Health Management Information System

(HMIS)

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 PRESENTATION OUTLINE
 Overall Objective

• Specific Objectives

• The Information cycle

• Data handling processes in the info cycle

• Overview of HMIS paper based tools

• HMIS data flow guideline

• DATA Quality 2
 OVERALL OBJECTIVE
To ensure availability of relevant, accurate, timely and
accessible health data, to support the planning,
coordination, monitoring and evaluation of health
services.

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 SPECIFIC OBJECTIVES
• To ensure that data is being collected and aggregated
correctly.

• Ensure that activity/tally sheets are always available and

being used at all the time

• Data is being recorded according to HMIS guidelines

• Registers are being updated every time you are conducting

the service

• To ensure that verification of reports is done timely always

• To ensure good records/reports keeping 4

 INTRODUCTION
 The Health Management Information System (HMIS) is
the Ministry of Health’s routine system designed to
gather information for assessing health status; health
services utilisation and health outcomes as well as
measuring the determinants of such outcomes.

 It is designed for use at all levels of health service

delivery starting with the health post, health centres,
hospitals, districts, provinces and the national levels for
planning, managing and performance monitoring of the
health care delivery system. These important tasks are
necessary in order to continually improve the quality of
health care in Zambia.
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 The information cycle
• This is the process by which data is collected, collated
and analysed to provide meaningfull information. This
information is used for planning and assessment. The
successful completion of this cycle is dependent on a
number of tools:

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 Overview of HMIS paper based tools
• The HMIS uses a number of paper based tools to record and aggregate health
data during service provision.

• The standard paper based tools are classified as:

• a) Record of health services Patient/Client Record and Service Registers;

• b) Aggregation tools Activity Sheets/Collation sheets and/or Tally sheets;

• c) Data transmission/Reporting tools Health Information Aggregation

• d) Monitoring tools
 Overview of HMIS paper based tools
• Patient/Client Record
• This is a book or card that keeps patient/client information including
the identity,history, diagnoses and/or service provided. Depending on
the service, the patient/client record may be kept at the facility or by
the patient/client. Common practice is that curative patient records
except for chronic illnesses are kept at the health facility while
preventive client records are kept by the client. The list of
patient/client records includes OPD Booklet, IPD sheet, Under 5 Card,
Antenatal Care (ANC) Card OR Obstetric Care book, Family Planning
card, TB card, PMTCT card, ART card and Tetanus Toxoid (TT)
Immunisation Card,
 Overview of HMIS paper based tools
• Registers
The health facility maintains a copy of the patent/client record and services
provided in service/patient registers. Registers are books in which the
patient/client details and services being provided are recorded. Each line in the
register represents a client contact and/or service provided. The registers are
used for continuity of care, follow ups and validation of data submitted to the
District Office.In providing continuity of care the register has space for
predetermined number of visits or services. If a client does not report within the
expected period, the record is used to compile all patients/clients that must be
followed up. If the patient losses their card/book the register is used to
reconstruct the health information when a replacement card/book is issued. Where
patient/client records are retained by patients/clients the register must be updated
during provision of services otherwise the registers can be updated after service
provision.
 REGISTERS
• OPD

• IPD

• Antenatal care

• Maternity Admission registers

• Labour& delivery

• Postnatal

• Integrated family planning

• VMMC

• Growth monitoring and promotion

• Nutrition
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 REGISTERS CONT.
 Child Health Imunization

 Baby mother follow up

 CHA household activity

 Community mobilization and surveillance

 Patient care

 HIV Testing services

 HIV Care and Treatment Registers

 Pre/Post Exposure Prophylaxis Register

 STIs

 Malaria diagnostic test (RDT)

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 Environmental health
 REGISTERS CONT.
 Mortuary

 Radiology

 Theater

 Dental

 TB Treatment register

 TB presumptive register (Facility&Community)

 TB laboratory register

 Leprosy treatment register

 PEP

 PrEP
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 GBV Incidence
 Overview of HMIS paper based tools
• Tally sheets
Tally sheets consisting of groupings of “0” (zeroes) are used to count
elements defined on the sheet such as attendance by crossing a zero
for every occurrence.At the end of a given period may be a day, month
or quarter, the crossed zeros are counted and thus provide a tally of
what was being counted. Tally sheets can be used by individuals or
may be shared by a group of health workers. Ideally the tally sheet
should be updated at the time of providing services. The disadvantage
of the tally sheet is that it is difficult to audit in case of mistakes like
forgetting to tally,tallying more than once for the same incident or
tallying the wrong item.
Outpatient monthly attendance tally sheet
OPD First Attendance Tally Sheet
 Overview of HMIS paper based tools
• Activity sheets
The activity sheet combines the functions of the register and of the tally
sheet in one while providing accounting for each health worker’s effort.
The services and items to be tracked are pre-defined on the activity sheet.
The health worker simply provides the patient/client reference and tick the
service provided. The ticks provide a record of the service provided and a
count of the items to be tallied at the end of the period. In addition it
provides the name of the health worker. The activity sheet is easier to
audit than a tally sheet because it references the patient/client and the
health worker. The activity sheet also provides automatic validation in that
it is easy to spot wrong combinations of ticks. Instead of updating
registers from patient/client records the activity sheet is easier to use.
Growth monitoring and promotion activity sheet
Growth monitoring and promotion activity sheet
 Overview of HMIS paper based tools
 HIA forms
The Health Information Aggregation (HIA) form or report provides a pre-determined set of
data elements whose values are derived from the tally sheets, activity sheets and/or
collation sheets. Currently the HMIS provides for two main HIA reports,namely Service
delivery (HIA 2&3) and Disease (HIA 1A,HIA 1B) at facility level.And at community level there
are two reporting tools (HIA 4b,HIA 4b) The HIA is used to transmit facility aggregated data
for posting into the District Health Information System (DHIS) at the district office or at the
facility where facility staff have been trained in electronic reporting.Environmental
health,TB,surveillance being reported separately

