

Abbreviations . . . . . . . . . . . . v

1 Introduction . . . . . . . . . . . . 1

2 The basic concepts . . . . . . . . . . 3

3 Reviewing the existing system . . . . . . . . 5

4 Defining data needs . . . . . . . . . . 9

5 Determining the data flow . . . . . . . . . 13

6 Designing the data collection and reporting tools . . . . 17

7 Developing procedures for data processing . . . . . 21

8 Developing the training programme . . . . . . . 25

9 Pre-testing the system . . . . . . . . . . 29

10 Monitoring and evaluating the system . . . . . . 33

11 Developing data dissemination and feedback mechanisms . . 37

12 Enhancing the HMIS . . . . . . . . . . 41

Examples . . . . . . . . . . . . . 45

References . . . . . . . . . . . . . 53

Contents

v

Abbreviations

ARICP Acute Respiratory Infection Control Programme

BCG Bacille-Calmette Guérin

CDSS Communicable Disease Surveillance System

CHC Commune Health Centre

DHC District Health Centre

DHS Department of Hospital Services

DOF Department of Finance

DMCH Department of Maternal and Child Health

DP Department of Planning

DPT Diphteria-Pertussis-Tetanus

DSS Disease Surveillance System

EH Environmental Health

EPI Expanded Programme of Immunization

FPSF Family Planning Service Facilities

H Hospital

HACP HIV/AIDS Control Programme

HMIS Health Management Information Systems

MCH Maternal and Child Health

MOE Ministry of Education

MOH Ministry of Health

NIN National Institute of Nutrition

NMCP National Malaria Control Programme

NSO National Statistics Office

NTCP National Tuberculosis Control Programme

OPV Oral Polio Vaccine

ORS Oral Rehydration Salts

PHC Primary Health Centre

PHO Provincial Health Office

PMC Preventive Medical Centre

TT Tetanus Toxoid

1

Purpose of the Manual

This Manual is designed to be a quick-and-easy, user-friendly reference for the

development of health management information systems (HMIS), with the focus

on applications. It serves as a primer on HMIS development and provides a general

overview of the basic principles, as well as the fundamental steps and issues

involved in the different activities to be undertaken. The information is presented

in a concise, direct-to-the point, easy-reading, and outline format. It aims simply

to provide the basic elements on HMIS development for people who do not

have the time or the need to read deeply on the subject. For those who wish to

develop a more in-depth knowledge, the Manual can also serve as the springboard

for further reading and research.

Prospective Users of the Manual

This Manual was designed with the following persons in mind:

➤ Heads and staff of Statistics Units at the national, provincial, or even the

district health service level who are actively involved in the development of

their HMIS

➤ People who do not have the in-depth background on HMIS but need to have

a general overview of its components because they are members of Multi-

disciplinary Committees tasked with overseeing the development of the HMIS

in their country

➤ Managers and staff of vertical programmes whose responsibilities include

any component of the information system of their respective programmes

Scope and Style of the Manual

Each chapter in this Manual has four parts:

(a) Principles

(b) Steps

(c) Issues

(d) Worksheets

1 Introduction

2

The worksheets give the reader an idea of how to go through the different steps,

or how to process the different issues in an organized and systematic manner.

Sample entries for the worksheets are provided to demonstrate how they are

filled out.

The last part of the Manual gives an example of a list of basic indicators that

might be used in Ministry of Health programmes, together with the corresponding

data sources, modes and frequency of data collection, as well as the lowest

administrative level where the indicator is computed. While the reader can adopt

some of these indicators for their use, the main objective of the example is to

show how the set of indicators used by a country can be presented so that it will

be easy for the staff of the Statistics Unit to monitor their status. Also provided

at the end of the Manual is an example of a flow chart of the HMIS of hypothetical

country X. As in the first example, the aim is to show not “what”, but “how”;

not to prescribe a model flowchart for the HMIS as such, but rather to demonstrate

how the HMIS can be presented by means of a flow chart.

3

Some Definitions

System A collection of components that work together to achieve a common

objective1

Information System A system that provides information support to the

decision-making process at each level of an organization2

Health Information System A system that integrates data collection,

processing, reporting, and use of the information necessary for improving health

service effectiveness and efficiency through better management at all levels of

health services3

Health Management Information System An information system

specially designed to assist in the management and planning of health

programmes, as opposed to delivery of care4

Steps in Developing a Health Management Information System

(1) Review the existing system

(2) Define the data needs of relevant units within the health system

(3) Determine the most appropriate and effective data flow

(4) Design the data collection and reporting tools

(5) Develop the procedures and mechanisms for data processing

(6) Develop and implement a training programme for data providers and data

users

(7) Pre-test, and if necessary, redesign the system for data collection, data flow,

data processing and data utilization

(8) Monitor and evaluate the system

(9) Develop effective data dissemination and feedback mechanisms

(10) Enhance the HMIS

1 World Health Organization (2000)2 Hurtubise (1984)3 World Health Organization (2000)4 World Health Organization (1993)

2 The basic concepts

5

S T E P S

P R I N C I P L E

(1) Make an inventory of the forms, log books and other tools used to record and

summarize data at different levels.

(2) Assess the quality of the data being collected using the existing forms at different

levels. Among the aspects to be included in the assessment are:

➤ Accuracy

➤ Completeness

➤ Adequacy

➤ Timeliness

(3) Determine the problems encountered with the current system of data collection at

different levels, including the timing and flow of information.

(4) Determine the current status of the other components of the HMIS like:

➤ Data processing

➤ Data analysis

➤ Data dissemination

➤ Supply and logistics

➤ Staff development

➤ Coordination, cooperation and communication within and between different

units in the Ministry of Health, as well as with related agencies outside of the

ministry

Do not destroy existing systems; build on the strengths and learnfrom the weaknesses of what already exists.

3 Reviewing theexisting system

6

I S S U E S

(1) Who has the authority to make the assessment?

(2) Availability of technical expertise and resources to do the assessment.

(3) Cooperation among the different units in the assessment process; involvement of

end-users at all levels.

(4) Formation of a body (ideally an inter-departmental committee) tasked with planning,

monitoring and managing all phases of the development of the HMIS, from the

baseline assessment to the evaluation phase.

(5) Identify the aspects of the system that need to be:

➤ Retained

➤ Modified

➤ Abolished

(6) Summarize the results of the assessment in a formal report.

(7) Discuss results of the assessment with proper authorities.

7

WO

RK

SH

EE

TS

Wo

rksh

eet

3.1:

Ch

eck

list

of

Pro

ble

ms

En

cou

nte

red

Wit

h t

he E

xis

tin

g H

MIS

, at

Dif

fere

nt

Ad

min

istr

ati

ve L

evels

Typ

e o

f Pr

ob

lem

s En

cou

nte

red

Vill

age

Dis

tric

tPr

ovi

nce

Nat

ion

al

Dup

licat

ion

of f

orm

s✓

Too

man

y re

cord

boo

ks/f

orm

s be

ing

fille

d ou

t at

thi

s le

vel

✓

Lack

of

cons

tant

sup

ply

of f

orm

s

Repo

rts

not

subm

itted

on

time

Inad

equa

te t

rain

ing

of h

ealth

wor

kers

on

how

to

fill o

ut f

orm

s✓

✓

Hig

h de

gree

of

inac

cura

cies

in d

ata

colle

cted

✓✓

Lack

of

tech

nica

l exp

ertis

e of

sta

ff t

o pr

oper

ly a

naly

ze t

he d

ata

colle

cted

✓✓

✓✓

Lack

of

utili

zatio

n of

dat

a be

ing

colle

cted

✓✓

✓✓

Low

leve

l/no

diss

emin

atio

n of

and

fee

dbac

k ab

out

data

col

lect

ed

8

Wo

rksh

eet

3.2:

Ch

eck

list

of

Pro

ble

ms

En

cou

nte

red

Wit

h t

he E

xis

tin

g F

orm

s

Typ

e o

f Pr

ob

lem

s En

cou

nte

red

MC

H F

orm

Form

2--

----

----

-Fo

rm (

n)

Entr

ies

in t

his

form

dup

licat

e th

ose

of o

ther

for

ms

✓

Too

man

y da

ta e

lem

ents

req

uire

d to

com

plet

e th

is f

orm

✓

Stru

ctur

e of

the

for

m is

too

com

plic

ated

, mak

ing

it di

ffic

ult

to f

ill o

ut

Diff

icul

t to

col

lect

the

dat

a re

quire

d to

fill

out

the

for

m

Writ

ten

inst

ruct

ions

on

how

to

fill o

ut t

he f

orm

are

not

ava

ilabl

e✓

Lack

of

cons

tant

sup

ply

of t

his

form

Com

plet

ed f

orm

not

sub

mitt

ed o

n tim

e

Inad

equa

te t

rain

ing

of h

ealth

wor

kers

on

how

to

fill o

ut t

he f

orm

✓

Hig

h de

gree

of

inac

cura

cies

in d

ata

colle

cted

✓

Not

all

item

s in

the

for

m a

re f

illed

out

or

com

plet

ed✓

Ther

e ar

e di

ffic

ultie

s in

col

lect

ing

dat

a fo

r th

is f

orm

fro

m a

ll ge

ogra

phic

or

serv

ice

area

s co

vere

d

Lack

of

tech

nica

l exp

ertis

e of

sta

ff t

o pr

oper

ly a

naly

ze t

he d

ata

colle

cted

fro

m t

his

form

✓

Lack

of

utili

zatio

n of

dat

a be

ing

colle

cted

fro

m t

his

form

✓

Low

leve

l/no

diss

emin

atio

n of

dat

a co

llect

ed f

rom

thi

s fo

rm

9

(1) Define the different roles/functions of each level, for each of the major programmes.

