LECT - HMIS= BY Prof Tauseef Jawaid.ppt

MBBS.ECFMG-99, DPH, Dip-Card, M.Phil, FCPS.(PhD)
Professor Community Medicine
Gujranwala Medical College Gujranwala
Ex- Professor Community Medicine
UmulQurrah University Makka Saudi Arabia

Health Information
System
 A system that integrates data
collection, processing, reporting, and
use of the information necessary for
improving health service
effectiveness and efficiency through
better management at all levels of
health services”[1]
[1] World Health Organization: Regional Office for the Western Pacific. Developing
Health Management Information Systems - A Practical Guide for Developing Countries
2
PROFf: M TAUSEEF JAWAID

Health Management
Information System (HMIS)
3

A System that Provides
Specific Information
Support to the Decision
Making Process at Each
Level of Health System
Definition
4

What will you learn in this
session?
What is HMIS
Uses of HMIS
HMIS Data Sources
HMIS Data Tools
Type of Data Tools
Reporting System
Feedback System
5

HMIS
On going system of data collection and
processing from health care delivery out-
lets and utilization of this data for
management and improvement of services
at each level of health care system.
6

GENERAL OBJECTIVES OF HEALTH
INFORMATION SYSTEM
 To measure the health status of the people and to
quantify their health problems,medical and health
care needs
 For local,national and international comparison of
health status
 For planning,administration and effective
management of health services and programs
 For assessing health services
 For assessing the attitudes and degree of satisfaction
of the benificiaries with the health system
 For research into particular problem of health and
disease
7

1. To provide the information support to the
Health Managers at various levels of the
health system.
2. To compare performance overtime, with
districts and facilities etc.
3. To identify facilities, and districts in need
of support .
4. To monitor trends in disease pattern,
coverage, quality and population at risk.
Objectives of HMIS
8

COMPONENTS OF HEALTH INFORMATION
SYSTEM
 Demography and vital events
 Environmental health statisticts
 Health status;mortality,morbidity,disability and
quality of life
 Health resources;facilities,beds,manpower
 Utilization and non utilization of health
services
 Indices of outcome of medical care
 Financial statistics; cost, expenditure related
to the particular objective 9

Terms used in HMIS
First Level Care Facility (FLCF)
Referral Level Care Facility (RLCF)
Health Care Provider
Patient
Clint
Data collection tool / instruments
10

HMIS Development Steps
1. Determining the data sources
2. Development of data collection
tools
3. Data Reporting
4. Data Processing
5. Feedback and Utilization of data
based information
11

1. Population Catchment Area Chart
2. Total Population of the Area
3. Target population Groups
Gross Root Levels Data
Sources
12

Occurrence of Health Problems
Diagnosis / Prevention / Treatment
•Data Collection
•Disease Outbreak Control
•Program Management
•Supervision of Quality of Care
Computer Centers
Health Managers/ Disease Control Programs
TB CDD EPI ARI MCP AIDS Other
Population
First Level
Care Facility
District Level
District /
Provincial
Level
Provincial
/ National
Level
Immediate
Report
Monthly
Report
Yearly
Report
Supervisory
Checklist
Computerized Feedback Reports
Flow Chart Under HMIS/ FLCF
13

District HMIS Cells
Executive District Officer (EDO) Health
Provincial HMIS Cells
Director General Health Offices (DDHS)
National HMIS Cell
(Ministry of Health)
LHW-2 LHW-3 LHW-4
LHW-1
Rural Health Center
(RHC)
Consolidated Report
Basic Health Unit (BHC)
Consolidated Report
Feedba
ck
from
centers
to
periph
ery
Data
flow
from
periphe
ry to
the
Center
14

Information Flow
National Level
Provincial Level
District Level
Facility Level
Community Level
MOH-PHC Cell
Federal PIU National HMIS Cell
Prov. DG Health Services
Prov. PIU Prov. HMIS Cell
EDO/ DHO Office
Dist. PIU Dist. HMIS Cell
First Level Care Facility (FLCF)
Lady Health Workers (LHW)
LHW Reports
Consolidated
Monthly Report
HMIS
Monthly Report
Data on Diskette +
Manual Report
Data on
Diskette
Data on Diskette +
Manual Report
Data on
Diskette
LHW Prog.
HMIS Rpt.
Received at the 1st
week of next month
Reports from all districts
received by the end of
next to reporting month
Reports from all Provinces
received on the 5th week
after the reporting month.

