Lesson Learned of DHIS2

Implementation in Indonesia
Guardian Y. Sanjaya
John Lewis
Outline

• Project Phases

• Key partners

• DHIS2 Roll out

• Capacity Buildigng

• Lessons learned
 Leadership

2012 2013 2014 2015 2016 2017

•Introduce Oslo team to •DHIS2 Introduction to •Malaria staff of MoH join •Workshop DHIS2 at FIKI •WHO visitation for HIS •Develop module and
academic community and Pusdatin DHIS2 Academy in 2015 Conference, Strengthening in training materials for
MoH •Involvment Pusdatin staff Vietnam Yogyakarta involving HIS Indonesia DHIS2 Indonesia
in DHIS2 academy, India •Introduction DHIS2 to staff district and •Global Fund project for •Roll out DHIS2 at 5
•DHIS2 Presentation at Malaria Program MoH provincial level DHIS2 technical support Province and 10 Districts
FIKI 2013 based on DI •DHIS2 presented at and implementation •Develop DHIS2 blue print
Yogyakarta pilot testing AeHIN General Meeting •Preparing DHIS2 for 6 health programs
in Bali, Indonesia Indonesia as
datawarehouse for ATM
programs
•Serial Capacity Building
of DHIS2 with Oslo
University
•Establish of DHIS2
Indonesia Core Team

Ministry of Health Minister NM Health Minister SF

Health
(MoH), JS OS RB OS DD
Indonesia
Center for Data and Information (Pusdatin) MoH as main partner of DHIS2 implementation
Project Phases
• Phase 0: (2012/2013)
• Pilot project in Yogyakarta to integrate puskesmas data
• HISP India and UGM
• Phase 1: (2014/2015)
• Funding Solicitation
• Government buy-in at the national level.
• Phase 2: (2016/2017)
• Formulation of HSS through GF
• DHIS2 roll out in 10 districts across 5 Provinces.
• Phase 3: (Post 2017)
• Planned DHIS2 Roll out to more than 270 districts
Project Timeline Legend
Phase 0:2012/2013
Phase 1: 2014/2015
Phase 2: 2016/2017
Key Partners

• Team Composition
• Ministry of Health (Pusdatin)
• WHO
• University of Oslo
• Global Fund
• Centers of Excellence
• HISP Vietnam
• HISP India
• Gadjah Mada University (UGM)
• 11 Consultants at District and National level.
 Phase 2: DHIS2 roll Out Approach
Province
Assessment and Situation Analysis
• Meeting with Programme
Stakeholders
Day 1 • Identify Data Flows, existing
datasets & IS and bottlenecks
• Agreeing on actions framework
Field Visit
• Health Facility visits
Day 2 • Understating existing tools and flow
of data.
• Data Collections and interviews
Capacity Building
• DHIS2 Dashboard training
Day 3 • Information dissemination and
management Advocacy.
• Action planning
District A & B Other Activities
Assessment and Situation Analysis
• Meeting with Programme
Stakeholders
• Identify Data Flows, existing IS and
bottlenecks Data Analysis and System Design
• Analyze Data Flows and identify
bottlenecks
Field Visit • Assessing data collected
• Health Facility and Posyandu visits • Rationalization and standardization
• Understating existing tools and flow of data flows
of data. • Data Importations
• Data Collections and interviews • DHIS2 configuration
• Dashboard Design and configuration
Capacity Building
• DHIS2 Dashboard training
• Information dissemination and
management Advocacy.
• Action planning
Week 1 Week 2
Participants of DHIS2 roll out
• Resource person: Center of Excellence (CoE), Pusdatin (MoH), HIS
Consultants and Oslo University. Accompanied by SIK officers who
have been trained in DHIS2 preparation activities
• Participants from health office staff (National, province and district
level), Puskesmas and Posyandu staff, other sector (hospital, health
insurance, national statistic bureau, local government, information
and communication office, social and welfare office, civil registration
office and NGOs.
• Advocacy: head of local government (mayor), local parliament, head
of Province and District
 Data availability at province and district level
Outpatient Visit
Program Report Forms
AIDS, TB, Malaria HIV/AIDS SIHA or manual
Mental health MCH-Elderly Faskes
Faskes
Health
Faskes TB SITT or 7 forms manual
Occupation Facility Malaria eSismal forms
health Immunization KIA 11 forms
Inpatient visit
Gizi 5 forms
HR Health Pharmacy Imunisasi 7 forms
NCD Office Surveilans 4 Forms
KOMDAT Health Promotion Farmasi 6 forms

SP2TP Environmental health Kesling 12 Forms

Nutrition Health Survey
Kesehatan Kerja&OR 2 forms
(SDKI, SKRT, IKS)
SDMK Individual data
Promkes (UKS) 4 forms

