DISTRICT HEALTH INFORMATION MANAGEMENT
SYSTEM DHIMS II
THE EXPERIENCE OF THE GHANA HEALTH SERVICE
Dr. Frank Nyonator, Dr. Anthony Ofosu , Mr. Dan Osei , Mr.
Dominic K Atweam
Ghana Health Service-Policy Planning Monitoring and
Evaluation Division
BACKGROUND
The Ghana Health
Service (GHS)
• GHS is the largest
autonomous
national executive
body responsible for
implementing all
national health
policies in Ghana.
• It was established in 1996 through
Parliamentary Act 525 and works
in liaison with the Ministry of
Health
• Operates a decentralized system at
five levels: National, Regional,
District, Sub- District and
Community.
• GHS is authorized by MOH to
collect, collate and report on all
routine health services including
health service data from Mission,
Private and Quasi-government
health facilities everywhere in the
country
BACKGROUND
• All service delivery points generate essential routine service data
on health service utilization, morbidity and disease patterns.
• Such data are very useful to health managers at all levels for
planning, budgeting and decision-making.
• Routine service data also feed into the Health Sectors’
monitoring and evaluation system for analysis and dissemination
of results.
• Thus helping to reflect and judge performance, and highlighting
weak areas for strengthening intervention programmes.
HIMS Challenges
• Obtaining routine service data (USEFUL DATA) from all health
facilities across Ghana has been the single most immediate challenge of
the health sector
• USEFUL DATA for health managers at all levels for planning,
budgeting and decision-making has not been timely or complete.
• Difficulty in tracking both reporting and non-reporting facilities
•
Greater challenge for monitoring and evaluation activities of the sector.
• This culminates in the slow response of GHS in addressing potential
health emergencies and epidemics and planning based on estimates.
• Example –Neonatal
Dealths
• Burden of neonatal deaths, evident in routine data
as unacceptably high, remained undetected for years
because of late submissions and incompleteness of
reports.
•
It took the Demographic and Health Survey (2008)
to make this national crisis evident.
• Subsequent analysis of routine data showed the
same trend of high neonatal mortality.
ICT Solution
• GHS Collaborated with the University of Oslo developed a software
called the District Health Information Management System
(DHIMS2)
• DHIMS2 is a comprehensive HMIS solution for the reporting and
analysis needs of district health administrations and health facilities
at every level.
It’s been designed to
• Provide a comprehensive HMIS solution based on data warehousing
principles and a modular structure which can easily be customized to
the needs of different health systems - national, regions, districts, and
facilities
• DHIMS2 is centralized, which enables easy, online updates and
deployment of the application.
ICT Solution
• DHIMS2 has data entry
alternatives that can be
customized to replicate paper
forms – to simplify the process
of data entry .
• Dashboard for monitoring and
evaluation of health programs
that can also be user customized
to allow different indicators to
be generated and analyzed for
linking specific health outcomes,
with the added functionality of,
carrying out data quality
analysis
ICT Solution
•
The DHIMS2 offers a very userfriendly interface that is easy to
navigate.
•
Training is still required to equip
data entry personnel as well as endusers to utilize DHIMS2 optimally
for the desired outcome.
•
This is based on three fundamental
premises – knowing what one is
looking for (whether data element
or indicator), where one requires
this data or information from
(location- regional, district, subdistrict or facility level) and when
(period or point) time reference.
ICT Solution-Accessibility
• DHIMS2 is accessible in all 170 (216) districts and is being
used by health facilities and district health directorates to
collect, collate, transmit and analyze routine health service
data.
• All staff in District Health Directorates and health facilities
with the required capacity for DHIMS2 management has
been registered as secure users on the DHIMS2 server.
• There are currently 5,563 registered users from government,
quasi-government, private and faith-based facilities that are
submitting their service report each month.
ICT Solution
• Data in DHIMS2 is organized in
a hierarchy and reports are
generated the same way.
National, Regional, Districts ,
Sub districts and Facility level.
• Health data is entered at the
facility level only. And can be
entered for a facility at the sub
district or district level
• Reports of administrative
activities are entered using the
administrative office facility
corresponding to the sub-district,
district or regional health
directorate.
ICT Solution-Accessibility
• Only population data is entered
at the country, region, district or
sub-district level. These levels
are used to aggregate health
data.
• Facility -level organization units
can be moved among subdistricts.. there is no need to recreate them when sub-district
boundaries change
Requirement & Security
• The only requirements for the user is to have a web
browser installed on a computer and have an
Internet connection.
• To access DHIMS2 you do not need any software to
be installed on your computer. It works independent
of the operating system on your personal computer
INNOVATION
• Data is encrypted , ssl certficate
authentication
• Requires strict user guide line
• Districts data travels
between their computer
and GHS server, it is
encrypted by a
technology called Secure
SocketsLayer (SSL) using
128-bit encryption.
Personalized Dashboard that Managers can track their
service data of interest
Quick reports for managers
A user friendly interface for users to create their own graphs
INNOVATION
• GHS ensured in-house capacity building and
development of DHIMS2 application .
• All modifications done on the DHIS2 platform to
adapt it for GHS use as DHIMS2 were
accomplished by our own staff, trained by a TA ‘s
from the University Of Oslo.
• We have accomplished a nationwide
implementation of a web-based data collation and
reporting system involve private, quasi government
and government facilities without an initial pilot
project.
INNOVATION
• GHS to date has trained 5 health workers in each of the
170(216) districts (850 health workers), 180 system
administrators across the 10 Regional Health Directorates
and all 170(216) District health directorates to support
the use of DHIMS2 in collecting and collating health
service data.
•
Senior Managers at the headquarters level, Regional and
district level have also been trained and all now use
DHIMS2 to monitor the service utilization and inputs as
well as to generate their own reports due to the real time
data on DHIMS2
LESSONS LEARNED
• When routine health service data is visible, easily available and
accessible on a common platform for all managers, there are
constructive critiques on what the typical trends of specific indicators
should look like versus what anomalies are being recorded to prompt
further inquiry.
• This leads to continuous discussions on how to improve upon
reporting rates, data completeness, accuracy and internal
consistencies of the routine health service data.
• This also helps to draw the true pattern of service utilization
against the knowledge of the interventions that are being put into
the health care service delivery system across the various districts
CONCLUSION
• Introducing DHIMS2 into the Health Sector has been so far
successful in mitigating the challenges with service data collection
and reducing the information transmission bottlenecks and
timeliness.
Prior to the creation and introduction of DHIMS2, the information
systems and sub- systems within these defined levels were mostly
spreadsheet-based.
This made the data management process prone to many errors with the
knock on effect of many local level managers distrusting their own data,
hence rarely using it in decision-making or predicting trends.
In turn data collation and aggregation at central level was made even
more difficult. This resulted in heavy reliance on international estimates.
• WE CAN NOW CONFIDENTLY SAY THAT THESE ISSUES
HAVE BEEN RESOLVED TO A LARGE EXTENT .
Integrated architecture of interoperable systems
Integrated architecture of interoperable systems and infrastructures
(paper, computers, internet, mobiles telephones
Replicated at each
administrative level:
•
National
•
Regional
•
District
Data Warehouse
Reports, GIS, Pivot,
Graphs etc
Data from/to mobile
phones
Data capture from
Paper reports
Import e data
Household
Tracking
Export e summary data
Logistics
MIS
Open LMIS
Human
Resource
Records
iHRIS
Monthly summary
Reports
Medical
Records
Open MRS
Telephone
Register pregnant women
and immunization