HMIS Tools For LHW
1. Family Register (Register Khandan)
2. Treatment Register
3. Family Planning Register
4. Monthly Report Register
16

Information Process
Data Collection
Data Transmission
Data Processing
Data Analysis
Information for use in
planning and management
Indicators
Management
Resources
Organizational
Rules
Components of
National Health Information System
17

Central Registration
Point
Growth
Monitoring
Male Care
Provider
Female Care
Provider
CPR
Other Vaccination
/ Family Planning
Obstetric
Care
Curative Care
Preventive Care
HMIS Data Sources at
FLCF
18

Strengths of National HMIS.
• HMIS can provide a summative overview of major
health problems.
• HMIS provides necessary information support both
to information users and managers.
• Reasonably simple and understandable.
• Potential for immediate use at point of data
collection.
• Fully owned and appreciated by end users and
provincial health Departments.
• The only source of routine data collection
mechanism in the health sector.

HMIS Data Collection Tools and
sources at FLCF
1. Patient/ Clint Records / Cards
OPD ticket, MCH Card, Vaccination card etc
Referral forms, investigation request form etc
2. Facility Record Keeping System
OPD register, Child health register
Stock register Abstract register
3. Facility Reports
Immediately Reports
Monthly Report
Yearly Report
20

Data Consolidation and
processing Levels
1. Data consolidation at Health Facility
2. Data consolidation at District Level
3. Provincial Data consolidation
4. Federal Data Consolidation
21

Data Utility at Federal
1. Overall situational analysis
2. Disease burden assessment
3. Planning and resources allocation
4. Epidemic Early Warning
5. Data used for research purpose
6. Assessment of health needs
7. Monitoring and Evaluation of health services
22

Data Utility at Province
1. Overall situational analysis at provincial level
2. Disease burden evaluation at provincial level
3. Health Planning of provincial projects
4. resources allocation at provincial level
23

Data Utility at District Level
1. Diseases profile at district level
2. Health care delivery efficiency and effectiveness
3. Planning and resources allocation
24

HMIS data is important for every
health worker
1. Medical Officer
2. Dental surgeon
3. MT, LHV, Dispenser and Lab. technician
4. Vaccinator
5. CDC supervisor
6. Sanitary Inspector
7. LHW
8. Dai
25

Data Utility at Facility Level
1. Mapping of disease
2. Assessment of medicine and supplies
3. Supervision and monitoring of staff
4. Monitoring and evaluation of services
6. Vaccine Coverage
7. CDC supervision
26

SOURCES OF HEALTH INFORMATION
 Census
 Registration of vital events
Births, deaths, marriages, divorces,
adoptions etc.Union council  tehsil.
Council  distt. Council,
 Notification of diseases
 Hospital records
 Disease registers
 Record linkage
 Epidemiological surveillance
 Environmental health data
27

Uses of health information
 To measure the health status of a
community
 For comparison and conclusion
 For planning and management
 To see performance of a health care
programme
 To assess satisfaction of consumer
 For research
28

DHIS
 To improve the health care services through
evidence based management of service
delivery.
 Improved service delivery will contribute to
the improvement of health status of the
population
29

OVERVIEW OF DHIS
DHIS VISION
To improve the health care
services through evidence-based
management of services delivery.
Improved service delivery will
contribute to the improvement of
health status of the population
30

DHIS: OBJECTIVES.
 To provide information for management and
performance improvement of the district
health system. DHIS will:-
 Provide selected key information from FLCF,
Vertical Programmes, Secondary Care
hospitals, subsystems such as logistics,
financial, human resource and capital asset
management systems for improving the district
health system’s performance.
 Cater to the important routine information
needs at the federal, provincial levels for
policy formulation, planning and M&E of health
programme.
31

• Teaching Hospital 19
• DHQ Hospital 37
• Tehsil Headquarters Hospital
77/126
• Rural Health Center 345
• Basic Health Unit
2,744
• MCH Center
287
• Dispensaries( CDs/RDs/GRDs) 434
• TB Clinic 22
Basic Data
(Functional Status)
33

