HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS).pptx

HEALTH MANAGEMENT
INFORMATION SYSTEM (HMIS)
PRECIOUS MONDE MWIYA

Introduction
HMIS
• Stands for Health Management Information
System
• HMIS is a routine monitoring and evaluation
system
• HMIS collects, compiles & aggregates data on
disease epidemiology and service delivery
related indicators

Introduction
• The M & E unit of the Ministry of Health
has the responsibility of coordinating and
reporting all HMIS activities
• The HMIS was developed as part
of the health service delivery support system
under the health sector reform programme of
1992

Introduction
• However, over time, the system was faced
with a number of developmental challenges
• Such as its inability to provide
disaggregated data by age and sex

Introduction
Two types of data are used in the M& E
process of the sector which are;
• i. Non routine system(surveys i.e.
Demographic and Health Survey, Sexual
Behavioural Survey, Other surveys)
• ii. Routine System (District Health Information
System and Smart care)

Introduction
• The Ministry is using the DHIS 2 which
is web based
• The soft ware was adopted in 2013
• Before 2013 the Ministry was using DHIS 1.4
which is a stand alone(not an online) system

Overall Goal of HMIS
Overall Goal of Health Information
System(HMIS)
• To further improve health service
delivery in order to signiﬁcantly
contribute to the attainment of the
health MDGs and national health
priorities

Overall Vision of HMIS
• To develop an efficient and well coordinated
national HMIS that ensures availability,
quality, value and use of timely and accurate
health information for evidence based
decision making for the provision of
quality, equitable cost effective and affordable
health services as close to the family as
possible.

HMIS Data Flow (Routine)
MOH
PROVINCE
DISTRICT
FACILITY LEVEL

• From the Province to MOH-HQ (5th of the 3rd
Month)
• From the District to the Province (30th of the
2nd Month)
• From the Health Facility to the District (7th of
the 2nd Month)

• ACTION
• AGGREGATION
• ANALYSIS

HMIS TO DHIS
DHIS - District Health Information System
• Web based
• Has restrictions on manipulation according to
the level
• Submissions can be noted immediately

Definition of Indicators
• Variables that help to measure changes, directly or
indirectly (WHO, 1981)
• Indirect measure of an event or condition (Wilson,
1993)
• Variables that indicate or show a given situation &
thus can be used to measure change (Green, 1992)

An Ideal Indicator RAVES
RELIABLE
• Give the same result if used by different people
APPROPRIATE
• Best way of measuring what we want to know
VALID
• Measures what you want to measure
EASY
• How feasible is it to collect the data to use this indicator
SENSITIVE & SPECIFIC
• Reflects changes in events being measured

Indicators
Measures of Coverage & Quality
Events / counts once processed help measure change:
• Used to monitor stated objectives
• Monitor progress towards defined targets
• Describe situations
• Measure trends (changes) over time
• Provide a measurement whereby institutions / teams
can compare themselves to others

The Information Filter
INTERNATIONAL IMPACT
NATIONAL OUTCOME
PROVINCE OUTPUT
DISTRICT PROCESS
COMMUNITY INPUT

Indicators - A Systems Classification
INPUT/PROCESS
• Monitors activities that are carried out
• Monitors affordability of resources
• Measures availability of resources
• Measures accessibility of services – coverage &
quality

Examples of Input/Process Indicators
• Utilisation rate
• Staff to population ratios

OUTPUT
• Monitors results of activities
• Measures acceptability - use, change, performance,
coverage & quality
Examples
• Immunisation coverage rate
• Antenatal coverage rate

OUTCOME
• Monitors changes in health status of populations
• Measures appropriateness - effectiveness, efficiency,
sustainability
Examples
• Hypertension Incidence Rate
• Malaria case fatality rate
• TB cure rate

IMPACT
• Measure the extent to which the goal has been achieved
(usually long term)
Examples
• Maternal Mortality Rate
• Child Mortality Rate
• HIV Sero Prevalence Rate

Zambia Health Sector
Goals, Objectives, Indicators
When monitoring the performance of the
health sector there is a range of different
goals, objectives and indicators consisting of,
amongst others:
• Millennium Development Goals
• 5th National Development Plan (NDP) 2005-
2011- Zambia with the Performance Assessment
Framework (PAF) a
subset .

Zambia Health Sector
Goals, Objectives, Indicators
• 4th National Health Strategic Plan (NHSP)
2006-2011-
• Health Sector.
• MoH Strategic Plan - Ministry of Health.
• Program strategic and operational plans.
• Provincial and district strategic and
operational plans.