• Monitoring chart
The monitoring chart is used to monitor progress of service delivery
(immunizations,antenatal etc) in the facility catchment’s area. It provides basis for local
decisions and planning of interventions at each facility
Health Information Aggregation Form 1 (HIA 1A)
Health Information Aggregation Form 1
(HIA 1A)
Health Information Aggregation Form 1 (HIA 1A)
Health Information Aggregation Form 1 (HIA 1A)
Health Information Aggregation Form 1 (HIA 1A)
Health Information Aggregation Form 1 (HIA 1A)
Health Information Aggregation Form 1 (HIA 1B)
Health Information Aggregation Form 1 (HIA 1B)
Health Information Aggregation Form 2 (HIA 2)
Health Information Aggregation Form 2 (HIA 2)
 Health Information Aggregation Form 2 (HIA 3)
5.0 Cancer Screening and Diagnosis

5.1 Breast Cancer

Number of women screened for breast
cancer
Number of women diagnosed with
breast cancer
Patients with Breast Cancer referred for
Treatment
Referred for
5.2 Cervical and Prostate Cancer Screened Diagnosed
Treatment

Number of women for cervical cancer

Number of men screened for prostate cancer

5.3 Treatment provided

5.4.1 Curative Surgery Radiotherapy Bracktherapy Chemotherapy Nuclear medicine
Number of patients given (Curative)
Number of patients given (Paliative)

5.5 Staging Stage I Stage II Stage III Stage IV

Number of patients in stage
5.6 Follow ups

6 months 1 Year 3 Year 5 Year

Number of patients followed up at

 Health Information Aggregation Form 2 (HIA 3)
Anesthesia & 7.Anesthesia
6.Anesthesia & 7.Anesthesia

General Regional Local Sedation Other types

Anesthesia

7 Surgery
7.2.General surgery
Biliary Surgery
Gastroenterology
Excission
Others

7.3.Obstetrics & Gynaecology - Surgery

Caesarean Section Pelvic Abscess

Hysterectomy Maternal Haemorrhage

Bilateral Tubal Ligation EUA

Rupture Uterus Others

Ectopic Pregnancy
Environmental health reporting Form (EH2)
Environmental health reporting Form (EH2)
Environmental health reporting Form (EH2)
Health Information Aggregation Form (HIA 4a)
Health Information Aggregation Form (HIA 4a)
Community HMIS Integrated Reporting Tool (HIA4b)
Community HMIS Integrated Reporting Tool (HIA4b)
Monitoring charts
 Monitoring charts - Disease
Disease

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Year:_______________
 Data handling processes in the info cycle
Tools:
Collection Client Cards
Tally Sheets
Activity sheets
 Indicator based essential dataset Registers
 Data elements - std. definitions
 Data sources & tools defined
 Data capture streamlined
Use of Information Tools:
Programme Management
 Regular review of data Planning Processing Tools:
 Relate to operational plans Budgeting Collation tools
Validation rules
 Monitor service coverage & quality Data flow  Collation
 Data quality checks (manual)
Tools:  Data validation (computer)
Interpretation Explore
Ask questions Tools:
Research
Feedback Indicator formulas
 Making sense of information Analysis
 Possible interpretation
 Explore Tools:
 Indicators
Presentation Tables
Graphs
Discussions
 Flow of information Feedback

 Format of tables, graphs & reports

 Feedback mechanisms
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 HMIS Data Flow Guideline
A g gr eg n
ation io
From the PROVINCE to MOH -HQ Act
(5th of the 3rd Month) MoH Hq
s is
al y
An

io n
From DISTRICT to PROVINCE
A g gr eg
ation Act
(30th of the 2nd Month) Province
s is
al y
An

io n
From HEALTH FACILITY to A g gr eg
ation Act
DISTRICT District
(7th of the 2nd Month)
s is
al y
An

io n
Facility Level A g gr eg
ation Act

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s
a l ys i
 DATA QUALITY
• The state of completeness,validity,consistency,timeliness and accuracy that
makes data appropriate for specific use

• Data quality involves things that help one be sure that the data say the right
thing, and that the right thing is accurate.

• Do we trust the data?

• Are the data reliable?

• For example, do we know that the people entering or submitting the data
know what they are doing?

• Are the data valid?

• For example, do we know that the people reporting the data have double
checked what they are actually submitting for errors?
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END OF PRESENTATION
QUESTIONS,CLARIFICATIONS,
COMMENTS

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