HMIS in Health Service

Delivery
A Case study of Uganda
ANGELICA KIWUMMULO

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 OBJECTIVES
1. Define HMIS
2. Understand the importance of HMIS in Health
Service Delivery
3. Introduction to HMIS use in Uganda
4. Strengths of the HMIS in Uganda
5. Challenges of using HMIS in Uganda
6. Ways to overcome the challenges

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 INTRODUCTION
The World Health Assembly in
2005 recognized the potential of
eHealth to strengthen health
systems and improve quality,
safety and access to care, and
encouraged Member States to take
action to incorporate eHealth into
health systems and services (58th
World Health Assembly, 2005;
Geneva, Switzerland).
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 DEFINITION OF KEY TERMS
Data:
Raw and unprocessed observations, the origin of information.

Information:
Facts or data organised in a meaningful form that allows knowledge to be
expanded, understanding to be deepened, conclusions to be drawn, decisions to be
made.

Information technology:
The means used to process data and transform them into information.

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DEFINITION OF KEY TERMS
A System
A system is the combination of interacting components operating within a boundary for
a specified purpose.
It receives inputs from the environment, transforms them and sends them back into the environment
as its outputs.

Management Information System (MIS)

A system of people and resources used to convert data from internal and
external sources into information and to communicate that information, in
an appropriate form, to managers at all levels in all functions to enable
them to make timely and effective decisions for planning, directing and
controlling the activities for which they are responsible.

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DEFINITION OF KEY TERMS
eHealth
eHealth is the use of information and communication technologies (ICT) for
health (WHO, 2017)

mHealth
mHealth or mobile health as medical and public health practice supported by
mobile devices, such as mobile phones, patient monitoring devices, personal
digital assistants (PDAs), and other wireless devices (WHO, 2011)
mHealth is a component of eHealth

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DEFINITION OF KEY TERMS
Health Information System
Health information systems refer to any system that
captures, stores, manages or
transmits information related to the health of
individuals or the activities of organizations that work
within the health sector.

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COMPONENTS OF A HEALTH INFORMATION
SYSTEM

• HEALTH INFORMATION SYSTEM RESOURCES

• INDICATORS
• DATA SOURCES

• DATA MANAGEMENT
• INFORMATION PRODUCTS
• DISSEMINATION & USE

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Conceptual HIS Framework
DEFINITION OF HMIS
A Health Management Information System is an
information system specifically designed to assist in the
management and planning of health programmes as
opposed to delivery of care (WHO, 1993)
A Health Management Information System (HMIS) is a
data collection system specifically designed to support
planning, management and decision making in health
facilities and organizations.
◦ HMIS is one of the six building blocks essential for
health systems strengthening.

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The WHO Health Systems Framework

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 QUALITIES OF A GOOD HMIS
❖Simple: Easy to understand, easy to use and producing easily
understandable information
❖Flexible: easy to be changed if and when required by the people that
fill in the forms as well as by the interviewees and the users
❖Cheap: it is affordable at all levels of implementation
❖Sensitive: it should give all the needed data, nothing less
❖Specific: it should give only needed data, nothing more
❖Timely: it minimises the steps and can detect trends

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 STEPS IN DEVELOPING A HEALTH
MANAGEMENT INFORMATION SYSTEM
1. Review the existing system
2. Define the data needs of relevant units within the health system
3. Determine the most appropriate and effective data flow
4. Design the data collection and reporting tools
5. Develop the procedures and mechanisms for data processing
6. Develop and implement a training programme for data providers
and data users

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 STEPS IN DEVELOPING A HEALTH
MANAGEMENT INFORMATION SYSTEM
7. Pre-test, and if necessary, redesign the system for data collection,
data flow, data processing and data utilization
8. Monitor and evaluate the system
9. Develop effective data dissemination and feedback mechanisms
10. Enhance the HMIS

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PRINCIPLES OF HEALTH MANAGEMENT
INFORMATION SYSTEM DEVELOPMENT
Health data must be action- oriented: no data should be
requested from a service level, to be reported to higher
levels, which does not have an actionable use at the
recording level.
Countries should use priority health indicators which can be
measured with the data generated routinely.
Emphasis on enhancing service staff and manager capacities
in data generation, analysis and use, rather than creating
specialists in health data analysis (and informatics).

