Ethiopian Federal Ministry of Health

Information Revolution
Roadmap

April 2016

Information Revolution Roadmap

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Table of Contents

Table of Contents......................................................................................................................................................... 2
Acronyms..................................................................................................................................................................... 4
Introduction................................................................................................................................................................. 6
Realizing the Information Revolution........................................................................................................................ 8
Why the Information Revolution?....................................................................................................................... 8
Objective............................................................................................................................................................... 8
Specific Objectives............................................................................................................................................... 8
Situational Analysis – The Current State.................................................................................................................. 9
Quality and Utility of the Routine Data................................................................................................................. 9
Performance Monitoring................................................................................................................................... 10
Electronic Government (eGov).......................................................................................................................... 10
Utilize and Broaden Existing ICT Infrastructure............................................................................................. 10
National Health Information Enterprise Architecture........................................................................................... 13
Envisioning the Connected Woreda: Improving Patient Care................................................................................ 14
Pillars of the Information Revolution...................................................................................................................... 17
Pillar 1: Cultural transformation for health data use............................................................................................. 19
Focus Area 1.A: Data for service delivery, coverage, and equity....................................................................... 19
Intervention 1.A.1: Strengthen availability, readiness, quality, use, and transparency of service data.....20
Intervention 1.A.2: Increase the availability and quality of service coverage data......................................20
Intervention 1.A.3: Create data comparability and synthesis across multiple information sources.........21
Intervention 1.A.4: Improve population data and coverage estimates.........................................................22
Focus Area 1.B: Strengthen programmatic birth and establish linkage with civil registration and vital
statistics system (CRVS).......................................................................................................................................24
Intervention 1.B.1: Strengthen programmatic birth and establish linkage with civil registration and vital
statistics system (CRVS)...................................................................................................................................24
Focus Area 1.C: Strengthen health workforce capacity and motivation to collect, analyze, and use information
at the frontline and program level.......................................................................................................................26
Intervention 1.C.1: Strengthen human resources for health capacity to effectively use ICTs....................26
Intervention 1.C.2: Design and implement information workflows to maximize data use........................28
Focus Area 1.D: Surveillance and response.........................................................................................................28
Intervention 1.D.1: Strengthen public health emergency management data quality and integrity..........28
Intervention 1.D.2: Reinforce data transparency and openness...................................................................29
Focus Area 1.E: Patient safety and response.....................................................................................................29
Intervention 1.E.1: Promote and build comprehensive patient safety culture that is open and fair for sharing
information and ensuring lessons are learned...............................................................................................30
Intervention 1.E.2: Strengthen and improve transparency of patient safety surveillance and patient safety
incident reporting system.................................................................................................................................31

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 Intervention 1.E.3: Learn and share safety lessons and encourage staff to learn how and why incidents
happen................................................................................................................................................................31
Intervention 1.E.4: Build leadership and knowledge to improve patient safety culture and incident reporting........32
Focus Area 1.F: Patient engagement and awareness raising...........................................................................34
Intervention 1.F.1: Raise public awareness through ICT.................................................................................34
Intervention 1.F.2: Increase transparency of information flows and promote accountability...................34
Pillar 2: Digitalization and scale-up of priority health information systems......................................................35
Focus Area 2.A: National health information systems......................................................................................35
Intervention 2.A.1: Electronic health management information system (eHMIS).......................................35
Intervention 2.A.2: Electronic integrated financial management information system (eIFMIS)................36
Intervention 2.A.3: Health geographic information system (HGIS)...............................................................36
Intervention 2.A.4: Electronic laboratory information system (eLIS)............................................................36
Intervention 2.A.5: Electronic regulatory information system (eRIS)...........................................................36
Intervention 2.A.6: Health data depot (HDD)...................................................................................................36
Intervention 2.A.7: Data presentation tools and techniques.........................................................................38
Intervention 2.A.8: Electronic human resource information system (eHRIS)..............................................38
Focus Area 2.B: Standards-based digital registries...........................................................................................38
Intervention 2.B.1: Master facility registry (MFR)...........................................................................................38
Intervention 2.B.2: Data dictionary and terminology management service (TMS).....................................39
Focus Area 2.C: Point of service health information systems..........................................................................39
Intervention 2.C.1: Electronic medical/health record (EMR/EHR).................................................................39
Intervention 2.C.2: Telemedicine and tele-education (TM, TE).......................................................................40
Intervention 2.C.3: Mobile health (mHealth)....................................................................................................40
Intervention 2.C.4: Electronic community health information system (eCHIS)............................................40
Intervention 2.C.5: Electronic logistics management information system (eLMIS)....................................40
Selecting and Establishing Information Revolution Demonstration Sites..........................................................43
Governance of the Information Revolution............................................................................................................45
Performance Measures............................................................................................................................................ 47
Action Plan................................................................................................................................................................. 51
Appendix ..........................................................................................................................................................................................61

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 Acronyms

ADRs ���������������������������������������������������������������������Adverse drug reactions

CHIS �����������������������������������������������������������������������Community Health Information System
CRVS ���������������������������������������������������������������������Civil Registration and Vital Statistics
CSA ������������������������������������������������������������������������Central Statistical Agency
DHS �����������������������������������������������������������������������Demographic Health Survey
DQA �����������������������������������������������������������������������Data quality assessment
DTC ������������������������������������������������������������������������Drug and Therapeutic Committee
eCHIS ��������������������������������������������������������������������Electronic Community Health Information System
eHMIS �������������������������������������������������������������������Electronic Health Management Information System
HER �����������������������������������������������������������������������Electronic Health Record
eHRIS ��������������������������������������������������������������������Electronic Human Resource Information System
eIFMIS �������������������������������������������������������������������Electronic Integrated Financial Management Information
System
eLIS �����������������������������������������������������������������������Electronic Laboratory Information System
eLMIS ��������������������������������������������������������������������Electronic Logistic Management Information System
EMR ����������������������������������������������������������������������Electronic Medical Record
EPHI ����������������������������������������������������������������������Ethiopian Public Health Institute
EPI �������������������������������������������������������������������������Expanded Program of Immunizations
eRIS �����������������������������������������������������������������������Electronic Regulatory Information System
FF ��������������������������������������������������������������������������Family Folder
FMoH ��������������������������������������������������������������������Federal Ministry of Health
GIS �������������������������������������������������������������������������Geographic information system
HC ��������������������������������������������������������������������������Health center
HP ������������������������������������������������������������������������Health Post
HDA �����������������������������������������������������������������������Health Development Army
HDD �����������������������������������������������������������������������Health Data Depot
HEP �����������������������������������������������������������������������Health Extension Program
HEW ����������������������������������������������������������������������Health Extension Workers
HGIS ����������������������������������������������������������������������Health Geographic Information System
HIS �������������������������������������������������������������������������Health Information Systems
HIT �������������������������������������������������������������������������Health information Technicians
HITD ����������������������������������������������������������������������Health Information Technology Directorate
HMIS ���������������������������������������������������������������������Health Management Information System
HRIS ����������������������������������������������������������������������Human Resources Information Systems
HSDP ���������������������������������������������������������������������Health Sector Development Program
HSTP ���������������������������������������������������������������������Health Sector Transformation Plan
ICD-10 �������������������������������������������������������������������International Classification of Disease (10th set)
ICT �������������������������������������������������������������������������Information Communication Technology
IFMIS ���������������������������������������������������������������������Integrated financial management information system
IR ���������������������������������������������������������������������������Information Revolution
IVR �������������������������������������������������������������������������Interactive vocal recording system
LQAS ���������������������������������������������������������������������Lot quality assurances system
M&E ����������������������������������������������������������������������Monitoring and evaluation
MFR ����������������������������������������������������������������������Master Facility Registry
MNCH �������������������������������������������������������������������Maternal, newborn, and child health
NESB ���������������������������������������������������������������������National Enterprise Server Bus
NGOs ���������������������������������������������������������������������Non-governmental organizations
PHCU ���������������������������������������������������������������������Primary Health Care Unit
PHEM ��������������������������������������������������������������������Public health emergency management
PRT ������������������������������������������������������������������������Performance Review Team
RCA �����������������������������������������������������������������������Root cause analysis

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RDQA ��������������������������������������������������������������������Routine data quality assurance
RFP �����������������������������������������������������������������������request for proposal
RHB �����������������������������������������������������������������������Regional Health Bureau
RS ��������������������������������������������������������������������������remote sensing
SCMS ���������������������������������������������������������������������Supply Chain Management System
SNNPR ������������������������������������������������������������������South Nations, Nationalities and People’s Regional State
SARA ���������������������������������������������������������������������Service Availability and Readiness Assessment
SPA+ ����������������������������������������������������������������������Service Provision Assessment
TE ��������������������������������������������������������������������������Tele-education
TM �������������������������������������������������������������������������Telemedicine
TMS �����������������������������������������������������������������������Terminology Management Service
VERA ���������������������������������������������������������������������Vital Event Registration Authority
WorHO ������������������������������������������������������������������Woreda Health Office
ZHB �����������������������������������������������������������������������Zonal Health Bureau

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 Introduction

There have been remarkable improvements in the health status of Ethiopia over the past two decades
during the five rounds of the Health Sector Development Program (HSDP). However, despite the progress
achieved so far, there are still challenges to be addressed in improving the health of the population, the
quality of care, and the inequalities in access and service.

The Federal Ministry of Health (FMoH) introduced the Health Sector Transformation Plan (HSTP), which
focused on addressing quality and equitable distribution of health service delivery for all. One of the four
transformation agendas in the current HSTP is the Information Revolution. It refers to the phenomenal
advancement in the methods and practice of collecting, analyzing, presenting, and disseminating
information that can influence decisions in the process of transforming economic and social sectors.
It entails a radical shift from traditional methods of data utilization to a systematic information
management approach powered by a corresponding level of technology. The Information Revolution is
not only about changing the techniques of data and information management; it is also about bringing
about fundamental cultural and attitudinal change regarding perceived value and practical use of
information.

Health Information Systems (HIS) in Ethiopia are run under different authorities. For example, while the
routine Health Management Information System (HMIS) is managed primarily by the FMoH, population-
based information comes predominantly from the Central Statistical Agency (CSA). The Ethiopian Public
Health Institute (EPHI), universities, and individuals conduct various research activities, the former in
line with the priority research needs identified by the FMoH. The fragmentation of the governance of
HIS puts in place organizational obstacles in the coordination of digital health investments.

The routine HMIS has been a primary source of information for continuous monitoring of health services
in the country. In response to the changes in health system organization, epidemiological patterns (with
an increment of non-communicable diseases), service delivery modality, focus on maternal health, and
quality of services, as well as international strategies and programs, the FMoH has undertaken revision
of the HMIS which is more comprehensive and is strengthening the standardization process through
incorporating new initiatives. The electronic system is in place to support this function. Similarly,
a Community Health Information System (CHIS) was introduced to capture basic health and health
related information by Health Extension Workers (HEW) at household and individual level. The CHIS
collects data on basic demographic statistics and health service delivery and utilization based on the
health extension package delivered through the Health Extension Program.

The FMoH, through the HSTP, envisions all of its citizens enjoying equitable and affordable access to all
types of health services. The achievement of this vision entails robust monitoring and evaluation (M&E)
systems that reveal the status of utilization of health services and desirable healthy practices using
key equity lenses. This is addressed through the establishment of an effective cycle of data gathering,
sharing, analysis, understanding, reporting, and application in decision making. This is the process
whereby data are transformed into information and knowledge for action.

6 Information Revolution Roadmap

Multiple data sources will be used to track the HSTP targets. Data sources will include: routine
administrative sources, such as the HMIS; household surveys, such as the Demographic Health Survey
(DHS) and Expanded Program of Immunizations Coverage Survey (EPI); health facility surveys, such as
the Service Provision Assessment Plus (SPA+) and the Service Availability and Readiness Assessment
(SARA); disease and behavioral surveillance; civil registration and vital statistics; financial and
management information; censuses; and research studies.

The utilization of the newly produced information in policy and strategy formulation and in planning and
decision making, especially at the lower levels, is not widely practiced. The national health information
system (HIS) is lagging behind in generating information needed to measure and respond to health
inequities and their key determinants. In addition to measuring average or aggregate levels of indicators,
it is essential to be able to stratify and disaggregate measures according to demographic (age and sex),
geographic (urban/rural and regional differences) and socioeconomic (wealth and education) categories,
as well as to develop appropriate indicators reflecting equity. Furthermore, data from both the public and
the private sectors will be gathered to provide the full picture of the health system performance. Since
many determinants of health are found outside the health system (e.g., education, road infrastructure,
water, and sanitation), it is crucial to integrate data sources from other sectors.

The rationale for developing this Information Revolution Roadmap is that all functions of the health
system rely on the availability of timely, accurate, and dependable information for decision making.
Revolutionizing the availability, accessibility, quality, and use of health information for decision-making
processes, through the appropriate use of information communication technology, can ultimately impact
the access, quality, and equity of healthcare delivery at all levels in Ethiopia.

