1. The cutting edge in ICT RHIS thinking Norah Stoops HISP South Africa 4th International RHINO Conference Mexico March 2010

2. Use of DHIS in Africa I have worked in the following countries Myanmar Liberia Swaziland Namibia DRC South Sudan Zimbabwe South Africa

3. Common features Inappropriate use of Excel spread sheets Use of rigid databases – unable to change Collecting LOTS of data – poor reporting rates Unable to use almost all of the collected data Not collecting data that is really needed Vertical parallel programmes – no communication with anyone else HIS (sometimes) seen as not effective Very poor analysis of data Poor data quality – unable to run data quality checks

5. Introduction of DHIS Standardised clinic/facility list Standardised data elements and definitions Country staff involved in customisation Able to see links between data elements/indicators and population in Pivot tables – see coverage rates Communication between various programmes Integration of parallel reporting systems ‘Why have we taken so long to introduce the DHIS’ Revision of reporting systems and data flow

6. Used only for TB data

7. Myanmar Required a system for quarterly TB data Able now to make own changes to database in terms of facilities, population figures Able to view TB data over time instead of just for 1 year

9. Zimbabwe Was using a non linked database Very limited reporting abilities Able to import all historical data MOH responsible for customisation of DHIS with off site support

11. Liberia Excel being used for all programmes!!!!! Able to develop a National Essential Indicator Dataset Able to integrate ALL vertical programmes into 1 database Lots of training in definitions Lots of training in using the DHIS – capacity and skills transfer to local staff

13. Democratic Republic of Congo Used for 1 project Use of both English and French in one database MOH interested in roll out in whole country MOH system unable to integrate provincial data files into 1 system – no country picture available

14. The ability to switch languages for data element names

16. South Sudan New state LOTS of INGOs and M&E staff Have NO system for routine data Disease surveillance in Excel Have LOTS of registers – BUT not printed Desperate for a comprehensive solution DHIS will be rollout in 4 states

17. Results Ownership of system by all staff Encourage local staff to make alterations/adaptations Allows staff at lowest levels to analyse and use own information to improve health status and health service management.

18. The cutting edge in RHIS(or how to move RHIS into the 21 century) Norah Stoops HISP South Africa 4th International RHINO Conference Mexico March 2010

19. Characteristics of a failed RHIS ‘Ownership’ of the data belonging to the HIS Unit Interpretation of data/information done by HIS (reports prepared without input of managers) Vertical programme management recording & reporting (duplicate data collection) Inflexibility of system to adapt to changes in information needs (paper forms/software) Demanding data without considering resources available Extensive use of Excel spreadsheets Use of databases that are not relationship based (i.e. tables not linked)

20. Factors hindering a functional RHIS Applying research methodology in RHIS environment Data collection/tools (PMTCT) Longitudinal registers Donor demands (PEPFAR indicators) EVERYTHING is thrown into the Routine system No consideration of other data collection methods i.e. Record review, sentinel surveillance, surveys etc Data from different facility types not integrated – unable to determine the full district picture

21. Defining an Essential Dataset. . . determine “must know” information needs Must Know Dangerous to know Should Know Nice to Know

22. The fewer resources a country has – the more determined they are to waste them Collecting ‘Dangerous to know’ information

23. Aim of a Routine Health Information System Health management strives to translate health policy into practice Health management information systems provide the mechanisms needed to monitor the translation of health policy into practice – this cascades down from ministry through provinces/regions/county/district and facility levels The RHIS enables counties to assess whether the goals, objectives, indicators and targets, based on both strategic & operational plans are being achieved

24. High Detail in Data Low Information System Low Low Resources(time, people, h/w, s/w) Staff Capacity High High

25. There are obstacles to a functional RHIS

26. Sometimes you pick up free riders You may have to ‘dump’ some things (going nowhere)

27. Sometimes you are not sure how something got into the system Occasionally you are given a warning that this road is not the right one

28. Sometimes you are doing well and just need a bit of panel beating to be fully functional

29. How do you get to be the best Be pro-active, out in front and responsive to changing information needs Make friends with all the programme managers Develop a ESSENTIAL INDICATOR DATA SET (indicators are analysed data – consist of numerator and denominator – this defines what you collect) Definitions for all data elements and indicators MDGs/National Objectives – have you included the most basic input, process, output, outcome, impact indicators that you need to measure these Say NO – donors/managers Rethink your M&E plan Plan for regular changes Appropriate computer software application – DHIS works Training, training and more training

30. 30 Ancient wisdom says that when you discover you are riding a dead horse, the best strategy is to dismount. In organizations, however, we often try many other strategies, including the following: 1. Changing riders.2. Buying a stronger whip.3. Falling back on. "This is the way we've always ridden."4. Appointing a committee to study the horse.

31. 31 5. Arranging a visit to other sites to see how they ride dead horses. 6. Appointing a committee to revive the dead horse.7. Creating a training session to improve riding skills.8. Hiring an outside consultant to show how a dead horse can be ridden.9. Harnessing several dead horses together to increase speed.10. Increasing funding to improve the horse's performance. 11. Doing a study to determine if outsourcing will reduce the cost of riding a dead horse.

32. 32 12. Buying a computer program to enhance dead horse performance.13. Declaring a dead horse less costly to maintain than a live one.14. Forming a work group to find uses for dead horses.15. Promoting the dead horse to a supervisory position. Is your RHIS a dead horse?

33. We have a RHINO baby on the way