MANAGEMENT

INFORMATION SYSTEMS
GUIDED BY PRESENTED BY
DR. SUSHIL KUMAR SHUKLA DR. TANYA AGARWAL
PROFESSOR & BIOSTATISTICIAN PG JR -2
DEPARTMENT OF COMMUNITY DEPARTMENT OF COMMUNITY
MEIDICINE MEIDICINE

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 CONTENTS
• Abbreviations
• Background
• Introduction
• Objectives of HMIS
• Components of HMIS
• Sources of data
• Flow of data from various
facility
• Data Quality dimensions
• Data Process
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• Requirements for HIS
• Indicators
• HMIS formats and reports
• Uses of HMIS
• Issues with Indian HMIS
• HMIS- Strength and constraints
• MCTS
• Conclusion
• References
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 ABBREVIATIONS
• HMIS: Health Management Information Systems
• HIS: Health Information Systems
• NHM: National Health Mission
• MOHFW: Ministry of health and family welfare
• PIP: Program Implementation Plan
• GIS: Geographical Information Systems
• SAS: Statistical Analysis System
• DHQ: District Headquarters
• DH: District Hospital
• MCTS: Mother and Child Tracking system

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 BACKGROUND

Launched in October Web based management Facility level reporting was Around 2,00,000 health SAS platform services
2008 by MOHFW to information system initiated 2010-11 onwards facilities across all districts of for Data analytical &
monitor NHM and other India are uploading data reporting
health programmes and every month
provide key inputs for
policy formulation and
appropriate programme
interventions at district
level

GIS module of HMIS is HMIS provides ready to use National, State, Platform for evaluating the PIP on
available in Public District and sub-district reports (available in the basis of services rendered by
domain Public domain) health facilities
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Source: https://nrhm-mis.nic.in ( accessed on 19.11.2020)
 INTRODUCTION
• A mechanism for collection, processing, analysis and transmission of
information required for organizing and operating health services, and also for
research and training
• HIS has four key functions:

DATA ANALYSIS AND COMMUNICATION

COMPILATION
GENERATION SYNTHESIS AND USE

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INTRODUCTION (CONT...)

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INTRODUCTION (CONT...)

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 OBJECTIVES OF HMIS
 To monitor the performance & quality of health care services under the National Health
Mission

 Evidence-based health planning

 Repository of information on health care indicators and trends

 Used for testing the effectiveness, efficiency and coverage of health programs and schemes

 To improve availability and access of health care to the population

 Develop and monitor performance-based health indicators

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 COMPONENETS OF HIS

DATA/ INFORMATION HARDWARE/ SOFTWARE/ PROCESS/ TASK/ SYSTEM

COMPONENT NETWORK COMPONENT COMPONENT

INTEGRATION/ INTER- USER/ADMINISTRATION/

OPERABILITY COMPONENT MANAGEMENT COMPONENT

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 SUB COMPONENETS OF HMIS

Epidemiological surveillance

Routine service reporting

Specific program reporting

Administrative systems

Vital registration

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 SOURCES OF INFORMATION

Sample
Registration of Notification of
Census registration
vital events diseases
system (SRS)

Epidemiological Health services

Hospital records Disease registers
surveillance records

Population surveys
Health Health interview
Environmental
manpower Health examination survey
health data
statistics Health records survey
Mailed questionnaire survey
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 HMIS MATRIX COLLECTORS
LOCATION PERSON/ ORGANISATION RESPONSIBLE

SUB CENTER ANM

PHC/ HOSPITAL Pharmacist, statistical assistant

District District statistical officer- health, family welfare, TB, Malaria, Leprosy officers

State Dy/ Joint Director Statistics- Family welfare

Dy/ Joint Director- Vital statistics
Surveillance Unit
Sample Registration system

Central government Central Bureau of Health intelligence

Statistics Division- Department of Family Welfare
CGHS
Statistics Division- Department of Health
Sample Registration System- head quatered

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Flow of Data in case of Facility Level Reporting (Case-I)

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Flow of Data in case of Facility Level Reporting (Case-II)

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 DATA QUALITY DIMENSIONS

Relevance

Consistent Accuracy

Comparability

Timeliness & Punctuality

Accessibility & Clarity

Completeness

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 DATA PROCESS
DATA COLLECTION

