HIS in Ethiopia

Concepts, objectives, and strategies

Outline
What is HIS?
HIS in Ethiopia
–HIS progress
–Information revolution agenda
–HIS strategic plan
–IR implementation guideline
–CBMP
Background: What is HIS?
 One of the six WHO building blocks of health system, that serves the
purpose of generation of information to enable decision-makers at all levels
of the health system to identify problems and needs, make evidence-based
decisions on health policy and allocate resources optimally (WHO).
 A health information system (HIS) is broadly defined as 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 services (UNDP).
 Routine Health Information Systems (RHIS) is a subset of Health
Information Systems (HIS) that involves the regular collection of data and
reporting from health facilities (WHO).
 HIS has six components
Background: Component of HIS
Making readily
accessible to
decision makers,
ensure information
use
Data translated to
information
Covers all aspects of data
handling, collection, storage,
quality-assurance, flow,
processing, compilation &
analysis,
Legislative, regulatory, & planning
framework, personnel, financing,
logistics support, ICT, coordinating
mechanisms
Measures, usually core set
of indicators (determinants,
inputs, outputs, outcomes &
health status)
1. Population-based sources
(censuses, CRVS, surveys)
2. Institution based data (individual,
service & resource records)
3. Others: occasional surveys,
research, & information, CBOs,
Background: HIS in Ethiopia

Before 2008 2007/8-2015 2016-

present
• Fragmented • Reform with motto “one • HSTP-I
systems with plan, budget, & report” transformation
multiple parallel agendas with IR
• Three overarching • 3-pillars (DUG)
vertical systems principles
(data burden & • CW program
• Standardization: common • Few model woredas
quality) definitions of indicators, forms,
• Neglected (focus • No connected woreda
procedures, reporting
• HSTP-II: HIS str.
of leadership, IT, channels & calendar, structure
Plan
HR) • Integration: a single channel
• 2 strategic directions
• Focused on sending as source for all with unified
report to higher level effort
(limited data use) • Simplification: only relevant
• Lack of standards data and digitizing the system
(no comparison & • Facility HMIS & CHIS,
linkage of sources) digital systems
What is Information Revolution? IR roadmap?

Information Revolution
• TA during HSTP I&II
• IR refers to phenomenal advancement on the
methods & practice of collecting, analyzing,
presenting & disseminating information that
can influence/inform decisions in the process
of transforming economic & social sectors.
• Its implementation guided by IRR (2016-20)
and HIS strategic plan (2021-2025)
• Has three pillars
• Cultural transformation in information use
• Digitization and scale-up of priority systems
• HIS Governance
What connected woreda?
Connected woreda program
• A program developed based on the IRR
• Meant to translate IR at woreda level and health facilities level
• Intends to allow health data to be collected, shared & used in timely
manner among service delivery points throughout the woreda with
linkage to the regional and national health systems [connected]
• Aims to improve district health system performances through
evidence-based decision making process
• Foster their functional linkages in providing equitable provision of
quality health services
• Has pathway/stages for woredas and facilities (four stages)
Background: HIS Strategic Plan (2021-2025)
Strategic Objectives
– Improve service coverage, quality, equity
and health outcomes by enhancing
evidence-based decision-making
– Enhance the use of digital health
information technologies for HIS
– Improve HIS governance and Leadership
at all levels of the health system
Strategic Directions: Eight SDs
Background: HIS Strategic Plan (2021-2025)
Strategic directions
– Improve culture of information use
– Improve routine data management and quality
– Nurture digitalization for data management and use
– Improve HIS Infrastructure
– Strengthen vital statistics, Surveillance, Survey and Research
– Improve HIS financing
– Improve HIS capacity of Health Workforce
– Strengthen HIS governance
Background: HIS Strategic Plan (2021-2025)
Strategies
– Model health institution Strategy
– Capacity Building and Mentorship Program (CBMP)
– Instituting Innovation scheme and Centre of Excellence (IICE)
– Strengthen harmonization and collaboration
– Integration of efforts
– Advocacy, communication and culture for HIS
Information Revolution Implementation Guideline
• HIS Infrastructure and capacity
Objectives of the guideline • Data quality
• Data use
 Guide the implementation of IR
at all levels of the health system

 Define the standard package of

interventions to implement IR

 Create common understanding

regarding measurement and DigitalIR
Revised: model
Demonstration
implementationsite level
guideline
verification
EmergingCandidate
level Modle
(low and
levelhigh) level
Information Revolution Implementation Guideline

What is new in the IR implementation guideline

 Change in naming of the guideline “Connected Woreda”

 Change in end state criteria “digital model”

 Change in pathway (six stages)

 Composite score for levels (PHCU, woredas, ….)

 Pathway for ZHD, RHBs,

Summary of levels

Level Definition Criteria

Emerging A health unit that performed low in HIS <65% of the
performance (<65%) assessment criteria
Low candidate 65-80% of the
Medium performing health unit assessment criteria
High Candidate 81-90% of the
assessment criteria
Model High performing health unit with a score >90% of the
of more than 90% assessment criteria
End state or fully High HIS performing health unit and >90% and criteria for
digitized model stage implementing electronic patient level end state
and aggregate level data management
systems
Digitization – Digital Health blue print: concept
eHealth architecture
Capacity building and mentorship program
• A collaborative arrangement aimed to bridge the health sector and
academia
• It was devised as one strategy to realize IR
• Engaged local universities through competitive process
• Co-created implementation plan & tailored woreda & facility specific
support
CBMP … …
Six clusters
PROJECT IMPLEMENTATION APPROACH
• MOH and DDCF called for application
• 6 universities selected through a
competitive process
Competitive selection process
• MOH, Universities and DUP
• Collaborations with RHBs & consortia
academic institutions
Co-creation process:
• Universities with consortia institutions, RHB
• MOH organized regular coordination
meetings
Joint implementation and monitoring
CBMP … …

Objectives of the program

• Improving the health data quality and information use

• Improving capacities to prepare, analyze, and use quality data for
decision
• Building capacities to analyze, use, and prepare quality reports
• Implement DHIS-2 at facilities and district health offices and
Major achievements
• Created model woredas, health facilities in IR
• CRVS started
• Data centers
• Digitization: eCHIS, EMR, eLMIS, others
• Data centers
• HIS workforce: curriculums developed, programs in many universities
• CBMP implemented: Universities established centers of excellences
Major challenges
• Attitude or values towards data is still questionable??
• Demotivation of HITs due to dissatisfaction with salary scale, career ladder
• Human resource capacity: skills
• Limited culture of information use and data quality assurance practices
• Leadership focus to HIS
• Resource constraint for HIS
• Limited infrastructure: connectivity, gadgets, electricity, card rooms-wares
• Suboptimal implementation of HIS in the private sector
Way forward
???
Data science: big data analytics, data mining, machine learning
Visualizations
Tracking health system performance
Monitoring health system building blocks
UHC index
??
Woreda transformation score??
Thank You!