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HIS IMPLEMENTATION IN ZANZIBAR 

HIS IMPLEMENTATION IN ZANZIBAR . Juma Lungo jumal@ifi.uio.no University of Oslo 13 th April 2007. 1. Ministry of Health. Province. District. Health posts, dispensaries, health centres,and Hospitals. CBD, TBA, VHW. Motivation. Routine health delivery services

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HIS IMPLEMENTATION IN ZANZIBAR 

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  1. HIS IMPLEMENTATION IN ZANZIBAR  Juma Lungo jumal@ifi.uio.no University of Oslo 13th April 2007 1

  2. Ministry of Health Province District Health posts, dispensaries, health centres,and Hospitals CBD, TBA, VHW Motivation • Routine health delivery services • Basic health services at community level, health posts, dispensaries, health centres, and hospitals • Decision-making and health planning take place at the top (Ministry, and provincial levels) 2

  3. Why HIS? • Patients/clients at a remote • health facility. • How does health planners at the Ministry of Health plan for these health facility clients • Health planner at the Ministry • of Health, • “ah! the number of clients has increased this year. The health facility needs one more Nurse”

  4. Introduction • Zanzibar Health Sector has a number of sub-systems for collecting and reporting data: • Expanded Programme on Immunization (EPI), • Schistosomiasis/ Helmenthisis Control Programme, • Nutrition Unit, • Reproductive and Child Health (RCH), • TB and Leprosy, • Zanzibar AIDS Control Programme (ZACP) and • Malaria Control Programmes. • All these vertical programmes have introduced their own specific forms for data collection. 4

  5. Introduction • As a result the Primary Health care Units and hospitals ended to have different forms (from handwritten pages to printed forms), for data collection and reporting • At the end of 2004, a HMIS review revealed that the HMIS in Zanzibar is fragmented and does not support data driven decision-making 5

  6. Objectives • A roadmap towards development of HMIS was agreed as follows: • Developing essential indicator and data sets • Streamline the data collection tools • Develop and implement a computer database to assist the process of storage and analysis of heath data. 6

  7. Methodology HISP contracted to re-design the HMIS Action Research 7

  8. Action Research • Action research has been typified as a way to build • theory, • knowledge, and • practical action • by engagement with the world in the context of practice itself 8

  9. Action Research • Is a research approach, which has the dual aims of action and research • action to bring about change in some community or organisation or program; • research to increase understanding on the part of the researcher or the client, or both 9

  10. Action Research • Action research aims to contribute both to the practical concerns of people in an immediate problematic situation and to the goals of social science by joint collaboration within a mutually acceptable ethical framework 10

  11. Essence of Action Research • Diagnostic Stage • Analysis of the social situation by the researcher and the subject of the research • Theories are formulated concerning the nature of the research domain • Therapeutic Stage • Involves collaborative change experiment • Changes are introduced and the effects are studied 11

  12. Phases of Action Research • The most prevalent description of action research details a five phase, cyclical process which can be described as an ‘ideal’ exemplar of the original formulation of action research 12

  13. Phases of Action Research • This ideal approach first requires the establishment of a ‘client-system infrastructure’ or research environment • Then, five identifiable phases are iterative: • (1) diagnosis, • (2) action planning, • (3) action taking, • (4) evaluating, and • (5) specifying learning 13

  14. Phases of Action Research DIAGNOSING Identifying or Defining a Problem ACTION PLANNING Considering alternative courses of action CLIENT SYSTEM INFRASTRUCTURE Specification and agreement that constitutes the research environment SPECIFYING LEARNING Identifying general findings EVALUATING Studying the outcomes of an action ACTION TAKING Implementing a course of action

  15. Implementation of HIS in Zanzibar • HMIS taskforce to foresee and implement the HMIS was created • HISP was contracted as a technical implementation team to work together with the taskforce and other stakeholders • Initially started to work in Four districts in Zanzibar • Micheweni, Chakechake, North A, and North B 15

  16. ACTION RESEARCH CYCLE • Establishment of a ‘client-system infrastructure’ or research environment • HISP contract signed • The taskforce was a team of health officers working under the MOHSW, • HISP Zanzibar is a team of hired software developers, • Masters and PhD students registered at the University of Oslo were also involved 16

  17. ACTION RESEARCH CYCLE 17

  18. ACTION RESEARCH CYCLE 18

  19. ACTION RESEARCH CYCLE 19

  20. Comparative with baseline data 20

  21. Opportunities and Challenges • Developing effective, need based and indicator driven datasets • aligning the interests of various stakeholders to agree that a particular data element should be dropped and so to adopt new forms was a big challenge • it is easy for stakeholders to add more health data elements than dropping one 21

  22. Opportunities and Challenges • Training of district officers in managing computer database in the context of poor computer literacy • Most of the health workers are not conversant with computers • ‘computers are strange talking machines which scares illiterate computer users’, a health officer told us • The challenge was to train health workers to operate computers and then to update and manage large database of health data 22

  23. Opportunities and Challenges • Gradually improve the quality of data and use of information for management • The challenge here is to change the attitude of senior health officers to rely on health data to make sensible decisions 23

  24. Project Outcomes • Essential datasets and indicators have been developed • Reporting routines from one level to another has been established • Health data collection forms are successfully electronically mimicked in the DHIS and that the DHIS is installed and being used in all districts, the zonal offices, and at the HMIS unit 24

  25. Concluding Remarks • The main achievement in this project is: • to be able to combine the interest of many stakeholders (especially the vertical programs) and point them to single source of data, the DHIS. • this paved the way to concentrate on the technical side of implementing and training users to use the software (DHIS) instead of struggling with political and administration barriers. 25

  26. Thanks The End 26

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