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 Realizing the Information Revolution
Why the Information Revolution?
The principal driving force for the Information Revolution in the health sector can be explained using two
major factors. The first factor is the growing magnitude and type of information needed in the health
sector which has increased the overall demand for health information. The reasons for this increased
demand are many. It is a priority of the Federal Ministry of Health (FMoH) to expand and sustain the
progress that has been made previously, which will require visioning the future health care system
and strategic planning. Over the last couple of years, the FMoH engaged in a visioning exercise to think
broadly and strategically about how the long-term development of the Ethiopian primary health care
system will ensure high quality, equitable, sustainable, adaptive, and efficient health services to meet the
health needs of a changing population. Responding to such dynamic internal and external environments
requires an increased amount and type of data and more reliable quality of information. The second
factor is related to the political will where the sector is expected to operate within an accountable and
transparent environment. Results-oriented, accountable, and transparent systems require the use of a
wide range and various types of information.

The secondary driving force for the Information Revolution can be attributed to the opportunities
created by the advancement of the information and communications technology (ICT) industry. The
fact that ICTs revolutionized the way information is managed demands that the health sector shift
from custom-based technology to modern technology. This advancement is further expedited by the
level of technological innovation within the sector. This force can be explained as a stimulant of the
technological environment and the response of the health sector to harness the benefits.

Objective
The objective of the Information Revolution is to maximize the availability, accessibility, quality, and use
of health information for decision making processes through the appropriate use of ICTs to positively
impact the access, quality, and equity of healthcare delivery at all levels

Specific Objectives
• Create a culture of data use that leads to evidence-based decisions and action at all levels of the
health system
• Significantly improve the methods and practices of the analysis and use of health information
• Optimize data quality at all levels
• Enhance access and visibility of health information for patients and the wider public
• Establish an interoperable architecture to strengthen integration, standardization and
harmonization among priority data sources and health information systems
• Employ appropriate information and communication technologies to strengthen all aspects of
data use

8 Information Revolution Roadmap

Situational Analysis – The Current State
Quality and Utility of the Routine Data
Quality of data is a key factor in generating reliable health information that enables monitoring progress
and making decisions for continuous improvement. The need for organized, accessible, timely, and
accurate data for health decision making has become a growing concern at national and international
levels. In response to this, the FMoH has undertaken an extensive reform and redesign of the national
HMIS. The reform has taken major steps to respond to the deficiency of routine health data that limited
the quality of care, planning, and management systems, as well as decision making by managers at all
levels in the health care system.

Following the reform process, efforts were made to train managers, health professionals, and support
staff on the reformed HMIS to enhance their knowledge and skills, improve data management (recording,
reporting, data quality), and establish and institutionalize performance review teams (PRT) and data
quality assurance mechanisms.

Efforts were also undertaken to promote the use of ICTs in the delivery of health services. Accordingly,
health information technology initiatives have been put into place, though to varying levels of
implementation and adoption, to improve access and quality of health services using appropriate
technology. The initiatives cover a wide range of applications including telemedicine, tele-education,
mobile health, electronic HMIS (eHMIS), electronic medical records (EMR), geographic information
systems (GIS), and human resource information systems (HRIS).

CHIS has been designed to extend effective information management and decision making to the
grassroots level. Owing to the family-centered provision of health services, a Family Folder (FF) was
put in place to record health information related to members of the family from birth to death, as
well as housing conditions. The implementation of the Family Folder and CHIS improved availability
of various data for planning, monitoring, and informed decision making at lower levels. However, the
increasing number of health posts and enormous quantity of data being collected through the FF and
CHIS makes the data collection process cumbersome and time consuming. Digitization of the Family
Folder will reduce the data collection burden and simplify data collection, compilation, storage, analysis,
and reporting, and thereby transform the value of the CHIS.

Efforts have also been made to improve the culture of information use, in particular at the point of data
collection. Although some improvements have been observed, ensuring data of sufficient quality and
promoting an information-use culture at the point of collection remains critical and challenging.

Gaps in knowledge and skill of health professionals on data management are a critical issue that needs
continuous effort in order to change the mindset of health professionals. The knowledge and skill
level of health workers on the reformed HMIS significantly influences data management processes,
timeliness, completeness, and accuracy of data at the point of service delivery. Therefore, ongoing
training of health professionals on the HMIS, incorporating HMIS and M&E in the training curriculum
of health professionals, and strengthening generic training of ICTs for health is a great benefit to the
health sector.
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9
 A well-functioning health information system ideally comprises: census, demographic, surveillance
system, and administrative records, disease surveillance; household surveys; registration of vital
events; patient and service records; and program-specific monitoring and evaluation. In Sudan, due
to the absence of a robust health information system, surveys are held periodically. These are often
purpose-specific and rarely comprehensive.

The overall data quality assurance and the tools that are commonly used were assessed, and it was
revealed that they use Lot Quality Assurances System (LQAS), PMT, and ISS, however those are also
done less frequently and not with proper focus on data. They are done with the limited skills of the
HEWs and other health professionals. Therefore, the quality of the health information is poor in most
cases and is a major challenge. It was found that most data quality assurance tools used in the Ethiopia
health system were self-assessed and not sufficiently comprehensive. It is important to implement
comprehensive data quality assurance mechanisms, such as routine data quality assurance (RDQA)
and to provide additional capacity building in this area. There is a need to improve information-use
practices with better understanding of the health indicators on the revised HMIS and others, self-quality
assessment though LQAS, added skills on analysis and information use, and mentorship to all involved
in the health information systems. The greater focus could be on the HITs and all health professionals
and health extension workers.

Performance Monitoring
Well-designed and documented data sources, monitoring and evaluation structures, availability of
guidelines, finance, and skilled staff are all key resources for an effective performance monitoring
system. These factors enable the system to contribute to remarkable improvements of health status
through the tracking progress of key indicators, early identification of health system bottlenecks, and
enhancement of evidence-based decision making. In this regard, the routine data quality assessment
found that shortages of HIT personnel, missing and incomplete source documentation, gaps in knowledge
and skills in monitoring and evaluation, and insufficient budgetary allocation were major challenges to
an effective performance monitoring system.

Selecting key indicators based on their importance and representativeness is crucial for routine
monitoring of key aspects of health system performance. Based on the performance improvement
framework, teams should monitor performance compared to planned targets using different decision
support tools. However, the RDQA report indicated that few health facilities have practiced institutional
performance monitoring to periodically compare their performance with their plan. The majority of
health facilities assessed did not have action plans that were communicated to the respective bodies,
and few health institutions were using display charts.

Knowledge sharing and reapplication of experience narrows the performance difference and enhances
country progress in setting goals. In line with this, the FMoH developed guidelines to enhance and
standardize documentation and sharing of best practices in 2013. Since then, administrative units at
different levels have considered documenting and sharing best practices on different priority areas in
their annual plans, but the achievement is not yet satisfactory.

10 Information Revolution Roadmap

Available information must be disseminated in a timely fashion and used for strategic decision making
at all levels of the health system, otherwise its availability is meaningless and useless. In this regard,
the FMoH has begun to disseminate M&E findings to stakeholders using different channels such as
reports, M&E digests, policy and practice bulletins, health and health related indicators, newsletters and
fact sheets, and web sites. However, the distribution of published information dissemination tools is
generally limited to higher levels. Regional Health Bureaus (RHBs), health agencies, and hospitals have
used some of the communication outlets to share public health messages. Some regions have web
sites (e.g. Tigray, SNNPR, etc.) and most of them have annual health bulletins.

In the past, the performance monitoring system was framed in such a way to measure achievements
using selected indicators and Millennium Development Goals (MGDs). There were no indicators to review
and measure quality and equity of the services. However, given the fact that the current HSTP focuses
on quality and equity, indicators that could measure quality and equity should be incorporated in to the
core indicators. Furthermore, the five-year Information Revolution plan of the health sector at all levels
needs to have a documentation mechanism and a tool to track the performance monitoring methods
that are being conducted as per schedule and per procedures.

Electronic Government (eGov)

Electronic health (eHealth) is one of the focus areas for the government of Ethiopia. It is imperative that
the field of health is IT-enabled, not only to improve the efficiency and the effectiveness of hospitals
and labs, but also to build a base for gaining access to future advancements in the medical sciences.
The field of health is also a prime candidate for leveraging ICT for better service delivery to the citizens
of Ethiopia.

Utilize and Broaden Existing ICT Infrastructure

Woreda Network: This is a state-of-the-art ICT infrastructure deployed by the Ministry of Communication
and Information Technology. It has high bandwidth connectivity between ministries and agencies for
sharing data, voice, and video communication throughout the country. WoredaNet is mainly used to
connect government institutions that exchange sensitive data electronically. Health data is confidential
data that needs more security and high bandwidth infrastructure. In addition, WoredaNet has reached
almost all woredas, which is a cost effective way to connect RHBs, ZHBs, WorHOs, hospitals, health
centers, health posts, and communities. Moreover, since some major nationwide electronic systems
such as IFMIS (Integrated Financial Management Information System) have already deployed in the
WoredaNet infrastructure, it will be much easier to create interfaces and coordinate with national
eHealth systems. Therefore, WoredaNet will be one channel to implement various eHealth systems
during the implementation of HSTP.

National Data Centre: This is a centralized storage facility that helps to store and provide adequate
space to the data that is coming from various government sectors and agencies. The major applications
that are hosted in the national data center are the national Ethiopia government portal (www.ethiopia.
gov.et), Electronic Health Management Information System (eHMIS), Electronic Community Health
Information System (eCHIS), and IFMIS. Therefore, this data center will also support the health sector to
store health data and make it accessible to the responsible bodies when needed.
Information Revolution Roadmap
11
 Interoperability Layer Across eHealth Applications: To avoid redundancy and fragmentation, it is
mandatory to create an interoperability layer among all eHealth applications. Many applications might be
developed by different software programming tools and run on different hardware platforms. Because
of this, the FMoH has been facing many challenges. Specifically, exporting and importing data from
one electronic system to another electronic system is unthinkable. As a result, it is very hard to gather,
organize, and analyze health information across various information sources and use it for decision
making. The National Enterprise Service Bus (NESB) will provide a platform for seamless integration of
ministry and agency applications and databases at the back end and integrate all front end channels
to deliver electronic health applications. Above all, this NESB system will support the health sector by
creating an interoperable environment at the back end for various eHealth applications.

2G, 3G, and 4G Internet Connectivity

Ethiopian Telecom (Ethio Telecom) is working relentlessly to cover all parts of the country with mobile
network connectivity. Along this network, voice and 2G mobile internet coverage reaches almost all
woredas, 3G is available in major cities, and 4G is only available in Addis Ababa but Ethio Telecom has
a plan to scale it up nationwide. It is a breakthrough technology that helps to reach all agricultural
and pastoral communities. Therefore, this mobile coverage is an opportunity for all health facilities to
deploy various mobile-based systems, for example MNCH/PHEM/Stock Out IVR system, Mobile-Based
Community Health Information System (mCHIS), Enat Messenger, etc.

Electronic Health (eHealth)

ICTs have a fundamental role in today’s healthcare delivery system, especially in simplifying information
exchange, assisting with timely decision making processes, and improving the effectiveness of
operations. The FMoH has long since recognized the benefits of ICT to support and transform the health
sector of Ethiopia. The FMoH, together with agencies, NGOs, civil societies, and communities at all levels,
has deployed a number of ICT initiatives. The health sector must invest significant resources to leverage
these ICT investments as supportive tools for the effective and efficient delivery of services and to bring
critical information to the table for all health system actors.

12 Information Revolution Roadmap

National Health Information Enterprise
Architecture

An enterprise architecture defines the conceptual relationships between the health information
systems (HIS) that the FMoH proposes to support, and provides a roadmap for iterative development
and integration of a robust health information infrastructure. The architecture illustrated in Figure 1
represents the Ethiopia national health enterprise architecture based on the interventions described
in this Information Revolution Roadmap. The architecture differentiates between the HIS that will
be supported centrally at the national level and the point of service HIS that directly support service
delivery. The national HIS includes key systems such as the eHMIS and eLMIS, population data sources
such as the census and surveys, and standards-based registries such as a Master Facility Registry and
Data Dictionary that facilitate interoperability. The national level infrastructure also includes a Health
Data Depot (HDD) that will serve as a data warehouse for aggregation and reporting of health data
across many sources.

Point of service systems are those that are deployed in health facilities or provided to health workers
directly, such as electronic medical records, laboratory information systems, and the electronic
community health information system (eCHIS). The national HIS are linked to the point of service HIS
through an interoperability layer, also known as a national enterprise service bus (NESB), which validates
and relays electronic messages between information systems in the architecture.

Each system presented in the enterprise architecture is defined in further detail in specific interventions
below.

Figure 1: Ethiopia National Health Information Enterprise Architecture

National Health ICT Infrastructure (National Data Center and Woreda Net

Standards National HIS Population data Source

Master Facility Registry eHRIS
ePHEM Population Source
Data Dictionary
eHMIS
(census, surveys, research, vital
eRIS IFMIS registrations, estimate sites) Health Data Depot
ICD,HL7, DICOMM...... eLMIS HGIS
Health Data Depot

Business Intelligence
Interoperability Layer (e.g. national enterprise service bus) Tools & Techniques

Point of Service HIS Health Data Dissemination

& Usage
EMR/EHR TM/TE mHealth Using, Portial and other
communication medias.
eLIS Digital Family Foldeer /eCHIS
End Users (Managers,
community, Health
Goveernance, Policies, Guidelines, and procedures Professionals etc.)

