Investing to Strengthen Health Information System,

The Experience of Ethiopia

PPMED—Ministry of Health—Ethiopia
Outline

• Evolution of HIS in Ethiopia

• Before 2008

• 2008-2015

• 2016-present

• Major HIS investments in Ethiopia

• Major Challenges

• Lessons
Evolution of HIS in Ethiopia
Before 2007/08

• HIS implemented without a well developed and defined strategy

• In 2006, a national situational analysis conducted
• Findings from situational analysis showed national HMIS various limitations
• Fragmented system and limited investment
• Limited and program based investment
• Sub-optimal leadership support: attention given to HIS process, HR deployment,
• Inadequate HIS professionals production, no training, no curriculum
• Poor infrastructures: ICT, shelves, forms, cabinets, tables, rooms
Evolution of HIS in Ethiopia
Before 2007/08
• Duplication of HIS efforts
• Data flow: multiple non-standardized data capturing systems: huge data burden
• Program based vertical reporting
• Parallel multiple reporting channels
• Many reporting and registration forms
• Limited coordination of stakeholders
• Low data quality:
• data burden, limited skills, poor data quality assurance and data use practices
• Limited data use: focus was sending reports to higher level
• Weak HIS governance structures: lack of coordination of stakeholders
• Lack of standards: no combination and comparison of data from sources
• Limited use of ICT: less efficient systems
Evolution of HIS in Ethiopia
2007/08-2015
• Reform with motto “one plan, budget, & report”
• HMIS reform was one of the eight priorities of HSDP III through BPR
• Informed by the national HMIS situational analysis conducted
• PPMED became core-process at national and down the line
• Four overarching principles
• Standardization: common definitions of indicators, forms, procedures, reporting
channels & calendar, structure
• Integration: a single channel as source for all with unified effort
• Simplification: only relevant data and digitizing the system
• Institutionalization: data use at starting from the point of data collection
Evolution of HIS in Ethiopia
2007/08-2015: Major HIS Initiatives

• HMIS strategic plan in HSDP III and HSDP IV

• National Advisory group established, provided technical guidance for HIS
• Facility level HMIS started in 2008
• Four HMIS implementation manuals developed: HMIS Indicator definition, disease classifications,
recording & reporting procedures, and Information use
• National HMIS/M&E training materials developed for facility level HMIS
• Training cascaded to all health workers in health centers, hospital and administration levels
• HMIS implemented in all HCs, hospital and administrative levels
• Human Resource:
• Health Information Technicians (HITs) curriculum developed and training started in 2009 in
colleges (Harar and Shashemene …): scaled-up in most of health science colleges
Evolution of HIS in Ethiopia
2007/08-2015

• Community Health Information system (CHIS)

• Piloted in 2009
• Agrarian CHIS started in 2009, pastoral CHIS in 2016/17 and urban CHIS in 2018/19
• Agrarian was scale-up in almost all health posts
• Efforts to digitize HMIS in Ethiopia until 2015
• Smart care (patient level recording) started in 2010 in selected few hospitals and few HCs
• MRU-EMR started in majority of HCs and hospitals
• CHIS module of smart care piloted in 2010
• Electronic HMIS (eHMIS): data aggregation and data reporting system in all regions except in
SNNP (different system)
• HRIS was piloted in 2010
• eLMIS started in 20-- (HCMIS)
Evolution of HIS in Ethiopia
2016-present

• HSTP-I has four transformation agendas

• Information Revolution (IR) was one of the TAs
• “[The Information Revolution] entails a radical shift from traditional ways of data utilization to a
systematic information management approach powered by corresponding levels of
technology... it is also about bringing fundamental cultural and attitudinal change regarding
perceived value and practical use of information.” (HSTP I, 2015)
• IR with 3 pillars:
o Cultural Transformation in data use
o Digitization and scale-up of priority HIS
o Strengthen HIS governance
Evolution of HIS in Ethiopia
2016-present

• IR model district (connected woreda) strategy

• Introduction of Capacity Building and Mentorship Program (CBMP): Academia
supported IR implementation
• Produce learning woredas/institutions
• Implementation researches, innovations
• Developed curriculum for HIS professionals
• Train postgraduate students working researches on HIS
• HSTP-II: HIS strategic plan
• IR still one of the agendas with 3- pillars
Evolution of HIS in Ethiopia
2016-present
• Strengthen HIS governance
• Various HIS governance documents developed
• HIS regulation, data access and sharing directive, governance framework, NHDD standard operating procedure,
….
• Electronic governance structure developed, national eHealth architecture
• HIS governance structures established
• National level: HIS steering committee, NAG, TWGs (Data use, Governance, Digitization),
sub-TWGs
• Regional level: Steering committee, RAG, TWGs,
Evolution of HIS in Ethiopia
2016-present