A common set-up is as follows:

Different administrative levels in the health system have

different roles, and therefore have different data needs.

Not all data needs should be generated through the

routine system of data collection. Data that are not

frequently needed or are required only for certain subsets

of the population can be generated through special studies

and sample surveys.

(2) Identify the indicators needed by each level to perform its functions. Note that

some levels, especially at higher administrative levels, need data coming from other

ministries or departments related to the health sector.

(3) Determine the formula and identify the variables or data elements needed in order

to compute the indicators.

P R I N C I P L E S

S T E P S

4 Defining data needs

Administrative Level Function

Village Case finding; service delivery

District Monitoring and supervision

Province Programme planning; evaluation

National Policy formulation

10

(1) Roles and functions of different units with respect to data generation and utilization

are not well defined.

(2) Defining minimum basic data needs.

(3) Differentiating data that should be included in the routine data collection system,

from data that are best generated through the conduct of special studies and

sample surveys.

(4) Inability of staff at different levels to identify their data needs; understanding of

indicators often lacking.

(4) Determine the source of the different data elements needed for both the numerator

and denominator of each indicator. The major sources can be:

➤ Routine data generated from the health management information system of

the Ministry of Health

➤ Special studies and surveys conducted by the Ministry of Health, as the need

arises

➤ Other health-related information systems under the responsibility of other

agencies or institutions (Examples of these are the vital registration system –

usually under the Department of Justice or the National Statistics Office – and

the nutrition data collected by the Ministry or Department of Agriculture)

I S S U E S

Group discussion on selecting relevant health indicators.

11

WO

RK

SH

EE

TS

Wo

rksh

eet

4.1:

Id

en

tifi

cati

on

of

Ind

icato

rs C

orr

esp

on

din

g t

o E

ach

Pro

gra

mm

e O

bje

ctiv

e a

nd

Str

ate

gy

Pro

gra

mm

e O

bje

ctiv

es

To in

crea

se t

he c

over

age

ofim

mun

izat

ion

by 2

0% a

tth

e en

d of

the

yea

r

To in

crea

se t

he u

tiliz

atio

nof

hos

pita

l ser

vice

s by

20%

To d

ecre

ase

the

inci

denc

eof

nos

ocom

ial i

nfec

tions

by

30%

Inp

ut

•N

umbe

r of

hea

lth e

duca

tion

clas

ses

on im

mun

izat

ion

cond

ucte

d•

Num

ber

of t

he f

ollo

win

gin

form

atio

n, e

duca

tion

and

com

mun

icat

ion

(IEC

) m

ater

ials

deve

lope

d an

d di

strib

uted

:–

post

ers

–le

afle

ts

Num

ber

of s

emin

ars

cond

ucte

dN

umbe

r of

hos

pita

l sta

ff t

rain

ed

Ind

icat

ors

Effe

ct/I

mp

act

•C

hang

e in

the

kno

wle

dge

and

attit

udes

of

mot

hers

on

imm

uniz

atio

n•

Cha

nge

in t

he p

erce

ntag

e of

fully

imm

uniz

ed c

hild

ren

(FIC

)<

1 ye

ar b

etw

een

2002

and

2003

Inci

denc

e of

nos

ocom

ial

infe

ctio

ns

Stra

teg

ies

Impl

emen

tatio

n of

a h

ealth

educ

atio

n pr

ogra

mm

e on

imm

uniz

atio

n fo

r m

othe

rs

Stre

ngth

en t

he r

efer

ral

syst

em

Con

duct

sem

inar

s fo

rho

spita

l sta

ff o

n th

epr

even

tion

and

cont

rol o

fho

spita

l-acq

uire

d in

fect

ions

Ou

tpu

t

•Pe

rcen

tage

of

mot

hers

who

atte

nded

hea

lth e

duca

tion

clas

ses

on im

mun

izat

ion

•Pe

rcen

tage

of

mot

hers

who

have

see

n/re

ceiv

ed

each

of

the

IEC

mat

eria

ls o

nim

mun

izat

ion

deve

lope

d

Bed-

occu

panc

y ra

te

Un

it:

Mat

ern

al a

nd

Ch

ild H

ealt

h (

MC

H)

Div

isio

nPro

gra

mm

e:

Imm

un

izat

ion

(EP

I)1

Year:

2003

Un

it:

Dep

artm

ent

of

Ho

spit

al S

ervi

ces

Pro

gra

mm

e:

Year:

2003

1 EPI

= E

xpan

ded

Prog

ram

me

of Im

mun

izat

ion

12

Wo

rksh

eet

4.2:

Id

en

tifi

cati

on

of

Data

Need

s at

Dif

fere

nt

Levels

Ind

icat

or

Num

ber

of h

ealth

educ

atio

n cl

asse

son

imm

uniz

atio

nco

nduc

ted

Perc

enta

ge o

fch

ildre

n <

1 w

hoar

e fu

llyim

mun

ized

(FIC

)

Bed

Occ

upan

cyRa

te

Nos

ocom

ial

Infe

ctio

n Ra

te

Un

it R

equ

irin

g In

dic

ato

r

Uti

lizat

ion

Vill

age

Vill

age

Dis

tric

t

Dis

tric

t

Pro

v.H

lth

Serv

.

Nat

l.M

CHPr

og

.

Nat

l.Pl

an/S

tat.

Ofc

.O

ther

s

Dis

t.H

lth

Serv

.C

olle

ctio

n

Vill

age

Vill

age

Dis

tric

t

Dis

tric

tLow

est

Leve

l of

Freq

uen

cy o

fC

olle

ctio

n

Qua

rter

ly

Bian

nual

Mon

thly

Ann

ually

Dat

a So

urc

e fo

r

Nu

mer

ato

r

MC

H F

orm

1

EPI F

orm

1

Dai

lyH

ospi

tal

Cen

sus

Form

Patie

ntM

edic

alRe

cord

s

Den

om

inat

or

Not

App

licab

le

Targ

et C

lient

List

for

EPI

Med

ical

Reco

rds

Dep

t.

Med

ical

Reco

rds

Dep

t.

Form

ula

Non

e

(No.

of

FIC

am

ong

1yr

old

chi

ldre

n / T

otal

no. o

f ch

ildre

n <

1) x

100

(No.

of

occu

pied

bed

-da

ys/t

otal

ava

ilabl

ebe

d-da

ys)

x 10

0

(No.

of

in-p

atie

nts

who

dev

elop

hosp

ital-a

cqui

red

infe

ctio

ns w

ithin

the

year

/tot

al n

umbe

r of

hosp

ital i

n-pa

tient

-da

ys w

ithin

the

yea

r)x

100

Dep

art

men

t o

f M

ate

rnal

an

d C

hil

d H

ealt

h

Dep

art

men

t o

f H

osp

ital Serv

ices

13

(1) Determine what data will be submitted to whom. This involves the:

➤ Identification of variables/indicators that need to be submitted to higher levels

➤ Identification of most appropriate unit and position of person to whom

summaries will be submitted

A major determining factor for this step is the function of the office and/or the

person to whom the data is submitted in relation to the generation and utilization

of information.

(2) Determine how frequently data should be submitted to each level, considering the

following factors:

➤ Needs of each level

➤ How common phenomenon is observed

Reports on infrequent events, or ones that are not often needed (e.g., the number

of immunization campaigns conducted in a village) can be submitted on a quarterly

or on a semi-annual basis, instead of monthly.

(3) Determine in what form data will be submitted to each level.

➤ Raw data versus summaries

➤ Hard copies versus electronic files

Not all the data collected at a certain level need to be submittedto higher levels. The most detailed data should be kept at the

source, and reporting requirements to higher levels should be keptat a minimum.

5 Determiningthe data flow

P R I N C I P L E

S T E P S

14

(1) Lack of understanding of use for which data is collected.

