A New Frontier in Strategic Information:
Strategies and Challenges to Strengthening the
National Health Information System in Lesotho
June 9, 2016
SI Unit Webinar
Tsigereda Gadisa, Chief of Party, Lesotho SI Project
Suzue Saito, Principal Investigator, Lesotho SI Project
Presentation Outline
1. What is Health Information Systems (HIS)
2. Why do we care about strengthening HIS?
3. ICAP experience supporting HIS strengthening
4. Lesotho SI Project
5. Rationale & Objectives
6. The Baseline Assessment
7. Proposed Solution
8. Strategy: Advocate, Educate, and Act
9. Achievements
10. Lessons Learned
11. Next Steps
12. Acknowledgements
What is an HIS?
What is an HIS? Key Component of Health Systems
Source: Everybody business : strengthening health systems to improve health outcomes : WHO’s framework for action. World Health Organization 2007
Anatomy of an HIS
HIS
Resources Indicators
Data
Sources Data
Management
Dissemination
& Use
Health Information System Components
Source: Everybody business : strengthening health systems to improve health outcomes : WHO’s framework for action. World Health Organization 2007
HIS policy,
regulatory
framework
Indicators to
help monitor
programs
Census, health
services
records,
surveys, etc.
Processes/
systems to
collect,
aggregate, and
analyze data
Clearly defined
path to
integrate data
into decision
making
Why HIS Strengthening?
It’s Part of What We Do Best
• ICAP goals:
– Transformative solutions to strengthen health systems
– High performing health systems strengthening initiatives
• Well functioning HIS is essential to ability of health
systems to improve health
Why HIS Strengthening?
We Need Data to Assess Progress
The right
- Things
- Time
- Place
- Way
All imply availability of actionable data
Epidemic Control
to end AIDS
to achieve AIDS-free
generation
ICAP Experience with HIS Strengthening
SI/HIS-focused awards won by ICAP
• Swaziland
• Cameroon
• Kazakhstan, Kyrgyzstan, Tajikistan
• Mali
• Lesotho—Not limited to HIV, all health data
Lesotho SI Project
Strengthening SI Activities in the Kingdom of Lesotho
Rationale
• Health Metric Network Assessment, 2007
• Used a standardized tool to assess the different
components and overall functioning of the
health information system in Lesotho
Rationale: Inadequate HIS
Health Metric Network Assessment, 2007
Objectives: Lesotho SI Project
1. Strengthen HIS, Surveillance Planning, and
Coordination
2. Streamline Data Management and Use
3. Capacity Building for Country Ownership and
Sustainability
The 2014 Baseline Assessment
1. HIS is mainly paper-based and aggregation of data
is a large burden
2. Multiple and competing paper and electronic tools
used to transmit, collate and store reports
3. Existing electronic tools do not effectively
interoperate
Limited actionable
health information
available to decision
makers
Maternal Child Health,
(ANC, Delivery, and Family Planning),
Communicable diseases and NCDS
Expanded Program
of Immunization
Tuberculosis (TB)
HIV Care and Treatment
DISTRICT LEVEL District Health Management
Team (DHMT)
Monthly data entry into
district online DB, no
analysis
Quarterly collection; only a
pass through, no aggregation
Monthly collection and
submission; only a pass
through, no aggregation
Health
Planning and
Statistics
Family Health
Department
National TB Program
International
Health
Monthly Paper
Facility Reports
Aggregate statistical table
created and shared quarterly
Monthly Paper
Facility Reports
Quarterly Paper
Hospital Reports
Monthly Paper
Facility Reports
Monthly Paper
Facility Reports
Monthly collection and
submission; only a pass
through, no aggregation
HIV Testing & Counselling
Notifiable Diseases
Monthly/weekly Paper
Facility Reports
Monthly/weekly collection
and submission; only a pass
through, no aggregation
STIs, HIV and AIDS
Programme (SHAP)
FACILITY LEVEL Health Facilities &Hospitals
NATIONAL LEVEL Ministerial Departments
Monthly collection and
submission; only a pass
through, no aggregation
Quarterly Paper
Facility Reports
Entry of monthly facility data into
Epi Info DB
Entry of monthly facility
data into ACCESS DB
Entry of quarterly facility
data into Excel DB
Entry of monthly facility data into
Excel DB
Limited Progress Since 2007
The Proposed Solution: DHIS 2
DHIS 2
• Implemented in 47 countries across 4 continents and
increasingly being adopted as national and
subnational HIS
• Supported by diverse and large donors: PEPFAR,
Global Fund, NORAD, University of Oslo,
The Research Council of Norway
www.dhis2.org/deployments
DHIS 2 Advantages
• Open Source Software
– Free to download, install & modify source code in response to local
needs
– Continuous development and software improvement based on user
feedback
• Can be implemented at all levels of the health system: facility, district,
ministerial departments
• Can house different types of data: population-based data, health
facility data, administrative data
• Designed to serve as reporting tool, archiving tool, and dissemination
tool
Strategy: Advocate, Educate, Act
Full year of advocacy and
education at all levels
• How do we know your system is
going to be different?