Information Revolution Roadmap

13
 Envisioning the Connected Woreda: Improving
Patient Care

A primary goal of the Information Revolution is to make key data available at the point of service delivery,
and to capacitate the health workforce to use this data for evidence-based decision making that will
improve the quality and equity of care.

One approach to measurably enabling the Information Revolution is the “Connected Woreda”. Supported
by an interoperable health information system, the Connected Woreda allows for health data to be
collected, shared and used in a timely, equitable and transparent manner among and between points of
service throughout the Woreda and primary health care unit (PHCU) with linkages to the regional and
national health systems, thereby improving health worker performance and the quality of care.

The Benefits of the Connected Woreda

The PHCU generates and consumes considerable amounts of data, ranging from the Health Extension
Program Family Folder and supply chain information to monthly disease and service reports. The
Connected Woreda will establish the Woreda Health Office (WorHO) to serve as an information hub,
linking the community, the PHCU and the WorHO to the regional and national health information system,
and shifting ownership of health data to the PHCU. It will digitize prioritized health data, automate
reporting, and optimize processes, reducing the administrative burden and making information available
for use at all levels. The Connected Woreda will activate the information and cultural transformation
that is necessary to drive systematic data use for decision making and improvement of the quality and
equity of care.

The Connected Woreda improves performance and quality of care in many ways. A Connected Woreda:

• Improves patient care

• Informs care through improved access to patient records, reducing medical errors and
adverse events
• Increases the amount of time health workers spend with patient care due to
decreased administrative burden
• Links patients to higher levels of care through a digital referral network, ensuring that
patient medical history is available
• Improves health service delivery and equity
• Is able to monitor service coverage within its communities, allocate resources according
to utilization, and compare performance, equity and utilization with other districts

14 Information Revolution Roadmap

 • Has alerts and dashboards to allow health workers, administrators and M&E officers
to respond quickly with targeted actions to service and surveillance reports
• Utilizes ICTs to raise public awareness and promote accountability
• Empowers the health workforce
• Electronically captures and automatically reports routine service data from health
centers to higher levels, significantly reducing the administrative burden
• Has a health workforce that understands the value of data and is motivated and
trained to collect, use and share it

This concept improves upon traditional health information system approaches by structuring the use
of data around the woreda, taking advantage of the unique role it plays in translating policies and goals
set at the national level into action within health facilities and kebeles. The WorHO is at the heart of this
activity, orchestrating care and public health programming. This structure provides a systemic backbone
for the Information Revolution that is measurable in terms of its impact on service delivery, rather
than measurable in terms of eHealth systems. The Connected Woreda directly links the Information
Revolution to the Woreda Transformation Plan and builds off the Minister’s priority of digitizing the
family folder.

Related interventions presented in the Information Revolution Plan that are not at the woreda level will
inherently have synergistic impact with the Connected Woreda. For example, efforts that strengthen
regional hospital systems also improve the referral network for PHCUs and better informed national
decision-making (i.e. through consolidated reports from the health data depot) improves Woreda-level
planning and resource allocation.

Demonstrating the Value of the Connected Woreda

The examples in Figure 2 below (see text boxes 1-6) illustrate how stakeholders at all levels, from
community members and health workers to administrators and decision makers, will experience the
benefits of the Connected Woreda.

Information Revolution Roadmap

15
 Figure 2. The value of the Connected Woreda to stakeholders at all health system levels

MOH/RHB
Secondary & Tertiary
6. RHB/MOH Decission maker: Hospital 5. Doctors:
“I have real time access to information
‘’Care for patients referred to me from the
across many sources, disagregated to the Referral Information PHCU are coordinated for the first time
woreda-level, helping me to better allocate Network Flow becouse i have access to their medical
resouces, prepare reports, and respond to
histories.”
public health emergencies”

4. Woreda M&E Officer:

WorHo 3. Health Workers:
“Data Collection is not a burden, and the
‘’Reporting is automated and i can technology i use allows me to do my work
generate actionable dashboards to better and focus on provideing quality
respond to gaps in coverage”. care to my patients.”

Primary Health Care Unit

1. Community Member Primary Hospital 2. Health extension Workers:
‘’The Digital family folder allows me to
‘’My health extension worker and clinical
assess the needs of the community and
always have access to my latest health Health Centers ensure continuity of care for my
records, giviing me confidence that I’m
patients.”
getting high quality care”. Health Posts

Community

The Connected Woreda will interface with the interoperable national HIS to automate reporting, and
subscribe to shared identifiers for facilities, providers, and terminology through standards-based digital
registries. It will also integrate with the national HIS (e.g. eHMIS or HDD) for reporting and to generate
dashboards to support local planning, supervision, and quality-improvement activities. The Connected
Woreda demonstration project will equip the WorHO, health centers and selected health posts with
the necessary infrastructure for power and periodic internet connectivity, utilizing WoredaNet where
possible. The Connected Woreda will build off this infrastructure to digitize family folders, empowering
health extension workers to better manage patient care and outreach to communities.

16 Information Revolution Roadmap

Pillars of the Information Revolution

The Information Revolution aims to transform the culture of data use to positively impact population
health and health-system performance. The data-use transformation will be enabled and driven by
the implementation and scale up of prioritized health information systems. This transformation is
represented by two pillars:

• Pillar 1: Cultural changes on health information systems

• Pillar 2: Digitalization and scale-up of health information systems

Pillar 1 encompasses the cultural change and data-use objectives of the Information Revolution, which
will be enabled through the digitalization and scale-up of the national HIS, digital shared registries, and
point of service systems described in Pillar 2. Each pillar is comprised of several focus areas, which are
broken down into specific interventions that are actionable and measureable.

The foundation of both pillars of the Information Revolution is sustainable HIS governance, which will
be established to coordinate across governmental and non-governmental stakeholders, to align HIS
strategies with health system goals, and to monitor and evaluate the execution of this roadmap. The
Connected Woreda demonstration projects will ensure that interventions are designed and executed to
yield improvements that impact actual health workers and patients.

Figure 3: The Components of the Information Revolution

Ethiopia
Inforamtion Revolution

Pillar 1: Pillar 2:

Cultural Digitalization The connected

transformation Woreda Transormed
and scale-up
for health Demonstration Woredas
of priority HIS
date use projects

HIS Governance

Information Revolution Roadmap

17
 Table 1: Summary of the Information Revolution Focus Areas and Interventions

Pillar 1: Cultural transformation for health data use

1.A. Data for service 1.B. Strengthen 1.C. Strengthen 1.D. 1.E. Patient safety and 1.F. Patient
delivery, coverage, programmatic health workforce Surveillance response engagement
and equality birth and capacity and and response and awareness
establish motivation raising
linkage with civil to collect,
registration and analyze, and use
vital statistics information at
system (CRVS) the frontline and
program level
1.A.1. Strengthen 1.B.1. Strengthen 1.C.1. Strengthen 1.D.1. 1.E.1. Promote and 1.F.1. Raise
availability, programmatic human resources Strengthen build comprehensive public
readiness, birth and for health capacity public health patient safety awareness
quality, use, and establish to effectively use emergency culture that is open through ICT
transparency of linkage with civil ICTs management and fair for sharing
service data registration and data quality information and 1.F.2. Increase
vital statistics 1.C.2. Design and integrity ensuring lessons are transparency
1.A.2. Increase the system (CRVS) and implement learned of information
availability and information 1.D.2. flows and
quality of service workflows to Reinforce data 1.E.2. Strengthen and promote
coverage data maximize data transparency improve transparency accountability
use and openness of patient safety
1.A.3. Create data surveillance and
comparability and patient safety incident
synthesis across reporting system
multiple information
sources 1.E.3. Learn and share
safety lessons and
1.A.4. Improve encourage staff to
population data and learn how and why
coverage estimates incidents happen

1.E.4. Build leadership

and knowledge to
improve patient safety
culture and incident
reporting

Pillar 2: Digitalization and scale-up of priority health information systems

2.A. National health information 2.B. Standards-based digital 2.C. Point of service health information
systems registries systems
2.A.1. Electronic health management 2.B.1. Master facility registry (MFR) 2.C.1. Electronic medical/health records
information system (eHMIS) (EHR/EMR)
2.B.2. Data dictionary and
2.A.2. Electronic integrated financial terminology management service 2.C.2. Telemedicine and tele-education
management information system (TMS) (TM, TE)
(eIFMIS)
2.C.3. Mobile health (mHealth)
2.A.3 Health geographic information
system (HGIS) 2.C.4. Electronic community health
information systems (eCHIS)
2.A.4. Electronic laboratory information
system (eLIS) 2.C.5. Electronic logistics management
information system (eLMIS)
2.A.5. Electronic regulatory system
(eRIS)
2.A.6. Health data depot (HDD)
2.A.7. Data presentation tools and
techniques
2.A.8 Electronic human resource
information system (eHRIS)

18 Information Revolution Roadmap

Pillar 1: Cultural transformation for health
data use
Focus Area 1.A: Data for service delivery, coverage, and equity

Intervention 1.A.1: Strengthen availability, readiness, quality, use, and

transparency of service data
To assess the availability, readiness, and quality of services being delivered, there needs to be regular
measuring of compliance with service and outcome standards, such as those developed for maternal,
child health, and disease prevention. There are multiple sources of data on health service delivery. These
include quality routine facility reporting systems, health facility assessments (both facility censuses and
surveys), and other special studies. No single method provides all the information required to assess
service delivery, and multiple methods are needed to understand it completely.

Health facility assessments provide externally generated information either through interviews or
observation for data collection. Health facility assessments can be implemented as a census (i.e.,
assessment of all facilities in a district or country) or by using a sample survey approach (i.e., assessment
of a selected sample of facilities in a district or country).

A general facility survey usually focuses on a wide range of key health services and collects information
on facility infrastructure, equipment and supplies, support systems, management systems, and
providers’ adherence to standards. Facility surveys may also measure the quality of specific services
and whether all required elements are present to provide routine care.

The facility surveys cover all types of health service sites, from hospitals to health posts, and include
all public and private institutions. Data collection includes a facility resources audit, provider interviews,
client–provider observations, and client exit interviews.

A facility census includes visits to all public and private health facilities in a defined area; the facility
census scope can be national or sub-national, covering one or more provinces, regions, or districts. It
is designed to form the basis for a national and sub-national monitoring system of service delivery.
The key output is a national database and, where possible, district databases of health facilities. The
database is updated on a regular basis every year. Once a reliable database system (used at the district
level) is in place, the census is carried out by district teams as part of their regular supervision, with
a quality control component provided by regional teams. If resources are limited and do not allow for
visiting all health facilities in a country (or sub-nationally in a district, region, or province), a census is
implemented in sentinel districts with additional districts added each year, to achieve a full census over
a longer time period.

During the HSTP period, service delivery monitoring will be carried out on a regular basis, and the
management of health services will be further strengthened. Health facility assessments (both facility
censuses and surveys) and mapping will be conducted to gather data on health issues at the health
Information Revolution Roadmap
19
 facility or unit level (health posts, health centers, hospitals). Accordingly, Service Availability Mapping will
be carried out on a regular basis to ensure availability of health services that meet a minimum quality
standard. Mapping will produce a service availability score card by region, woreda, and health facility (HP,
HC, hospital) use selected types of services appropriate to health facilities. For example, at the HP level
use EPI-Penta-3; at HC level use TB (TCD), maternal health (FP, ANC, SBA, PNC), and malaria; and at the
hospital level use HIV/AIDS. Furthermore, service provision assessment (SPA+) will also be conducted
every three years as scheduled. During these surveys, geo-coordinates for each health facility will be
recorded.

Major Activities

• Identify data elements collected during the census

• Conduct facility census every 2-3 years

• Conduct facility survey every year

• Expected reporting units produce regular reports

• Triangulate the facility census and survey data with different sources

• Regularly present analysis of facility census and survey data to decision makers and users at
every level

Intervention 1.A.2: Increase the availability and quality of service coverage

data
The problems associated with developing service coverage estimates from facility data relate to
completeness and accuracy of recording and reporting, as well as biases arising from differences in
use of services by different populations. Low-quality data is used to make decisions without sufficient
checks to verify completeness and accuracy.

The information system will respond to the issue of equity using demographic, geographic, and
socioeconomic lenses. To realize this, the initiative will uncover the status of the utilization of health
services and health outcomes for the disadvantaged. Equity measurement will be completed using
key equity indicators and appropriate statistical measures. The country is keen to measure equity and
produce a status of inequality report.

Major Activities

• Implement integrated data management protocol

• Strengthen implementation of HMIS in private health facilities
• Strengthen routine data quality assessment at all levels
• Strengthen health quality and equity monitoring

20 Information Revolution Roadmap

 • Institutionalize measurement mechanism for service quality improvement
• Integrate service quality measurement into M&E system
• Produce a state of inequality report
• Strengthen regions and woredas to conduct action oriented research/M&E
• Conduct equity oriented study/survey every year
• Develop standard for evaluation

• Institutionalize evaluation methodologies

Intervention 1.A.3: Create data comparability and synthesis across multiple

information sources
Intervention 1.A.3 is about enabling data visualization, reporting and charting across multiple information
sources so that data might be used for planning, identification and prioritization of problems, performance
monitoring, and providing feedback reports to support transformative and sustainable evidence-based
decision making.