(2) Inability to distinguish which data are needed for service delivery and which data

are needed for programme management and monitoring.

(3) Inability of lower administrative levels to generate summaries of raw data collected

due to:

➤ Lack of technical expertise of staff

➤ Lack of data processing facilities (calculators, computers, etc.)

➤ Lack of computer skills of staff

(4) Lack of storage facilities for raw data at lower administrative levels.

(5) Data retrieval issues; inability to generate any information because of computer

breakdown.

(4) Make a flow chart that shows the flow of information from the peripheral to the

highest level. An example of this flow chart is shown in Figure 5.1. Another example

is shown in the Appendix.

I S S U E S

Discussion on how to streamline morbidity/mortality reporting.

15

WO

RK

SH

EE

T

Wo

rksh

eet

5.1:

Su

mm

ary

of

Data

Flo

w o

f EPI

Rep

ort

at

Each

Ad

min

istr

ati

ve L

evel

Ad

min

istr

ativ

eLe

vel

Vill

age

Dis

tric

t

Prov

ince

Nat

iona

l

Posi

tio

n o

f Pe

rso

n in

Ch

arg

eo

f A

cco

mp

lish

ing

Fo

rm/R

epo

rt

Publ

ic H

ealth

Nur

se in

cha

rge

ofEP

I pro

gram

me

EPI D

istr

ict

Nur

se S

uper

viso

r

EPI P

rovi

ncia

l Nur

se S

uper

viso

r

MC

H P

rogr

amm

e In

form

atio

nO

ffic

er

Form

s/R

epo

rts

Acc

om

plis

hed

at

this

Lev

el

EPI V

illag

e H

ealth

Cen

tre

Form

1

EPI D

istr

ict

Sum

mar

y Fo

rm 1

EPI P

rovi

nce

Sum

mar

y Fo

rm 1

EPI N

atio

nal S

umm

ary

Form

1

Posi

tio

n o

f Pe

rso

n in

Ch

arg

e

EPI D

istr

ict

Nur

se S

uper

viso

r

EPI P

rovi

ncia

l Nur

se S

uper

viso

r

MC

H P

rogr

amm

e M

anag

er

Info

rmat

ion

Off

icer

Un

it/O

ffic

e

Stat

istic

s U

nit,

Dis

tric

t H

ealth

Ser

vice

Stat

istic

s U

nit,

Pro

vinc

ial H

ealth

Ser

vice

MC

H D

ivis

ion,

Nat

iona

l Off

ice

MO

H P

lann

ing

and

Stat

istic

s O

ffic

e

Freq

uen

cy o

fSu

bm

issi

on

Qua

rter

ly

Qua

rter

ly

Qua

rter

ly

Qua

rter

ly

To W

ho

m C

om

ple

ted

Fo

rm/R

epo

rt is

Su

bm

itte

d

16

Fig

ure

5.1

Flo

w C

hart

of

EPI

Data

Fro

m t

he V

illa

ge t

o t

he N

ati

on

al

Level

��

��

��

��

��

��

�

��

��

��

��

��

��

��

��

��

��

��

��

� �

��

��

��

��

��

��

��

��

��

��

��

��

��

� �

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

17

(1) Develop the first draft of each form that is needed, using as a guide the list of

indicators to be used for the programme. This step entails either the modification

of existing forms, or the development of new ones.

(2) Compare the first draft of the form that has been developed with the list of indicators

to ensure that all the data needs can be generated from the form.

(3) Present the first draft of the form to relevant staff members and discuss with them

the following aspects of the new form:

➤ How does it compare with the old forms?

➤ What are the advantages and disadvantages of the new form?

➤ What modifications need to be done to the new form to enhance its advantages

and minimize the disadvantages?

➤ For countries that have a number of dialects, is it necessary to translate the

forms into the major dialects used in the different regions of the country?

(4) Prepare a draft of the Instructions Manual on how to fill out the new forms.

(5) Pre-test the use of the new forms as well as the Instructions Manual.

(6) Assess the results of the pre-test.

(7) Modify the forms and the Instructions Manual based on the results of the pre-test.

6 Designing thedata collection andreporting tools

P R I N C I P L E S

S T E P S

The capability of the staff who will be tasked with filling out theforms must be taken into consideration in designing them.

The most effective data collection and reporting tools are simpleand short.

18

(1) Technical expertise/capability of data providers at data source is not consistent with

the level of complexity needed for data collection tools to meet the data needs of

users.

(2) Designing the pre-testing activity, ensuring the comparability of conditions with

actual implementation.

➤ Where?

➤ Who will be involved?

➤ How long?

I S S U E S

19

WO

RK

SH

EE

T

Wo

rksh

eet

6.1:

Iden

tifi

cati

on

of

En

trie

s fo

r th

e D

evelo

pm

en

t o

f N

ew

Fo

rms

an

d t

he P

rep

ara

tio

n o

f an

Inst

ruct

ion

Man

ual

Dat

a El

emen

ts N

eed

ed

Num

ber

of 1

-yea

r-ol

dch

ildre

n w

ho a

re f

ully

imm

uniz

ed

Def

init

ion

A f

ully

imm

uniz

ed c

hild

ison

e w

ho h

as a

lread

yco

mpl

eted

the

fol

low

ing

imm

uniz

atio

ns b

y th

e tim

ehe

/she

is 1

yea

r ol

d: B

CG

,O

PV3,

DPT

3 an

d m

easl

es

Nam

e o

f Fo

rm:

EPI F

orm

1Le

vel

Acc

om

pli

shin

g T

his

Fo

rm:

V

illag

eD

istr

ict

Pro

vin

ceN

atio

nal

Cat

ego

ries

(If

Ap

plic

able

)

Fully

imm

uniz

edN

ot f

ully

imm

uniz

ed

Inst

ruct

ion

s fo

r D

ata

Co

llect

ion

an

d/o

r R

epo

rt G

ener

atio

n

Revi

ew a

ll th

e im

mun

izat

ion

regi

ster

s/ca

rds

for

all 1

-yea

r-ol

d ch

ildre

n in

the

ser

vice

area

of

the

Vill

age

Hea

lth C

entr

e. A

ll ch

ildre

n w

ho h

ave

com

plet

ed t

heir

BCG

, OPV

,D

PT a

nd m

easl

es im

mun

izat

ions

will

be

coun

ted

as f

ully

imm

uniz

ed

21

(1) Assess the advantages and disadvantages of manually processing the data compared

to using computers, considering the following factors:

➤ Cost

➤ Availability of personnel with the proper background/level of technical expertise

to run a computerized system; in particular the software skills of the staff at the

lowest level where computers can be provided should be looked into

➤ Availability of technical support in case of hardware breakdown

(2) If a computerized system is to be implemented, decide the lowest level where

computers will be used to process data. Among the important considerations in

choosing this level is the presence of staff trained in system maintenance.

(3) Define the specifications for software development, in consultation with different

levels of data users. Among the important aspects to be decided are:

➤ Summary Reports to be routinely generated

➤ Data quality control mechanisms/checks to be incorporated within the software

➤ Data analysis requirements of the data users

7 Developingprocedures fordata processing

P R I N C I P L E

S T E P S

The way the HMIS data is processed should be consistent withthe objectives for data collection and the plans for data analysis

and utilization.

22

(4) Develop the software needed to process the data at each level where computers

will be used, based on the required specifications. It may also be possible that the

softwares designed to generate outputs similar to those of the HMIS have already

been developed, requiring only minor modifications to customize it. In this situation,

the resources needed to acquire and customize the software should be determined.

A decision then needs to be made on whether to develop new software or acquire

and modify an existing program.

(5) Pre-test the software, paying attention to:

➤ Identification of bugs

➤ Ability of software to generate the expected data

➤ Ability of staff to use it

(6) Develop and pre-test the User’s Manual for the software.

(7) Design a training programme to train relevant staff on the use of the software.

I S S U E S

(1) Capability of existing hardware, especially at the lower levels, to accommodate the

software, as well as its ability to store all the data.

(2) Compatibility of the developed software with other existing software (both within

and outside the Ministry of Health) that it might need to interface with in the

future.

(3) Basic system maintenance procedures.

(4) Security system.

