INF5750INF5750 September 23 - 2008p

HISPH lth I f ti S t PHealth Information Systems Programme

Ola Hodne Titlestadolati@ifi.uio.no

Overview of this lecture

Introduction to HISP

Health information systems (basics)

The DHIS softwareThe DHIS software

- And please interrupt me, participation is encouraged!encouraged!

What is HISP?Health Information Systems Programme

Global network of individuals and organisationsAcademic institutionsAcademic institutionsNon-governmental organisationsGovernmental organisationsF lFree-lancers

A South South North collaborationA South-South-North collaboration

Research and education on open source softwareResearch and education on open source software development and use in the field of public health care

Why HISP?yThe overall objective of HISP is to improve health information

systems (HIS) in developing countries

In many developing countries killer diseases (like HIV/AIDS) and poor health services hamper human, social and economic developmentsdevelopments

Appropriate information and HIS are seen as crucial to strengthen the health systems in developing countriesstrengthen the health systems in developing countries

3 of 8 Millennium Development Goals (MDGs) are related to healthhealth

Despite huge economical efforts (incl. Norwegian funding) most HIS initiatives tend to fail to sustain over timeHIS initiatives tend to fail to sustain over time

HISP objectivesjTo support local management of health

care delivery and information flows

Design, implement and sustain HIS f ll i ti i t hfollowing a participatory approach

Facilitate the spread of best practices and software within and acrossand software within and across developing countries

How did it all begin?gStarted as a small pilot project in one district in Western Cape,

South Africa in 1994

Collaboration between University of Oslo and University of Western Cape, funded by NORAD

Just after the fall of Apartheid, political context of change and local empowerment

Objective to support a district-level health information system

The DHIS software was developed in the field in South Africa following Scandinavian IS research methodologies

Why did it take off?yBased on the relative success in one district

the Eastern Cape province wanted the projectthe Eastern Cape province wanted the project and soon other provinces followed

The DHIS became the national standard for HIS in SA in 1999HIS in SA in 1999

Fl ibl ft i li ti h dFlexible software, a simplistic approach and an academic network facilitated the “transfer” of HISP to Mozambique in 2001 and later to manyHISP to Mozambique in 2001 and later to many more countries in Africa and Asia

HISP anno 2008 is truly globalHISP anno 2008 is truly global

HISP componentspResearch and Education

Important contribution to the research field of information systems in developing countriesdeveloping countries

PhD school (more than 20 international PhD students)International masters programmes (local masters and in Oslo)

e.g. a similar open source course run in Dar es Salaam, TZ

Software developmentGlobal open source sw developmentDHIS 1.4 and DHIS 2 used in several countries

Project implementationSupporting/responsible for HIS implementation in many countries

(South Africa, Nigeria, Botswana, Zanzibar, Zambia, 3-4 states in India, Malawi, Mozambique, Vietnam, Ethiopia, Tajikistan, Sierra Leone)

Funded by Norwegian government (NORAD, NFR), EU, WHO/HMN, various local governments

The domain:The domain:Health Information systems (HIS)Our main focus: Primary Health Care (PHC) and Routine HIS

Primary health care:first level health care, in the community (helsestasjon og

fastlegetjenesten in Norway)focus on mothers and children and killer diseases (HIV/AIDS,

Tuberculosis Malaria)Tuberculosis, Malaria)Routine HIS:

Aggregated statistical data (numbers not patient names)Typically monthly or quarterly data reporting from clinics to districtsTypically monthly or quarterly data reporting from clinics to districts

to province to ministryTo support local health administration

Information on important health management issues like: p ghow many of the children in a give areas is receiving vaccines, how many of the pregnant women are coming to check-ups, what are the major diseases in the population, h f tl th li i i it d b th l tihow frequently are the clinics visited by the populationhow many patients per doctor and nurse per day

Main components of a HIS(also the DHIS metadata model)(also the DHIS metadata model)

The organisational hierarchyg yservice-delivery and administrative organisational units organised

in a hierarchy of typically 4-6 levels and following administrative areas (country, province, district/municipality, sub-district)

Ministry of Public Health

(MINSAP)Nationalhealth units( )

Provincial health office

Provincial health office…….………..

units

Provincial health units

Municipal health office

Municipal health office

Municipal health office…….…….