Lainnya Disease registry PTM 5 forms

BPS Lainnya
Lainnya Kesehatan Jiwa 2 forms
Other
SIK Komdat or 5 forms
BKKBN
SP2TP 5 forms
Dukcapil Vital Statistic
SIRS 5 Forms
Dinsos Diskominfo
BPJS Kes
Data Mapping (Moving from Manual to
Electronic )
• Analyzing
• Duplication of data collection
points
• Variations of data elements
disaggregation
• Understanding the gaps
between the local and
national guidelines.
• Data Elements
• Indicators
• Organisationunits
• Submitted values
Maluku Province – Health Programs Structure
Kota Ambon – Health Program Structure
PKM Lompoe from Makassar
Standardization efforts
• Aim is to establish a standardized dataset for puskesmas
• Possible scaled to other regions
• Analyze information as indicators and not in raw data form
(incorporating coverage statistics)
• Puskemas based analysis instead of district level to help identify
source of issues.
• District and National HMIS and programmatic integrated dashboards
Capacity Building Process
Character of capacity building
• Multilevel
• University and research institution
• Provincial and district health office
• Ministry of health (health program manager)
• Individual
• Multimode
• DHIS2 academy (official training)
• Pilot testing of DHIS2 in province and district level
• Seminar
• Workshop on DHIS2 and HIS
• Local training (Technical, ToT, user)
 Multilevel and multimode capacity building on DHIS2 and HIS

2012 2013 2014 2015 2016 2017

• DHIS2 academy India • DHIS2 Pilot in DI • DHIS2 academy • Oslo visitation to • DHIS2 Academy • Training for trainer
Yogyakarta Province Vietnam UGM and MoH Vietnam (expanding DHIS2
• Preparing NORAD • AeHIN Meeting • Serial workshop • Online course DHIS2 network)
proposal Manila DHIS2 with MoH • DHIS2 preparation in • AeHIN Myanmar
• FIKI 2015 national level • Roll out DHIS2 in 10
• AeHIN Meeting, Bali (multiple workshop) districts

Ministry of
Health Minister NM Health Minister SF
Health
(MoH), JS OS RB OS DD
Indonesia
Center for Data and Information (Pusdatin) MoH as main partner of DHIS2 implementation
DI Yogyakarta DHIS2 Team 2013
• DHIS2 training in DI Yogyakarta
involved:
• UGM
• Provincial health office
• 5 district health office
• Oslo University and HISP India
supported by NORAD
Online Course DHIS2 for
beginner 2016
Number of Participants: 342
Industry; 15; 6%

Health
Facility;
Health 32; 12%
Office/MoH/BPJS
-K; 38; 15%

University; 176;
67%
DHIS2 Online Academy (dhis2.org)
 Serial workshop preparing DHIS2 instance
(2016)
Dashboards
(Aggregate and Individual)

Information Outputs
Manual/ Semi Manual

Fix Format
Data Sources

Reporting
Multiple eHealth

DHIS2
Secondary Data
Use
Population Data
Datawarehouse
Statistical Tools
Individual Data

Other Data
DHIS2 Local Training 2017
• Expand DHIS2 network
• MoH (Pusdatin, TB, Malaria and
HIV/AIDS Program)
• 10 HIS Consultants,
• HIS Staff in 10 districts and 5
provinces, and
• 3 Center of Excellence (UNAIR,
UNHAS and USU)
 DHIS2 training in province and district level
Cross-Sectorial data
BKKBN BPJS BPS

Data Source
Information
SITT Data Integration
output
SIHA

Komdat
DHIS2
eSismal Program-based data
eLog

Nut Surv. MCH Immunization

Capacity building strategy Lessons learned from
previous provinces and
districts

National Dashboard

Provincial Health Office

Training
Dinkes Provinsi Provincial dashboard

Health information use for

Health program manager
SITT Health information
HIS national
advocacy

decision making
consultant, Pusdatin
SIHA and CoE (UGM) Training and implementation support

Coordination ToT
ToT Local HIS Consultant and CoE
Komdat
and integration Konsultan
KonsultanHSS
HSSdan
danCoE
CoE Output of DHIS2 Training
data
Training and implementation support
Core Tim DHIS2
eSismal
Training District Health office
Dinas Kesehatan District dashboard
Dinas Kesehatan
Kab/Kota
eLog Kab/Kota
Health Program Manager
Health information
ToT, Technical
Support advocacy

Oslo University
Lesson learned from capacity building
• Continuous advocate and transfer of knowledge to local stakeholder in all
level at any chances (meeting, workshop, training)
• Develop network
• Ministry of health (inter-department)
• University (Center of excellence)
• HIS staff in district and province level
• HIS Consultant
• Vendor or Individual
• DHIS2 team
• Technical staff
• Super user
• User
Social bonding and networking over Durian
Lessons learned as inputs to further
processes
• Use of dashboards to ‘attract’ stakeholders, and non-threatening to existing structures

• Sequential implementation key as it enables cumulative learning's

• Flexible implementation approach to accommodate emerging challenges.

• Process of standardization in establishment of standard dataset based on local learnings and

practices

• Capacity building at all levels on a continuous basis, through the presence of district coordinators
and supported by local CoE

• Information dissemination and advocacy through constant engagement with MoH and donors

• Focus on monthly meetings and data use at local levels.

Phase 3: Planned scaling of roll out
• National Ministry of Health satisfied with progress to date
• Global fund actively considering continuing funding
• Plan is to initiate process of extending the project to 270 districts
• Key challenges for us
• Implementation of standardization datasets
• Scaling of implementation processes, including capacity strengthening
• Institutionalization of the systems
• Further integration efforts