Historical Development of MIS in
Pakistan
A. Pre-independence to 1990.
 Annual reporting
 Manual System
 Annually Based
 All Diseases included i.e. out door / indoor
 Data collected by Health Facility staff
 Consolidated at higher level and submitted
to Federal Government and International
Partners.
 No analysis 34

B. 1990-2006 (HMIS)
 Automated
 Monthly
 Manual at facility level
 Computerized at district level
 Only 18 priority diseases included
 Coverage up to OPD only
Historical Development…
35

C. 2006-(DHIS)
 Extended up to indoor
 Not covering tertiary care level
 43 disease
Historical Development…
36

DHIS Information
DHIS
(Improve health status of population)
By
Reduction in:-
• Morbidity,
•Mortality,
•Disability,
• Malnutrition
&
• Improvement in Health Behaviour.
Promotiv
e
Preventive Curative
Rehabilitative 37

Interpret DHIS
information
Identify
performance
gap
Identify causes
of performance
gap
Prioritize causes for
developing solutions
Advocacy and Non-
advocacy based
solutions
Develop an
action plan for
solution
Monitor action
plan and changes
in performance
Use of DHIS Information for Improving Health System
Performance
Guiding Principles
• Problem solving
• Continuous
Improvement
 Self-regulation
 Culture of information
38

Categories of DHIS Indicators
1. Overall health facility utilization: 15 indicators
2. Preventive and curative service delivery: 48 indicators – 14
preventive care and 34 curative care.
3. Financial management: 3 indicators
4. Logistics: 1 indicator
5. Human resources: 2 indicators
6. Capital assets: 6 indicators
7. Regulation: 1 indicator
8. Information system: 3 indicators
39

DHIS Instruments
 There are 25 DHIS instruments for
collection, aggregation and transmission of
data from the primary health care facilities
(BHU, RHC, MCH Centers) and secondary
care facilities (DHQH and THQH).
40

Use of DHIS information model
 The mechanisms for implementing this model at district level
include:
 Training of the district managers and facility in-charges on Use
of DHIS Information Model
 Computer generated data analysis and feedback reporting
 Procedures for use of DHIS information at facility, district and
provincial levels
 Monthly facility staff meeting
 District health system performance review meeting where the
district managers will:
 Analysis and interpret DHIS data
 Set performance targets/goals
 Identify performance gaps using DHIS data
 Recognize causes of performance gaps
 Prioritize causes
 Develop advocacy and non-advocacy based solutions
for improvement
 Monitor action plan, and
 Conduct self-regulation.
41

Comparison between HMIS & DHIS
HMIS Tools & Instruments:
Total Registers: 19
Facility Record/Registers 10
Administrative Register 9
1. OPD register
2. Abstract Register
3. Mother Health Register
4. Child Health Register
5. Birth register
7. Tuberculosis Register
8. Laboratory Register
9. Stock Register (medicines, supplies)
10. Stock Register (linen & equipments)
11. Daily Expense Register
12. Meeting Register
13. IDD Register
14. Attendance Register
15. Log Book
16. Stock Register (vaccines)
17. Population Chart of the Catchment Area
18. Daily EPI Register
19. Permanent EPI Register
JICA Tools & Instruments:
Registers: 17
1. Central Registration Point Register (new)
2. OPD Reg.
3. Abstract Reg. (BHU, RHC)
4. Abstract Reg. (DHQ Hospital)
5. Maternal Health Register
7. Obstetric Reg. (new)
8. Indoor Reg. (new)
9. Daily Bed Statement Register (new)
10. Laboratory Register.
11. Radiology Register (new)
12. OT Register (new)
13. Stock Register (medicines, supplies)
14. Stock Register (linen & equipments)
15. Daily Expense Register
16. Community Meeting Register
17. Facility Staff Meeting Register (new)
42

DHIS Implementation
Districts trained in DHIS – 18
 Khanewal ( was first Pilot Distt;).
 Kasur, Nankana Sahib, Sheikhupura (UNICEF)
 Rawalpindi, Chakwal, M.B.Din, Gujrat, Sialkot, Jhang,
Multan, Muzaffargarh, D.G.Khan, Bahawalpur (NHIRC).
 Pakpattan & Mianwali ( SOHIP)
 Narowal & Khushab ( Govt. of Punjab)
 Remaining 17 districts will be trained by Dec-
2008.
 Planned Computer Software & data entry
trainings in all districts of Punjab.
43