• I like the system I am using now
• When you leave how can we
sustain it?
Advocacy target Responsible person Venues/Frequency
Minister of Health, Director General, Principal secretary
Country Director/Chief of Party
Monthly briefing meetings Impromptu meetings
Department Heads Chief of Party/HMIS specialist & HMIS managers
Stakeholder workshop, follow- up meetings, demo
Program Managers HMIS specialist & HMIS managers
Stakeholder workshop, follow- up meetings, demo
Strategy: Advocate, Educate, Act
DHIS 2 System Support:
US Ambassador providing
tablets to Berea DHMT (above)
Providing the US Ambassador a tour of
DHIS 2 features (below)
Strategy: Advocate, Educate, Act
• Stakeholder workshop to
collectively define the
need
• Joint dissemination of
baseline assessment results
with MOH
• Demonstration of DHIS 2
carefully tailored to address
needs expressed by
stakeholders
• Consistent efforts for
sustained advocacy/ education
with MOH and USG
Key Achievements: Customization
• A seven-person team, made up of ICAP (3) and
MOH(4) developers, was assembled to customize
the DHIS 2
• Modeled DHIS 2 on the current paper forms
• Imported legacy data for HIV and TB/HIV programs
• Created dashboard using a few HIV and TB/HIV
program indicators for the ART manager
• Organized a half day forum for live demonstration of
DHIS 2
• Scheduled follow up one-on-one meetings
Key Achievements: Data Warehousing
1. Obtain all program
indicators
2. Obtain all reporting forms,
program data files and
paper based records
3. Defined SOPs to
import/enter electronic
and paper based data
Systematic collection of program indicators
and legacy data
Key Achievements:
Dashboard & Validation Rules
• Over 898 dashboards developed and implemented
for program managers at central and district levels
• Data cleaning using validation rules completed for
data for all 8 programs
Key Achievements:
Validation Rules & Dashboards
Key Achievements:
Capacity Building for National Roll-Out
• Developed training manual and data use SOPs
• Trained key staff at Central (32), District (56), and Facility
(173) levels
• Conducted systematic follow-up with each ministerial
department and each DHMT with individualized
mentorship
• Distributed 55 tablets and 10 modems (4G) for use by
DHMT staff
• Distributed 157 tablets for facility use
Timeline of National Roll-Out
February 18, 2015 National HIS
launched
May 2016 Distribution of tablets to
facility staff
October 2015 Distribution of tablets and
modems to DHMTs
February 2015 Training manual and data
use SOPs developed
February 2015 – March 2016 Trained DHMT staff
March – April 2016 Trained facility staff
February 2015 – Present Conducted systematic follow-up with each ministerial department and each DHMT with individualized mentorship
January 2015 – March 2016 Trained Central staff
Key Achievements: Summary
• Customization: Launched the National HIS on
February 18, 2015
• Data Warehousing: Imported legacy data from 2008 –
2015 for 8 health programs with established reporting systems
– over 40 million data values!
Key Achievements: Summary
• Defined Validation Rules & Dashboards: Developed and implemented 77 validation rules for data quality
control, developed custom dashboards for each program, and
trained users to develop their own dashboards – over 898
dashboards created!