No single source can provide sufficient information for monitoring service delivery. Thus, a service delivery
monitoring system relies on multiple sources of data brought together for analysis and decision-making.
Data from routine health facility reporting systems needs to be supplemented with data from health
facility assessments, surveys, etc. In addition, data generated through facility assessments should be
complemented or cross-checked with data from other sources, such as the databases of health workers,
infrastructures, equipment, and procurement, which are often available in various departments of the
Ministries of Health. This can serve as complementary or benchmarking material for data on service
delivery generated through the routine HMIS.

Health information is often not available to those who are best placed to use it to improve performance of
the health system. Health and health-related data should be analyzed, made accessible to stakeholders,
and utilized at all levels. Hence, data visibility refers to analyzing the health and health-related data and
making accessible different data presentation techniques from display charts in the health institutions
to stakeholders and mass media.

The introduction of ICT provides many opportunities, but too often data results are not used for
improving clinical care and facility management. Information, regardless of the source, should preferably
be collected and made available at the woreda/district level. Ideally, the foundation of a system of
monitoring health resources lies at the district level, as it provides information required for decision
making. Therefore, establishing a district-based system is the primary goal with support at the national
or regional levels.

Major Activities

• Improve advanced analytical skill (in depth analysis, data mining)

• Conduct regular self-assessment (PMT establishment & functionality)
• Enhance accountability scorecard at all levels
Information Revolution Roadmap
21
 • Strengthen the decision support system
• Develop an integrated platform
• Develop data access protocols for users
• Strengthen geospatial data generation, analysis, and use
• Improve data triangulation mechanisms from different data sources

• Pool health and health-related studies raw data

Intervention 1.A.4: Improve population data and coverage estimates

Population data are essential for public health decision making and generate information not only about
those who use the services but also, crucially, about those who do not use them. Population-based
surveys have become a primary source of data in developing countries where facility-based statistics
are of limited quality. Ethiopia is not an exception.

Large scale population-based surveys are being carried out by CSA every five years. These surveys provide
very valuable information and remain the only reliable source of information on health-sector outcomes
and impacts. Despite their goodness as a source of information, the information lacks timeliness. Thus, to
bridge the observed information gap between the surveys, it is envisioned that small-scale population-
based surveys will be conducted to come up with small area estimates to answer the information
need of the health sector. This process will also help to evaluate the discrepancy between the survey
and routine data, supplement global estimates, and help us to produce a national micro database for
small scale surveys. Hence, during the next HSTP period, efforts will be exerted to strengthen better
population-based data coverage and estimates, strengthen community health information systems
by introducing the use of home-based records at the HP level, and promote biometric-type recording
systems for mobile communities. Furthermore, the community health information system for urban
and mobile communities will be designed and implemented to further expand data sources and ensure
the availability, quality, and use of service delivery coverage data.

Major Activities

• Produce a national micro database for small-scale surveys

• Strengthen home-based records and improve ownership of community data
• Design a different system for urban and pastoral communities
• Promote a biometric type recording system for mobile population
• Establish a community jury to facilitate performance review
• Establish a community name-based recording and tallying mechanism
• Develop standard HDA recording and reporting tools to ensure compatibility with CHIS
• Conduct capacity building training of HDA on M&E
• Strengthen health worker competency on data literacy
• Produce small area estimates

22 Information Revolution Roadmap

Role and responsibility of each actors

FMoH/RHB

• Design and implement an integrated data management protocol

• Strengthen implementation of a private HMIS
• Build capacity on data handling analysis and interpretation
• Print HMIS materials
• Identify research/evaluation agenda to be used with the results of different interventions
• Conduct a DQA every 3-6 months
• Integrate service quality measurement into a M&E system
• Measure service quality regularly
• Produce a state of inequality report
• Conduct equity-specific evaluation
• Conduct facility survey every year
• Present to decision makers and users at every level
• Promote operational research and evaluation
• Develop data access protocols for users
• Develop a data integrated platform
• Produce small estimate reports every year
• Institutionalize a system of performance reward based on the DQA
• Support implementation of the CHIS and community scorecard in all setups

Facilities

• Check data quality regularly

• Measure service quality regularly
• Synthesize information in terms of equity to access, utilization, and quality of care
• Cooperate when facilities’ censes and survey are conducted
• Conduct regular self-assessment (PMT establishment & functionality)
• Develop a community-level facility evaluation checklist
• Develop a scorecard software to be used at the woreda and above levels
• Establish a community jury to facilitate performance review
• Conduct data quality assessments at the household level
• Develop standard HDA recording and reporting tools to ensure compatibility with CHIS
• Conduct capacity building training of HDA on M&E

Information Revolution Roadmap

23
 • Ensure competency on data literacy
• Strengthen regular performance monitoring of HDA
• Document and disseminate best practice of community M&E

Focus Area 1.B: Strengthen programmatic birth and establish linkage

with civil registration and vital statistics system (CRVS)

Intervention 1.B.1: Strengthen programmatic birth and establish linkage

with civil registration and vital statistics system (CRVS)
A well-functioning civil registration and vital statistics (CRVS) system registers all births and deaths,
issues birth and death certificates, and compiles and disseminates vital statistics including cause of
death information. It may also record marriages and divorces. Despite the well-documented benefits
of CRVS, many countries do not have adequate systems in place. Globally, the births of tens of millions
of children are known to be unregistered every year, and it is estimated that two-thirds of deaths are
never registered and are thus not counted in the vital statistics system. In Ethiopia, while some progress
has been made, there is still an enormous gap in the registration of vital events, especially for birth
registration. This intervention seeks to improve coverage and use of civil registration, including causes
of death at health facilities and at the community level.

Major Activities

• Develop a standard form for death reporting (adopt international certificate of death for public
and private health facilities)

• Orient and disseminate the standardized death report form to all public and private health care
providers, VHSG, and local authority

• Develop a tool for assessing completeness of vital registration at national and sub-national levels
• Conduct training on vital data processing and analysis at all levels of the health system
• Publish annual vital registration statistics, disaggregated to woreda (including causes of death)
and distribute to all concerned institutions at central, regional, and woreda levels in collaboration

with VERA

• Introduce and provide training in ICD-10 coding and verbal autopsy

Roles and responsibilities

Federal Ministry of Health

• Improve its visibility by supporting input supply such as manpower, finance, material, and budget
allocation to support the vital events registration system and implementation

• Improve the quality of registration by preparing registration formats and providing the required

24 Information Revolution Roadmap

 technical support to implement as per the proclamation; register the data of birth and death

of military force under national obligation; enable diasporas and travelers by ship to get events

registered in region and city administration.

• Improve the registration coverage of birth and death (and its reason) by providing training for
governmental and private health institutes on understanding vital events registration definitions,

use of registration methods, promotion means, and certificate issuance of events occurring at

institutes

• Create a reliable vital events registration system by making governmental and private health
facility data open to the nearby notary status document chief concerning vital events registration

• Distribute birth and death certificates bearing the detailed information indicated under vital
events registration and national identity proclamation in all institutes where the events are

occurring, and provide birth and death certification in a timely manner to all those happening in

the health facilities, by designing a distribution strategy when the certificates are finished

• Information handling and security, as well as information exchange, shall be based on vital events
registration and national identity proclamation No. 760/2004, chapter 4 and 5. Accordingly, the

collected information in health families shall be maintained properly in a usable manner without

disclosing it to a third party by the health facilities.

• Undertake monitoring and support work on the prepared checklist concerning birth and death
information gathering; issue certificate and their accessibility to the nearby chief of notary

• Improve events registration coverage by making birth, death, and reason of death be the agenda
of the meeting during the regular assemblies of Office of the Ministry and regional health

bureaus.

• Expand the procedural system by discussing with the concerned bodies the registration of home
death and reason of death to get a legal framework

• Expand the procedural system and provide training for home birth to bring about using health
professionals

Regional health bureaus

• Support input supply such as manpower, finance, material, and budget allocation to support the
vital events registration system and implementation

• Distribute registration recording and reporting formats

Information Revolution Roadmap

25
 • Provide training on understanding the vital events registration systems
• Expand use of reliable vital events registration system
• Complete supportive supervisions to health facilities
• Improve vital events registration coverage
• Expand the procedural system by discussing with the concerned bodies the registration of home
death and reason of death to get a legal framework

FMoH and FVERA

• The joint roles and responsibilities that will be done in collaboration between FMoH and FVERA
are:

• Form a reliable vital events registration system at the national level

• Coordinate the means of notifying birth and death occurring in governmental and private
institutes

• Conduct monitoring and evaluation to increase registration coverage

• Find donors and other stakeholders who potentially can provide technical and financial
assistance

• Conduct a joint forum every three months, focusing on bilateral issues and strengthening the
registration system

• Integrate a clear procedure at the national level to register death and reasons of death occurring
at home and health facilities

Health facilities

• Complete vital events registration based on recording and reporting formats

• Conduct data quality assessments
• Provide training and sensitization programs

Focus Area 1.C: Strengthen health workforce capacity and motivation

to collect, analyze, and use information at the frontline and program
level

Intervention 1.C.1: Strengthen human resources for health capacity to

effectively use ICTs

This intervention focuses on:

• Ensuring the M&E units at each levels of the health system are staffed with an adequate number
and mix of M&E experts. It involves defining the level of M&E expertise required at each level of
26 Information Revolution Roadmap
 the health system, revising the structure and employing the required experts. Collaboration with

regional health bureaus, human resource directorates, and partners will be critical in realizing this

initiative.

• Improving the capacity of health care providers, M&E personnel, and health mangers at all levels
on data management, and ensuring quality of information and use of information. It includes

defining the HMIS/M&E capacity-building needs of health care providers, M&E personnel, and

health managers with respect to the role they will play in the health system. This should be

followed by developing training modules for the three categories of health professionals. It also

intends to establish a platform to effectively communicate survey reviews, findings of surveys

and other research, and best experiences to stakeholders, which could help in informing decision

and policy makers.

• Incorporating training on routine health information system and M&E system of the health
system in the pre-service curriculum of health professionals. It will help in creating understanding

on the existing health information and M&E system of the health sector among the health

professionals during their in-school trainings and practicums. Thereby, it will ensure that health

professionals will use the existing systems appropriately while providing services. Collaboration

with the Ministry of Education, universities, and professional associations will be of paramount

importance in the whole process of realizing this initiative.

• Developing the ICT workforce in the health care system of Ethiopia by creating ICT-aware health
information technicians, health informatics experts, physicians, and other health professionals.
By developing such a workforce, it is possible to strengthen the sustainability of eHealth systems

to be deployed in the country. Such a workforce learns and uses, with minimal training, the new

electronic systems and could easily address minor faults in the systems, thereby reducing the

burden for the implementer. Currently, regional health bureaus and hospitals in different parts of

the country are hiring ICT professionals to support their overall ICT infrastructure, which includes

the eHealth systems deployed there. When new electronic health systems are deployed, users of

the system are provided training on how to use the system. However, to ensure the sustainability

of the different electronic systems being deployed at the health facilities, we need to devise

a way to equip the health workers with basic ICT knowledge on the usage of electronic health

record systems.

Major activities

• Ensure adequate staffing of each level of the health system with appropriate M&E personnel
Information Revolution Roadmap
27
 • Enhance HIS staff career development opportunities

• Improve the capacity of health professionals, M&E personnel, and health managers

• Ensure the pre-service curriculum includes training of health professionals on routine health
information, eHealth, and M&E systems

• Establish training centers at regional health bureaus and at major hospitals

• Provide TOT training for those who will run the training centers

Intervention 1.C.2: Design and implement information workflows to

maximize data use
Selecting and employing the best health data dissemination and presentation techniques is as important
as identifying best health data collection, processing, and storage methods.

Major activities

• Assess the information needs of health workers at all levels

• Develop and implement workflows to maximize the availability and use health information for
decision making and action

• Identify the types of health information and mechanisms for communication

Focus Area 1.D: Surveillance and response

As for all health care data, public health authorities need data collection, analysis, and dissemination
systems to provide accurate, reliable, consistent, and complete information to evaluate existing
resources, plan for the future, and introduce measures to anticipate problems before they arise. In
public health, the Information Revolution focuses on strengthening integrated disease surveillance and
response systems.

Intervention 1.D.1: Strengthen public health emergency management data

quality and integrity
Poor-quality data can mislead. The entire process of data design, collection, management, analysis, and
dissemination needs to be of high quality and integrity.

Major Activities

• Ensure the data collected is of sufficient detail to help inform and promote evidence-based
policymaking at every level (i.e. disaggregated across dimensions based on relevance to the
program or policy)

28 Information Revolution Roadmap

 • Strengthen the disease surveillance system by introducing and expanding relevant data collecting
tools such as cancer registries
• Review and revise the existing framework for quality assurance
• Introduce appropriate information technology to improve data timeliness
• Strengthen the disease surveillance system in the private health facilities
• Strengthen health workforce capacity and motivation to collect quality data

Intervention 1.D.2: Reinforce data transparency and openness

Many publicly-funded datasets, as well as data on public spending and budgets, are not available to other
ministries or to the general public. All data on public matters and/or funded by public funds, including
those data produced by the private sector, should be made public and “open by default” with narrow
exemptions for genuine security or privacy concerns. It needs to be both technically open (i.e., available
in a machine-readable standard format so that it can be retrieved and meaningfully processed by a
computer application) and legally open (i.e., explicitly licensed in a way that permits commercial and
non-commercial use and re-use without restrictions).

