Health Information Systems Programme. Professor Kristin Braa Department of Informatics, University of Oslo

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1 Health Information Systems Programme Professor Kristin Braa Department of Informatics, University of Oslo

2 Health Information Systems Program District Health Information System - DHIS 2 HISP a global action research network headed and initiated at the Dept. of Informatics, University of Oslo since 1994 DHIS 2 is an open source software for reporting, analysis and dissemination of data for all health programs Aggregate and individual records and event captures Shared and integrated data warehouse for essential health data: information for action Implemented in more than 40 countries, national standard in 15 countries, WHO endorsed Joint 3-donor (PEPFAR, Global Fund, Norad) effort to strengthen DHIS 2 use in countries UiO Innovation award 2013

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4 Action oriented multidisciplinary research Strengthening national health information systems Collaborating with Ministries of Health Research theme: Sustainable implementation Interoperability Architect(ing) Scaling Open source software development done in a global network Building capacity locally At present 32 PhD students worldwide. 30 graduated PhD school 6 international Masters program DHIS Academy East Africa, West Africa, Asia, Latin America) From national level to regional level ECOWAS (WAHO), East Africa Community (EAC)

5 Capacity building at scale In addition to the DHIS Academies Integrating DHIS2 in undergraduate education for all (from nurses to doctors) Building up Health Informatics Master program Rwanda and Malawi Advanced DHIS 2 Academy, Gisenyi, Rwanda May 2014

6 Present in over 40 countries National standard: Kenya, Ghana, Uganda, Rwanda, Tanzania, Nigeria, Liberia, Sierra Leone, Gambia, Zanzibar, Malawi, Zimbabwe, Zambia, Burkina Faso, Bangladesh, 12 Indian states WHO endorsed 6

7 DHIS2 as a platform Generic and generative platform - supports a wide range of uses also beyond the health sector Allows for distributed innovation in a wide network Flexible configuration and customization for a range of organizations and use cases Allows for new functionality through open APIs and app development

8 Customization of DHIS2 You can set up a system without being a programmer Organization hierarchy with any number of levels Specify any kind of data to be collected Define any type of indicator to be calculated User profiles and roles Management of data Configure many types of output, including charts, tables, maps and dashboards Define analysis and reports along any number of categories and dimensions On different devices and.

9 Apps can be selected from DHIS2 App store Or be developed We encourage people to make apps generic and share

10 DHIS2 App development Web Application Programming Interface (Web API) provides flexibility to extend the functionality Current architecture lets you install web apps that use the API to add functionality to solve specific use cases Web Apps let you use the DHIS data model in more flexible and customizable way With tailored User Interface Can share them with others in the DHIS App store

11 Web App Future The long term goal of the DHIS team is to primarily use web apps for the User Interface (Core apps) The DHIS core User Interface will be replaced by core web apps : Events (capture/reports/visualizer), Mapping Pivot Tracker capture Visualizer.

12 Ebola case tracking in Liberia

13 Registering symptoms

14 Including coordinates

15 PEPFAR The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government initiative to help save the lives of those suffering from HIV/AIDS around the world PEPFAR will use DHIS2 for reporting from all Implementing Partners in 36 countries For example the number of Implementing Partners in Kenya are 400

16 PEPFAR Approvals use case PEPFAR needs to approve lots of data In the core DHIS2 you can only approve one dataset at a time An custom Approvals App supports approval of multiple datasets at the same time and at different approval levels The App supports PEPFAR funding mechanisms structure The App was developed on the standard DHIS2 API data structure

17 PEPFAR Approvals (Global level)

18 PEPFAR Approvals (Country level)

19 PEPFAR Approvals (Data view)

20 Extending the DHIS reach through mobiles Districts / Hospitals Clinics Community Health Workers Community / Villages SMS Java Browser Android PC/laptop/tablet

21 The importance of backbone for scaling Web Portal Data from Mobile devises Data warehouse DHIS 2 -Data mart -Meta data -Visualising tools Dashboard Annual measles coverage % Measles under 1 year coverage by district 2006 (Measles doses given to children < 1 year / total population < 1 year) Chake Michew eni Mkoani Wete Central North A North B South Urban West Chake District District District District District District District District District District Pemba Zone Unguja Zone LMIS Graphs District HR EMR Mobile Maps Getting data in - Data warehousing Getting data out - Decision support systems

22 Information for action Collect Use Analyze

23 Learning through network of action: National online HIS using mobile internet Kenya First mover, cloud Ghana Fast moving learning from Kenya Uganda Maternal and neonatal death audits Tracking of pregnant women Rwanda Tracker, ANC, sophisticated integration Zambia 600 mobiles for malaria incidence reporting Malawi Browser vs app Nigeria Building an SMS infrastructure for any project Indian states Mobile HIS reporting, 6000 health workers Punjab, Himachal Pradesh

24 Tracking HIV positive mothers through pregnancy and birth

25 Covering simple and advanced interfaces

26 Uganda: epmtct SMS Reporting Goal: Elimination of mother to child transmition of HIV Scaled to all facilities Option B+ implementing service outlets pmtct a.400. b.359. c.50. d.98. e.10. f.50. g.0. h.n. i.y

27 emtct Real-time Reporting Send to 8989 Dashboard Measles under 1 year coverage by district 2006 (Measles doses given to children < 1 year / total population < 1 year) Annual measles coverage % Chake Michew eni Mkoani Chake District District District Wete District Central District North A District North B District South District Urban District West District Pemba Zone Unguja Zone District Graphs Mobile Maps

28 epmtct Real-time Reporting At a facility - Aggregate data - Enter data - phone (sms) - Send to DHIS2 central server - Receive Automatic feedback At a District - Validate report - Approve reports (Completeness) - Follow-up on missing report At a National - League tables - Follow-up on missing report and query data - Further aggregation and analysis

29 In search of the missing data: Uganda Saving Mothers Giving Life Project in 4 districts in Uganda National DHIS2-based infrastructure is used for reporting SMS reporting by Village Health Teams (CHWs) National DHIS Database SMS Broadcast Messages

30 Results

31 Results

32 SMS Broadcast to Village Health Teams and Beneficiaries From SMGL: Dear VHT member, Encourage all pregnant mothers to attend antenatal care at least four times during pregnancy

33 Leverage on the social network

34 Mobile = communicate and share The mobile is primarily a communication tool! Don t forget to improve communication, even if it is the secondary goal of a specific mhealth project Community features help create sustainability Example: Closed User Group makes people positive about project and acts as an attractor

35 Improving data quality through social media Interpretations Charts, reports, maps can be shared with other users of DHIS 2 Discussion forum open to all users to comment on the data Fostering communities of data use

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37 High tech low resource big impact

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39 More Apps (PEPFAR) To fit all the PEPFAR use cases after Approvals there will be three more apps Deduplication of data User management apps that simplifies creating users within the pepfar hierachy Adding users to usergroups, copying permissions etc. Maintenance/Config app that simplifies the process of creating Funding Mechanisms within the system This will create usergroups / category options / Categories / Category option combinations etc all by using one form.