• National Roll-out: 7 Departments, 10 Districts, and a
total of 462 users have access to the system
Maternal Child Health,
(ANC, Delivery, and Family Planning),
Communicable diseases and NCDS
Expanded Program
of Immunization
Tuberculosis (TB)
HIV Care and Treatment
DISTRICT LEVEL District Health Management
Team (DHMT)
Monthly data entry into
district online DB, no
analysis
Quarterly collection; only a
pass through, no aggregation
Monthly collection and
submission; only a pass
through, no aggregation
Health
Planning and
Statistics
Family Health
Department
National TB Program
International
Health
Monthly Paper
Facility Reports
Aggregate statistical table
created and shared quarterly
Monthly Paper
Facility Reports
Quarterly Paper
Hospital Reports
Monthly Paper
Facility Reports
Monthly Paper
Facility Reports
Monthly collection and
submission; only a pass
through, no aggregation
HIV Testing & Counselling
Notifiable Diseases
Monthly/weekly Paper
Facility Reports
Monthly/weekly collection
and submission; only a pass
through, no aggregation
STIs, HIV and AIDS
Programme (SHAP)
FACILITY LEVEL Health Facilities &Hospitals
NATIONAL LEVEL Ministerial Departments
Monthly collection and
submission; only a pass
through, no aggregation
Quarterly Paper
Facility Reports
Entry of monthly facility data into
Epi Info DB
Entry of monthly facility
data into ACCESS DB
Entry of quarterly facility
data into Excel DB
Entry of monthly facility data into
Excel DB
Maternal Child Health,
Epidemiology and Family Planning
Communicable
diseases and NCDS
Tuberculosis (TB)
HIV Care and Treatment
DISTRICT LEVEL
District Health Management Team (DHMT)
Data Entry,
Analysis,
Feedback
and Use
in DHIS 2
Family Health Department
Health Planning and Statistics
National TB Program
International
Health
Monthly Paper
Facility Reports
Monthly Paper
Facility Reports
Quarterly Paper
Facility Reports
Monthly Paper
Facility Reports
Monthly Paper
Facility Reports
HIV Testing & Counselling
Notifiable Diseases
Monthly Paper
Facility Reports
STI, HIV and AIDS Programme
(SHAP)
FACILITY LEVEL
Health Facilities &Hospitals
NATIONAL LEVEL
Ministerial Departments
Quarterly Paper
Hospital Reports
Maternal Child Health,
Epidemiology and Family Planning
Communicable
diseases and NCDS
Tuberculosis (TB)
HIV Care and Treatment
DISTRICT LEVEL
District Health Management Team (DHMT)
Data Entry, Analysis,
Feedback and Use in
DHIS 2
Family Health Department
Health Planning and Statistics
National TB Program
International
Health
HIV Testing & Counselling
Notifiable Diseases
STI, HIV and AIDS Programme
(SHAP)
FACILITY LEVEL
Health Facilities &Hospitals
NATIONAL LEVEL
Ministerial Departments
Lessons Learned:
Essentials for Success • Securing MOH Commitment from the highest level critical to
create a system that “sticks”
− Leadership change at MOH meant that we had to redo
advocacy/education work
• A highly skilled locally-based informatics and data management
staff fundamental
− Timely and sustained solutions have to be developed and implemented
locally
• Being responsive to expressed needs and identifying gaps in
the current system collaboratively is important
• Data need to be comprehensive and high quality
− Need to systematically query and address issues indicator by indicator
Next Steps for Continued Success
• Institutionalize program analysis and data use by
provision of tailored dashboards
− DHIS 2 must continue to replace paper/existing systems
• Continued advocacy, education at all levels
• Develop additional validation rules to further
improve data quality
• Continued capacity building at national, district and
facility levels, with particular emphasis on data use
• Teboho Koma, Tlohang Moeketse, Haroon Seruli, Pheletso Tau
• Lesotho Ministry of Health
• Tsele Moloeli, Rethabile Selebalo, Monaheng Maoeng, Kamohelo
Mokhesi
• Health Planning and Statistics Department (Mahlape Ramoseme,
Masebeo Koto)
• Program Leads
• PEPFAR/CDC Lesotho
• HISP South Africa
• Miriam Rabkin
• Blanche Pitt
• Kieran Hartsough
• Piku Patnaik
Acknowledgements