Transcript Integrated Basic Health Services
The Blueprint for evolving single National Routine Health Information System (HIS)
A Brown Bag Presentation of FHI360/SIDHAS Project Monitoring & Evaluation Directorate @MEMS II Office, Wuse Abuja. 15 th May 2013
Outline:
• Rationale for this presentation • USG Health Portfolio structure and the NHSDP (2010 -2015) • The evolving National Routine Health data reporting system (DHIS) • Things to note • Suggested Blueprint • Take homes
Rationale
• To discuss the need, plausibility and the blueprint for single routine health Information System (HIS) in Nigeria
USAID Public Health Portfolio Structure
• HIV/AIDS and TB Team: is an integrated office that seek to improve access, coverage and sustainable capacity for HIV/AIDS and TB services in Nigeria – Assistance Objective 3: HIV/AIDS and TB Response Increased Nigerian Capacity for a Sustainable • Health, Population and Nutrition Team: is an integrated office that seeks to improve basic health services, HIV/AIDS, child survival, malaria, tuberculosis, population and maternal and child health and nutrition services.
– Assistance Objective 4: Increased Use of High-Impact Health Interventions • The Biggest Assumption: Accurate and timely data to gauge the impact of the national response will be available.
CDC Public Health Portfolio Structure
• Strengthening Public Health Systems : provides technical leadership and direct assistance to strengthen epidemiology, surveillance, laboratory, blood safety, operations research, and workforce capacity—essential components for strong, sustainable public health systems.
Institutionalize Nigeria HIVQual (NHIVQual) Establishment of National EMR Dataware house
CDC Public Health Portfolio Structure
• Development of National Medical Laboratory
Strategic Plan
National and International Accreditation of Medical Laboratories Establishment of a national reference lab for TB and other diseases • Establishment of Nigeria Center for Disease Control • The Biggest Assumption: Accurate and timely data to gauge the impact of the national response will be available.
6
GoN Health Portfolio USG Health Portfolio CSOs, CBO and Private Sector Health Portfolio
What is USG’s Commitment?
Data Source: 2011 Annual NHMIS Report
Analysis of national routine health data reporting Table 1 Health Facilities in Nigeria by Type
• PHCs accounts for 88% of the HFs in Nigeria.
Type and Ownership, 2012 Ownership Total Public Private
• If all PHCs report complete dataset, 88% national report is met.
Primary 21808 8290 30098 (88%)
• Reporting from all PHCs is under the control of LGAs HMIS Officers.
Secondary Tertiary 969 73 3023 10 3992 (12%) 83 (0.002
%)
• LGA-led Integrated health data management approach can solve our problem.
Total 22850 11323 34173
Data Source: FMoH/DPRS 2012
Long History …… Unending Discussion
22miles bridge : The Chinese sea bridge which will cut travel by 200 miles –
US Mail Online
20miles: Connect US to China Port
What is the central purpose of strengthening the National Health Management Information System (NHMIS) ?
1. To make truly GoN-owned high quality routine health data available (from both the private and public sectors) and 2. To plan for and build sustainable NRHIS around the GoN structures and levels with expert TA and supportive supervision from all in-country-IPs.
Principles & Context:
•
GHI Principles:
•
a new business model aimed at delivering dual objectives:
• achieving significant health improvements • creating an effective, efficient and country-led platform for the sustainable delivery of essential health care and public health programs.
(HIV/AIDS, Malaria, TB, INMCH, Nutrition, FP/RH, NTDs)
•
Third-Ones Principles:
•
One agreed country level Monitoring and Evaluation System.
(M&E Framework for the NHSDP )
Health Services & Routine Data
Overview of Nigerian Health Data
NHMIS Data (including Routine Surveillance) Routine Health Data Disease Program Data – e.g. ATM Nigerian Health Data Non-Routine Health Data Surveillance studies, Surveys, Operations Research, e.t.c
• • •
What are we using Health Data/Information for in Nigeria: Health Program Design & redesign, management Decision Making? Health Policy Formulation and Development? Health Planning and Budgeting?
