The Study on Improvement of Management Information Systems

in Health Sector in the Islamic Republic of Pakistan

District Health Information

System (DHIS) Design

Steering Committee Meeting, Islamabad

29 August 2005
 Outline of Presentation
Rationale
Objective of DHIS
DHIS Specifications
Pilot testing DHIS
 Rationale for DHIS
After devolution, decision-making and resource
management authority transferred to districts
District responsible for improving health services
from 1st and 2nd level facilities & outreach
Strengthening the Districts for managing their
health systems is a priority
Thereby, improving HIS to respond to the
information needs of the Districts is a priority
 Objective of DHIS
Overall objective:
To provide information for management
and performance improvement of primary
and secondary healthcare services
provided by the public health sector at
district level
 Specific objectives:

Provide necessary information for monitoring the

performance of district health system by
incorporating selected key information from
HMIS/FLCF, vertical programs and support-
systems at district level
Cater to the important routine health information
needs of the federal and provincial levels for
monitoring policy implementation
DHIS incorporates selected key data
from existing HISs

Data/information
from HMIS/FLCF
and 2nd hospital

Data/information
DHIS from VPs-MIS

Data/information from
HIS sub-systems
 System Specification

DHIS is a routine health information system

responds to the information need of the District health
systems performance monitoring function

DHIS provides minimum set of indicators

for monitoring of health services from
First and Secondary level facilities,
Outreach

The DHIS indicators are not an exhaustive list of all

possible indicators
Provide readily understandable indication of positive or
negative deviances
System Specification DHIS Indicators

DHIS has 79 indicators

The selection process has been consultative using specific
criteria like relevance, importance, specificity, feasibility,
utility.
Grouped into 8 broad categories
Service delivery: 14 preventive; 38 curative
Utilization: 13
Financial management: 3
Logistics: 1
Human resources: 2
Capital assets: 6
Private sector regulation: 1
Information system performance: 1
Comparison between DHIS and HMIS/FLCF

DHIS HMIS/FLCF
79 indicators (66 similar to 111 indicators
those in HMIS/FLCF)
Cover both outdoor and Outdoor and outreach
indoors, as well as outreach
Only 1st level
(vertical programs)
(introduced in 2nd level
1st and 2nd levels with different using same format)
instruments according to its
specialization
HMIS/FLCF required to
DHIS from RHC requires to
capture 446 variables
capture140 variables
System specification Data flow and use
Data
DataFlow
Flow Activity
Activity

International International review of

organizations performance vs. policy standard
feedback
Information
Federal review of performance
Federal
vs. policy standard
feedback
feedback
Information
Province Provincial review of
performance vs. policy standard
feedback
feedback Information
District District performance review
feedback
feedback
Information
Facility Facility performance review
feedback
feedback
assessment of own performance
Data collector
data
(care provider)
System specification- Data Quality Assurance 1

Quality of data by DHIS

Reduce data burden at collection points
Revision of FLCF data collection and reporting
instruments
Upgrade software for data compilation and analysis
ICT unit at district
Introduction of data quality assurance procedures
(e.g., LQAS), and data cross check at all levels
System specification- Data Quality Assurance 2
Data handling steps Interventions Weaknesses

A part of raw data to Reports to concerned

provincial database authorities

Data processing
- presentation 1. Upgrade software;
- analysis (computation) Outdated software with
at district

2. Introduce data
- add to database limited capacity for
quality check;
- data check (LQAS)
3. Introduce data cross flexible data presentation
- data consistency
(for data in DHIS and VPs) check
- data entry

Data transfer

New step to improve Data accuracy

Data check (LQAS)
facility to district

accuracy of compilation

Simplify forms Complex forms

Data compilation

Reduce amount of data Data burden

compiled

Revise FLCF registers Complex procedures

Data collection
Add hospital registers Data coverage limited to
FLCF
System Specification- Continuous Use of
Information
Strengthening District HMIS cell/ICT unit
Strengthening EDOH functions for
performance improvement using DHIS
information
Strengthening Facility functions
Enhancing staff/managers knowledge and
skills (capacity building)
 DHIS Design Synthesis
Provincial & Federal level Data Review

SYSTEMS FOR CONTINUOUS USE OF INFORMATION

for Monitoring Policy Implementation
SYSTEMS FOR DATA QUALITY AT ALL LEVELS

Transfer need-based Data for Monitoring Feedback

(LQAS, CROSS DATA CHECK)

District level Data Review for

Performance Monitoring

Analyzed Data Presentation Tables, Graphs, Bar Charts

Self-improvement of Data Quality (LQAS, Data Cross Check)
Substantial Feedback to lower levels for Performance Improvement

District ICT

Rationalize Collection of Data, Limited Performance Indicators

Short Feedback Loop Performance Monitoring

RHIS VPs HISs Hospital MIS Sub-systems HISs

 Benefits of DHIS Design
Caters to management needs of devolved
district health system
Enhanced coverage for performance monitoring
FLCF, Secondary Hospitals, Vertical Programs, & HIS
sub-systems, viz. logistics, financial, human resource,
capital assets MISs
Flexibility to evolve for future information needs

Improved data quality assurance procedures at

all levels
 Benefits of DHIS Design 2
Continuous use of information at all levels
Strengthening of feedback loops within the
districts and at all levels
Problem identification, implementation of
solutions for performance improvement
Capacity building of staff on data quality
and use of information at all levels
Ownership at all level
 Pilot Test of DHIS Model
Objectives:
To prove the model DHIS in terms of quality of
information and continuous use for the improvement of
health management at district level
Specific Objectives:
To contribute to the finalization of draft NAP for
strengthening of health management capacity through
use of DHIS Model
To clarify the cost for expansion across the country
during scaling up stage
To transfer relevant skills and technologies to personnel
concerned with the DHIS
 Broad Interventions and Activities

Examining improvement of government support to DHIS

Examining contents and draw up draft DHIS strategy paper for HIS
policy

Testing self-evaluation and improvement functions

Periodical review of DHIS activities by PWG

Introduction of DHIS design in selected districts and

facilities
Revised and improved DHIS tools and instruments
District computer software and manuals
Manuals and guideline material for feedback reports and review
meetings
Instruments and guidelines for requesting data from sub-systems
Examining coordinating mechanism among various sub-systems
 Broad Interventions and Activities

Strengthening of district HMIS Cell

Establishing district ICT unit and capacity building of relevant staff on
IT and data quality assurance systems (LQAS, data cross check etc
Clarification of accountability of ICT unit and HMIS Coordinator
Strengthening of EDOH functions
Introduction of regular review meetings at district level
Capacity building on data quality and use of information
Establishing system for monitoring pilot test
Strengthening of facility functions
Building coordination between facility in-charge and out reach staff for regular
review meetings at facility level
Capacity building on data quality assurance and use of data at facility level
Commitment from EDOH and higher tiers for regular facility review meetings
Broad Interventions and Activities
Capacity building

Implementation of education and training to continuously

improve knowledge and skills at all levels

Capacity building of selected staff at pilot districts

Data quality Assurance
Use of information
ICT
 Establish

Provincial Working Group Meeting

Implement supervision and monitoring for pilot test
Ensuring support (HR, Financial) and commitment from higher levels
Considering draft DHIS Strategy Paper
Recommend further implementation of NAP after pilot test results
Review of training programs and curriculum
New education and training plans for relevant staff
District Working Group Meeting
Examine issues related to strengthening of DHIS at district level through
holding review meetings
Introducing periodic DHIS design review and Consideration of draft
DHIS Strategy Paper
Recommend improvement of district performance review meetings
 Thank you!

End of presentation