DATA REPORTING

DATA ENTRY

DATA AUTHENTICATION

DATA ANALYSIS

USE OF INFORMATION
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 REQUIREMENTS FOR HIS

Population based

Avoid unnecessary agglomeration of data

Problem oriented

System should employ functional and operational terms

Express information briefly and imaginatively

Provisions for the feedback of data

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 INDICATOR
• Variables that help to measure changes, directly or indirectly
• Indicators are tools used to convert data into information

Indicator = X 100 = .......%

• NUMERATOR: activities / interventions / events

• DENOMINATOR: population at risk

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 CLASSIFICATION OF INDICATORS
INDICATOR REPRESENTATION EXAMPLE

Input Indicate resources invested in the system number of doctors per 100,000 people.

Process indicate activities of the health system percentage of doctors trained in safe delivery
skills

Output indicate achievements made specific health percentage of women who received 3 ANCs
strategies

Outcome indicates achievements of a health institutional delivery rate, breastfeeding in one

programme or health system hour rate etc.

Impact indicates achievement health status of Maternal Mortality Ratio, Infant Mortality Rate,
particular group of people Total fertility Rate etc

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INDICATORS AT THE LEVELS OF PLANNING

Goals Impact indicators

Objectives Outcome indicators

Strategies Output indicators

Activities/ Processes Process indicators

Inputs Input indicators

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 INDICATOR DICTIONARY

Immunisation
Antenatal care Delivery services
coverage
coverage indicators
indicators

Child & Family Planning

Post Natal Care
Neonatal Health Coverage
indicators
indicators indicators

Laboratory
Mortality Service Delivery
Services
indicators indicators
indicators
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 ANTENATAL CARE
COVERAGE
•ANC registration rate
•early registration rate
•TT2/Booster coverage
rate
•ANC 3 check ups rate
•ANC 100 IFA coverage
rate
IMMUNISATION
COVERAGE
•Full immunisation coverage
rate
•BCG coverage rate
•DPT3 coverage rate
•OPV3 coverage rate
•Measles coverage rate
•BCG -Measles dropout rate
•DPT3- Measles drop out rate
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DELIVERY FAMILY PLANNING MORTALITY LABORATORY
SERVICES SERVICES DELIEVRY SERVICES
COVERAGE INDICATORS
•Institutional delivery
•contraceptive prevalence •neonatal mortality rate •ANC services delivery •HIV positive as % of HIV
rate
•Institutional delivery rate •Infant death rate •ANC moderately tested
•Sterilization coverage rate •Under 5 mortality rate anaemic rate •Proportion of antenatal
rate
•Home delivery rate •IUD •Peri Natal mortality •ANC hypertension new women tested for HIV
•OCP rate case detection rate •HIV prevalence among
•Skilled Birth Attendant
•Condoms •MMR •ANC severely anaemic antenatal (ANC) tested
delivery rate •HIV prevalence among non
•Caesarean section rate •proportion of limiting treated rate
methods •Eclampsia management ANC tested (excluding
•proportion of spacing rate ANC women)
•JSY coverage •HIV prevalence among
methods
•JSY registration rate males tested
•Annual parasite incidence
•%institutional delivery
•Annual Blood Examination
receiving JSY benefit
•IPD as percentage of OPD rate
•Operation major as %of
CHILD AND OPD
POST NATAL CARE
NEONATAL HEALTH •Operation minor as %of
•PNC rate(48 hours) •% newborns OPD
•PNC rate (48 hrs-14 days) breastfed<1hr •Dental utilization ratio
•Sex ratio at birth •Bed occupancy rate
•Low birth weight rate
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 HMIS FORMATS

Annual Quarterly Monthly (Service

(Infrastructure) (Trainings) delivery)
• • State • District HQ
DH
• • District • DH
CHC
• • CHC
PHC
• • PHC
SC
• SC

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 HMIS Reports

Analytical reports Standard reports Live reports

• CHC Grading
• PHC Grading
• Scorecard & Dashboard
• Factsheet: State & District
• Facility monitoring • Data reporting Status
reports: Range wise & • Data item reports
Min-Max • Master’s reports
• Drill Down report • Log reports (& others)
• Data item reports
• Key indicator reports
• RCH performance reports
• Data Quality reports.
(validation & outlier
report)
• Data comparison reports
(& others)

