SHSRC CONSULTANTS WORKSHOP NHSRC NEW DELHI 17 AUGUST 2010

Introduction to HMIS NRHM & required monitoring HMIS reform & its implementation Current status Challenges Other e health initiatives

Health Management Information Systems

Management Process
Ungathered Information
Gathering Information
1. Screen all PW for anaemia. Decision making 2. Provide IFA to everyone (about treating Gathered with focus oneffectivesevere anaemia cases & efficient Information 3. Make sure anaemic & allocation of complicated cases are resources) referred on time & treated.

Decision
1.

Unallocated 2. Resources
3. 4.

5.

Blood testing facility in all health centres. IFADecision for to be available distribution. implementin Ensure Blood storage facility in CHC/FRUs g/resource ANM & Doctors are allocation trained on dealing with obstetric complications & severe anaemia cases. Provide referral transport to send complicated cases to higher centre for care.

Effectively & efficiently allocated resources & Achievement of desired AIM Monitor Progress

Basic building blocks of HMIS

Data- are raw material in the form of numbers, characters, images that give information after being analyzed. Information: is a meaningful collection of data organized with reference to a context. Knowledge: when information is analyzed, communicated and acted upon, it becomes knowledge. Data Information Knowledge

Translation of data-information-knowledge

DATA
In the box number of women registered for ANC is given
& called DATA ELEMENT, Values given on the right side are the DATA. Data Element- Record of an event or activity

Information
Information means putting data into context. E.g., In this box data are being put into the context of Maternal Health Indicators by months. Data term, pregnant women registered for ANC is converted into information by calculating an indicator % of pregnant women registered for ANC in first trimester.
Maternal Health Indicators % First trimester ANC registration (Early ANC Registration Rate) % pregnant women given TT % pregnant women consuming IFA100 Tabs % pregnant women with severe Anaemia % Pregnant women consuming IFA200 Tabs (Double Dose)

Apr-07

May-07

Jun-07

55.6 81.8

57.0 90.5

55.9 86.4

59.4

68.8

62.3

23.9

24.3

26.6

Knowledge
Knowledge, once information is analysed and acted upon, the consequences of these actions can be further evaluated and used to revise need for more information as well as action.

% of ANC registration

2 PHCs had over 90% ANC registration rate. Is it right, are we registering all ANC cases?

ANC registration of one PHC is 14%; What are the different reason or measure to be taken to ensure that its ANC registration can be improved?

NRHM-Key intervention & required monitoring

Architectural correction of Basic health care delivery system

Reducing regional imbalance in health infrastructure ex. BIMARU STATES.

FRUs/24x7 PHC/ IPHS standards

Decentralization & local management of programmes & health facilities. Integration of organizational structures, programsRCH/VBDCP/Blindness/Leprosy/ Effective management of Human Resources Pooling of resources. Increasing community participation & ownership.

Integration of determinants of health such as- sanitation, hygiene, nutrition and drinking water with health.
ASHA

Comprehensive HMIS for NRHM

Strengthen capacities for data collection, assessment and review for evidence-based planning, monitoring and supervision. Challenge: Routine reporting system inefficient for effective management of health services.

HMIS Reform under NRHM

Focus to shift from FORMATS and DATA ELEMENTS to INDICATORS and their use for action Each data element collected should contribute to at least ONE indicator, preferably MORE. HMIS should be local action-led, not data-reportingdriven Reduce duplication of reporting e.g. Form 6, RIMS Eliminate design ambiguity- ANM to report services she provided NOT institutional services. Disaggregated data to be best captured by surveys. e.g. SC/ST & M/F data.

HMIS Reform under NRHM.

Creation of data sets for district level & below.

1. 2. 3. 4. 5. 6. 7.

Sub Centre monthly data set PHC monthly data set CHC monthly data set District monthly stock data set District Quarterly data set District quarterly FMR District Annual data set

Proposed use of Free & Open Source software for optimum utilization of available resources (75% for capacity building, 25% for Software etc.)

Stages of HMIS implementation under NRHM

Stage 1-Establishment of overall system across states in country.