Initial Practice
Referral Chain Communities ------------------ CHEWs 1 0 HFs ------------ PHCs 2 0 HFs ------------ GHs 3 0 HFs ------------ UTHs & FMCs Range of Health Services
•
Range of Data Reporte d
•
Basic Community Health Services (100%) Community NHMIS
• •
Basic Health Services (100%) Facility NHMIS
• • • •
Basic Health Services (30%) Specialized Healthcare Services (70%) Facility NHMIS Disease Programs Report
• • • •
Basic Health Services (10%) Specialized Healthcare Services (90%) Facility NHMIS Disease Programs Report
Referral Chain Recent Shift Communities --------------- -CVs / CORPs/CBOs 1 0 HFs ------------ PHCs 2 0 HFs ------------ GHs 3 0 HFs ------------ UTHs & FMCs Range of Health Services Range of Data Reported
• • •
Integrated Basic Health Screening & Services (100%)
• •
Integrated Basic Health Services (100%) Decentralized Special Services
• •
Integrated Health dataset Community NHMISplus
•
Facility NHMISplus
• •
Integrated Basic Health Services (30%) Specialized & Integrated Healthcare Services (70%) Facility NHMISplus Disease Programs Report
•
Integrated Basic Health Services (10%)
• • •
Specialized & Integrated Healthcare Services (90%) Facility NHMISplus Disease Programs Report
Routine Health Services Databases
Databases: Schematic Overview 2 (Proposed)
DHIS 2.0: (Web-based Version
) NHMIS
NHMIS
Disease Programs INMCH TB / HIV/AIDS / Malaria NTDs Nutrition FP/RH
Hierarchical Organization of the Integrated DHIS Platform Routine Health Data ATM datasets NHMIS dataset HIV & AIDS dataset SRH/HIV Integration dataset Malaria dataset TB & TB/HIV dataset NPI dataset Epid. & Disease Surveillance dataset
Central DHIS Instance Instance National State LGA PHCs Community Tertiary Facilities Secondary Facilities Facilities
Can DHIS address the bigger picture about NHMIS? Legend: IT Programming codes
• Align USG instance metadata with GoN DHIS instance • Derive PEPFAR-NGIs from the data elements contained in the National MSFs • Integrate Data Management Process at all levels.
Current challenges:
1. Multiple DHIS platforms and its inter-operability &
2. Complicated data management process
National DH&PRS DHIS Instance eNNRIMS DHIS Instance National HIV Response routine datasets (mainly from 2 0 and 3 0 Facilities) Development partners’ DHIS2.0 platform Project-level HIV/TB/Malaria and NHMIS routine datasets (mainly from 1 0 , 2 0 and 3 0 Facilities) USG DHIS Instance USG HIV and TB Program routine datasets (mainly PEPFAR-NGIs from 1 0 , 2 0 and 3 0 Facilities)
Solution:
Moving towards one data management system national Integrated health
1.
GoN-led and driven data management system (sustainability)
Community –level data LGAs PHCs data 2 0 HFs data 3 0 HFs data
2. Promote integrated health data management 3. One sole source for routine health data @ National, State and LGA-levels
National DH&PRS DHIS Instance
4. Considers all-levels of health care including community.
Suggested Blueprints
• Confidence-building on GoN System’s ability to deliver timely routine health data if supported by Donors and IPs.
• Address Institutional weaknesses and capacity constraints for functional HIS at Community-level, HFs, LGAs, State and National levels • Institutionalize LGAs Data Management team and data
entry HUB approach
– Strengthen our M&E system for better efficiencies and cost reduction – Advocate for IPs to unify tools, systems and processes for M&E.
Deep Reflection!
• The problem of M&E systems development in Nigeria is caused by IPs and their Donors! • The fragmentation in terms of M&E systems and processes is as a
result of each IPs/Donors’ requirements.
• If only M&E processes, systems and tools were unified, we
will have a more organized system that produces timely and unified/harmonized program results.
What are our fears about having One central HIS for routine health data in Nigeria?
• • • • •
FEARS
Delayed access to routine data by stakeholders Quality of what is coming through the Central HIS Server Administration and IT infrastructural capacity requirement (5,000+ Users in one Window) Resource Coordination (Single funding basket) • Stakeholders’ Representative Data Management Team in place @ National level
Is it likely to offer any cost saving measure on the long run?
• Yes ! The cost of:
– HR need and capacity development for HIS management @ all level. – IT Infrastructure and Maintenance – Uninterrupted power supply – Maintaining streamlined Data Management Systems, Processes and Operations such as: • Data Collection and Data Entry • Data Verification and Data Quality Assurance (DQA) and Change Management Process (CMP)
Would this process have a chance for capacity transfer to the Government staff; leading to sustainability on the long run?
• Yes! Through the: – Stakeholders’ Representative Data Management Team @ National level – Establishment of Integrated Data Management Team (GoN and IPs) at LGAs and State-level – Initial Joint Routine Supportive supervision and DQAs – Training of M&E practitioners for better results at the State and LGA levels.