23

WO

RK

SH

EE

T

Wo

rksh

eet

7.1:

Co

mp

ara

tive A

ssess

men

t o

f So

ftw

are

to

be U

sed

in

th

e H

MIS

Cri

teri

a f

or

Sele

ctio

nSo

ftw

are

1So

ftw

are

2So

ftw

are

3

Cos

t of

acq

uirin

g/de

velo

ping

the

sof

twar

e2

1 –

Very

exp

ensi

ve2

– M

oder

atel

y ex

pens

ive

3 –

Nil/

free

Exis

tenc

e of

sta

ff w

ithin

MO

H w

ho k

now

how

to

use

the

soft

war

e2

1 –

Non

e2

– So

me

3 –

Seve

ral

Ava

ilabi

lity

of lo

cal t

echn

ical

sup

port

in c

ase

of p

robl

ems

31

– N

one

2 –

Lim

ited

avai

labi

lity

3 –

Hig

hly

avai

labl

e

Com

patib

ility

with

the

ope

ratin

g sy

stem

s of

the

com

pute

rs u

sed

by o

ther

uni

ts w

ithin

the

2M

OH

with

who

m t

he H

MIS

nee

ds t

o in

terf

ace

1 –

Not

com

patib

le2

- C

ompa

tible

Com

patib

ility

with

oth

er s

oftw

are

used

in t

he M

OH

tha

t H

MIS

nee

ds t

o in

terf

ace

with

31

– N

ot c

ompa

tible

at

all

2 –

Soft

war

e in

terf

ace

poss

ible

aft

er a

dditi

onal

pro

cess

es3

– N

o co

mpa

tibili

ty p

robl

ems

3

Ava

ilabi

lity

of U

ser’s

Man

ual f

or t

he s

oftw

are

1 –

Not

ava

ilabl

e at

all

2 –

Ava

ilabl

e, b

ut c

anno

t be

acq

uire

d lo

cally

3 –

Ava

ilabl

e lo

cally

Leve

l of

com

pute

r sk

ills

need

ed t

o us

e th

e so

ftw

are

21

– H

igh/

adva

nced

2 –

Mod

erat

e3

– Lo

w (

very

use

r-fr

iend

ly)

Tota

l17

Sco

re

25

(1) Conduct a training needs assessment for data providers and data users. Four types

of training are usually conducted. These are:

➤ Training of trainers

➤ Training of data providers at the peripheral levels on how to fill out forms

➤ Training of computer operators on the use of the software and hardware

➤ Training of staff at different levels on data utilization

A separate training-needs assessment should be conducted for each type of training.

Among the variables to be collected for the training-needs assessment are as follows:

➤ Basic functions of each staff related to HMIS

➤ Extent of previous training received on the performance of such functions

➤ When training was received

➤ Adequacy of previous training to enable staff to perform expected functions

➤ Desired training areas

(2) Develop the curriculum for each type of training, based on the results of the training

needs assessment. The following aspects should be covered:

➤ Target group (For Whom?)

➤ Content (What?)

➤ Strategies (How?)

➤ Duration (How long?) – This refers to the total duration of the training

programme, as well as the time allocated for each topic included in the training

8 Developing thetraining programme

P R I N C I P L E

S T E P S

Training programmes should be designed according to the needsand level of the target groups.

26

The output of this step is a course syllabus for each training programme to be

conducted.

(3) Develop the training materials. The following training materials are suggested:

The participants of the Training of Trainers should be provided with a copy of the

Data Dictionary, the Manual for Data Providers and the Manual for Data Users.

(4) Reproduce the training materials. Since there is a chance that some modifications

in the format, structure and content of the training materials will be made based

on the evaluation results, the number of copies to be reproduced at this point

should be limited.

(5) Formulate the evaluation design for the training programme. It is important to

determine this prior to the conduct of the training activities, since most evaluation

designs require the collection of a baseline or a pre-training level of knowledge

among the participants.

(6) Identify the most appropriate participants for each type of training, based on their

duties and responsibilities related to data generation, management and utilization.

An efficient strategy to use is to identify and train a core set of staff who can act as

trainers for the neighbouring areas. If this strategy is adopted, it is important to

consider the geographic distribution of participants for the Training of Trainers.

(7) Conduct the training of data providers.

(8) Conduct the training of data users. This is usually conducted after sufficient data

from the HMIS has been collected for use as examples during the training.

(9) Evaluate the training programme, including the training materials used.

Type of Training

Training for DataProviders

Training for Data Users

Training for ComputerOperators

Training of Trainers

Training Material

Data Dictionary

Manual for DataProviders(separate Manual foreach level)

Manual for Data Users(separate Manual foreach level)

Computer SoftwareUser’s Manual

Trainer’s Manual

Contents

List of indicators, formulas, definitions,data sources

Instructions on how to fill out forms

Data analysis, interpretation and utilization

Detailed instructions (with examples) onhow to use the software; troubleshooting

Instructions on how to implement thetraining programme for data providers anddata users; teaching strategies; guidelineson the use of the Manual for Data Usersand Manual for Data Providers

27

(10) Modify the training materials and the training programme itself based on the results

of the evaluation. This should be done prior to the conduct of another series of

training activities.

(1) Selection of the appropriate participants for the different training programmes to

be conducted.

(2) Backgrounds of staff identified to enter data and generate reports using the software

developed for the HMIS. Are they very different?

(3) Language/dialects to be used for the training materials.

(4) Extent of dissemination of training materials and manuals.

(5) Preparation of adequate facilities to conduct training.

I S S U E S

Training seminar on data use.

28

WO

RK

SH

EE

T

Wo

rksh

eet

8.1:

Pre

para

tio

n o

f a L

ess

on

Pla

n f

or

the T

rain

ing

of

Data

Use

rs a

nd

Data

Pro

vid

ers

Learn

ing

Ob

ject

ives

By t

he e

nd o

f th

e se

ssio

n, t

hepa

rtic

ipan

ts s

houl

d be

abl

e to

:1.

Iden

tify

the

diff

eren

t lo

cal a

ndin

tern

atio

nal s

ourc

es o

f he

alth

data

tha

t ar

e co

llect

ed e

ither

on a

rou

tine

or o

n an

ad

hoc

basi

s2.

Kno

w t

he t

ypes

of

data

avai

labl

e fr

om t

he d

iffer

ent

loca

l and

inte

rnat

iona

l sou

rces

3.Be

aw

are

of t

he p

robl

ems

face

d by

the

rou

tine

data

colle

ctio

n sy

stem

s fo

r he

alth

and

heal

th-r

elat

ed d

ata,

part

icul

arly

on

the

MO

H h

ealth

info

rmat

ion

syst

em a

nd t

hevi

tal r

egis

trat

ion

syst

em4.

Kno

w h

ow t

o as

sess

a g

iven

set

of h

ealth

dat

a ac

cord

ing

totim

elin

ess,

com

plet

enes

s,ad

equa

cy,

accu

racy

and

relia

bilit

y5.

Iden

tify

fact

ors

affe

ctin

g th

equ

ality

of

heal

th d

ata

Ou

tlin

e o

f Le

ctu

re

1.H

ealth

Sta

tistic

s1.

1So

urce

s of

hea

lth d

ata

a.Th

e h

ealth

info

rmat

ion

syst

em o

fth

e M

inis

try

of H

ealth

b.Th

e vi

tal r

egis

trat

ion

syst

emc.

Oth

er lo

cal s

ourc

es o

fhe

alth

dat

a (in

clud

ing

othe

r se

ctor

s su

ch a

sth

e po

lice

for

acci

dent

s, e

tc.)

d.In

tern

atio

nal s

ourc

esof

hea

lth d

ata

(WH

O,

UN

ICEF

, et

c.)

1.2

Ass

essi

ng t

he q

ualit

y of

heal

th d

ata

a.Ti

mel

ines

sb.

Com

plet

enes

sc.

Ade

quac

yd.

Acc

urac

ye.

Relia

bilit

y

Sp

eci

fic

Top

ics

to b

e C

overe

d i

n t

he L

ect

ure

➤D

ata

sour

ces

➤Ro

utin

e da

ta c

olle

ctio

n sy

stem

➤A

d ho

c da

ta c

olle

ctio

n sy

stem

➤M

OH

hea

lth in

form

atio

n sy

stem

➤V

ital r

egis

trat

ion

syst

em➤

Def

initi

ons

and

way

s of

det

ectin

g pr

oble

ms

in t

hefo

llow

ing

aspe

cts

of d

ata

qual

ity:

•Ti

mel

ines

s of

dat

a•

Com

plet

enes

s of

dat

a–

exte

nt t

o w

hich

the

who

le f

orm

/dat

aco

llect

ion

tool

is f

illed

out

–ge

ogra

phic

are

a co

vere

d by

the

rep

ort

–tim

e fr

ame

cove

red

by t

he r

epor

t•

Ade

quac

y of

dat

a•

Acc

urac

y of

dat

a•

Relia

bilit

y of

dat

a•

Fact

ors

affe

ctin

g th

e qu

ality

of

the

data

Top

ics

to b

e C

overe

d/ A

ctiv

itie

s to

be

Un

dert

aken

fo

r th

e P

ract

ical

Exerc

ises

Crit

ique

dat

a pu

blis

hed

in t

he A

nnua

l Hea

lthSt

atis

tics

Repo

rt

Typ

e o

f Tr

ain

ing

:Tr

aini

ng f

or D

ata

Prov

ider

sTr

aini

ng f

or D

ata

Use

rsTr

aini

ng o

f Tr

aine

rsTr

aini

ng f

or C

ompu

ter

Ope

rato

rs

Sess

ion

No

.:1

Top

ic:

Intr

oduc

tion

to H

ealth

Sta

tistic

s

Du

rati

on

of

Lect

ure

(in

hrs

):2.