Major Activities
• Develop an integrated, centrally managed electronic network that provides access to national,
state, and local information systems
• Use a data system that helps to provide services to the public

Focus Area 1.E: Patient safety and response

Unfortunately, patient safety is compromised due to medicine safety problems that are commonly
caused by medication errors, poor quality of the medicine, inherently unsafe drugs, communication
failures (failures between patient/patient proxy and practitioners, practitioner and nonmedical staff, or
among practitioners), patient management (improper delegation, failure in tracking, wrong referral, or
wrong use of resources), and clinical performance (before, during, and after intervention). Drug safety
problems are manifested through adverse drug reactions (ADRs), which may result in serious patient
harm.

Improving the culture of safety within health care is an essential component of preventing or reducing
errors and improving overall health care quality. A safety culture exists where staff within an organization
have a constant and active awareness of the potential for things to go wrong. Both the staff and the
organization are able to acknowledge mistakes, learn from them, and take action to put things right.
Being open and fair means sharing information freely and treating staff fairly when an incident happens.

A key aspect of a patient safety systems is a culture that encourages clinicians, patients, and others
to be vigilant in (1) identifying potential or actual errors, 2) encouraging a culture where the reporting
of errors and safety issues facilitates learning and takes appropriate steps to mitigate harm, and (3)
promoting a culture where one learns from errors, near misses, and other identified safety issues.

Information Revolution Roadmap

29
 Monitoring and addressing medication errors, monitoring and ensuring drug quality, and monitoring
and managing ADRs is critical and crucial. The ability to capture and measure patient safety is central
to enabling clinicians to provide excellent care, improving patient outcomes, reducing infection rates,
preventing serious adverse events, controlling near misses, and standardizing treatments using
evidence-based medicine. Reporting patient safety incidents and prevented incidents provides the
opportunity to ensure that the learning gained from the experience of a patient in one part of the
country is used to reduce the risk of something similar happening to future patients elsewhere. It is
a key to success for Ethiopia’s national and local health care delivery system. Efforts are underway
to improve patient safety in areas of drug use problems/ADR, monitoring drug reactions, prescription
monitoring, drug utilization monitoring, and antimicrobial prescribing and use; however due to lack of
strong, transparent incident reporting systems and well-documented evidence, it is not possible to
quantify the full magnitude of the patient safety-related problems with certainty.

Intervention 1.E.1: Promote and build comprehensive patient safety culture

that is open and fair for sharing information and ensuring lessons are
learned

Activities

• Establish a national patient safety forum/team who will work hand-in-hand with the national
quality forum

• Establish and strengthen a national drug advisory committee

• Adopt and standardize patient safety standards, definitions, checklists, guidelines, and survey
tools

• Organize a national level TOT on patient safety and patient safety assessment
• Conduct regional level TOTs on patient safety and patient safety assessment
• Organize hospital level patient safety trainings
• Undertake hospital level baseline assessments on patient safety and patient safety culture
• Undertake health center level baseline assessments on patient safety and patient safety culture

• Produce a baseline patient safety culture report

Intervention 1.E.2: Strengthen and improve transparency of patient safety

surveillance and patient safety incident reporting system

Activities

• Identify and agree on reportable incidents (adverse events, near-miss, or errors)

• Design, print, and distribute an incident register/logbook, reporting form, and related guidelines/
protocols

30 Information Revolution Roadmap

 • Establish a national adverse events, near-miss, and error reporting system and a database and
learning center for reporting patient safety incidents.

• Design and deploy an interoperable patient safety/incident reporting system (adverse events,
near-miss, or error) and a data exchange platform at HF level (hospitals and health centers),

linked to the regional and national reporting and learning system for the reporting of patient

safety incidents

• Report incidents (complication, adverse event, near-miss or, error) as they are recorded/reported
by each department

• Investigate and analyze each observed or reported incident (complication, adverse event, near-
miss or error)

• Prepare reports and submit them to an executive; prepare regular patient safety report twice a
year

Intervention 1.E.3: Learn and share safety lessons and encourage staff to
learn how and why incidents happen

Activities

• Organize root cause analysis (RCA), auditing, and data mining training course for professionals
(national TOT)

• Organize an advanced RCA, auditing, and data mining training course (Regional TOT)

• Facilitate training at the facility level/hospital level

• Conduct annual review meetings on patient safety incidents at national, regional, facility/hospital
level

• Conduct operational research/assessments on patient safety and patient safety culture

Intervention 1.E.4: Build leadership and knowledge to improve patient

safety culture and incident reporting

Activities

• Ensure that all hospitals and health centers have appointed a safety manager
• Appoint a safety champion for each unit/department of each hospital/HC
• Organize special trainings on patient safety and patient safety data quality for hospital and HC
leadership
Information Revolution Roadmap
31
 • Institutionalize leadership Walk Rounds by hospital medical directors on patient safety and follow
up meetings with the staff on weekly basis without interruption

• Organize awareness creation meetings on patient safety at hospital and health center level

• Institutionalize and strictly implement weekly meeting on patient safety at each department

• Organize in-country and out-of-country experience sharing tours

Roles and responsibilities

FMoH/RHB

• Play a lead role in coordinating applied research agendas on patient safety, focusing on enhancing
knowledge, developing tools, and disseminating results to maximize the impact of patient safety

systems among federal agencies, hospitals, universities, sub-national levels, and the private

sector.

• Develop standard registries, reporting formats, and interoperable database and data interchange
standard formats (standard formats for electronically encoding the data elements, including

sequencing and error handling; data interchange standards can also include document

architectures for structuring data elements as they are exchanged and information models that

define the relationships among data elements in a message

• Organize capacity-building training programs

• Establish a national interoperable pharmacovigilance database

• Investigate and aggregate reported incidents; give feedback to reporting institutions and regions

• Produce and disseminate annual patient safety report

• Strengthen/establish national drug advisory committee

Health Facilities (Hospitals and Health Centers)

• Establish comprehensive patient safety programs at all health care institutions; these should be
operated by trained personnel within a culture of safety, specifically when involving an adverse

event, medical errors, surgical errors, and near-miss detection and analysis

• Establish a patient safety incident reporting system and database and report accordingly

• Establish/strengthen the Drug and Therapeutic Committee (DTC)

• Appoint a safety manager/focal person

32 Information Revolution Roadmap

 • Designate a safety champion in each unit; having a designated safety champion in every
department and patient care unit demonstrates the organization’s commitment to safety and

may make other staff members feel more comfortable about sharing information and asking

questions. Champions must have proper training, resources, and authority.

• Hospital leadership: provide leadership on patient safety, walk rounds on weekly basis without
interruption. Senior leaders can demonstrate their commitment to safety and learn about the

safety issues in their own organization by making regular rounds (executive walks) to discuss

safety issues with the frontline staff.

• Hospital leaders who conduct executive walks should give feedback briefings to the teams

• Strictly follow weekly case team/unit meetings on patient safety

• Build awareness in hospital/HC of patient safety

• Organize training programs in patient safety, incident reporting, quality of care

• Make patient safety training available for staff with specific responsibility for safety

• Conduct a baseline assessment on patient safety culture at hospitals, HCs, and HP, and produce a
baseline report

• Investigate thoroughly and analyze each observed complication/reported incident

• Prepare and submit to the executive regular (twice per year) patient safety reports as recorded
by each department. The report may include type of incidents: mortality and root cause analysis
report (what, where, why, recommendations, and detailed improvement activities)

Health Professionals

• Identify areas prone to errors, this will help design a proactive, systems-approach intervention for
minimizing the opportunities for errors and can prevent adverse events

• Routinely report incidents and near misses: this is the key to effective reporting. Unless staff
members trust that the organization will use the information for improvement and not to blame

individuals, they will be reluctant to report incidents.

• Follow standard operating procedures and update skill and knowledge

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33
 Focus Area 1.F: Patient engagement and awareness raising

Intervention 1.F.1: Raise public awareness through ICT

Citizens have a right to receive relevant information about health conditions and services and the FMoH
has a responsibility to make this information available. This intervention is about allowing people to get
the latest information about health and health-related activities throughout the health sector that will
impact their health conditions. The public should be aware of the importance, usage, and mechanisms for
communication of health information. One of the basic objectives for the health system of the country
is to make information available at the individual or community level, so that the public is informed and
can make timely decisions about health related topics.

The FMoH has been working actively in this respect by using a variety of communication media to
disseminate health information and to make the public aware of how to maintain good hygiene and
general well-being. However, this work could be strengthened and made more effective by employing
different ICTs that are available. One example is the FMoH is setting up an audio studio on premises of the
Ministry that utilizes weekly air time on the Ethiopian Broadcasting Corporation (EBC) to communicate
health messages.

Major Activities

• Identify best technologies and mediums to disseminate health information to the public
effectively

• Identify major topics which needed to be disseminated to the public

• Incorporate ICTs into health awareness campaign strategies to increase coverage and
effectiveness

• Follow up and measure the effectiveness of the methodologies

• Continuous follow up in new technologies and effective practices elsewhere and adapting them
to Ethiopia specifically

Intervention 1.F.2: Increase transparency of information flows and promote

accountability
A transparent system makes information available to patients and their families enabling them to make
informed decisions (e.g. when selecting a hospital, when choosing among alternate treatments). In the
Ethiopian health care system, so far there is no a standard guideline on how to make health information
transparent. Transparency in health care appears to be an inevitable evolution in the information and
consumer age.

It is also critical to identify and assess the various accountability roles that health sector actors play
and to ensure that these roles are made known to the public. Each health sector actor has a role in
accountability. These actors include the FMoH, funding agencies, regional government officials, non-
governmental organizations, hospital boards, professional associations, unions, health care providers
(facilities and individuals, public and private), and international donors.
34 Information Revolution Roadmap
Major Activities

• Create awareness on the need and importance of health information transparency

• Gather best practices
• Develop a standard guideline on the creation of a transparent health system
• Identify the issues that need to be transparent
• Implement the strategy

Pillar 2: Digitalization and scale-up of priority health information

systems

In the past two decades during the execution of HSDP1, HSDP2, HSDP3, and HSDP4, the FMoH has
implemented different technologies and electronic systems. These contribute to a national health
information architecture and are aimed to streamline the efficiency and effectiveness of healthcare
delivery from the community up to the national level. These electronic information systems have been
categorized into national HIS, standards-based digital registries, and point of service HIS. These include
EMR, eHMIS, eHRIS, IFMIS, LMIS, LIS, RIS, Telemedicine and Tele-education, and mHealth, among others.
The strengths and weaknesses of each system will be assessed according to its ability to meet the
current and upcoming needs of the health system. Gaps will be addressed through improvements and
modifications and incompatible systems will be replaced. The Golden Initiatives implemented by FMoH,
agencies, RHBs and partners are described below.

Focus Area 2.A: National health information systems

Intervention 2.A.1: Electronic health management information system

(eHMIS)
The eHMIS is the automation of the health management information system of the country. It is used to
modernize the health data collection, organization, analysis, and management of the health information
system. Currently the health management information system of the country is half paper and half
electronic based. Therefore, the Ministry would like to deploy this electronic system throughout the
nation that will thoroughly shift the manual based system into digital. Eventually, we will ensure the
one channel reporting system at health premises.

Intervention 2.A.2: Electronic integrated financial management information

system (eIFMIS)
This financial system is a web based system and accessible over a wide area network or LAN, depending
on the accessibility of the client from the main server hosting the application. This application helps
FMoH, agencies, RHBs, all health facilities, and other responsible donors to distribute the budget and
manage expenditures in a timely basis in line with the accomplishment of tasks or activities.
Information Revolution Roadmap
35
 Intervention 2.A.3: Health geographic information system (HGIS)
A geographic information system or geographical information system (GIS) is a system designed to
capture, store, manipulate, analyze, manage, and present all types of spatial or geographical data.
Geographic information systems, remote sensing (RS) satellites and other environmental observing
technologies are providing researchers with the tools and the data to make clear the geographic
relationships between environmental habitats of disease vectors and agents and the occurrence of
disease. The responsible government bodies, health program managers, and other individuals can
effectively analyze the incidence and direct cause of illness if they get information directly from the
community spatially. GIS and RS have the capability to gather data to assess outbreaks of diseases,
pathogens, and environmental contaminants that adversely affect human health and watch and model
environmental and habitat changes. Therefore, FMoH has considered GIS as one big eHealth system
that must be scaled up in the health sector from the federal to the community level.

Intervention 2.A.4: Electronic laboratory information system (eLIS)

The eLIS is a nationwide laboratory service with the support of a well-developed, customized, quality,
and cost-effective electronic system. It is defined as a computer information system that manages
laboratory information for all the laboratory disciplines such as clinical chemistry, hematology,
microbiology, etc. Laboratory information is used for sending laboratory test orders to the instruments
through its instrument interfaces, tracking those orders, and then capturing the results as soon as they
become available.