Health Facility (Manual) 1st of each month
District 8th of each month
Province 20th of each month
National
DHIS Data Flow
44

DHIS Management Tasks,
Responsibility & Cut-off Dates
No DHIS Management Task Responsibility Cut-off date for
completion
1 Filing-out data collection
instruments
Service providers
2 Data Compilation Service providers 3rd of every month
3 Monthly facility staff meeting Facility OIC 4th of every month
4 Consolidation of monthly report DHIS Focal Peron at
health facility
4th of every month
5 Monthly report sent to District
HMIS Cell
Facility OIC 5th of every month
6 Data entry District HMIS Cell
staff
13th of every month
45

Continued:-
No DHIS Management
Task
Responsibility Cut-off date for
completion
7 Compiled district report &
feedback report
District HMIS Cell
staff
15th of every month
8 Submission of district report,
feedback reports & summary
of salient features to EDO (H)
District HMIS
Coordinator
17th of every month
9 Dissemination of report to
Nazims/DCO & facility OIC
EDO (H) 20th of every month
10 Monthly health management
team meeting to review &
discuss monthly report data
for performance monitoring &
identify areas for improvement
EDO (H), DOH,
DDOH, Facility OIC
& HMIS Coordinator
25th of every month
46

LIST OF DHISINSTRUMENTS
DHIS Instrument No. DHIS Instrument
DHIS – 01 (R) Central Registration Point Register
DHIS – 02 (F) OPD Ticket DHIS – 02-A (F) Medicine Requisition Slip
DHIS – 03 (R) Outpatient Department Register
DHIS – 04 (F) OPD Abstract Form
DHIS – 05 (R) Laboratory Register
DHIS – 06 (R) Radiology/Ultrasonography Register
DHIS – 07 (R) Indoor Patient Register
DHIS – 08 (F) Indoor Abstract Form
DHIS – 09 (R) Daily Bed Statement Register
DHIS – 10 (R) Operation Theater (OT) Register
DHIS – 11 (R) Family Planning Register
DHIS – 12 (C) Family Planning Card
DHIS – 13 (R) Maternal Health Register
DHIS – 14 (C) Antenatal Card
DHIS – 15 (R) Obstetric Register
DHIS – 16 (R) Daily Medicine Expense Register
DHIS – 17 (R) Stock Register (Medicine/Supplies)
DHIS – 18 (R) Stock Register (Equipment/Furniture/Linen)
DHIS – 19 (R) Community Meeting Register
DHIS – 20 (R) Facility Staff Meeting Register
DHIS – 21 (MR) PHC Facility Monthly Report Form
DHIS – 22 (MR) Secondary Hospital Monthly Report Form
DHIS – 23 (MR) Tertiary Hospital Monthly Report Form
DHIS – 24 (YR) Catchment Area Population Chart
DHIS – 25 (YR) Health Institute Database (HIS) Report Form
47

CATEGORIES OF DHIS INDICATORS
1. Overall health facility utilization: 15 indicators
2. Preventive and curative service delivery: 48 indicators – 14
preventive care and 34 curative care
3. Financial management: 3 indicators
4. Logistics: 1 indicator
5. Human resources: 2 indicators
6. Capital assets: 6 indicators
7. Regulation: 1 indicator
8. Information system: 3 indicators
48

LECT - HMIS= BY Prof Tauseef Jawaid.ppt

• Procurement & distribution medicine
• Staff performance
• Planning & development
• Disease patterns
• DEWS
• Performance of Preventive Services
District Level:
• Dev. & Dissemination of Tech.Reports
• Regular Info.on PRSP & MDG .
• Use by MOP for Digital Atlas.
• Use by NIPS for district profiles.
• Use by FBS for Monthly Bulletins.
• Use by WFP for Program Monitoring
• Research by MPH Students
• To De-emphasize FLCFs (e.g. NWFP).
• Responding to Parliamentarian's Queries
• NIH Rabies Project, GIDSAS etc.
National/
Provincial
Level:
Facility Level: • Possible but Very rare
Current Users of HMIS Data
53

Information Process of
Decision-Making
Decisions
Community
Media Special Interests
Past Experience
Political Influence
Users Advice Budget Constraints
Donor’s Interest
Health Information System Blocks
54

LECT - HMIS= BY Prof Tauseef Jawaid.ppt

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