Digitalisation of the Health Information System in Cameroon

Current situation and prospects

BLN Discussion meeting, Lusaka, Taj Pamodzi Hotel – Lusaka19-22/09/2017

MINSANTEPEV

Plan

• Context

• Status of use of ICTs

• Key findings

• prospect

• Constraints to be taken into account

• Conclusion

Le Cameroun (1)

• Area

• 475 650 Km2

• Total population 2017

• 24,253,757 inhabitants

• Natural growth rate

• 2.5%

• 10 administrative regions

• Official languages

• French

• English

Le Cameroun (2)

• Climate: equatorial and tropical

• 4 ecological zones

• Coastal zone: Littoral, South and South-West

• Sahelian zone: Adamaoua, North and Far North

• Forest area: Central, South and East

• Highlands: West and North

• Nearly 240 ethnic groups, 58 departments, 360 arrondissements;

• Main religions: Christianity, Islam and Animism.

Contexte (1)

• Several vertical programs have led to

• The emergence of partitioned health information subsystems;

• A multiplicity of data collection tools in the field;

• Increased workload for already insufficient staff;

• Disparities in the processing of data from different programs;

• Inadequate quality of health information;

• Data up-scaling with low feedback.

Contexte (2)

• Increasing interest of public health authorities and partners for ICTs;

• Strategic plan for strengthening the health information system with

emphasis on ICT;

• ICTs could contribute to improved completeness, consistency,

analysis and use of data for informed decision-making.

Status of use of ICTs (1)

• Commitment of the MINSANTE in a process of unifying the data collection

system through the DHIS 2 housed at the CIS

• Different projects, Programs and Directions of MINSANTE with the support of the

partners, collaborate in the development of a single integrated platform of data

management in order to ensure the availability of quality data enabling informed

decision-making. Three modules are operational;

• The platform ensures aggregation of the data and generates the reports, tables and

graphs specific to each of the programs and projects according to the parameterization

carried out;

Situation de l’utilisation des TICs (2)

Nowadays

• The 10 regions and 189 health districts of the country were equipped with

computers, equipped with connection modems and their staff trained in the

use of this platform;

• The health map has been updated and now includes geolocation;

• Health facilities provide information on the Monthly Activity Report (paper),

which is the integrated reporting tool; the data of the functional modules are

entered on the platform at the health district level.

Situation de l’utilisation des TICs (3)

42%

8% 8%3%

25%17%

25%19% 17% 15%

22%

19%27%

3%

21%

11%

42%

17%

10%

30%

21%

1st grade hospitals 2nd grade hospitals

Figure 1: Système de gestion des données sur la plateforme DHIS 2

CENTRAL LEVEL:

Directions, 1st grade hospitals

REGIONAL LEVEL:

10 regional delegations

DISTRICT LEVEL: 189 health

districts

COMMUNITY 1784 health areas

IMPLEMENTATION STRUCTURES

1566 health facilities

Data transmiss

ion

Datavalidation

Community: Community health workers

Health District Service: Chief of Bureau Health

Regional delegation: Health Information Service Head–Programme data managers

Health Information Unit –National Public Health Observatory

Feedback

Health facilities:Data manager

Figure 2: Rapportage des données sur la pateforme DHIS 2 par Région

Le PEV est un pionnier de la culture de production et utilisation des données.

NIVEAUOUTILS DE GESTION DES

DONNEESTYPE DE SUPPORT/TECHNOLOGIE OBSERVATIONS

Formation sanitaire

Registre de vaccination Support manuel (livret)Revisés lors d'introductions de vaccins; renseignés manuellements par chaque formation sanitaire qui vacccine/stocke les vaccins

Registre de pointage Support manuel (livret)

Registre de gestion de stocks Support manuel (registre)

Rapport mensuel d'activités Support manuel (formulaire de rapport)

Aire de santé Rapport mensuel d'activités Support manuel (formulaire de rapport) Annulé depuis 2016

District de santé

DVDMT Support électronique (outil Excel)Depuis 2008; Saisie des données des rapports mensuels d'activités des formations sanitaires

Registre de gestion de stocks Support manuel (registres) Renseigné manuellement à chaque mouvement de stock

Rapport mensuel d'activités Support manuel (formulaire de rapport) Généré par le DVDMT depuis 2016

Niveau régional

DVDMT Support électronique (outil Excel) Depuis 2008; Saisie des données abolie depuis 2016

Stock Management Tool (SMT) Support électronique (outil Excel) Saisie des informations à chaque mouvement de stock

Registre de gestion de stocks Support manuel (registre) Renseigné manuellement à chaque mouvement de stock

Rapport mensuel d'activités Support manuel (formulaire de rapport) Généré par le DVDMT depuis 2016

Niveau Central

DVDMT Support électronique (outil Excel) Depuis 2008; Saisie des données abolie depuis 2016

Stock Management Tool (SMT) Support électronique (outil Excel) Saisie des informations à chaque mouvement de stock

Routine Immunization Utility Support électronique (outil Access) Depuis 2009; Saisie des données abolie depuis 2016

Outils de gestion des données du PEV

Circuit des données de vaccination

Les données collectées dans les formations sanitaires sont transmises au niveau central à travers le

district et la région où elles sont consolidées au fur et à mesure.