• Cultivating data use practices at various platforms

• Facility level
• Individual level:
• Team level performance reviews:
• Facility level performance reviews:
• Community forums:
• Administrative level performance reviews (districts, zones, regions, national):
• Major data use forums: JSC, ARM, JCCC ..
• Information products: quarterly analytics report, data quality checks, annual reports, ….
• Researches groups, scientific forums, policy reviews, deliberations …
• Visualization: EHDAP, DHIS-2, dashboards, score cards,
• Capacity building: training on data use
• Continuous quality improvement initiative introduced at facility level
Evolution of HIS in Ethiopia
2016-present

• Digitization
• Electronic regulatory information system (eRIS)
• Implemented since ….
• An umbrella system implemented by eFDA
• Has subcomponents for processes related to pharmaceutical supplies importing and control
system (iLicense, iRegister, iImport, iVerfiy)
• All types of pharmaceutical supplies, government and private importers,
• District Health Information Software (DHIS-2)
• eHMIS was replaced by DHIS-2 in 2017/18
• Data aggregation, data reporting, and analysis
• Implemented in all hospitals and 95% of health centers
• Planning tool for district based health sector planning in 2022
• Tracker for COVID-19 vaccination, MDR-TB,
Evolution of HIS in Ethiopia
2016-present

• Digitization
• Electronic Community Health Information System
• Five modules developed
• More than 7800 HPs strated implementation
• More than 23K HEWs trained
• More than 34K tablets distributed
• Server, dashboard, SIM cards, power banks …
• Government invested about 170.4 million ETB
• DHA, DUP, WEEMA, L10K, Universities supporting the implementation
• Electronic Medical Record (EMR)
• 41 hospitals and 30 HCs started EMR, 470 ART clinics
Evolution of HIS in Ethiopia
2016-present

• Digitization
• Integrated Human Resource Information System
• Development completed, piloted, TOT delivered
• eLMIS: supply transactional systems
• Dagu-2: 850 facilities,
• mBrana: 549 woredas,
• Vitas in all hubs
• Fanos: Dashboard for visualization of eLMIS data
• Blood safely information system (BSIS) implemented in three blood banks,
• eVVRT
Evolution of HIS in Ethiopia
2016-present

• As of 2022

• Service report completeness: 88%

• Service report timeliness: 63%

• Birth Notification: 52%

• Dearth notification: 3.6%

• Information products

• Reduction in discrepancy of routine data and survey data

Major partners that supported HIS in Ethiopia
• JSI Basics, ESHE,
• Tulane International (2007—2017):
• JSI HMIS-scale-up project: 2009—2018
• JSI Deliver:
• JSI-Urban
• JSI-HPCAPS
• JSI AIDS free project:
• Chemonics:
• JSI DUP (2016—present):
• ICAP (2017—present):
• JSI DHA (2019—present):
• Italian corporate
• Transform PHCU/HDR: 2016-2022
• JSI L10K (2016—present)
• WEEMA
Major Challenges to HIS in Ethiopia

• Limited skills and capacity of recording, quality assurance and use of data

• Capacity to conduct operational researches, surveys, and policy analysis

• Shortage of supplies: CHIS and HMIS tools, gadgets,

• Infrastructure: electricity, rooms, shelves, internet connectivity (coverage)

• Limited ownership and capacity to implement HIS at various levels

• Sub-optimal implementation of HIS within the private sector

• Limited pooled investment for HIS

Major Challenges to HIS in Ethiopia

• Suboptimal coordination in spearheading implementation of HIS

• Contraction of donors support

• Conflicts: disrupted HIS, diversion of resources, damage to HIS infrastructures

• Sustainability of HIS implementation

• High turnover of trained human power

• Limited support from (engagement of) programs to the implementation of HIS

• Absence of performance based incentive mechanisms
Lessons
• Engaging stakeholders at different levels coordinated consolidated efforts to
realize IR
• Engaging local universities supported local capacity building efforts (innovations
& trainings, curriculums)
• Investing in HIS HR ensure sustainable capacity to HIS implementation (HITs and
Health informatics-BSc and MSc)
• Successful implementation of DHIS-2 in more than 5000 facilities
Thank You!