Intervention 2.A.5: Electronic regulatory information system (eRIS)

An electronic regulatory information system automates the current paper-based regulatory information
system in the country and provides integrated and centralized licensing-related activities including the
issuing, renewal, suspension, and revocation of health sector licenses.

Intervention 2.A.6: Health data depot (HDD)

The HDD establishes a common digital working environment for all eHealth applications and facilitates
data exchange between different electronic systems based on data standardizations. This will make
data exchange and integration very efficient. HDD is a system that is used to collect, aggregate, and
analyze giant health data stores, coming from various sources of electronic health applications and
establishing one central database. The data will be archived to the central database and will help users
extract information using various data mining techniques and tools to depict the historical trends of
the health care delivery system. Eventually, this accumulated information and knowledge will help the
FMoH to retrospectively assess the state of the health system and revise the health policy of the
country.

36 Information Revolution Roadmap

Major activities

• Analyze different health data standards and recommend best alternative (Data Dictionary, HL7,
DICOM Standards, etc.)

• Identify the major challenges to the current system

• List the best solutions to address the identified problems
• Select best solutions
• Customize the system based on the current system
• Conduct software usability testing
• Select a demonstration site based on the prepared checklist by HITD and other responsible
directorates

• Deploy the system at the demonstration sites

• Collect feedback from demonstration sites and make amendments
• Scale up the system
• Prepare end user, technical, and other relevant documentation related to the system
• Continual follow up, support, and evaluation

Responsible Stakeholders

• Federal Ministry of Health

• Agencies
• Regional Health Bureaus
• Zonal Health Offices
• Woreda Health Bureaus
• Hospitals and health centers
• Partners
• Private companies

• MCIT and other ministries

Intervention 2.A.7: Data presentation tools and techniques

Many factors could be mentioned that undermine evidence-based decision making in the health system
of Ethiopia. The failure to present data to end users and decision makers in user friendly, accessible
formats affects the ease of using data in the decision-making process.

Many of the eHealth systems implemented in the country are not robust enough to present data or
information in an easy and suitable manner so that the end users (the public), managers, and decision
makers can make informed and timely decisions. This is one of the constraints that make the system
users reluctant to fully depend on it.
Information Revolution Roadmap
37
 The Federal Ministry of Health has identified the need to devise mechanisms that present health data
to different users in a helpful and timely manner.

Major Activities

• Identify existing gaps and constraints to data presentation

• Identify best methodologies and techniques in data presentation

• Adopt the best techniques to the Ethiopian context

Intervention 2.A.8: Electronic human resource information system (eHRIS)

The main objective of eHRIS is to provide managers with appropriate knowledge, information, and tools
to assist them in the management and development of their staff for effective delivery of service. eHRIS
includes data for personnel, payroll, and HR-related information. eHRIS is planned and developed to be a
web-based application that helps to harmonize the nationwide human resource information systems.
In time, information that is generated from eHRIS can eventually be used for budget management,
people management, learning development, workforce planning, and other important purposes.

Focus Area 2.B: Standards-based digital registries

Intervention 2.B.1: Master facility registry (MFR)

A Master Facility Registry (MFR) is a foundational component of a national health information system
(HIS) architecture that allows government agencies and partners to manage and share common health
facility identifiers and related metadata such as location, facility type, available equipment, and photos.
The use of shared facility identifiers are a prerequisite to harmonizing data across information systems
and essential to understanding the distribution of disease prevalence, health services, and resource
consumption and allocation throughout the health system. Without an authoritative source of health
facility information, systems collect and store separate lists of health facilities with divergent levels
of standardization, quality, and completeness, leading to incompatible datasets that are difficult to
harmonize.

The Master Facility Registry (MFR) will act as the central authority to collect, store, and distribute an
up-to-date and standardized set of facility data. The resulting standardized and current facility dataset
stored in the registry is called a master facility list (MFL). While these concepts are closely related, a
facility service can be understood as the technology that manages and shares facility data, and an MFL
is the standardized data stored in the tool.

Currently, stakeholders in Ethiopia’s health system use multiple, competing lists of health facilities
leading to incompatible datasets, but the building blocks are in place to converge on a single, authoritative
health facility list. An open-source, standards-based MFR could be initialized in Ethiopia that builds
off existing datasets and processes (ESPA+, SARA, eHMIS, etc.) and sets the stage for sustainable
governance, integration, and broad adoption of standard facility identifiers. Upon successful integration
of the MFR with other information systems, the FMoH will be able to change facility data once in the
central MFR, and the changes will be updated throughout all connected information systems. Other
38 Information Revolution Roadmap
countries, such as Tanzania, Kenya, and Rwanda have had success implementing similar services and
can serve as examples to guide the planning process in Ethiopia.

The goal is to implement the open-source Master Facility Registry (MFR) at the National Data Center
with up-to-date facility data (from SPA+ and other sources) to enable interoperability of facility-based
data across the health system.

Major Activities

• Investigate the existing system

• Identify the major challenges
• List the best solutions to address the identified problems
• Select best solutions
• Customize the system
• Conduct software usability testing
• Select demonstration site based on the prepared checklist by HITD and other responsible
directorates

• Deploy the system at the demonstration sites

• Collect feedback from demonstration sites and make amendments
• Scale up the system
• Prepare end-user, technical, and other relevant documentation related to the system
• Continual follow up, support, and evaluation

Responsible Stakeholders

• Federal Ministry of Health

• Agencies
• Regional Health Bureaus
• Zonal Health Offices
• Woreda Health Bureaus
• Hospitals and health centers
• Partners
• Private companies
• MCIT and other ministries

Intervention 2.B.2: Data dictionary and terminology management service

(TMS)
A terminology management service (TMS) is a shared resource to host, curate, and customize data
Information Revolution Roadmap
39
 dictionaries, which are libraries of definitions for health data and indicators. A TMS supports distributed
governance of published content, as well as facilitates harmonization of data across disparate sources
and information systems. Currently, there is no way for the FMoH and other coordinating partners to
publish terms and indicators in a way that lets them be harmonized, locally customized, and easily
pulled into common on-the-ground tools. Upon successful integration of the TMS, the FMoH will be
able to coordinate national level indicators and terminologies across disparate health programs (health
extension program, low-level facilities, referral hospitals, and HMIS indicators), to push new and edited
terminology changes to relevant stakeholders and other integrated HIS systems in a timely manner,
as well as develop local capacity and governance around terminology needs for Ethiopia. The approach
used in Ethiopia will utilize an open-source solution based on similar solutions in other Sub-Saharan
countries and will begin by developing data dictionaries based on the existing HMIS indicator definitions
and the adapted ICD-10 disease classifications.

Major activities

• Analyze the current environment for indicator and data definitions

• Prepare data dictionary based on HMIS indicator definitions and ICD-10 disease classifications
• Assess existing governance models for HMIS indicator definitions
• Configure and deploy the TMS in Ethiopia beginning with the developed data dictionaries
• Support the validation of developed data dictionaries (e.g., ICD-10 disease classification pilot)
• Integrate the TMS with key HIS
• Support planning for the expansion of the TMS, integration into other HIS, and development of
additional data dictionaries

Focus Area 2.C: Point of service health information systems

Intervention 2.C.1: Electronic medical/health record (EMR/EHR)

The Electronic Medical Record is a computerized patient tracking and patient caring system. To bring
the Information Revolution to ground through ICT, the health sector needs to have comprehensive and
robust medical recording systems in all health facilities which captures all patient histories and related
transactions confidentially. This will give significance to the HMIS because a routine patient record will
be available in the EMR. Therefore, the Ministry intends to implement EMR in all hospitals and health
centers to convert the entire medical recording system from manual to digital.

Intervention 2.C.2: Telemedicine and tele-education (TM, TE)

In order to address the challenges of accessible and quality health care delivery, and also to drastically
increase the number and quality of medical professionals in the country, the FMoH would like to scale
up the implementation of various TM and TE initiatives which make possible the success of the Health
Sector Transformation Plan (HSTP).

40 Information Revolution Roadmap

Major Activities

• Roll out telemedicine services to all hospitals in the country

Intervention 2.C.3: Mobile health (mHealth)

This intervention is the use of mobile phones and other wireless technology in the health system. Mobile
phones can be used for referrals, training and education, supply chain management, data exchange,
decision support during patient consultations, and information reference. Using mobile coverage and
expansion as an opportunity, mobile phones and technologies can also be considered as a major
mechanism to bring health services, education, and data exchange to the community living in both rural
and urban areas. The Ministry is eager to scale up and explore innovative mobile health technologies
that help create accessible, quality, and equitable health services.

Intervention 2.C.4: Electronic community health information system (eCHIS)

The Health Extension Program (HEP) is at the heart of Ethiopia’s health system, which has been delivered
by 16 health packages together with the Family Folder. HEP is an effort towards the development of
a family-oriented approach to the solving of health problems and to the organization of health care
services. It is the health information management system that adopted the family as a unit for provision
of health services and maintenance of records. HEP has been delivered to the community using paper,
and the use of paper combined with limited capacity at health posts limits data recording, collecting,
organizing, handling, and managing of Family Folders as a whole. Therefore, to mitigate these challenges
and strengthen this system, we can reach out to many households, digitize this information in eCHIS,
and plug it into the national eHealth systems, making broader use of it. Thus, Health Extension Workers
(HEW) are the major and frontline users of this system. By providing the Health Extension Workers a
modern and appropriate electronic system, we can make the health system delivery and equity more
efficient and also help to address one of the goals of HSTP that is primary health care coverage.

Intervention 2.C.5: Electronic logistics management information system

(eLMIS)
The eLMIS is an automation of the Supply Chain Management System (SCMS) of the health sector. It
will facilitate and manage the end-to-end process of SCMS, such as usage of all medical equipment
and drugs, procurement, distribution, functional status of medical devices, and drug stock-out including
expiration dates. Using this system, it is also possible to determine which health facilities are partially
equipped, fully equipped, and not-equipped. Therefore, by deploying this electronic system we can create
non-abused, fair distribution of medical equipment and drug resources and monitor their condition for
maintenance and/or replacement and future planning.

Information Revolution Roadmap

41
 Selecting and Establishing Information
Revolution Demonstration Sites
The main objectives of the Information Revolution demonstration sites are to test and refine approaches,
to inform scale-up plans through identification of best practices and lessons learned, and to evaluate
progress towards achieving the goals of the Information Revolution. The demonstration sites will focus
on how the Information Revolution focus areas and interventions apply to and benefit health workers
and patients at the front line.

While demonstration sites will be selected at multiple levels of the health system (e.g. secondary and
tertiary hospitals, regional health bureaus), the Connected Woreda sites will serve as the primary
targets for demonstrating the value of the Information Revolution at the ground level. Specifically, the
Connected Woredas will be used to test and refine how, where, and for whom the cultural change and
data use objectives of the Information Revolution will be applied to frontline workers, while providing
actionable information to stakeholders at higher levels of care or administration. The woreda focus
incorporates the primary health care unit, consisting of woreda health offices, general hospitals,
health centers and health posts, which aligns with the transformation agenda priority of leveraging
investments to improve quality and equity of service delivery, in part through optimizing data use by
frontline workers.

The demonstration site selection criteria will be developed and tailored to the purpose of conducting
the Information Revolution agenda. As the Revolution focuses on model site creation, the different
contexts should be considered to ensure the full agenda is achieved. The availability of ICT infrastructure,
connectivity, the status of HMIS and M&E systems in the region and administrative structures will be
used to define regional context. Demonstration site selection criteria will also consider the minimum
requirements of each administrative and service unit in order to enable successful implementation of
the Information Revolution agenda.

The Connected Woreda demonstration sites will be carefully selected according to relevant criteria. At
these demonstration sites, eHIS interventions coupled with training and capacity building for health
workforce professionals will allow for high quality data to be used to drive improvements in health
service delivery within the selected woredas. Success within these demonstration sites will help to make
the case for investments to scale-up the Connected Woreda model nationally. A detailed design and
implementation strategy for the demonstration of Connected Woredas will be developed in alignment
with Information Revolution plan priorities and focus areas.

Documenting the lessons from the Connected Woreda and other demonstration sites, the Information
Revolution agenda will be rolled out to the rest of the woredas in phases. Considering the fact that
implementation of any new system is certain to involve different challenges in different contexts and
optimal utilization of resources, woredas that are selected for the woreda transformation agendas and
all health facilities within will be considered for the demonstration sites.

42 Information Revolution Roadmap

Major activities

• Design the strategic implementation plan for demonstration sites for each level of the health
system, including the Connected Woreda

• Develop selection criteria for each type of demonstration site, including the Connected Woreda
• Select demonstration sites
• Implement the strategic implementation plan
• Conduct monitoring and evaluation activities and document lessons learned to assess successes,
challenges, and to inform and refine scale-up plans

• Develop scale-up plans

• Scale up to the other sites

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43
 Governance of the Information
Revolution
Coordination of HIS activities undertaken by various stakeholders is critical to the achievement of the
Information Revolution objectives. To facilitate this coordination, the MOH will establish a governance
structure for the national HIS and Information Revolution that will ensure alignment of HIS activities
with health system strategies, provide leadership and oversight of the execution of the Information
Revolution, oversee development and adoption of standards and guidelines for eHealth implementation,
direct HIS investments towards the iterative development of a national HIS architecture, manage
communications of the Information Revolution and other HIS activities, and enable ongoing dialogue
and coordination with other constituencies. The stakeholders involved include governmental agencies,
including statistical agencies such as the Central Statistical Agency (CSA), non-governmental
organizations, the private sector, civic societies, and prominent individuals.