Health Health

Municipalhealth units

PHC servicesarea area

Working group

Working group

Working group

…..…PHC services

Family doctor office

Family doctor office

Family doctor office

Family doctor office ……

……..…

DHIS metadata model cont.Collection forms, data elements, indicators and reports

Data is collected in data entry forms that are typically grid-based

Each value captured in the form is linked to a data element which describes the phenomena captured e g “Number of BCG vaccines given” andthe phenomena captured, e.g. Number of BCG vaccines given , and referencing the organisation unit (e.g. a clinic) and the period (Sep 2008) the specific form is valid for.

After registration data values are exported to administrative units at theAfter registration data values are exported to administrative units at the higher level using XML files (when offline), or data is registered directly on a national server

For better comparative analysis indicators can be defined as formulasFor better comparative analysis indicators can be defined as formulas combining data elements, e.g. BCG Coverage < 1 year = 100 % x BCG vaccines given < 1 year / Population < 1 year

Data elements and indicators can be grouped across many dimensions and the values are visualised in various output formats (tables, charts, maps).

Record of patients seen Summary of key information Data analysis and use

Data entry into database

HISP software – The DHISDHIS 1.4

MS Access/VB 6Developed in South Africa since 1996Large user base in Sub-Saharan Africa (80 %)

DHIS 2Java open source web frameworksIntegrates other web-based report and analysis tools for

i li ti f d t (WHO/O H lth BIRT)visualisation of data (WHO/OpenHealth, BIRT)Developed in a global community with developers from India,

Ethiopia, Tajikistan, Mali, Nigeria, Vietnam and Norway since 2004Large user base in 5-6 states in India 2 provinces in Vietnam andLarge user base in 5 6 states in India, 2 provinces in Vietnam, and

7 of 13 districts in Sierra Leone

It’s all open source

DHIS 2Background

development started in 2004need for a web-enabled DHISneed for a modular architecture to

distribute sw development in the HISP network

need for OS and database independence

Technologies and toolsTechnologies and toolsSpring, Hibernate, WebWork, Maven,

SubversionSubversion

DHIS 2 developmentpFirst release (2.0-M1) in February 2006

The current release is 2.0 RC2, and a 2.0 release planned for Oct 1 d h1, see roadmap here: http://www.hisp.info/confluence/display/DHIS2/Roadmap

Global team of core developersL H l NLars Helge – NorwayAbyot – EthiopiaBharath – IndiaTri VietnamTri - Vietnam

Important contributions from other master students in Oslo and students from INF5750students from INF5750

Local technical teams in India, Vietnam and Sierra Leone/Mali develop local report modules and other specialised functionalitydevelop local report modules and other specialised functionality

Vietnam and India are recruiting and training new core developers – but long term processdevelopers but long term process

DHIS 2 communication platformpThe confluence wiki for collaborative

d t tidocumentationThe Trac issue tracker for bug tracking and

project managementSubversion for source control managementgMailing list for developers, users, and a

subversion commit-list (scm)subversion commit list (scm)

A t i l i f t t f lA typical infrastructure for larger open source projects

DHIS 2 pros and conspPros:

Web enabled can be used offline and online- Web-enabled, can be used offline and online- OS and DBMS independency with java and Hibernate- Flexible configuration ( modular web portal )- Flexible configuration ( modular web portal )- Architecture and dev. process supports distributed developmentp

Cons:- slow processing of large amounts of data- complex core module (transaction management, user

it t l l ti t )security, portal solution etc.)- difficult to grasp the frameworks

Some referencesHISP:HISP International Wiki – www.hisp.infoHISP SA – www hisp orgHISP SA www.hisp.orgHISP India – www.hispindia.orgHISP research papers - http://www.hisp.info/confluence/display/HISP/ResearchPapers

HIS:HIS:RHINO (Routine HIS network) - http://www.rhinonet.org/MDGs for health - http://www.who.int/mdg/en/

Global health:Global health:Foreign Affairs roundtable debate - http://www.foreignaffairs.org/special/global_health/Norwegian Prime Minister’s campaign on MDGs:http://www.regjeringen.no/en/dep/smk/Selected-topics/The-Millenium-Development-Goals.html?id=87050

DHIS:DHIS 1 downloads - http://www.hispkerala.org/latest_downloads/DHIS 2 wiki - http://www hisp info:8080/display/DHIS2/HomeDHIS 2 wiki - http://www.hisp.info:8080/display/DHIS2/HomeDHIS 2 issue tracker – www.hisp.info/dhis2DHIS 2 online demo - http://www.hisp.info:8090BIRT reports - http://www.eclipse.org/birt/phoenix/

Q&A

Questions?

Thank you.