Implementing District Health Information System Implementing District Health Information System (DHIS) in Botswana(DHIS) in Botswana

Omprakash ChandnaOmprakash ChandnaDept of Information TechnologyDept of Information Technology

ochandna@gov.bw

• Large number of facilities across the country: 3 referral hospitals, 7 district hospitals, 17 primary hospitals, 259 health clinics and 340 health posts

• Limited health human resources: ≈ 30 physicians and 262 nurses per 100,000 population (vs. 56 / 471 for South Africa and 229 / 897 for Canada)

• Health system is a blend of public and private sector in both service delivery and funding organizations: Botswana spends 4% of GDP on health

• HIV / AIDS a key issue

Health System in Botswana

• 300 000 people are HIV+, which is 17.1 % of the total population, 37.4% of the 15-49 age group infected.

• Life expectancy dropped from 62 to 56 years.110 000 need immediate enrollment to Anti Retro Viral Therapy (ARVT), 70 000 on ARVT

AIDS Epidemic – Update on BotswanaAIDS Epidemic – Update on Botswana

Current Challenges – Health Information Systems in Healthcare

1. Manual transcription of data in districts (24); electronic means utilised less frequently

2. Demand for data from different stakeholders (MOH, MLG, NACA, TB, ARV etc.) in ~ 30 different forms. 1564 data elements being captured

3. Quality of data captured --- doubtful

4. Fragmented data sets (18) generated by 9 healthcare programmes like PMTCT, ARV, TB, Nutrition, Home-Based-Care, Family Planning etc.

5. Essential Minimum Indicator Set at national level and in healthcare programmes last revised in year 2001.

Current Challenges: ICT in Healthcare Programmes – contd.

6. Vertical Systems, various software programmes being used for data analysis requiring training of end-users at districts and national levels (EPI-Info, Excel, IMPS etc.)

7. Patient level Data collected for some programmes (IPMS, TB) while aggregated data (PMTCT, MCH, Nutrition) in others at the districts

8. Delayed management reports (months, years); Delayed decision-making

9. Lack of skilled manpower at districts

10. Lack of unified approach at district and national levels

Nyangabgwe Hospital (F’Town)

Maun Hospital

Clinic 3

Sekgoma Hospital (Serowe)

Princess Marina Hospital (Gaborone)

Clinic 2 Clinic 1

Clinic 4

Clinic 1

Clinic 2

Clinic 3 Clinic 4 Clinic 4 Clinic 3

Clinic 2

Clinic 1

Clinic 4

Clinic 3

Clinic 2 Clinic 1

Dept of Info Technology/GDN

IPMS Project Brief

Health Facilities

Health Statistics

District - DHT

Facility 1 Facility 2 Facility n

IDSR – NotifiableDiseases

PMTCT

EPI

STD

Home Based Care

Nutrition

MCH

Family Planning

HIV/AIDS

TBSchool Health

Mental HealthAnd more …

Facility 3

IPMS

ARV

Current Scenario – contd.Current Scenario – contd.

FP6 Programme

DHIS operational in several countries South Africa, Ethiopia, Malawi, Mozambique, India

South Africa

Botswana

Mozambique

Tanzania

Malawi

Sweden

Ethiopia

Norway

Asian partnersEuropean

Union - Beanish

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• Project funded by EU – BEANISH (Project funded by EU – BEANISH (BBuilding uilding EEurope urope AAfrica frica collaborative collaborative NNetwork for applying etwork for applying ISIST in the T in the HHealth care sectorealth care sector

• The project is an outcome of WITFOR 2005 case study. The project is an outcome of WITFOR 2005 case study. Agreement reached to implement DHIS by MCST, MOHAgreement reached to implement DHIS by MCST, MOH

• Collaborative project involving MOH, MLG, UB and NACACollaborative project involving MOH, MLG, UB and NACA

Health Statistics

Facility 1 Facility 2 Facility n

IDSR – Notifiable

Diseases

PMTCT

EPI

STD

Home Based Care

Nutrition

MASA

MCH

Family Planning

IPT

TBSchool Health

Mental HealthOthers

Facility 3

National HIS

District 1 DHIS

District n DHIS

IPMS

District 2 DHIS

Proposed Solution – BEANISH InitiativeProposed Solution – BEANISH Initiative

Action

Clinics, Health Posts, Mobile Stops

DHT1

(PS, CHN, Matron,

Coordinators)Data

MINISTRYOF HEALTH

MIN. of LOCAL GOVERNMENT

DONORS and PARTNERS

DHT2 DHT3

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Patients

?

?

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?

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Community

?

Data

Others

Flow of information and Flow of information and reporting structures reporting structures

• Felt need for reliable and timely health information and management reports (National, districts, facility-wise) on aggregated. General appreciation of the DHIS application

• Current data quality questionable - data collection, capturing need monitoring

• IT infrastructure inadequate at districts for a roll-out. Reliable Internet/e-mail connectivity not available at DHTs

• Need for regular training programmes and refresher courses.

• Technical support on the application needs strengthening

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DHIS Pilot Project –Lessons LearntDHIS Pilot Project –Lessons Learnt

• Project Steering Committee not in place (MOH, MLG,UB)

• Frequent movement and transfers of health personnel in districts and at national levels. Loss of continuity in operations

• Project delays. Burn rate of EU funds low

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DHIS Project –ChallengesDHIS Project –Challenges

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• Project Initiation Report (PID) disseminated• S/W Application customised for pilot run• DHIS piloted in 4 health districts; Gaborone,

South-East, Kgatleng, Okavango• At the pilot districts, end-Users (CHN, PHS,

Matrons, IT Officers in the districts) trained in DHIS

• Workshop organised for programme managers and stakeholders at national level

• Pilot Project Review report finalised and circulated to all stakeholders

DHIS Project – StatusDHIS Project – Status

• Setting-up of a training facility at MOH• Procurement of additional hardware in

tendering stage• 44 Health Info. Officers recruited. Training

being conducted at UB from 15 Oct, 2007.• Roll-out in 8 districts by March 2008. End of

EU funding.• Roll-out in 16 districts by Dec 2008. PEPFAR

funding.• Project reporting to the sponsors – EU-

BEANISH done quarterly

DHIS Project – StatusDHIS Project – Status

Questions

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Thank You