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PRINCIPLES OF HEALTH MANAGEMENT
INFORMATION SYSTEM DEVELOPMENT
Priority attention should be given to improving data
generation and use at the local level to support the
enhancement of service performance.
Existing data must be used at all levels of the health system,
through analysis and presentation, to identify, understand
and solve health and service problems.

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PRINCIPLES OF HEALTH MANAGEMENT
INFORMATION SYSTEM DEVELOPMENT
Computer use must focus on tasks which are essential for
ongoing services and programme management, using
generic and widely available software packages
Preference given to on-the-job training and problem solving
processes.
Occasionally, there may be need for formal training
programmes.

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 IMPORTANCE OF HMIS IN HEALTH
SERVICE DELIVERY
❖Aid problem Identification
❖Increased efficiency and effectiveness
❖Positive influence on the Objectives and inputs of a program
– evidence based decision making
❖Improved quality of service
❖Provides standardized information – easy to integrate

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 SAMPLE INDICATORS TRACKED USING
HMIS
❖Birth Rates
❖Death Rates
❖Percentage of Positions filled (HRH)
❖Facility Service Utilization
❖Disease prevalence

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 ADVANTAGES OF STANDARDISED
HEALTH INFORMATION
1. It makes information more easily usable.
2. It allows internal and external comparability.
3. It eases analysis at source and central level.
4. It eases identification of problems at source and central level.
5. It eases combination of information for statistical use.
6. It eases the elaboration of meaningful feedback information and comments.
7. It makes the quality of reports less dependent on the individuals compiling them.
8. It helps building a healthy sense of common purpose.
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HEALTH SERVICE MANAGEMENT AND
INFORMATION
A health services manager is constantly involved in some stages of the
planning spiral, and must take sound, timely and evidence based
decisions
Information is required at all stages of the planning spiral to make, justify
and implement decisions.
Managing is all about decision making
Decision making is about having the right information at the right time,
interpreting it the right way, “deciding to decide”, taking actions (and
risks).

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HEALTH SERVICE MANAGEMENT AND
INFORMATION
All too often, decisions are made on the basis of
political pressure or convenience
Intuition/Emotions

Rarely are decisions made after rational analysis

Information is the basic requirement for decision-making
Information is power

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 INFORMATION NEEDS AT THE VARIOUS
LEVELS OF HEALTH SERVICE DELIVERY
MANAGERIAL LEVEL FUNCTIONS INFORMATION NEEDS
Top/Strategic level - MOH setting policies and strategies, clear, summarised, to be matched
monitoring their implementation, with information from outside the
training and funds mobilisation health sector
Middle Level – District & Health Planning and monitoring more sophisticated monitoring
Sub District allocation and use of resources in systems and database systems.
a wide geographical area, with Attention to single health units
many actors and factors involved. and to the overall rsponsibility
area (need for disaggregated and
aggregated data).
Operational Level – Health unit Implementation and monitoring Data are collected, analysed and
(Hospital / Health Center ) of day-to-day activities. reflected upon for immediate use

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HMIS IN UGANDA

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 HMIS IN UGANDA
The Health Management Information System (HMIS) is an integrated
reporting system used by the Ministry of Health, Development Partners
and Stakeholders to collect relevant and functional information on a
routine basis to monitor the Health Sector Strategic Plan (HSSP)
indicators to enable planning, decision making and monitoring and
evaluation of the health care delivery system.
Some of the Health Information Systems / tools in the Health Sector in
Uganda are:
DHIS 2
iHRIS
mTrac

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GOAL OF HMIS IN UGANDA
The major goal of HMIS is to provide
quality information to support
decision-making at all levels of the
health care system in Uganda.

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 GOAL OF HMIS IN UGANDA
❖Provide quality information to support
decision-making in the Health Sector
❖Aide in setting performance targets at all levels of
health service delivery
❖Assist in assessing performance at all levels of the
Health Sector
❖Encourage use of Health information
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 HMIS FRAMEWORK
HMIS was developed within the framework of the following concepts:
❖The information collected is relevant to the policies and goals of the
Government of Uganda, and to the responsibilities of the health professionals
at the level of collection.
❖The information collected is functional; it is to be used immediately for
management and should not wait for feedback from higher levels.
❖Information collection is integrated; there is one set of forms and no
duplication of reporting.
❖ The information is collected on a routine basis from every health unit in all
districts within Uganda.
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 COMPONENTS OF THE HMIS
❖Management information e.g. finances
❖Curative info
❖Preventive info
❖Drugs Management info
❖Laboratory info
❖Management of Resources info e.g. HRH