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 USES OF HMIS

• Measure the health status and quantify health problems and medical and healthcare
needs of the people
• Rigorous standardization and quality-controlled data for local, national and
international comparisons of health status
• For planning, administration and effective management of health services and
programmes [HMIS data is widely used by States in preparing Program Implementation
Plans (PIPs) under NHM.]
• Assessing effectiveness and efficiency of health services
• Assessing attitude and degree of satisfaction of the beneficiaries
• For research into particular problems of health and disease

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 ISSUES WITH INDIAN HMIS

Absence of
feedback
Human
Structural Procedural defeats the Content Technological
resources
issues issues purpose of related issues
related
information
collection

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 HMIS- STRENGTHS & CONSTRAINTS

STRENGTHS CONSTRAINTS
Data Flow  Daily Reporting not available
Usability  No Automation of Analytical
Well conversant reports(Grading/Score
Over the 10 years major Cards/Factsheets)
improvements  Dashboard not available
Rationalization of formats  Outdated Software and Hardware
Easy to use & upload data (offline as Technology
well)
Acceptance
Facility Level Data Entry

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 MOTHER AND CHILD TRACKING SYSTEM IN
INDIA
• It was launched in 2009 as part of a global trend towards harnessing e-health innovations in
improving service delivery
• The MCTS is designed to capture and track all pregnant woman (from conception upto
42 days post partum) and all newborn children (up to 5 years of age).
• Its objectives are to ensure that:

All pregnant women receive their antenatal (ANC) and postnatal care (PNC)
services at the due times

Institutional deliveries for pregnant women, particularly for high risk mothers,
are encouraged

All children receive the full immunization schedule at the due times

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 DATA FLOW AND ENTRY -MCTS

Village /SC
level- PHC level –
FHWs in for entry in National
District and
registers MCTS portal
(beneficiaries
by data entry
state level level
operators
&service
data)

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 CHALLENGES OF MCTS

• Non standardized data collection tools , hand drawn formats

• Linguistic challenges-data entry in portal is in English

• Inadequate training of FHWs on data formats

• Errors in Data Entry (both unintentional and intentional)

• Irregular electricity supply, inconsistent internet connectivity and the

slow speed of the MCTS web portal

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 STRATEGIES TO OVERCOME THE CHALLENGES

These guidelines
should clearly lay
out a plan for
Designing clearly data collection , Strengthening the
Registers and defined consolidation and infrastructure i .e.
Adequate training
formats should be standardised data transfer to the internet
of human resource
standardised processes and data entry point connectivity and
guidelines with stipulated speed
timelines and clear
organizational
rules

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 CONCLUSION
• A good health service superstructure can be built only on a solid base provided by the reliable
health statistics collected through a well-organized infrastructure

• HMIS is efficient way to track health expenditure in all states and identify patterns of disease
occurrence

• HMIS eases the mundane task of salary administration, inventory management, accounting and
finance, equipment management and overall hospital management

• Though there are challenges in implanting HMIS in developing countries ,the situation is improving
with experience, time and understanding about the importance of allocating resources to HMIS

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 REFERENCES

1. Management H, Systems I. http://nhsrcindia.org/ (Accessed on 19.11.2020)

2. Bodavala R. Evaluation of Health Management Information System in India
Need for Computerized Databases in HMIS. … Bodalava, Tak Fellow Int
Health. 1998; Available from:
http://folk.uio.no/patrickr/refdoc/teams/Evaluation of HMIS in India.pdf
3. McKean WI. Health information. N Z Med J. 1987;100(831):553 available from
https://www.who.int/healthinfo/statistics/toolkit_hss/EN_PDF_Toolkit_HSS_Informa
tionSystems.pdf

4. WARREN MD. Social and preventive medicine. Br J Clin Pract. 1961;15:217–27.

5. Mother and Child Tracking :: Govt. Of India [Internet]. [cited 2020 Nov 22].
Available from: http://nrhm-mcts.nic.in/

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 The Most Successful Person In Life Is The Person Who Has
The Best Information

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