Health Management

Information Systems
Assessment
Final Presentation
May 23, 2006

Presented by Andrea Chitouras

What is an HMIS?
 A System of systems that allows for the
collection, storage, compilation, transmission,
analysis and usage of health data that assist
decision makers and stakeholders manage and plan
resources at every level of health service

 Information systems transform raw data into useful

information through input, processing and output
(Management Information Systems, Laudon & Laudon)
What’s the HMIS objective?
 Ensuring the quality of
all health data
 Strengthening the
ability to analyze and
use the data and
 Making informed and
cohesive decisions
can and will positively
affect the health and
lives of the people of
Rwanda
What is
Information Technology (IT)?
IT consists of:
 Computer hardware
 Computer software

 Storage technology

 Communications technology

 Network
How do IT and IS work
together?

Strategy & Policy

Information
Architecture
Management i.e. Info
Systems
Knowledge & Coordination

Operational
Programs & Projects, HR, Finance
level

Hardware Software Data storage IT

Networks Communications
Infrastructure
Adapted from Management Information Systems, Laudon & Laudon
Changing Environment
 Assessment conducted in the midst of
decentralization reforms
 Reduced staff at the central level (from 12 to 1)
 Increased staff at the district levels
 Newly appointed personnel unsure of their roles,
responsibilities or how to perform tasks
 New processes and procedures
 Uncertainty regarding reporting procedures
 Interruption of monthly meetings and supervision
Methodology
 The HMIS Team of 4 and HMIS specialists (RTI)
 Interviews with:
 Health center directors
 District hospital directors
 Heads of Nursing
 Chiefs of services
 Supervisors (now at hospitals)
 District (admin) health directors
 District (admin) newly appointed supervisors
 Partners
 Donors
 Review of secondary sources (published and
unpublished documents, presentations)
 Site Visits
Reference and District Hospitals
Health Centers
Dispensaries
Districts
Number of HMIS Assessment Site Visits by
Province and as Percentage of Total Visits

West, East,
14 sites, 10 sites,
23% 16%

Kigali City,
12 sites
20%
South,
13 sites,
21%
North,
12 sites,
20%
HMIS Assessment Sites
Visited, by Type
Private, 8 sites
13%

Public, 20 sites
District Office, 33%
7 sites, 11%

Reference
Hospital, 2 sites
3%

Religious
Affiliated, 24
sites
40%
Health Facility Routine Reports
 Weekly--Epidemiological (maladies d’alertes)
 Monthly--TRACnet, SIS, CAMERWA,
Contractual Approach, Partner reports
 Trimester--Tuberculosis
 Annual--Facilities

 Monthly SIS reports often take providers up

to 3 working days to complete.
Current Data Flow (SIS)

MINISANTE

Reference Hosp. Military Hosp.

?
District Hospital District Ex-District

Private Disp.
Health Centers
Community
Health
Workers
ASC ASC ASC ASC ASC (AS)
Performance of Health Facilities in
Submitting Monthly SIS Reports

Health District
Year Centers Hospitals
2003 96.5% 74%
2004 98.5% 88.2%
2005 93.3% 77.5%
January–March 47.3% 35.3%
2006
Data from MoH
Key Strengths of Rwanda’s HMIS
 GoR has recognized the importance of a
strengthened HMIS and has set out
ambitious goals for improving it.
 Some health centers and district hospital
directors and nurses take the initiative to
analyze and use data to whatever degree
they can.
 Health workers expressed a keen interest for
more training and better tools to perform
analysis and learn how to use transformed
data.
HMIS Gaps
Lack of:
 Policies for easy access to data and
enforcement of data sharing (while respecting
patient privacy).
 Coordination with vertical programs
 Communication and coordination within,
between and amongst GoR, donors and
partners.
 Communication of current HMIS roles,
responsibilities, procedures, reporting
 Information systems human and financial
resources and management
 Important data sources (community, reference
hospitals, private health facilities, military)
HMIS Gaps (cont.)
Lack of:
 Training on all levels from computer and software
program usage to data entry, quality data, usage of
tools, process and procedure guidelines,
supervision, analysis, usage, feedback, patient
information, and knowledge about how to perform
tasks.
Additional Issues
 GESIS does not reflect the new districts and does
not have the capacity to manipulate data and
produce necessary reports.
 Heavy site level reporting burdens
 Logistical challenges in report submission
(transportation, communication, electricity)
Recommendations:
Immediate Implementable
Actions
1. The GoR needs to determine policies that will facilitate
the effectiveness of a national HMIS
(data access; donor, partner and program involvement
and coordination; flow of data and information; roles etc.)
2. GoR and Donors must devote appropriate resources,
staffing and support to improve the national HMIS
(coordinators, IT and IS specialists, program developers
and training programs)
3. All stakeholders need to improve communication,
coordination and cooperation
Key Recommendations (cont.)
4. Develop long-term HMIS strategy to
meet short and long term needs of GoR,
donors, partners and ultimately inform
decisions to improve the overall healthcare
system
5. Modify existing GESIS program to reflect the
newly defined districts with correct health
centers linked to them as an interim fix
6. Reinforce capacity for Information Systems (IS)
and Information Technology (IT)
Policy
1. Align data standards, data collection tools,
measurement methods, content, feedback, and
technology for all districts
2. Develop policies for easy and efficient access
to health information to avoid individual
organizations having to create parallel
systems (which increases the burden on the
health care provider)
3. Adopt International Classification of Disease
data and Current Procedural Terminology
Communication and Coordination