0 hr

sD

ura

tio

n o

f Pra

ctic

al

Exerc

ises

(in

hrs

):1

hrTo

tal

Tim

e A

llo

cate

d f

or

this

Sess

ion

(in

hrs

):3

hrs

29

(1) Prepare the guidelines for pre-testing the system. This involves addressing the

following questions:

(1.1) Where? Selection of the place(s) where the pre-testing will be conducted.

There is a need to develop criteria for selecting the pre-testing sites. These

can include technical factors like the level of expertise or qualifications of the

staff in the area, or practical considerations like the proximity of the area, the

provision/availability of infrastructure support, or how cooperative the staff

are.

(1.2) Who? Who will participate in the pre-testing? It is important for the different

types of data providers and data users to participate in the pre-testing.

(1.3) What? What are the specific objectives of the pre-testing? Specifically, what

aspects of the HMIS will be pre-tested? What are the different activities to be

undertaken to achieve these objectives?

(1.4) How? What modes and tools for data collection will be utilized to

systematically collect the data required for an efficient pre-testing of the

forms?

(1.5) How long? For how long will the pre-testing be conducted?

(2) Orient the staff involved in the pre-testing.

(2.1) Inform them on the objectives of and procedures for the pre-testing.

(2.2) Train the data users and data providers in the pre-test areas on the new

system.

The system should be pre-tested in conditions that reflect as muchas possible the actual conditions prevailing during its

implementation.

9 Pre-testingthe system

P R I N C I P L E

S T E P S

30

(3) Implement the pre-testing activities.

(4) Write a report on the results of the pre-testing.

(5) Formulate recommendations, based on the results of the pre-testing.

I S S U E S

(1) Implementation of a systematic and proactive monitoring mechanism during the

pre-testing phase.

(2) Systematic updating of the software in all units where it has been installed.

(3) Ensuring that all elements and staff are ready for the pre-testing phase.

31

WO

RK

SH

EE

T

Wo

rksh

eet

9.1:

Log

bo

ok o

f Pro

ble

ms

Iden

tifi

ed

Du

rin

g t

he P

re-t

est

ing

Ph

ase

Act

ion

Tak

en

Add

ition

al s

uppl

y of

new

form

s se

nt t

he f

ollo

win

g da

y

Prob

lem

ref

erre

d to

sof

twar

ede

velo

per

Prob

lem

ref

erre

d to

EPI

Uni

t

Res

ult

/Sta

tus

of

Pro

ble

m

Prob

lem

sol

ved

Bug

in t

he s

oftw

are

iden

tifie

d;co

rrec

tion

of s

oftw

are

inst

alle

d in

all

dist

ricts

sch

edul

ed f

or n

ext

wee

k

Age

cut

-off

ver

ified

to

be <

1;w

ritte

n cl

arifi

catio

n of

def

initi

on o

fFI

C d

istr

ibut

ed t

o al

l hea

lth c

entr

es

Oth

ers

Co

mp

ute

r1Fo

rms

Des

crip

tio

n o

f Pr

ob

lem

Ran

out

of s

uppl

y of

new

form

s

Com

pute

r do

uble

s th

een

trie

s fo

r so

me

form

s

Con

fusi

on in

def

initi

on o

fFI

C –

whe

ther

cut

-off

age

is <

1 or

<2

Oth

ers

(Sp

ecif

y)Fi

eld

Vis

itPh

on

eC

all

Dat

e

3/1/

03

3/3/

03

3/10

/03

1 Incl

udes

bot

h so

ftw

are

and

hard

war

e-re

late

d pr

oble

ms

Pro

vin

ce:

____

____

____

____

__D

istr

ict:

____

____

____

____

__V

illa

ge

He

alt

h C

en

tre

:__

____

____

____

____

Mo

nth

/Ye

ar:

____

____

____

____

__M

arch

200

3

Ho

w P

rob

lem

Was

Iden

tifi

edPr

ob

lem

Are

a

33

(1) Develop a plan for the systematic monitoring and evaluation of the system.

➤ What will be monitored and evaluated?

➤ How will it be done?

➤ Who will do it?

➤ How frequently will it be conducted?

➤ How will the results be systematically disseminated?

➤ How will action resulting from the evaluation results be generated?

(2) Identify the resources needed to implement the monitoring and evaluation plan.

(3) Prioritize the activities, based on availability of resources and need.

(4) Implement the monitoring and evaluation plan.

(5) Document and disseminate the results of monitoring and evaluation activities.

(6) Make recommendations based on the results of monitoring and evaluation activities.

10 Monitoringand evaluatingthe system

P R I N C I P L E

S T E P S

The goal of monitoring and evaluation is not to focus on what iswrong and condemn it; rather, it is to highlight the positive

aspects of the system that make it work, as well as to identify whatwent wrong as a basis for improving the system.

34

I S S U E S

(1) Institutionalization of monitoring and evaluation to ensure that it becomes a regular

activity and will be allocated the corresponding resources.

(2) Availability of technical expertise and other resources for monitoring and evaluation.

Checking data entry work at a health centre.

35

WO

RK

SH

EE

T

Wo

rksh

eet

10.1

:D

ata

Co

llect

ion

Act

ivit

ies

for

the E

valu

ati

on

of

the H

MIS

Are

a

Dat

age

nera

tion

and

repo

rtco

mpi

latio

n

Dat

aut

iliza

tion

Com

pute

rso

ftw

are

and

hard

war

e

Trai

ning

Mon

itorin

g

Gen

eral

Maj

or

Var

iab

les

to b

e C

ove

red

➤D

ata

qual

ity in

clud

ing

timel

ines

s, c

ompl

eten

ess,

acc

urac

y an

d re

liabi

lity

➤C

orre

ct c

ompu

ting

of in

dica

tors

➤A

ppro

pria

tene

ss o

f da

ta s

ourc

es➤

Exte

nt a

nd n

atur

e of

pro

blem

s m

et b

y vi

llage

hea

lth c

entr

e st

aff

on d

ata

entr

y an

d re

port

gen

erat

ion

➤A

dequ

acy

of f

orm

s to

mee

t th

e ne

eds

of t

he n

atio

nal,

prov

inci

al,

dist

rict

and

villa

ge le

vels

➤Ex

tent

and

nat

ure

of in

tera

ctio

n am

ong

staf

f at

diff

eren

t le

vels

on

the

HM

IS f

orm

s an

d re

port

s➤

By w

hom

and

how

dat

a ge

nera

ted

from

the

HM

IS a

re u

tiliz

ed a

t th

e na

tiona

l, pr

ovin

cial

, dis

tric

t, a

ndvi

llage

leve

ls

➤Ex

tent

and

nat

ure

of p

robl

ems

in d

ata

entr

y an

d re

port

gen

erat

ion

at t

he n

atio

nal,

prov

inci

al,

dist

rict

and

villa

ge le

vels

➤A

dequ

acy

of t

he s

oftw

are

to m

eet

the

need

s of

the

pro

vinc

es a

nd d

istr

icts

, as

wel

l as

the

natio

nal l

evel

➤Pr

oble

ms

met

with

the

sof

twar

e

➤A

sses

smen

t of

the

tra

inin

g fo

r da

ta u

sers

and

dat

a pr

ovid

ers

➤A

sses

smen

t of

the

tra

inin

g of

tra

iner

s➤

Ass

essm

ent

of t

he t

rain

ing

on t

he u

se o

f th

e so

ftw

are

➤A

sses

smen

t of

the

Use

r’s M

anua

l for

the

sof

twar

e

➤M

onito

ring

activ

ities

and

str

ateg

ies

used

at

the

natio

nal,

prov

inci

al,

and

dist

rict

leve

ls.

