The Blueprint for evolving single
National Routine Health
Information System (HIS)
A Brown Bag Presentation
of
FHI360/SIDHAS Project
Monitoring & Evaluation Directorate
@MEMS II Office, Wuse Abuja.
15th May 2013
Outline:
• Rationale for this presentation
• USG Health Portfolio structure and the NHSDP (2010
-2015)
• The evolving National Routine Health data reporting
system (DHIS)
• Things to note
• Suggested Blueprint
• Take homes
Rationale
• To discuss the need, plausibility and the blueprint
for single routine health Information System (HIS) in
Nigeria
USAID Public Health Portfolio Structure
• HIV/AIDS and TB Team: is an integrated office that seek to improve access,
coverage and sustainable capacity for HIV/AIDS and TB services in Nigeria
– Assistance Objective 3: Increased Nigerian Capacity for a Sustainable
HIV/AIDS and TB Response
• Health, Population and Nutrition Team: is an integrated office that seeks to
improve basic health services, HIV/AIDS, child survival, malaria, tuberculosis,
population and maternal and child health and nutrition services.
– Assistance Objective 4: Increased Use of High-Impact Health Interventions
• The Biggest Assumption: Accurate and timely data to gauge the impact of the
national response will be available.
CDC Public Health Portfolio Structure
• Strengthening Public Health Systems: provides
technical leadership and direct assistance to
 strengthen epidemiology, surveillance, laboratory,
blood safety, operations research, and workforce
capacity—essential components for strong, sustainable
public health systems.
 Institutionalize Nigeria HIVQual (NHIVQual)
 Establishment of National EMR Dataware house
CDC Public Health Portfolio Structure
• Development of National Medical Laboratory
Strategic Plan
 National and International Accreditation of Medical Laboratories
 Establishment of a national reference lab for TB and other
diseases
• Establishment of Nigeria Center for Disease Control
• The Biggest Assumption: Accurate and timely data to gauge
the impact of the national response will be available.
6
GoN Health Portfolio
USG Health Portfolio
CSOs, CBO and Private Sector
Health Portfolio
What is USG’s Commitment?
Data Source: 2011 Annual NHMIS Report
Analysis of national routine health data reporting
• PHCs accounts for 88% of the HFs
in Nigeria.
• If all PHCs report complete dataset,
88% national report is met.
• Reporting from all PHCs is under
the control of LGAs HMIS Officers.
• LGA-led Integrated health data
management approach can solve our
problem.
Table 1 Health Facilities in Nigeria by Type
and Ownership, 2012
Ownership
Type
Total
Public
Private
Primary
21808
8290
30098
(88%)
Secondary
969
3023
3992
(12%)
Tertiary
73
10
83
(0.002
%)
Total
22850
11323
34173
Data Source: FMoH/DPRS 2012
Long History …… Unending Discussion
20miles: Connect US to China Port
22miles bridge : The Chinese sea
bridge which will cut travel by 200
miles – US Mail Online
What is the central purpose of strengthening the
National Health Management Information System
(NHMIS) ?
1. To make truly GoN-owned high quality routine health data
available (from both the private and public sectors) and
2. To plan for and build sustainable NRHIS around the GoN
structures and levels with expert TA and supportive supervision
from all in-country-IPs.
Principles & Context:
• GHI Principles:
• a new business model aimed at delivering dual objectives:
• achieving significant health improvements
• creating an effective, efficient and country-led platform for the
sustainable delivery of essential health care and public health
programs.
(HIV/AIDS, Malaria, TB, INMCH, Nutrition, FP/RH, NTDs)
• Third-Ones Principles:
• One agreed country level Monitoring and Evaluation System.
(M&E Framework for the NHSDP)
Health Services & Routine Data
Overview of Nigerian Health Data
NHMIS Data
Routine
Health Data
Nigerian Health
Data
Non-Routine
Health Data
(including Routine
Surveillance)
Disease Program
Data – e.g. ATM
Surveillance
studies, Surveys,
Operations
Research, e.t.c
What are we using Health Data/Information for in Nigeria:
• Health Program Design & redesign, management Decision
Making?
• Health Policy Formulation and Development?
• Health Planning and Budgeting?
