Transcript Accurate Assessment for a Better National Health

Accurate Assessment for a Better
National Health Information
System: Bangladesh Experience
Muhammed Emranul Haq, GTZ, Bangladesh
AM Zakir Hussain, WHO, Bangladesh
September 01, 2009, Atlanta, USA
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Background
• Bangladesh is located in the northeastern part of South Asia with land
area of 147,570 square kilometers. Most densely populated country in the
world with a population of about 150 million, more than 920 persons per
square kilometer.
• For administrative purposes, the country is divided into 6 divisions, 64
districts, and 496 upazilas (sub districts).
• Started HMN activities from December 2007
• Currently (2003-2011) the government of Bangladesh is implementing one
of the biggest health sector programme named Health Nutrition and
Population Sector Programme (HNPSP).
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Regional Context
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Administrative Distribution
Unit
Number
Division
6
District
64
Upazila
(Sub district)
496
Union
4,490
(not shown in the map)
(not shown in the map)
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Existing Health System
• Bangladesh has made significant progress in recent times in many of its
social development indicators particularly in health.
• This country has made important gains in providing primary health care
since the Alma Ata Declaration in 1978.
• Infant, maternal and under-five mortality rates have all decreased over the
last decades, with a marked increase in life expectancy at birth.
• Due to a good health infrastructure and dedicated workers it has been
possible to make those successes
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Existing Health System
Ministry of Health and Family Welfare (MOHFW)
Director
General of
Health
Services
(DGHS)
Director
General
of Family
Planning
(DGFP)
National
Nutrition
Program
me
(NNP)
Directorate
of Drug
Administrati
on (DDA)
Directorate
of Nursing
Services
(DNS)
Line directors are the responsible for
implementation of various programmes
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Existing Health System
The Public Sector
• Primary: It comprised of Upazila Health Complex (UHC) at sub-district level
which works as a health-care hub.
• Secondary: There are also field level personnel who are responsible for
preventive healthcare services
• Tertiary: Above the sub district are the district hospitals, medical colleges,
providing secondary care and national tertiary level care facilities.
The Private Sector
• Both specialized and general hospital, clinic, diagnosis facilities are
provided
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Current Health Information System
• Mostly vertical data
collection, less
integration, no quality
control, lack of regular
dissemination, less
utilization for decision
making
• Logical flow of data and
availability is fairly
absent
• Whereas, in other
places, it needs
attention
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Health Information System Assessment :
The HMN Tool
• The process of HMN for assessing country health information was useful
to have some general picture of the whole system.
• Series of workshops were arranged with different level participants to get
their input into the standard HMN Tool
• The process of assessment was useful which actually geared-up talking
and thinking about the whole information system. This has created the
opportunity for finding gaps and prospects
• Although all those workshop ended with fruitful outcome, the participants
were not confident about the answers or they had lack of knowledge
about the subject matter in most of the cases.
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Participants are working in the first
workshop using HMN Tools
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More assessment initiatives
• Later the HMN steering committee recommended to conduct more
intervention like:
– In-depth review of existing system
• The participants took part in detail discussion in round table meetings. By
active interaction it brought the real scenario
– Focus group discussion
• Small meetings based on some selected topics helped to draw the insight
of the Health Information Status
– Field observation to key stakeholder organization
• It gave the opportunity of verification of they discussed with the reality
– Small scale survey
• The target group were 64 district level manager, who also gave valuable
answer of some simple questions.
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Roundtable discussion on different thematic topics
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Opportunity
• The assessment process and subsequent initiatives made the opportunity
to start dialogue on Health Information and about the importance to build
a efficient country health information system
• Created increased motivation among the data users, producers and
among the donor community
• Add on activities (e.g. FGD, in-depth review, field observation, survey etc)
helped to draw the real thrust sector, those needs to be improved further
• Identified the critical areas require immediate actions and long term
actions
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Progress and Outcome :
Some Evidence
• 2009 Annual Programme Review (APR) of Health sector took the
assessment findings seriously and made comments and suggestions for
future development
• GTZ (German Technical Cooperation Deutsche Gesellschaft für
Technische Zusammenarbeit) came forward to help the country to build
an efficient health information process thorough a participatory manner
• In March 2009 GTZ has initiated new initiative named Data
Management Information System (DMIS) as a support to the Ministry of
Health and Family Welfare Bangladesh
• This DMIS actively considering the HMN Assessment Result as a basis
and they are also conducting more review and interview to know the
actual need and finding out the gaps
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Planned DMIS Phases
Inception
Analysis
Design
Implementation
Post Implementation
• Already completed the
inception phase and analysis
phase at final stage
• Phase wise dissemination
and feedback will take place
• More participatory manner
• Always keeping close touch
with the policy makers and
fully
considering
their
expectation
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Conclusion
• The democratic government has adopted a vision called “Digital
Bangladesh”
• This positive and congenial environment from the policy makers will be
helpful to implement such kind of information system for the health sector
• It needs to be mentioned here that during the first SWAP (Sector Wide
Approach Programme) in the period of 1998-2003 some sort of unification
initiatives named UMIS (Unified Management Information System) were
taken but it failed finally
• DMIS is actively considering those lessons; they are trying to implement in
previously requires very cautious steps to implement such kind of a
system as this kind of initiatives were also taken and huge amount of
money also been spent
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Conclusion
• The HMN assessment process made the start, though it took a longer time
to really start the process due to some unavoidable situations
• With a careful eye the implementation of DMIS is taking place
• Ensuring more participation and suggestions from the policy makers have
• The government are very keen to see a fruitful outcome at the end
• More collaboration and support will be required
• For sustainability issue the government should come forward to
implement and sustain it
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Thank you
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