Reporting Formats HMIS resource material Infrastructure (Computer, People) Information Flow Training Review & addressing challenges

Stage 2-Improvement in the data quality & information use

Process of data verification, confirmation etc. Developing culture of information use at all levels

Stage 3-Ensuring sustainability, developing advance skill & review of overall implementation

HMIS- Information Flow & reporting forms

Web Portal

National Level

DHIS -2
STATE HEAD QUARTER

District Head Quarter (DPMU)

District / Civil Hospital Data set Block CHC Data Set

PHC Data set

Subcentre Data Set

Data entry status

Districts
District reporting through blocks Districts not reporting Districts reporting at district level

Blocks
Blocks reporting through lower facilities Blocks reporting at block level

District level facilities

Existing blocks

not reporting

reporting

Existing

Existing

STATES

Tamil Nadu HP MP Nagaland

32 12 50 11 30 1 35 29 22 13

31 0 0 11 0 0 20 0 0 0

0 12 50 0 30 1 15 29 22 13

1 0 0 0 0 0 0 0 0 0

0 73 330

0 73 328

0 0 0

0 0 2

0 19 68

0 17 56

Starting Facility wise data entry from this month 327 4 37 178 111 103 322 0 15 0 0 103 0 4 22 178 110 0 5 0 0 0 1 0 93 3 0 0 18 34 91 3 0 0 15 32

Orissa
Chandigarh Maharashtra Karnataka J&K Uttarakhand

Facility wise below block data entry Block wise data entry District wise data entry

Districts
District reporting through blocks Districts not reporting Districts reporting at district level

Blocks
Blocks reporting through lower facilities Blocks reporting at block level

District level facilities

Existing blocks

not reporting

reporting

Existing

Existing

STATES

Assam BIHAR Kerala Meghalaya West bengal Punjab Manipur Gujarat Mizoram Sikkim Total

27 38 14 7 19 20 9 26 8 4 407

27 1 0 7 3 0 0 0 0 0 100

0 37 14 0 16 20 9 26 8 0 302

0 0 0 0 0 0 0 0 0 4 5

0 489 207 0 343 117 41 181 82 0 2623

0 462 0 0 289 0 0 0 0 0 1592

0 0 201 0 0 117 41 181 81 0 935

0 27 6 0 54 0 0 0 1 0 96

0 71 93 0 126 97 9 46 22 0 699

0 48 93 0 108 97 8 46 9 0 623

Facility wise below block data entry Block wise data entry District wise data entry

Uttarakhand

Data Entry Status (in %) by states in DHIS application Oct-09

No. 16 1 2 18 13 3 17 4 12 5 6 15 9 8 10 7 11 14 19 20 Level of data entry Block/PHC/SC/DH Punjab Tamil Nadu District level only District/Block HP District/PHC/CHC/SC Mizoram District/Block/PHC/CHC Kerala District/Block/SDH MP PHC/CHC/SC Manipur District level only Nagaland District/Block PHC/SDH BIHAR District/Block/SDH ORISSA Chandigarh District/SHC/PHC/SC/SDH West bengal District/Block District/Block/PHC/SDH J&K District/Block/PHC/CHC Karnataka Uttarakhand Only Block PHC/CHC/SDH Maharashtra District/rural/Corporation Assam District Meghalaya District Tripura Sikkim Apr_09 85 1 55 6 22 48 41 46 18 May_09 90 19 56 53 29 47 53 43 17 Jun_09 85 82 64 48 31 48 51 48 18 Jul_09 86 78 62 31 28 50 44 42 19 Aug_09 89 46 56 50 28 48 61 38 20 Oct_09 89 77 62 54 54 59 62 46 37 31 53 35 27 30 27 25 0 0 0 0

36
12 37 48 27 25 29 18 71 0 0

41
22 31 46 27 24 27 19 69 0 0

40
34 23 42 27 22 30 18 69 0 0

40
24 22 37 28 22 31 14 55 0 0

33
20 17 36 19 18 30 0 14 0 0

1-Jan-10 Nov_09 88 72 60 59 56 55 55 46 36 35 34 34 33 30 24 21 0 0 0 0

Dec_09 85 37 60 52 59 50 45 34 40 30 46 29 31 29 23 19 0 0 0 0

Challenges

Data reporting

From all lower facilities & from far flung areas. Ambiguity about data elements & reporting formats in field staff. Duplication Completeness of other vertical program information systems into routine reporting.

Data Quality

Integration

Use of Information at all levels

for monitoring & evaluation, for planning, for management of health programs & facilities. Data do not speak for themselves- Einstein

Other Innovations

Mobile Based Data Transmission & Reporting Hospital Information System Human Resources Management Information System NBITS E- Mamta

THANK YOU