Initial Practice
10 HFs
------------PHCs
Communities
------------------CHEWs
• Basic
Range
Community
of
Health
Health
Services
Services
(100%)
Range
of Data
Reporte
d
Referral Chain
•
Community
NHMIS
20 HFs
------------GHs
•
•
•
30 HFs
------------UTHs &
FMCs
Basic Health
Services
(100%)
Facility NHMIS
•
•
•
Basic Health
Services (30%)
Specialized
Healthcare
Services (70%)
•
Facility NHMIS
Disease
Programs
Report
•
•
•
Basic Health
Services (10%)
Specialized
Healthcare
Services (90%)
Facility NHMIS
Disease
Programs
Report
Referral Chain
Recent Shift
•
Range of
Health
Services
Range of
Data
Reported
HFs
------------GHs
10 HFs
------------PHCs
Communities
--------------- -CVs
/ CORPs/CBOs
•
•
•
Integrated
Basic Health
Screening &
Services (100%)
Integrated
Health dataset
Community
NHMISplus
•
•
30 HFs
------------UTHs &
FMCs
20
•
Integrated
Basic Health
Services (30%)
•
Integrated
Basic Health
Services (10%)
•
Specialized &
Integrated
Healthcare
Services (70%)
•
Specialized &
Integrated
Healthcare
Services (90%)
•
Facility
NHMISplus
Disease
Programs
Report
•
Facility
NHMISplus
Disease
Programs
Report
Integrated
Basic Health
Services (100%)
Decentralized
Special Services
Facility
NHMISplus
•
•
Routine Health Services
Databases
Databases: Schematic Overview 2 (Proposed)
DHIS 2.0: (Web-based Version)
NHMIS
NHMIS
INMCH
Disease
Programs
NTDs
TB / HIV/AIDS / Malaria
Nutrition
FP/RH
Hierarchical Organization of the Integrated
Routine
DHIS Platform
Health Data
ATM
datasets
HIV &
AIDS
dataset
SRH/HIV
Integration
dataset
Malaria
dataset
NHMIS
dataset
TB &
TB/HIV
dataset
NPI
dataset
Epid. &
Disease
Surveillance
dataset
Central DHIS
Instance
National
State
State DHIS
Instance
LGA
LGA DHIS Data
Entry Hub
Tertiary Facilities
PHCs
Secondary Facilities
Community
Facilities
Can DHIS address the bigger picture about NHMIS?
•
•
Legend:
IT Programming
codes
•
Align USG instance metadata with GoN DHIS instance
Derive PEPFAR-NGIs from the data elements contained in the
National MSFs
Integrate Data Management Process at all levels.
Current challenges:
1. Multiple DHIS platforms and its inter-operability &
2. Complicated data management process
eNNRIMS
DHIS
Instance
National HIV
Response routine
datasets
(mainly from 20 and
30 Facilities)
National
DH&PRS
DHIS
Instance
Development
partners’
DHIS2.0
platform
Project-level
HIV/TB/Malaria and
NHMIS routine
datasets
(mainly from 10, 20 and
30 Facilities)
USG DHIS
Instance
USG HIV and TB
Program routine
datasets (mainly
PEPFAR-NGIs from 10,
20 and 30 Facilities)
Solution: Moving towards one national Integrated health
data management system
Community
–level data
LGAs PHCs
data
20 HFs
data
National
DH&PRS DHIS
Instance
30 HFs
data
1.
GoN-led and driven data
management system
(sustainability)
2.
Promote integrated health data
management
3.
One sole source for routine
health data @ National, State
and LGA-levels
4.
Considers all-levels of health
care including community.
Suggested Blueprints
• Confidence-building on GoN System’s ability to deliver timely
routine health data if supported by Donors and IPs.
• Address Institutional weaknesses and capacity constraints
for functional HIS at Community-level, HFs, LGAs, State and
National levels
• Institutionalize LGAs Data Management team and data
entry HUB approach
– Strengthen our M&E system for better efficiencies and cost
reduction
– Advocate for IPs to unify tools, systems and processes for M&E.
Deep Reflection!
• The problem of M&E systems development in Nigeria is
caused by IPs and their Donors!
• The fragmentation in terms of M&E systems and processes is as a
result of each IPs/Donors’ requirements.
• If only M&E processes, systems and tools were unified, we
will have a more organized system that produces timely
and unified/harmonized program results.
What are our fears about having One central HIS
for routine health data in Nigeria?
FEARS
• Delayed access to routine data by
stakeholders
• Quality of what is coming through
the Central HIS
• Server Administration and
• IT infrastructural capacity
requirement (5,000+ Users in one
Window)
• Resource Coordination (Single
funding basket)
• Stakeholders’ Representative
Data Management Team in
place @ National level
Is it likely to offer any cost saving measure on the
long run?
• Yes ! The cost of:
–
–
–
–
HR need and capacity development for HIS management @ all level.
IT Infrastructure and Maintenance
Uninterrupted power supply
Maintaining streamlined Data Management Systems, Processes and
Operations such as:
• Data Collection and Data Entry
• Data Verification and Data Quality Assurance (DQA) and
Change Management Process (CMP)
Would this process have a chance for capacity
transfer to the Government staff; leading to
sustainability on the long run?
• Yes! Through the:
– Stakeholders’ Representative Data Management Team @ National level
– Establishment of Integrated Data Management Team (GoN and IPs) at LGAs
and State-level
– Initial Joint Routine Supportive supervision and DQAs
– Training of M&E practitioners for better results at the State and LGA levels.
Thanks for Listening
Lets Discuss