The governance mechanism will also promote the design and implementation of HIS solutions that
strengthen the cultural transformation in data use and local capacity through the establishment of
principles for HIS development. The principles will encourage local ownership of solutions and data,
building for scale-up and sustainability, protection of patient privacy and confidentiality, adoption of
standards-based and open-source solutions, and designing solutions with the input of patients and
users.

Major Activities

• Formalize governance structure that encompasses all health system levels

• Establish and coordinate intra- and inter-sectoral linkages
• Monitor and evaluate the implementation of the HIS strategic plan
• Prepare and obtain signature of the partnership protocols
• Monitor and evaluate of the implementation of the partnership protocols
• Set standards, guidelines and procedures on the procurement, design and implementation of HIS
infrastructure and solutions

• Set ethical standards in health information access to protect patient privacy and security
• Determine and carry out capacity building priorities and mechanisms to enable sustainable
operation of HIS solutions

• Direct selection and implementation of Information Revolution demonstration sites

44 Information Revolution Roadmap

Table 2: Key Stakeholders for Governance of Information Revolution

Group Responsibilities Composition

Health Sector • Gives overall direction High level management,
leadership including the Minister,
• Secures resources
• Assists with resolution of major issues, state minister, or council of
problems, conflicts, and other challenges directors

• Sets the overall vision and strategic

direction
• Guides the vision and planning process
• Approves and endorses the national
eHealth vision and carries out strategic
recommendations
Steering committee • Produces detailed Information Revolution Representatives from the
(IR) implementation plan concerned directorates of
• Makes decisions at key stages of the the FMoH, including PPD,
project HITD, etc.

• Makes follow up on the implementation of

the IR
• Oversees the overall progress of the IR plan
and approves changes to scope or approach
Stakeholders • Own and incorporate the IR plan into their Ministry of Education,
plan and work towards its success Ministry of ICT, INSA ,health
• Provide recommendations and guidance on professional associations,
the implementation of the IR academic & research

• Review the implementation of the IR and institutions, regional health

provide feedback bureaus, private health

institutions, health ICT
• Asses opportunities and gaps of the IR
vendors, media
• Provide recommendations
Partners • Provide assistance (technical, financial, NGO’s, development
etc.) during the development and partners, international
implementation of the IR organizations, etc.
• Provide insight into the system and advice
at all the stages of the implementation
process
• Provide lessons from similar international
programmes and projects

Information Revolution Roadmap

45
 Performance Measures

Table 3: Information Revolution Performance Measures

Pillars Focus Areas Interventions Performance Measures

Pillar 1: Cultural 1.A. Data for 1.A.1. Strengthen · Conduct facility census every 3 years
transformation service delivery, availability, readiness, · Conduct facility survey every year
for health data coverage, and quality, use, and
use equality transparency of · 100% of expected reports from
service data reporting units complete and on-
time
· Produce a health system
performance assessment report
· Increase proportion of health
facilities that conduct lots quality
assurance sampling (LQAS) from 36%
to 85%
· 100% implementation of community
score card
    1.A.2. Increase the · Produce annual report on the state
availability and quality of inequality in service coverage
of service coverage using routine facility service data
data · Increase woredas performing equity
analysis as per standard to 90%
· Increase health facilities that
implement measurement of service
quality to 90%
    1.A.3. Create data · Establish functional PMT in all
comparability and facilities
synthesis across · Develop data access protocols for
multiple information users
sources
    1.A.4. Improve · Improve population measurement
population data and by producing annual small area
coverage estimates estimate reports
  1.B. Strengthen 1.B.1. Strengthen · Increase coverage of birth
programmatic programmatic birth registration
birth and and establish linkage · Implement standardized death
establish with civil registration report with all public and private
linkage with civil and vital statistics health providers
registration and system (CRVS)
vital statistics · Publish annual vital registration
system (CRVS) statistics report disaggregated to
woreda-level including cause of
death

46 Information Revolution Roadmap

Pillars Focus Areas Interventions Performance Measures
  1.C. Strengthen 1.C.1. Strengthen · Establish health information, ICT,
health workforce human resources for and M&E competency requirements
capacity and health capacity to for each cadre of health workers
motivation effectively use ICTs
  to collect, 1.C.2. Design and · Implement at least one information
analyze, and use implement information workflow to maximize data use for a
information at workflows to maximize priority health system challenge
the frontline and data use
program level
  1.D. Surveillance 1.D.1. Strengthen public · Produce two burden of diseases
and response health emergency analysis reports during the HSTP
management data period
quality and integrity
    1.D.2. Reinforce data · Publicly release at least one
transparency and additional public health dataset on a
openness standard platform supporting digital
and other formats
  1.E. Patient 1.E.1. Promote and · Develop patient safety standards
safety and build comprehensive and guidelines, and conduct national,
response patient safety culture regional and hospital level patient
that is open and fair safety baselines and trainings
for sharing information
and ensuring lessons
are learned
    1.E.2. Strengthen and · Implement a national patient safety
improve transparency incidence reporting system
of patient safety
· Produce patient safety reports twice
surveillance and
each year
patient safety incident
reporting system
    1.E.3. Learn and share · Conduct annual patient safety
safety lessons and review meetings at national,
encourage staff to regional, and facility level
learn how and why
incidents happen
    1.E.4. Build leadership · Appoint and capacitate a safety
and knowledge to manager at 100% of hospitals and
improve patient safety health centers
culture and incident
reporting
  1.F. Patient 1.F.1. Raise public · Incorporate ICTs into health
engagement awareness through ICT awareness campaign strategies to
and awareness increase coverage and effectiveness
raising
    1.F.2. Increase · Develop and implement a
transparency of health sector transparency and
information flows and accountability guideline
promote accountability

Information Revolution Roadmap

47
 Pillars Focus Areas Interventions Performance Measures
Pillar 2: 2.A. National 2.A.1. Electronic · Implement FMOH-governed eHMIS
Digitalization health health management in 100% of health administration
and scale-up of information information system offices (regions, zones, woredas) and
priority health systems (eHMIS) in 100% of public and private health
information facilities
systems   2.A.2. Electronic
  integrated financial
management
information system
(eIFMIS)
    2.A.3 Health · Design and implement HGIS solution
geographic information
system (HGIS)
    2.A.4. Electronic · Implement eLIS solution throughout
laboratory information the country
system (eLIS)
    2.A.5. Electronic · Design and implement eRIS solution
regulatory system
(eRIS)
    2.A.6. Health data · Implement a data warehouse
depot (HDD) hosted by the MOH and integrated
with multiple priority data sources
· Achieve interoperability of priority
data sources in alignment with
the national health information
enterprise architecture
    2.A.7. Data · Design and implement
presentation tools and infrastructure to enable the
techniques presentation and dissemination of
priority sets of health information
    2.A.8 Electronic human · Implement eHRIS in all regions of
resource information the country
system (eHRIS)
  2.B. Standards- 2.B.1. Master facility · Establish authoritative master
based digital registry (MFR) facility registry governed by the
registries MOH
· Integrate and harmonize facility
identifiers with the MFR in the
eHMIS and other priority HIS
    2.B.2. Data dictionary · Produce harmonized data
and terminology dictionaries for the HMIS, disease
management service classifications, and other priority
(TMS) datasets
  2.C. Point of 2.C.1. Electronic · Design and implement EMR solution,
service health medical/health records develop implementation plan, and
information (EHR/EMR) initiate rollout into public hospitals
systems and health centers
    2.C.2. Telemedicine and · Implement telemedicine in 100% of
tele-education (TM, TE) public hospitals

48 Information Revolution Roadmap

Pillars Focus Areas Interventions Performance Measures
    2.C.3. Mobile health · Design and implement mHealth
(mHealth) solution
    2.C.4. Electronic · Design and implement eCHIS
community health solution throughout the country
information systems
(eCHIS)
    2.C.5. Electronic · Implement eLMIS solution
logistics management throughout the country
information system
(eLMIS)

Information Revolution Roadmap

49
 Action Plan
Table 4: Information Revolution Action Plan

Pillar 1: Cultural transformation for health data

1 Yearly Target  Estimated
use
USD
yr 1 yr 2 yr 3 yr 4 yr 5
Focus Area 1.A: Data for service delivery,
 1.A
coverage, and equity
  Interventions and Activities  
Strengthen the availability, readiness, quality,
1.A.1  
use, and transparency of service data
Identify data elements to be collected during
   
the census

  Conduct facility census every 2-3 years x

3,000,000

  Conduct facility survey every year x x x x

600,000

  Produce regular reports x x x x x

-
Triangulate the data with different sources and
  x x x x x
produce analytical reports -
Present data for decision makers and users at
  x x x x x
every level -
Increase the availability and quality of service
1.A.2
coverage data -
Prepare and implement integrated data
  x
management protocol -
Strengthen implementation of HMIS in private
 
health facilities -
Conduct regular HMIS mentoring to health
  x x x x
facilities -
Strengthen routine data quality assessment at
 
all levels -
Conduct regular HMIS mentoring to health
  x x x x
facilities 454,240

  Training x x x x
617,500

  Conduct RDQA x x x x
220,000
Strengthen health quality and equity
 
monitoring -
Institutionalize measurement mechanism for
  x x x x
service quality improvement -
Integrate service quality measurement in to
  x x x x
M&E system -

50 Information Revolution Roadmap

  Produce state of inequality report x x x x
-
Strengthen regions and woredas to conduct
 
action oriented research/ M&E -

  Conduct training on operational research x x

217,470
Conducting equity-oriented study/survey every
 
year -
Conduct baseline assessment and produce
  x x x x
initial report 81,420

  Develop standard for evaluation x

-

  Institutionalize evaluation methodologies

-
Conduct workshop on evaluation
  x x
methodologies 346,815
Create data comparability and synthesis across
1.A.3
multiple information sources -
Improve advanced analytical skills (in-depth
 
analysis, data mining) -

  Conduct training for data managers x x

2,098,866

  Mentor staff x x x x x
-
Conduct regular self-assessment (PMT
  x x x x
establishment & functionality) -

  Enhance accountability scorecard at all levels x x x x

-

  Train staff x x
1,761,125

  Strengthen decision support system x x x x

-

  Develop integrated platform

-

  Develop data access protocols for users x

-
Strengthen geospatial data generation,
  x x x x
analysis, and use -
Improve data triangulation mechanism from
  x x x x
different data sources -
Pool health and health-related studies raw
  x x x x
data -
Improve population data and coverage
1.A.4
estimates -
Strengthen home-based records and improve
 
ownership of community data -
Design different systems for urban and
 
pastoral communities -

Information Revolution Roadmap

51
 Promote biometric-type recording system for
 
mobile population -
Establish community name-based recording
 
and tallying mechanism -
Establish community jury to facilitate
  x x x x
performance review -
Develop standard HDA recording and reporting
  x x x x
tools to ensure compatibility with CHIS -
Conduct capacity-building training of HDA on
  x x x x
M&E -

  Ensure competency on data literacy x x x x

-

  Produce small area estimate

-

  Adopt manual for the small area estimate x x x x

-

  Train staff x
65,250

  Conduct estimate survey x x x x

81,420
Focus Area 1.B: Strengthen programmatic birth
 1.B and establish linkage with civil registration and
-
vital statistics system (CRVS)
Strengthen programmatic birth and establish
1.B.1 linkage with civil registration and vital statistics
-
system (CRVS)
Develop standard form for death report (adopt
  international certificate of death for public and x
-
private health facilities)
Conduct orientation and disseminate the
standardized death report form to all public
  and private health care providers, VHSG, and x x
979,225
local authorities, and ensure providers know
how to fill the Standard Death Report
Develop tool for assessing completeness of
  vital registration at national and sub-national x x
402,720
levels.
Conduct training on vital data processing and
  x x
analysis at all levels of the health system -
Publish annual vital registration statistics,
disaggregated to woreda (including causes
  of death), and distribute to all concerned x x x x
10,000
institutions at central, regional, and woreda
levels in collaboration with VERA
Introduce and provide training in ICD-10 coding
  x x
and verbal autopsy -
Focus Area 1.C: Strengthen health workforce
capacity and motivation to collect, analyze, and
1.C
use information at the frontline and program -
level

52 Information Revolution Roadmap

 Strengthen human resources for health
1.C.1
capacity to effectively use ICTs -
Ensure adequate staffing of each level of the
 
health system with appropriate M&E personnel -

  Train HIT professionals x x x x x

6,412,500
Enhancing HIS staff career development
 
opportunities -
Improve the capacity of health professionals,
  x x
M&E personnel, and health managers -
Ensure the pre-service curriculum includes
  training of health professionals on routine
-
health information, eHealth, and M&E system