Millennium Development Goals
• Goal 1
• Eradicate extreme hunger and poverty
• Goal 2
• Achieve universal Primary Education
• Goal 3
• Promote gender equality and empower women
• Goal 4
• Reduce childhood mortality

Millennium Development Goals
• Goal 5
• Improve Maternal health
• Goal 6
• Combat HIV/AIDS, malaria and other diseases
• Goal 7
• Ensure environmental stability
• Goal 8
• Develop a global partnership for development

NDP Indicators
Program Input Output Outcome Impact
Child Health % facilities with
functioning cold
chain
% Children fully
immunised <1
year *
Malaria % planned houses
sprayed with IRS
 % ANC clients
receiving
IPT
 % malaria cases
confirmed
Malaria case
fatality rate < 5
years*
Reproductive
Health
 % Births
assisted by
skilled health
personnel*
1st ANC
coverage
 Couple year
protection
rate
 Caesarean
section
rate
(Institutional)
Maternal Mortality
Ratio
HIV/ AIDS and STI Number of
condoms issued
annually per male
15-49 years
 Male Urethral
Syndrome
treatment
rate
 # people tested
for HIV
 # Persons with
advanced HIV
infection
receiving ARVs *
 % HIV +’ve
women
HIV prevalence 15-
24 year old
pregnant women

NDP Indicators continues
Program Input Output Outcome Impact
Human Resources  % Districts with
[WHO
standard]
Staff[2] / 1000
Population ratio
 PHC facility
Utilisation Rate *
 Health centre
staff
workload
(patients per day)
 % PHC
professional staff
trained in MDG-
related
skills.
Finance % MoH Budget
(domestic non-
donor) released to
district level*
Essential Drugs # Drug kits opened
per 1000 patients
(population )
% facilities out of
stock of tracer
drugs & vaccines
HMIS % health facilities
reporting on time
each month

Performance Assessment Framework
Indicators
Key Indicators Calculation
Indicator One: Percentage of deliveries assisted
by midwives, nurses, doctors or clinical officers
Number of deliveries by midwives, nurses,
doctors or clinical officers/ Number of expected
deliveries
Indicator Two: Percentage of fully immunized
children under one year of age in 20 worst
performing districts
Children under one year age who are fully
immunized / Total children under the age of one
year
Indicator Three: Malaria case fatality rate
among children below five years
Total malaria deaths under five years in health
institutions /Total malaria cases admitted under
five years
Indicator Four
Utilisation rate of PHC facilities per year
Total attendances at PHC facilities / Total
population / per year

Performance Assessment Framework
Indicators
Indicator Five
Percentage of Health Centres with two or more
qualified Health personnel
Health Centres with two or more qualified Health
personnel / Total Health Centres
Indicator Six
Percentage MoH releases to district level[1]
Releases by MoH (domestic, non-donor) to
district level / Total budget allocation to the MoH
Indicator Seven
Number of people tested for HIV and receiving
results
# people tested for HIV and receiving results
Indicator Eight:
Number of eligible people accessing ARVs
# people with advanced HIV/AIDS who receive
anti retro viral drugs

Good Data Quality
WHAT?
• Data that is correct, complete & consistent
WHY?
Facilitates:
• Good decision-making
• Appropriate planning

Good Data Quality
WHY?
Facilitates:
• Ongoing monitoring & evaluation
• Improved coverage & quality of care
• An accurate picture of a health programmes &
services

3 C’s of Good Data Quality
Correct
• Good quality data
Complete
• Submission by all (most) reporting facilities

3 C’s of Good Data Quality
Consistent
• data within normal ranges
• population shifts
• definition changes

Good Data Quality
Data, in order to be locally useful should be:
• AVAILABLE ON TIME fix dates for reporting
• AVAILABLE AT ALL LEVELS who reports to
whom - feedback mechanisms
• RELIABLE & ACCURATE check that all data is
correct, complete and consistent

Good Data Quality
Data, in order to be locally useful should be:
• COMPREHENSIVE collected from all possible
data sources
• USABLE if no action, throw data out
• COMPARABLE same numerator & denominator
definition used by all

Common problems with data
• Large gaps due to data entered in wrong
boxes
• Unusual month to month variations due to
math problems – poor calculation
• Inconsistencies – unlikely values
• Duplication
• Data present where there should not be due to
typing errors

Data to Information
Integrating information into management
Input Raw Data
• Quantity & quality of data elements (EDS)
• Data collection tools (tally sheets, registers, client cards)
Process Analysis
• Use planning tools to turn raw data into useful information
• Use indicators to convert data to information

Data to Information
Integrating information into management
Output Information
• Used for effective decision-making
• Assessment tools (aggregation, graphs, reports)

Data collection- Guiding Principles
Collect data that:
• Can be used to monitor progress toward
objectives & targets
• Is essential at local level “must know”
• Can be analyzed using pen, paper &
calculator
• Is easily available or already there

Data collection- Guiding Principles
By using tools that are:
Simple in design
Few in number
Tailored to local context

Essential Dataset (EDS)
WHAT?
• The minimum amount of data that needs to be collected
WHY?
• For the effective management of services which allows them
to make the greatest impact on the health needs of the
community which they serve (improving coverage & quality)
HOW?
• Routine data collection

EDS - Choosing a Type
Data – led
• Focuses on the need to collect data which is
required, is of interest or which may be useful.
• Is usually vague on what information output can be
obtained from data.

EDS - Choosing a Type
Action-led
• Focuses on the need to collect data that reflect
identified priority health needs & are required by
pre-determined indicators
• Indicator driven – national & local
• Usually directly linked to specific objectives &
targets

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HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS).pptx