Of

part

icul

arim

port

ance

are

mon

itorin

g ac

tiviti

es f

or t

he f

ollo

win

g ar

eas:

•da

ta q

ualit

y•

data

ext

ract

ion

from

var

ious

sou

rces

•ut

iliza

tion

of H

MIS

pro

duct

s➤

Mon

itorin

g ac

tiviti

es a

t th

e na

tiona

l and

pro

vinc

ial l

evel

on

the

use

of t

he s

oftw

are

➤Su

pply

of

form

s, c

ompu

ter

supp

lies,

and

oth

er m

ater

ials

nee

ded

for

the

vario

us c

ompo

nent

s of

the

HM

IS➤

Form

s an

d so

urce

s of

add

ition

al s

uppo

rt n

eede

d at

the

nat

iona

l, pr

ovin

cial

, di

stric

t, a

nd v

illag

e le

vels

Mo

de

of

Dat

a C

olle

ctio

n

Key

info

rman

t in

terv

iew

sFo

cus

grou

p di

scus

sion

s

Key

info

rman

t in

terv

iew

sFo

cus

grou

p di

scus

sion

s

Revi

ew o

f lo

gboo

k of

com

pute

r pr

oble

ms

Key

info

rman

t in

terv

iew

sFo

cus

grou

p di

scus

sion

s

Key

info

rman

t in

terv

iew

sFo

cus

grou

p di

scus

sion

sRe

view

of

reco

rds

and

logb

ooks

Key

info

rman

t in

terv

iew

sFo

cus

grou

p di

scus

sion

s

Dat

a C

olle

cto

r

HM

IS e

valu

atio

nC

onsu

ltant

HM

IS e

valu

atio

nC

onsu

ltant

IT s

peci

alis

t,N

atio

nal O

ffic

e

HM

IS e

valu

atio

nC

onsu

ltant

HM

IS e

valu

atio

nC

onsu

ltant

HM

IS e

valu

atio

nC

onsu

ltant

37

P R I N C I P L E

S T E P S

(1) Determine the most effective and efficient way of disseminating the data generated

from the HMIS by considering the following factors:

(1.1) To whom should the data be disseminated? The needs of target groups

have to be considered.

(1.2) What should be disseminated? This should include not only the outputs of

the HMIS, but also feedback on who is using the information and what/how

they are using it.

(1.3) How often should data be disseminated to the different target groups?

(1.4) In what form should the data be disseminated to each of the different target

groups? The whole range of forms and venues for data dissemination should

be considered.

(2) Identify the human, financial and other resources needed to implement the data

dissemination plan.

(3) Prioritize the different modes of data dissemination to be adopted, based on need

and availability of resources.

(4) Implement the data dissemination activities.

11 Developingdata disseminationand feedbackmechanisms

An effective way of motivating data producers is to constantlyprovide them with both positive and negative feedback on the

status of the data they produce.

38

(5) Develop and implement a system for monitoring and evaluating the data disse-

mination and feedback activities conducted. Among the factors to be considered

are:

➤ Coverage — to what extent is the material reaching the target audience?

➤ Effect of the feedback system on the staff

➤ Degree of utilization by the target audience — are they actually using the data

presented in the different materials prepared?

I S S U E S

(1) Preparation of a Management Report.

(2) Limited financial resources for dissemination.

(3) Ensuring that dissemination activities reach the ‘correct’ audience.

(4) Consistency between the data disseminated by the HMIS, and similar data published

and disseminated by other units within the ministry, especially those of the vertical

programmes.

39

WO

RK

SH

EE

T

Wo

rksh

eet

11.1

:Su

mm

ary

of

Data

Dis

sem

inati

on

an

d F

eed

back

Act

ivit

ies

Typ

e o

f R

ep

ort

/Act

ivit

y

Ann

ual H

ealth

Sta

tistic

s Re

port

Wee

kly

Mor

bidi

ty R

epor

tfo

r N

otifi

able

Dis

ease

s

Dis

tric

t M

onth

ly H

MIS

Mon

itorin

g M

eetin

gs

To W

ho

m I

t N

eed

s to

be D

isse

min

ate

d

➤G

over

nmen

t St

atis

tics

Off

ice

➤Se

cret

ary

of H

ealth

➤N

atio

nal H

ealth

Pla

nner

➤A

ll Pr

ogra

mm

e M

anag

ers

at t

he n

atio

nal l

evel

➤A

ll Pr

ovin

cial

Hea

lth O

ffic

es

➤D

istr

ict

Hea

lth O

ffic

es➤

Prov

inci

al H

ealth

Off

ices

➤Pr

ogra

mm

e D

irect

ors

➤N

atio

nal D

isea

se C

ontr

ol U

nit

➤Pr

ogra

mm

e M

anag

ers

at t

he d

istr

ict

leve

l➤

Vill

age

Hea

lth C

entr

e st

aff

Mo

de o

f D

isse

min

ati

on

Publ

icat

ion

➤Ra

dio

➤Te

leph

one

➤Fa

x➤

Emai

l

Mee

ting

Freq

uen

cy o

f D

isse

min

ati

on

/Co

nd

uct

Ann

ual

Wee

kly

Mon

thly

41

(1) Review the results of monitoring and evaluation activities conducted on the HMIS

in recent years.

(2) Identify aspects of the HMIS that need to be developed further to facilitate the

functioning of the core system. The basic question to be answered is, “Where do

we go next?”. Among the possible aspects that need looking into:

➤ Enhancement and institutionalization of procedures to assure data quality control

➤ Developing capacity to conduct special studies and sample surveys

➤ Defining coordinating mechanisms for the horizontal use of data generated

from vertical programmes

➤ Developing strategies to create and/or sustain the interest of staff at different

levels to use the data for programme planning, management and evaluation

➤ Establishing inter- and intra-sectoral linkages among units involved in different

aspects of the HMIS

➤ Unifying and coordinating initiatives of sectors and funding agencies involved

in activities related to the HMIS

(3) Identify resources needed to implement the different options for the enhancement

of the HMIS. This should include specific types of resources for each planned

expansion activity; the budgetary requirements (if any); and the desired source of

support for each type of resource needed.

The development of the HMIS is always a work in progress. It is adynamic endeavour where managers and workers strive for

constant improvement.

12 Enhancing the HMIS

P R I N C I P L E

S T E P S

42

(4) Prioritize the different options according to degree and urgency of need, and

availability of resources for its proper implementation.

(5) Prepare a timetable for the implementation of the different activities for the

expansion of the HMIS.

(6) Conduct the different activities needed to implement the desired enhancement of

the HMIS.

(7) Monitor and evaluate the effect of newly implemented aspect of the HMIS.

I S S U E S

(1) Sustaining interest among different stakeholders for the continuous development

of the HMIS.

(2) Generation of resources to support the different activities for system enhancement.

(3) Coordinating the activities of the different donor agencies so as to minimize the

proliferation of data collection forms and the duplication of efforts in areas related

to HMIS development.

(4) Ensuring the continued existence of a body/committee to oversee the HMIS after

the pilot-testing phase.

43

WO

RK

SH

EE

T

Wo

rksh

eet

12.1

:Tw

o-y

ear

Pla

n o

f A

ctiv

itie

s fo

r H

MIS

Exp

an

sio

n a

nd

Co

rresp

on

din

g R

eso

urc

e R

eq

uir

em

en

ts

Act

ivit

y

Prov

isio

n of

com

pute

rs t

o al

l the

10

dist

ricts

of

Prov

. X

Dev

elop

men

t of

tra

inin

g st

rate

gies

➤Id

entif

icat

ion

of p

artic

ipan

ts➤

Dev

elop

men

t of

tra

inin

g m

ater

ials

Trai

ning

of

dist

rict

leve

l Inf

orm

atio

nO

ffic

ers

on t

he u

se o

f th

e so

ftw

are

Prin

ting

of n

ew f

orm

s

Mon

itorin

g an

d in

spec

tion

Reso

urc

e R

eq

uir

em

en

ts

10 c

ompu

ters

and

prin

ters

Com

mun

icat

ion

cost

sH

onor

ariu

m f

or lo

cal c

onsu

ltant

Dev

elop

men

t an

d re

prod

uctio

nof

tra

inin

g m

ater

ials

Per

diem

of

part

icip

ants

Tran

spor

tatio

n, f

ood

and

venu

eH

onor

ariu

m f

or lo

cal c

onsu

ltant

/tr

aine

r

Prin

ting

cost

s

Tran

spor

tatio

n an

d da

ilysu

bsis

tenc

e al

low

ance

of

mon

itorin

g te

am(1

vis

it/di

stric

t/2

mon

ths)

Com

mun

icat

ion

cost

s (lo

ngdi

stan

ce c

alls

, fa

x, e

tc.)

Est

imate

d C

ost

$15

000

$600

$100

0

$400

0

$300

$200

0

$500

So

urc

e o

f Su

pp

ort

Don

or a

genc

y

Regu

lar

budg

et

Regu

lar

budg

et

Don

or a

genc

y

Regu

lar

budg

et

Don

or a

genc

y

Regu

lar

budg

et

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Year

1Y

ear

2

Tim

eta

ble

fo

r Im

ple

men

tati

on

45

Examples

Example 1 is a list of basic indicators that might be used in Ministry of Health programmes,

together with the corresponding data sources, modes and frequency of data collection,

as well as the lowest administrative level where the indicator is computed. While the

reader can adopt some of these indicators for their use, the main objective of the

example is to show how the set of indicators used by a country can be presented so

that it will be easy for the staff of the Statistics Unit to monitor their status.