  Conduct workshop on curriculum revision x

14,510

  Strengthen training centers at regional level

-
Provide equipment (computer, LCD, and
  x
furniture) 675,750

  Provide Training of Trainers trainings x

27,299
Design and implement information workflows
1.C.2
to maximize data use

1.D Focus Area 1.D: Surveillance and response

-
Strengthen public health emergency
1.D.1
management data quality and integrity -
Ensure that data collected is of sufficient
detail to inform and promote evidence-based
  policy making at every level (e.g., disaggregated x
-
across dimensions based on their relevance to
the program, policy, or other)
Strengthen the disease surveillance system
  by introducing and expanding relevant data x x
-
collecting tools such as cancer registries
Review and revise the existing framework for
  x x
quality assurance -
Introduce appropriate information technology
  x x
to improve data timeliness -
Strengthen the disease surveillance system in
  x x
private health facilities -
Strengthen health workforce capacity and
  x x x x x
motivation to collect quality data -

1.D.2 Reinforce data transparency and openness

-
Develop an integrated, centrally managed
  electronic network that provides access to x x
-
national, state, and local information systems

Information Revolution Roadmap

53
 Use a data system that helps to provide
  x x x x
services to the public -

1.D.3 Advance information-use culture

-
Make the timing of evidence generation
strategic so that timely, quality, and relevant
  x
data needed to fulfill needs at country, regional, -
and global levels will be used
Strengthen health workforce capacity and
  x
motivation to collect, analyze, and use data -
Determine data use and dissemination
  x
standards -
Support selected zones to meet a minimum set
  x
of surveillance capabilities -
Redesign program-specific data systems into
  x
integrated systems -
Implement a data management system that
meets local needs in systematic collection,
  x
analysis, and monitoring of standardized -
baseline data
Employ technical assistance to ensure a high
  standard of data analysis, dissemination, and x x x x
-
communication

 1.E Focus Area 1.E: Patient safety and responses

-
Promote and build comprehensive patient
1.E.1 safety culture that is open and fair for sharing
-
information and ensuring lessons are learned
Establish national patient safety forum/team
  that will work hand-in-hand with the national x
-
quality forum
Establish/strengthen national drug advisory
  x x x x x
committee -
Adopt/standardize patient safety standards,
  x x
definitions, checklists, guidelines, survey tools -
Organize national level TOT on patient safety
  x
and patient safety assessments 33,526
Organize regional level TOT on patient safety
  x
and patient safety assessments 407,975

  Conduct hospital-level patient safety training x x x x

-
Undertake hospital-level baseline assessment
on patient safety and patient safety culture
  x
and produce baseline report of referral 34,440
hospitals for FMoH
Undertake hospital-level baseline assessment
  on patient safety and patient safety culture x
-
and produce baseline report by hospital

54 Information Revolution Roadmap

 Strengthen and improve transparency of
1.E.2 patient safety surveillance and patient safety
-
incident reporting system
Identify and agree on reportable incidents (e.g.,
  x
adverse event, near miss, error) -
Design, print, and distribute register/logbook,
  x
reporting form, related guidelines/protocols 7,800
Establish reportable incidents reporting
  system, database, and learning center for x
-
reporting patient safety incidents.
Design and deploy interoperable patient
safety incidents (adverse event, near miss, and
error) reporting system and data exchange
  platform at health facilities (hospitals and x
-
health centers) level and link to the regional
and national reporting and learning system for
reporting patient safety incidents
Record and report incident (complication,
  adverse event, near miss, or error) as it is x x x x
-
recorded/reported by each department
Investigate and analyze each observed or
  reported incident (complication, adverse event, x x x x
-
near miss, or error)
Prepare and submit regular patient safety
  x x x x
reports to executive - twice a year -
Learn and share safety lessons, and encourage
1.E.3
staff to learn how and why incidents happen -
Organize root cause analysis (RCA) and auditing
  x
training course for professionals (National TOT) -
Organize root cause analysis (RCA) and auditing
  x
training course for professionals (Regional TOT). -

  Hospital-level training on RCA and clinical audit x

-
Conduct annual review meetings on patient
 
safety at: -

  National level 1 1 1 1
100,520

  Regional level 1 1 1 1
250,000

  Facility level 2 2 2 2
-
Conduct operational research/assessments on
  x x x x
patient safety and patient safety culture -
Build leadership and knowledge to improve
1.E.4
patient safety culture and incident reporting -
Ensure that all hospitals and health centers
  x x x x
have appointed a Safety Manager -
Appoint a Safety Champion for each unit/
  x x x x
department of each hospital/HC -
Information Revolution Roadmap
55
 Organize special trainings on data quality and
  x x x x
patient safety for hospital and HC leadership -
Institutionalize Leadership Walk Rounds by
hospital Medical Director on patient safety and
  x x x x
follow up meetings with the staff on weekly -
basis without interruption
Organize awareness creation meetings on
  patient safety at hospital and health center x x x x
-
level
Institutionalize and strictly implement weekly
  x x x x
meeting on patient safety at each department -
Organize in country and out of country
  x x x x
experience-sharing tours -
Focus Area 1.F: Patient engagement and
 1.F
awareness raising -

1.F.1 Raise public awareness through ICT

-
Increase transparency of information flows and
1.F.2
promote accountability
Pillar 2: Digitalization and Scale-up of Health
2 Yearly Target  Estimated
Information Systems
USD
yr 1 yr 2 yr 3 yr 4 yr 5
- ICT infrastructure assessment 50,000
Conduct a review on the existing ICT
infrastructure to implement the eHealth x x  
initiatives
Produce a list of ICT equipment and
x x  
infrastructure needs
ICT infrastructure procurement and
- 205,612,300
deployment
Deploy LAN/WAN at 50% of HCs, hospitals,
universities, WorHO, ZHB, RHB, agencies and x x  
FMoH
Produce RFP/bid document x x  
Float bids x x  
Procure the items x x  
Deploy the items x x  
Work with ETC to lay telecom infrastructure x x  
ICT training for HEWs, HIT personnel,
10,191,000
physicians, etc.
Recruit personnel x x  
Provide the necessary training x x  
Implement Electronic Medical/Health Record
2.C.1 23,809
(EMR/EHR) at all hospitals and health centers
Evaluate the existing system x  
Identify gaps (software, resource, personnel) x  
Customize the existing/new application x  
Provide training to end users x x  

56 Information Revolution Roadmap

 Procure ICT equipment x x  
Deploy  
Support & maintenance x x x x  
Implement Electronic Health Management
2.A.1 Information System (eHMIS) in all health 47,619
facilities
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x  
Customize the existing/new application x  
Provide training to end users x  
Procure ICT equipment x  
System deployment x  
Support & maintenance x x x x  
Implement the approved Health Information Included in
-
System eHMIS
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x  
Customize the existing/new application x x  
Provide training to end users x  
Procure ICT equipment x  
System deployment x  
Support & maintenance x x x x  
Implement Electronic Community Health
2.C.4 238,095
Information System (eCHIS)
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x x  
Customize the existing/new application x x  
Provide training to end users x  
Procure ICT equipment x  
System deployment x  
Support & maintenance x x x x  
Implement Telemedicine and Tele education
2.C.2 928,571
(TM & TE)
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x x  
Customize the existing/new application x  
Provide training to end users x  
Procure ICT equipment x  
Information Revolution Roadmap
57
 System deployment x  
Support & maintenance x x x x  
2.C.3 Implement Mobile Health (mHealth) 3,719,285

Assess the current/existing situation x  

Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x x  

Customize the existing/new application x x  

Provide training to end users x x  

Procure ICT equipment x  

System deployment x  

Support & maintenance x x x x  

Implement Electronic Human Resource
2.A.8 Information System (eHRIS) in all regions of the 238,095
country
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x x  
Customize the existing/new application x  
Provide training to end users x  
Procure ICT equipment x  
System deployment x  
Support & maintenance x x x x  
Implement Health Geographic Information
2.A.3 1,100,000
System (HGIS)
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x x  
Customize the existing/new application x  
Provide training to end users x  
Procure ICT equipment x  
System deployment x  
Support & maintenance x x x x  
Implement Electronic Logistic Management
2.C.5 238,095
Information System (eLMIS)
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x  

58 Information Revolution Roadmap

 Customize the existing/new application x  
Provide training to end users x  
Procure ICT equipment x  
System deployment x  
Support & maintenance x x x x  
Implement Electronic Laboratory Information
2.A.4 238,095
System (eLIS)
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x x  
Customize the existing/new application x  
Provide training to end users x  
Procure ICT equipment x  
System deployment x  
Support & maintenance x  
Oversight x x x x  
Implement Electronic Regulatory Information
2.A.5 238,095
System (eRIS)
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x x  
Customize the existing/new application x x  
Provide training to end users x  
Procure ICT equipment x  
System deployment x  
Support & maintenance x x x x  
2.A.6 Implement Health Data Depot (HDD) 952,380
Assess the current/existing situation x  
Lay out leadership and implementation
x  
guidelines
Identify gaps (software, resource, personnel) x x  
Customize the existing/new application x  
Provide training to end users x  
Procure ICT equipment x  
System deployment x  
Support & maintenance x x x x  
2.A.7 Data presentation tools and techniques
2.B.1 Master facility registry
Data dictionary and terminology management
2.B.2
service (TMS)
  Total 242,715,809

Information Revolution Roadmap

59
 Appendix
Implementation of the Information Revolution Plan at the Regional
Level
The Information Revolution Plan was developed by the Federal Ministry of Health, with contributions
from the Regional Health Bureaus. Each Regional Health Bureau (RHB) is responsible for creating a plan
for implementation of the Information Revolution at the regional level, ensuring alignment with the
framework of the national strategy.

Key Stakeholders

The Regional Information Revolution (RIR) Plan shall include a detailed action plan, adapted to the unique
context of each region. The regional directors will gather at the Planning Forum, along with key repre-
sentatives from the FMoH PPD, and key stakeholders will have the chance to provide further inputs to
the RIR Plan. PPD at the regional level are responsible for the development of the RIRs. Engagement
and participation of sub regional level representatives, development partners and the private sector
representatives is essential during the planning process. The RIR will be approved by the RHB head and
execution can commence.

The key stakeholders involved with this planning process shall be as follows:
Table 5: Stakeholder Responsibilities for the RIR Planning Process

Stakeholder Group Responsibilities

Regional Health Bureau ● Responsible for leading the planning process, in consultation with
Policy and Planning the FMoH PPD, and through engagement with local agencies and
Directorate (RHB PPD) partners
National Advisory ● Led by the FMoH PPD, and including key partners focused on
Committee (NAC) health sector strengthening in Ethiopia, they will be responsible for
supporting the RHB PPDs, and ensuring alignment with the national
level Information Revolution Plan
Performance Monitoring ● These teams, at the national and regional level, shall be engaged with
and Evaluation teams the design of the M&E framework for the RIR plans
RHB HIT representatives ● HIT shall have oversight of IT infrastructure and responsibly for
management of systems in support of the Information Revolution
Zonal Health Office ● Administrators from the ZoHO and WorHO, who will be involved with
(ZoHO) and Woreda the collection, reporting and consumption of data, will contribute
Health Office (WorHO) their recommendations from the user perspective, to enhance local
representatives ownership of health information
Private sector ● Engagement and participation during the development and
associations implementation of the RIRs

60 Information Revolution Roadmap

Ongoing Monitoring and Evaluation of Regional Information Revolution Plans

Once established, the performance of the RIR Plan shall be assessed according to the Monitoring and
Evaluation frameworks that were created within each plan. The regional M&E framework will serve as
a supplement to the performance measures defined in the national Information Revolution and the
Health Sector Transformation Plans. The regional M&E process will follow mechanisms that currently
exist, as guided by the Health Sector Monitoring and Evaluation Strategic Plan 2016-2020.1

The RIR Plan will leverage existing periodic performance monitoring meetings that take place quarterly,
biannually and annually. These review meetings occur at all levels based on the RHB’s own self-
assessment and will be used to determine actions needed to ensure achievement of the national
Information Revolution Plan. According to the HSDP Harmonization Manual (HHM), there are different
participatory review meetings at different levels:

● Central joint steering committee;

● FMoH development partners joint consultative meeting;
● Joint core coordinating committee;
● FMoH-RHB joint steering committee; and
● Annual Review Meeting (ARM)

Each of these review meetings shall be scheduled along a consistent timeline, to ensure that performance
is assessed in an ongoing way. Meeting results will be documented and shared between RHBs. This will
inform improvements that need to be made, and will also allow for higher performing regions to support
regions that are experiencing challenges. Knowledge sharing and reapplication of experience narrows
the performance difference and enhances Ethiopia’s progress to realizing the goals of the Information
Revolution.

In addition, both the National IR Roadmap (NIRR) and the RIRs should be further technically monitored
through partnership and technical forums such as:

• The National Policy and Planning Forum .

• National Advisory Committee and M&E Technical Working Group.
• Regional Planning forums
• Regional Performance Review Team
• Regional M&E partners forum

The status of implementation of the NIRR and the RIR plans will be monitored according to the
Monitoring and evaluation framework which is prepared in line with the M&E strategy. Regular M&E
review meetings are also among the mechanisms where implementation is monitored.

1 FMoH Monitoring and Evolution Strategic Plan, 2015-2020, p.12-13: Performance Monitoring

Information Revolution Roadmap

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Ethiopian Federal Ministry of Health

62 Information Revolution Roadmap