1. Clarify and communicate roles and

responsibilities (written guidelines, trainings)
2. Communicate current correct reporting
procedures to district supervisors, district
admin. health directors, health center directors
and nurses etc.
3. Re-establish Monthly Coordination meetings at
the district level
4. Assign sufficient and capable staff to HMIS
systems coordination
5. Coordinate HIV/AIDS vertical systems
Capacity Building:
Training and Education
1. Train Supervisors & health facility Directors in:
a) Data verification, supervision and offering
feedback
b) Data analysis and usage

c) Emphasize and Use feedback

d) Train staff in computer and software usage

2. Train health staff in the use of International

Classification of Disease Data coding and
Current Procedural Terminology (can be done
in phases)
 Develop and Support Data Analysis
and Utilization skills strengthening
 Train data collectors,
compilers and users in the
importance of data analysis
and utilization and increase
their ability to use these tools
 Incorporate data analysis
and utilization into
educational/training
programs: KIST, KHI, ICT &
IT schools and training
centers, schools of nursing
and management,
implementing partner
programs
Develop Feedback policy and
skills (reporting and transfers)
MINISANTE

Reference Hosp. Military Hosp.

District Admin & Hosp.

Private Disp.
Health Centers
Community
Health
Workers
ASC ASC ASC ASC ASC (ASC)
 Modifications and
System Development
1. Align GESIS with new districts
2. Integrate community-based data, private
sector, military and referral hospitals
3. Develop systems to record and use patient
information
4. Integrate International Classification of Disease
(ICD) data and Current Procedural
Terminology (CPT) into the new system.
A National HMIS
 An ideal system needs to provide useful
information to users at all levels
 The whole point of such a system is for people to be
able to get useful, timely and accurate data easily.
The system needs to be able to:
 Exchange data with other data systems
 Have capacity to store and manipulate
necessary data
 Produce graphs and charts
 Produce regular and custom reports
 Easy accessibility to:
 Enter data
 Already transformed data
Steps for designing a new or
partially new system
1. Thoroughly understand the organizational
procedures and processes
2. Get input from all levels of the information
system to make sure the system responds to the
needs of users.
3. Commission information systems specialists to
design a system which incorporates either all or
part of the existing system, or design a
completely new system based on the new
organizational procedures and processes and
reporting needs.
How to be Part of the Solution
GoR/MoH:
 Policy determination (data access, data sharing, roles and
responsibilities, reporting, including data analysis and usage
into curricula)
 Hire capable coordinators,IS, IT specialists at the all levels
of the health pyramid
 Clearly communicate policies to all stakeholders

Donors and GoR:

 Provide the necessary financial and human resources to
implement the next steps for the national HMIS
How to be Part of the Solution
(cont.)

Donors and GoR:

 Identify liaisons to communicate, coordinate,
harmonize and share information re: programs
Implementing Partners
 Coordinate and cooperate with other partners working
on HMIS programs to reduce duplication of effort and
resources and to ensure data quality and usage
 Include training for data collection, analysis and
utilization etc. in all health systems related projects
MURAKOZE CYANE!
THANK YOU !
Sincere thanks to the Ministry of
Health and GoR, USAID, staff at
health centers, districts, district
hospitals, donors, and partners
organizations for their cooperation
and collaboration in conducting the
HMIS Assessment.