Example 2 is a flow chart of the HMIS of hypothetical country X. As in the first example,

the aim is to show not “what”, but “how”; not to prescribe a model flowchart for the

HMIS as such, but rather to demonstrate how the HMIS can be presented by means of

a flow chart.

46

Exam

ple

1:

List

of

Ind

icato

rs U

sed

by t

he M

inis

try o

f H

ealt

h o

f C

ou

ntr

y X

Wit

h C

orr

esp

on

din

g D

ata

So

urc

es

an

d M

od

e o

f D

ata

Co

llect

ion

Col

ly, is

it p

ossi

ble

to p

rovi

de a

shor

t exp

lana

tion

of w

hat t

he fo

llow

ing

exam

ples

are

all

abou

t? E

ven

one

sent

ence

will

do,

so

as n

ot to

leav

eth

is p

age

blan

k (t

o re

plac

e th

is p

arag

raph

). A

noth

er o

ptio

n w

ould

be a

quo

tatio

n.

Ind

icato

rFo

rm/R

eg

iste

rFr

eq

uen

cy o

fD

ata

Co

llect

ion

Sp

eci

al

Surv

eyR

ou

tin

eSyst

em

Oth

er

Ag

en

cies

(Ple

ase

Sp

eci

fy)

Un

it/D

ivis

ion

Low

est

Level W

here

Ind

icato

r is

Co

mp

ute

dA

.Po

pu

lati

on

, So

cio

-eco

no

mic

an

d E

nvir

on

men

tal In

dic

ato

rs

1.Po

pula

tion

grow

th r

ate

NSO

Ann

ually

Vill

age

2.N

atur

al p

opul

atio

n gr

owth

rat

eN

SOA

nnua

llyV

illag

e

3.C

rude

birt

h ra

teN

SOA

nnua

llyV

illag

e

4.C

rude

dea

th r

ate

NSO

Ann

ually

Vill

age

5.To

tal f

ertil

ity r

ate

NSO

Ann

ually

Vill

age

6.Pe

rcen

tage

of

the

popu

latio

n by

age

and

sex

NSO

Ever

y 5

yrs

Dis

tric

t

7.G

ross

dom

estic

pro

duct

per

cap

itaN

SOA

nnua

llyN

atio

nal

8.Li

tera

cy r

ate

a.O

vera

llb.

Mal

esc.

Fem

ales

NSO

; MO

EEv

ery

5 yr

sPr

ovin

ce

9.Pe

rcen

tage

of

the

popu

latio

n us

ing

safe

wat

era.

Ove

rall

b.U

rban

c.Ru

ral

EHN

SOEv

ery

5 yr

sPr

ovin

ce

10.P

erce

ntag

e of

the

pop

ulat

ion

usin

ghy

gien

ic t

oile

ta.

Ove

rall

b.U

rban

c.Ru

ral

EHN

SOEv

ery

5 yr

sPr

ovin

ce

B.

Res

ou

rce

Ind

icat

ors

11.P

erce

ntag

e of

gov

ernm

ent

heal

thbu

dget

in G

DP

PHO

DO

FM

OH

DO

FN

SOA

nnua

llyN

atio

nal

MO

HSo

urc

eM

od

e o

fD

ata

Co

llect

ion

47

Con

tinue

d ne

xt p

age

➤

12.P

erce

ntag

e of

gov

ernm

ent

heal

thbu

dget

in e

xpen

ditu

re o

f na

tiona

lbu

dget

PHO

DO

FM

OH

DO

FN

SOA

nnua

llyN

atio

nal

13.H

ealth

bud

get

per

capi

taPH

O D

OF

MO

H D

OF

NSO

Ann

ually

Nat

iona

l

14.P

ropo

rtio

n of

hea

lth e

xpen

ditu

re b

ypr

ogra

mm

e (p

reve

ntiv

e, c

urat

ive,

trai

ning

, m

anag

emen

t)PH

O D

OF

MO

H D

OF

NSO

Ann

ually

Prov

ince

15.N

umbe

r of

hos

pita

l bed

s pe

r 10

00po

pula

tion

DH

S; D

PD

HS;

DP

Ann

ually

Prov

ince

16.N

umbe

r of

phy

sici

ans

per

10 0

00po

pula

tion

DH

S; D

PD

HS;

DP

Ann

ually

Prov

ince

17.N

umbe

r of

pha

rmac

ists

per

10

000

popu

latio

nD

PD

PA

nnua

llyPr

ovin

ce

18.N

umbe

r of

nur

ses

per

10 0

00po

pula

tion

DP

DP

Ann

ually

Prov

ince

19.N

umbe

r of

den

tists

per

10

000

popu

latio

nD

PD

PA

nnua

llyPr

ovin

ce

20.

Perc

enta

ge o

f vi

llage

s w

ith a

tra

ined

heal

th w

orke

rD

PD

PA

nnua

llyC

omm

une

C.

Perf

orm

an

ce a

nd

Ou

tpu

t In

dic

ato

rs

C1.N

utr

itio

n I

nd

icato

rs

21.W

eigh

t m

alnu

triti

on r

ate

ofch

ildre

n <

5 ye

ars

old

NIN

NSO

Ann

ually

Prov

ince

22.H

eigh

t m

alnu

triti

on r

ate

ofch

ildre

n <

5 ye

ars

old

NIN

NSO

Ann

ually

Prov

ince

23.W

eigh

t/he

ight

mal

nutr

ition

rat

e of

child

ren

<5

year

s ol

dN

INN

SOA

nnua

llyPr

ovin

ce

24.P

erce

ntag

e of

low

birt

h w

eigh

tD

MC

H; C

HC

Qua

rter

lyD

istr

ict

C2

.Cu

rati

ve S

erv

ices

25.N

umbe

r of

in-p

atie

nts

per

1000

popu

latio

nD

HS

Qua

rter

lyPr

ovin

ce

26.P

erce

ntag

e of

insu

red

in-p

atie

nts

amon

g to

tal i

n-pa

tient

sD

HS

Qua

rter

lyPr

ovin

ce

48

Exam

ple

1 (

Co

nt’

d)

Ind

icato

rFo

rm/R

eg

iste

rFr

eq

uen

cy o

fD

ata

Co

llect

ion

Sp

eci

al

Surv

eyR

ou

tin

eSyst

em

Oth

er

Ag

en

cies

(Ple

ase

Sp

eci

fy)

Un

it/D

ivis

ion

Low

est

Level W

here

Ind

icato

r is

Co

mp

ute

d

C2.C

ura

tive S

erv

ices

(Co

nt’

d)

27.N

umbe

r of

out

-pat

ient

s pe

r 10

00po

pula

tion

DH

SQ

uart

erly

Prov

ince

28.A

vera

ge le

ngth

of

stay

in t

heho

spita

lD

HS

Qua

rter

lyD

istr

ict

29.B

ed o

ccup

ancy

rat

eD

HS

Qua

rter

lyD

istr

ict

30.B

ed t

urn-

over

rat

eD

HS

Qua

rter

lyD

istr

ict

C3.R

ep

rod

uct

ive H

ealt

h a

nd

Fam

ily P

lan

nin

g

31.P

erce

ntag

e of

pre

gnan

t w

omen

vacc

inat

ed w

ith T

etan

us T

oxoi

d ≥2

EPI;

CH

C; D

MC

HQ

uart

erly

Dis

tric

t

32.P

erce

ntag

e of

wom

en w

ith ≥

3an

tena

tal v

isits

dur

ing

preg

nanc

yC

HC

; D

MC

HQ

uart

erly

Com

mun

e

33.P

erce

ntag

e of

del

iver

ies

in h

ealth

faci

litie

sC

HC

; DM

CH

Qua

rter

lyC

omm

une

34.P

erce

ntag

e of

del

iver

ies

atte

nded

by a

hea

lth w

orke

rC

HC

; D

MC

HQ

uart

erly

Com

mun

e

35.P

erce

ntag

e of

mot

hers

who

rece

ived

pos

tnat

al c

are

CH

C;

DM

CH

Qua

rter

lyC

omm

une

36.P

erce

ntag

e of

pre

gnan

t w

omen

amon

g <

19 y

ears

old

CH

C; D

MC

HN

SOEv

ery

2 yr

sD

istr

ict

37.C

ontr

acep

tive

prev

alen

ce

rate

FPSF

NSO

Qua

rter

lyD

istr

ict

38.M

etho

d-sp

ecifi

c co

ntra

cept

ive

rate

(IUD

, Pi

ll, e

tc.)

