HIS IMPLEMENTATION IN HIS IMPLEMENTATION IN ZANZIBAR ZANZIBAR 

Juma Lungojumal@ifi.uio.no University of Oslo

13th April 2007

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Ministry of Health

Province

District

Health posts, dispensaries,

health centres,and Hospitals

CBD, TBA, VHW

• Routine health delivery services– Basic health services at

community level, health posts, dispensaries, health centres, and hospitals

• Decision-making and health planning take place at the top (Ministry, and provincial levels)

MotivationMotivation

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- Health planner at the Ministry of Health,

“ah! the number of clients has increased this year. The health facility needs one more Nurse”

- Patients/clients at a remote health facility.

- How does health planners at the Ministry of Health plan for these health facility clients

Why HIS?

IntroductionIntroduction

• Zanzibar Health Sector has a number of sub-systems for collecting and reporting data:– Expanded Programme on Immunization (EPI),– Schistosomiasis/ Helmenthisis Control Programme, – Nutrition Unit, – Reproductive and Child Health (RCH), – TB and Leprosy, – Zanzibar AIDS Control Programme (ZACP) and – Malaria Control Programmes.

• All these vertical programmes have introduced their own specific forms for data collection.

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IntroductionIntroduction

• As a result the Primary Health care Units and hospitals ended to have different forms (from handwritten pages to printed forms), for data collection and reporting

• At the end of 2004, a HMIS review revealed that the HMIS in Zanzibar is fragmented and does not support data driven decision-making

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ObjectivesObjectives

• A roadmap towards development of HMIS was agreed as follows:

– Developing essential indicator and data sets– Streamline the data collection tools – Develop and implement a computer database

to assist the process of storage and analysis of heath data.

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MethodologyMethodology

HISP contracted to re-design the HMIS

Action Research

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Action ResearchAction Research

• Action research has been typified as a way to build

– theory,

– knowledge, and

– practical action

• by engagement with the world in the context of practice itself

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Action ResearchAction Research

• Is a research approach, which has the dual aims of action and research

– action to bring about change in some community or organisation or program;

– research to increase understanding on the part of the researcher or the client, or both

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Action ResearchAction Research

• Action research aims to contribute both to the practical concerns of people in an immediate problematic situation and to the goals of social science by joint collaboration within a mutually acceptable ethical framework

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Essence of Action ResearchEssence of Action Research

• Diagnostic Stage– Analysis of the social situation by the

researcher and the subject of the research– Theories are formulated concerning the

nature of the research domain

• Therapeutic Stage– Involves collaborative change experiment– Changes are introduced and the effects

are studied

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Phases of Action Research Phases of Action Research

• The most prevalent description of action research details a five phase, cyclical process which can be described as an ‘ideal’ exemplar of the original formulation of action research

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Phases of Action Research Phases of Action Research • This ideal approach first requires the

establishment of a ‘client-system infrastructure’ or research environment

• Then, five identifiable phases are iterative:– (1) diagnosis, – (2) action planning, – (3) action taking, – (4) evaluating, and – (5) specifying learning

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Phases of Action Research Phases of Action Research DIAGNOSING

Identifying or Defining a Problem ACTION PLANNING

Considering alternative courses of action

ACTION TAKING

Implementing a course of action

EVALUATING

Studying the outcomes of an action

SPECIFYING LEARNING

Identifying general findings

CLIENT SYSTEM INFRASTRUCTURE

Specification and agreement that constitutes the research

environment

• HMIS taskforce to foresee and implement the HMIS was created

• HISP was contracted as a technical implementation team to work together with the taskforce and other stakeholders

• Initially started to work in Four districts in Zanzibar– Micheweni, Chakechake, North A, and

North B

Implementation of HIS in Implementation of HIS in ZanzibarZanzibar

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ACTION RESEARCH ACTION RESEARCH CYCLECYCLE

• Establishment of a ‘client-system infrastructure’ or research environment

• HISP contract signed – The taskforce was a team of health officers

working under the MOHSW, – HISP Zanzibar is a team of hired software

developers, – Masters and PhD students registered at the

University of Oslo were also involved

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Phase Specific Activities

Diagnosing

• Semi-structured interviews with health staff• Observations on health data collection and analysis• Use of checklists by inspecting data registers, analysis tools, and health workers staffing level• Assessing available computers and computer programs• A kickoff workshop between HISP team and Taskforce

Action planning

• Acquiring DHIS Software from HISP network• Developing strategies for importing baseline data to DHIS• Acquiring sample health indicators

ACTION RESEARCH ACTION RESEARCH CYCLECYCLE

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Phase Specific Activities

Action taking

• Mapping of data elements to indicators• Reviewing health data collection forms• DHIS database setup and Data importation • Designing new health data collection forms• Training health workers on Computer Literacy• Training health workers on Health data analysis

Evaluation

• Group Discussions with health workers• DHIS demonstration• Testing newly designed data collection forms• Calculating indicators• Comparative with baseline data• Retrospective testing

ACTION RESEARCH ACTION RESEARCH CYCLECYCLE

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Phase Specific Activities

Specifying learning

• Presentations and Fieldwork reports• Publications: Theses and Scientific papers

ACTION RESEARCH ACTION RESEARCH CYCLECYCLE

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Comparative with baseline Comparative with baseline datadata

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Opportunities and Opportunities and ChallengesChallenges

• Developing effective, need based and indicator driven datasets – aligning the interests of various stakeholders

to agree that a particular data element should be dropped and so to adopt new forms was a big challenge

– it is easy for stakeholders to add more health data elements than dropping one

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Opportunities and Opportunities and ChallengesChallenges

• Training of district officers in managing computer database in the context of poor computer literacy – Most of the health workers are not conversant

with computers – ‘computers are strange talking machines

which scares illiterate computer users’, a health officer told us

– The challenge was to train health workers to operate computers and then to update and manage large database of health data

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Opportunities and Opportunities and ChallengesChallenges

• Gradually improve the quality of data and use of information for management – The challenge here is to change the attitude

of senior health officers to rely on health data to make sensible decisions

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Project OutcomesProject Outcomes

• Essential datasets and indicators have been developed

• Reporting routines from one level to another has been established

• Health data collection forms are successfully electronically mimicked in the DHIS and that the DHIS is installed and being used in all districts, the zonal offices, and at the HMIS unit

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Concluding RemarksConcluding Remarks

• The main achievement in this project is:– to be able to combine the interest of many

stakeholders (especially the vertical programs) and point them to single source of data, the DHIS.

– this paved the way to concentrate on the technical side of implementing and training users to use the software (DHIS) instead of struggling with political and administration barriers.

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ThanksThanks

The End

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