The Blueprint for evolving single National Routine

Health Information System (HIS)

A Brown Bag Presentationof

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

USG Health Portfolio

CSOs, CBO and Private Sector Health

Portfolio

GoN Health Portfolio

What is USG’s Commitment?

Data Source: 2011 Annual NHMIS Report

Analysis of national routine health data reporting Table 1 Health Facilities in Nigeria

by Type and Ownership, 2012

TypeOwnership

 TotalPublic

Private

Primary 21808 8290

30098

(88%)

Secondary

969 30233992(12%)

Tertiary 73 1083

(0.002%)

Total 228501132

33417

3

• 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. Data Source: FMoH/DPRS 2012

Long History …… Unending Discussion

22miles bridge : The Chinese sea bridge which will cut travel by 200 miles – US Mail Online

20miles: Connect US to China Port

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.

What is the central purpose of strengthening the National Health Management Information System (NHMIS) ?

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

Nigerian Health Data

Routine Health Data

NHMIS Data (including Routine

Surveillance)

Disease Program Data – e.g. ATM

Non-Routine Health Data

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

Range of Health Services

• Basic Community Health Services (100%)

• Basic Health Services (100%)

• Basic Health Services (30%)

• Specialized Healthcare Services (70%)

• Basic Health Services (10%)

• Specialized Healthcare Services (90%)

Range of Data Reported

• Community NHMIS

• Facility NHMIS

• Facility NHMIS

• Disease Programs Report

• Facility NHMIS

• Disease Programs Report

Communities-------------------

CHEWs

10 HFs-------------

PHCs

20 HFs-------------

GHs

30 HFs -------------UTHs & FMCs

Referral Chain

Recent Shift

Range of Health Services

• Integrated Basic Health Screening & Services (100%)

• Integrated Basic Health Services (100%)

• Decentralized Special Services

• Integrated Basic Health Services (30%)

• Specialized & Integrated Healthcare Services (70%)

• Integrated Basic Health Services (10%)

• Specialized & Integrated Healthcare Services (90%)

Range of Data Reported

• Integrated Health dataset

• Community NHMISplus

• Facility NHMISplus

• Facility NHMISplus

• Disease Programs Report

• Facility NHMISplus

• Disease Programs Report

Communities--------------- -

CVs / CORPs/CBOs

10 HFs-------------

PHCs

20 HFs-------------

GHs

30 HFs -------------UTHs & FMCs

Referral Chain

Routine Health Services Databases

Databases: Schematic Overview 2 (Proposed) DHIS 2.0: (Web-based Version)

NHMIS

Disease Program

s

NHMIS

INMCH

NTDs

TB / HIV/AIDS / Malaria

Nutrition FP/RH

Hierarchical Organization of the Integrated DHIS PlatformRoutine

Health Data

ATM datase

ts HIV & AIDS dataset

Malaria dataset

NHMIS dataset

NPI dataset

Epid. & Disease Surveillance dataset

TB & TB/HIV dataset

SRH/HIV Integration dataset

Secondary Facilities Facilities

LGA

State

National

PHCs Tertiary Facilities

Community

Central DHIS Instance

State DHIS Instance

LGA DHIS Data Entry Hub

Can DHIS address the bigger picture about NHMIS?

• 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.

IT Programming codes

Legend:

Current challenges: 1. Multiple DHIS platforms and its inter-operability & 2. Complicated data management process

eNNRIMS DHIS

Instance

Development partners’ DHIS2.0 platform

National DH&PRS

DHIS Instance

USG DHIS Instance

National HIV Response

routine datasets (mainly from 20

and 30 Facilities)

Project-level HIV/TB/Malaria and

NHMIS routine datasets

(mainly from 10, 20 and 30 Facilities)

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

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.

National DH&PRS DHIS Instance

Community –level data

LGAs PHCs data

20 HFs data

30 HFs data

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