FPSF

NSO

Qua

rter

lyD

istr

ict

39.S

pont

aneo

us a

bort

ion

ratio

HQ

uart

erly

Dis

tric

t

40.M

orbi

dity

and

mor

talit

y ra

tio o

fob

stet

ric c

ompl

icat

ions

HQ

uart

erly

Prov

ince

MO

HSo

urc

eM

od

e o

fD

ata

Co

llect

ion

49

Con

tinue

d ne

xt p

age

➤

C4.

Ch

ild H

ealt

h C

are

41.P

erce

ntag

e of

chi

ldre

n <

1 ye

ar o

ldfu

lly im

mun

ized

(FIC

)EP

IQ

uart

erly

Com

mun

e

42.P

erce

ntag

e of

chi

ldre

n <

1 ye

ar o

ldva

ccin

ated

aga

inst

TB

EPI

Qua

rter

lyC

omm

une

43.P

erce

ntag

e of

chi

ldre

n <

1 ye

ar o

ldva

ccin

ated

aga

inst

per

tuss

is,

teta

nus

and

dipt

heria

EPI

Qua

rter

lyC

omm

une

44.P

erce

ntag

e of

chi

ldre

n <

1 ye

ar o

ldva

ccin

ated

aga

inst

pol

ioEP

IQ

uart

erly

Vill

age

45.P

erce

ntag

e of

chi

ldre

n <

1 ye

ar o

ldva

ccin

ated

aga

inst

m

easl

esEP

IQ

uart

erly

Vill

age

46.P

erce

ntag

e of

chi

ldre

n <

1 ye

ar o

ldva

ccin

ated

aga

inst

hep

atiti

sEP

IQ

uart

erly

Vill

age

47.M

orbi

dity

and

mor

talit

y ra

te o

f6

vacc

ine

prev

enta

ble

dise

ases

of

child

ren

EPI

Qua

rter

lyPr

ovin

ce

48.M

orbi

dity

and

mor

talit

y ra

te o

fne

onat

al t

etan

usH

; D

SSQ

uart

erly

Dis

tric

t

49.A

vera

ge n

umbe

r of

dia

rrhe

aep

isod

es a

mon

g ch

ildre

n <

5 ye

ars

old

H; D

HC

PH

CQ

uart

erly

Vill

age

50.P

erce

ntag

e of

dia

rrhe

a ca

ses

amon

g ch

ildre

n tr

eate

d w

ithO

ral R

ehyd

ratio

n Sa

ltsH

; DH

C P

HC

;CH

CQ

uart

erly

Vill

age

51.M

orta

lity

rate

fro

m d

iarr

hea

amon

gch

ildre

n <

5 ye

ars

old

H; D

HC

PH

C; C

HC

Qua

rter

lyPr

ovin

ce

52.A

vera

ge n

umbe

r of

acu

te r

espi

rato

ryin

fect

ion

epis

odes

am

ong

child

ren

<5

year

s ol

dA

RIC

PQ

uart

erly

Vill

age

53.M

orta

lity

rate

fro

m a

cute

res

pira

tory

infe

ctio

n am

ong

child

ren

<5

year

s ol

dA

RIC

PQ

uart

erly

Prov

ince

54.P

erce

ntag

e of

sev

ere

pneu

mon

iaca

ses

amon

g ch

ildre

n <

5 ye

ars

old

refe

rred

to

high

er le

vel

ARI

CP

Qua

rter

lyV

illag

e

50

Exam

ple

1 (

Co

nt’

d)

Ind

icato

rFo

rm/R

eg

iste

rFr

eq

uen

cy o

fD

ata

Co

llect

ion

Sp

eci

al

Surv

eyR

ou

tin

eSyst

em

Oth

er

Ag

en

cies

(Ple

ase

Sp

eci

fy)

Un

it/D

ivis

ion

Low

est

Level W

here

Ind

icato

r is

Co

mp

ute

d

C5.S

ele

cted

Dis

ease

s

55.P

reva

lenc

e of

lepr

osy

DH

C P

MC

Qua

rter

lyPr

ovin

ce

56.P

erce

ntag

e of

new

lepr

osy

case

sw

ith d

isab

ility

deg

ree

2 an

d ov

erD

HC

PM

CQ

uart

erly

Prov

ince

57.M

orbi

dity

and

mor

talit

y ra

te o

ftu

berc

ulos

isN

TCP

Qua

rter

lyPr

ovin

ce

58.N

otifi

catio

n ra

te (

inci

denc

e) o

ftu

berc

ulos

isN

TCP

Qua

rter

lyPr

ovin

ce

59.P

erce

ntag

e of

tub

ercu

losi

s pa

tient

str

eate

d w

ith D

OTS

NTC

PQ

uart

erly

Prov

ince

60.C

ase

fata

lity

rate

for

tub

ercu

losi

s(a

mon

g tr

eate

d ca

ses)

NTC

PQ

uart

erly

Prov

ince

61.M

orbi

dity

and

mor

talit

y ra

te f

orm

alar

iaN

MC

P;C

DSS

Qua

rter

lyD

istr

ict

62.P

erce

ntag

e of

blo

od s

mea

rs p

ositi

vew

ith p

aras

iteN

MC

PQ

uart

erly

Dis

tric

t

63.N

umbe

r of

mal

aria

out

brea

ksN

MC

P;C

DSS

Qua

rter

lyD

istr

ict

64.P

erce

ntag

e of

hou

seho

lds

usin

gio

dize

d sa

ltN

INEv

ery

5 yr

sPr

ovin

ce

65.P

reva

lenc

e of

goi

ter

amon

gsc

hool

-age

chi

ldre

nN

INEv

ery

5 yr

sPr

ovin

ce

66.N

umbe

r of

new

HIV

-AID

S ca

ses

HA

CP

Mon

thly

Prov

ince

67.C

umul

ativ

e nu

mbe

r of

HIV

-AID

Sca

ses

HA

CP

Mon

thly

Prov

ince

68.N

umbe

r of

dea

ths

due

to A

IDS

HA

CP

Mon

thly

Prov

ince

69.N

umbe

r of

foo

d po

ison

ing

outb

reak

sA

nnua

llyC

omm

une

MO

HSo

urc

eM

od

e o

fD

ata

Co

llect

ion

51

D.I

mp

act

In

dic

ato

rsA

nnua

lly

70.M

orbi

dity

and

mor

talit

y ra

te f

orse

lect

ed c

omm

unic

able

dis

ease

sC

DSS

Ann

ually

Vill

age

71.T

en le

adin

g ca

uses

of

mor

bidi

tyan

d m

orta

lity

in h

ospi

tals

HA

nnua

llyD

istr

ict

72.P

erce

ntag

e of

hos

pita

l adm

issi

ons

acco

rdin

g to

diff

eren

t gr

oups

of

dise

ases

(ba

sed

on IC

D-1

0ca

tego

ries)

HA

nnua

llyD

istr

ict

73.U

nder

-fiv

e m

orta

lity

rate

MO

HN

SOA

nnua

llyPr

ovin

ce

74.I

nfan

t m

orta

lity

rate

MO

HN

SOA

nnua

llyPr

ovin

ce

75.P

erin

atal

mor

talit

y ra

teM

OH

NSO

Ann

ually

Prov

ince

76.M

ater

nal m

orta

lity

ratio

MO

HA

nnua

llyPr

ovin

ce

77.L

ife e

xpec

tanc

y at

birt

ha.

Mal

esb.

Fem

ales

NSO

Ever

y 5

yrs

Prov

ince

78.H

uman

dev

elop

men

t in

dex

NSO

Ever

y 5

yrs

Nat

iona

l

52

Exam

ple

2: D

ata

Flo

w f

or

the H

MIS

of

Co

un

try X

��

�� !��"��

��

!��"��

��

��"��

��

��

��

��!��

��

��!��

��

��!��

��" ��

��

��

��

�

�

�

� �

�� #��$

��#�

��$

��%��#��$

��

&�� #��$

#�� #��$��#��'

��#��'�#��$�#��

��'�

� �

(��

)#��*

��

��

�

53

References

Hurtubise, R. Managing information systems: concepts and tools. West Hartford, CT,

Kumarian Press, 1984.

Lippeveld, T., et al, eds. Design and implementation of health information systems.

Geneva. World Health Organization, 2000.

World Health Organization Regional Office for the Western Pacific. Workshops on the

assessment and development of national Health Information Systems (HMIS) and

epidemiological surveillance. Manila, Philippines. World Health Organization, 1986

(Unpublished document, (WP)HIN/ICP/HST/005-E).

World Health Organization Regional Office for the Western Pacific. A selection of

important health indicators. Manila, Philippines. World Health Organization, 2000.

World Health Organization Regional Office for the Western Pacific. Guidelines for the

development of Health Management Information Systems. Manila, Philippines.

World Health Organization, 1993.

developing health management information systems who library cataloguing in publication data...

Documents