Use of ICTs by the EPI (1)

• In parallel with its participation in the development and deployment of the

national platform on DHIS 2, the EPI

• Extension of the use of the 2016 version of the DVDMT to 100% of the

Regional Units and 85% of the health districts;

• Data capture reserved exclusively at district level (end of multiple seizures);

• Development of a semi-automated system for transferring data from the

region's DVDMTs to the MDB database (RIM);

Utilisation des TICs par le PEV (2)

• The Expanded Program of Immunization with the support of WHO uses

ODK forms for surveys and the rapid collection of certain specific

information including stocks

• Evaluation of the deployment sites of the equipment to be acquired within the

framework of the CCEOP;

• Supervision as part of the implementation of Polio emergency activities in the

Lake Chad basin;

• Tracking vaccinators for SIAs in selected pilot districts.

• The problems identified with respect to data quality are

• Inadequate completeness of data: completeness of health facilities (FOSA) to

98.5% with 672 reports not received over the 12 months of the year;

• Inadequate data readiness: 72% readiness of districts and lack of information on

FOSA at the central level;

• The inadequacy of the denominator in some DSs and Regions: Discrepancy

between vaccine coverage and outbreaks;

• Inadequate documentation (vaccine procedures, use of vaccines and inputs,

routine communication services);

• Vaccine losses (closed flasks);

• Vaccination coverage still suboptimal with many lost to follow-up

Key findings (1)

Key findings (2)

• Causes majeures

• Fréquentes ruptures de stocks des utilitaires du PEV à tous les niveaux depuis

plusieurs années;

• Faible visibilité des stocks de vaccins et intrants disponibles au niveau

opérationnel

• Difficile traçabilité des perdus de vue rattrapés dans les villes, où la densité de

la cible est forte et la mobilité accrue;

• Insuffisance de formation et de supervision formative des acteurs sur la

gestion des données et l'utilisation des utilitaires;

• Faible suivi et l’insuffisance de la maintenance du matériel informatique;

• Absence de SOPs pour la gestion des données;

Key findings (3)

Major Causes

• Lack of physical and digital archiving of documents;

• Lack of triangulation of vaccination and use of vaccines and inputs;

• Poor record keeping and documentation of data harmonization and validation

meetings by managers;

• High workload for staff at different levels of the system;

• Inadequate retro-information to districts and health facilities..

Key findings (4)

• Principaux défis auxquels le programme se trouve confronté

1. Comment assurer la documentation fiable des actes vaccinaux et de

l’utilisation des vaccins et intrants au niveau de prestation des services?

2. Comment distinguer plus aisément les vrais perdus de vue, notamment

dans les centres urbains?

3. Comment assurer la transmission exhaustive, prompte et régulière des

données des FOSA vers les différents niveaux de coordination ?

4. Comment assurer le suivi et la supervision formative réguliers et efficaces

des acteurs des niveaux intermédiaire et opérationnel ?

5. Comment mobiliser les ressources nécessaires à l’exécution du Plan

Stratégique d’Amélioration de la Qualité des Données 2017-2019.

Prospects (1)

• Migration of the current EPI data management system to DHIS 2

Activités2017 2018 2019 Besoin

d’ATT3 T4 T1 T2 T3 T4 T1 T2 T3 T4

Development of the EPI Dashboard in the DHIS2 accessible

by level with data transfer in DVDMT / RIM format (2017)Oui

Study on the consistency of data collected in the pilot

districts through the parallel use of DVDMT and DHIS2 (2018)

Oui

Production of utilities (2018) Non

Training of stakeholders on utilities and the DHIS2 tool

(2018)Non

Deployment to all health districts (2019) Non

Supervision, monitoring and evaluation of migration to

DHIS2 (2019)Non

Tableau 1:Migration plan of the current DVDMT / RIM system to DHIS 2

Prospects (2)

• Of the 5 challenges identified above, the gradual introduction of

electronic registries into FOSAs, in collaboration with the CIS could

help:

• Ensure more reliable documentation of vaccine procedures and the

use of vaccines and inputs at the level of service delivery;

• Identify more easily the real lost ones of sight to catch up, especially

in the urban centers;

• Ensure the exhaustive, timely and regular transmission of FOSA data

to the different levels of coordination

• Monitoring / monitoring and resource mobilization will remain

Constraints to Consider

• Irregular electricity supply and connection to the Internet in rural areas;

• Cost of acquisition and maintenance of electronic tools (tablets, smart phones and computers),

cost of internet connection or SMS;

• Probable resistance to changes related to the digitization of the system from the FOSA level

(luxury ???);

• Economic environment not very favorable

• National economic context marked by a slowdown in the economy ==> weak capacity to

mobilize state funding, part of which is devoted to northern struggle;

• Transition phase in the fight against poliomyelitis, also marked by a gradual decrease and the

envisaged end of funding related to the fight against poliomyelitis.

Conclusion

• ICTs have a strong potential for improving the health information system that

Cameroon would like to exploit with the DHIS 2 data management platform for the

spine;

• The EPI contributes to the development and deployment of the platform and has

planned the migration of the DVDMT / RIM system to the DHIS 2;

• The introduction of electronic vaccination registries would help solve some critical

quality problems and improve performance;

• The BLN represents a real opportunity in the digitization process;

• There are nevertheless constraints to be taken into consideration.

A tenkîMeyega be,

Na som Binyo Dita, N’gue Pîn,

Me Lapte Zîn, Ossoko, Akiba,

Massoma

Merci Thanks