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INFORMATION FLOW IN THE HMIS

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 OVERVIEW OF DHIS 2
❖DHIS = District Health Information System
❖DHIS2 is a tool for collection, validation, analysis, and
presentation of aggregate and patient-based
statistical data
❖DHIS 2 is an open source software

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 OVERVIEW OF DHIS 2
❖DHIS2 is developed by the Health Information
Systems Programme (HISP) as an open and globally
distributed process with developers currently in
India, Vietnam, Tanzania, Ireland, and Norway. The
development is coordinated by the University of Oslo
with support from NORAD and other donors.
❖The DHIS2 software is used in more than 40 countries
in Africa, Asia, and Latin America

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 OVERVIEW OF DHIS 2
❖Several countries that have adopted DHIS2 as their
nation-wide HIS software include Kenya, Tanzania,
Uganda, Rwanda, Ghana, Liberia, and Bangladesh
❖DHIS2 provides a comprehensive HIS solution for the
reporting and analysis needs of health information
users at any level

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 OVERVIEW OF DHIS 2
Data collected and recorded in DHIS 2 includes:
❖Outpatient (OPD) attendance
❖Number of cases recorded in the unit (e.g malaria, dysentery, etc)
❖Number of Children Immunized (disaggregated by vaccine type,
doses )
❖ANC Attendance
❖Number of deliveries in the unit
❖Number of Surgical procedures

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OVERVIEW OF DHIS 2

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 OVERVIEW OF THE iHRIS
❖The integrated Human Resource Information System
(iHRIS) is a human resources management tool that
enables an organization to design and manage a
comprehensive human resources strategy.
❖Open source using i2CE & LAMP Architecture
❖Computerized & online
❖Links all HR data: pre-service to leaving service
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OVERVIEW OF THE iHRIS
The overall goal of iHRIS is to contribute to better management of
health workers (HW) & to ensure availability of the right no. of the
HW with the right competencies, in the right place, doing the right
job at the right time.

◦Efficiency in the management

◦Quicken information flow & regular reporting
◦Timely availability of accurate HR data
◦Inform policy, planning & management.
◦Allows sharing with other HIS systems

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OVERVIEW OF THE iHRIS

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OVERVIEW OF THE iHRIS
iHRIS Module User Organisation
OSRS Health Training Institutions (HTIs)
Train 2 Examination Boards, HRD & HTC
Qualify 4 HPCs
Manage MOH HQs + its central
organisations, NRHs, RRHs,
Districts, PNFPs (UCMB, UPMB,
UMMB, UCBHCA)
Plan & Retain Central level planning
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HRIS Flow and HRH Data Sharing in Uganda

National HRIS and integrated Website & KMP

with DHIS2 and HIS Warehouse

Aggregated data sent to national HRIS & warehouse

MoH PFNPs Tutors In-Service & HPCs

Districts
Pre-Service

Data sharing between MoH, NRHs Online HRIS

MoES CPD systems
and Regional Referral Hospitals
Training
HRM HRD Schools &
NRHs
Exam Boards
RRHS Implementing
Partners

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Sample HRH Audit Report

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 Health Workers Registration – iHRIS Qualify
Cadre 2011 2012 2013 2014 2015
Pharmacy 364 471 578 578 697
Doctors and
Dentists 3,841 4,093 4,361 4,634 5,593

Allied Health 11,026 13,319 16,017 18,624 22,461

Nurses &
Midwives 29,847 33,417 36,641 40,277 56,523

Total 45,078 50,829 57,597 64,113 85,274

 OVERVIEW OF mTrac
❖ mTrac is a government led initiative to digitize the transfer
of Health Management Information System (HMIS) data via
mobile phones
❖ The focus of mTrac is to speed up the transfer of HMIS
Weekly Surveillance Reports (covering disease outbreaks
and medicines), provide a mechanism for community
members to report on service delivery challenges, and
empower District Health Teams by providing timely
information for action
 OVERVIEW OF mTrac

❖ mTrac also allows community engagement thorough the

anonymous, toll-free SMS-based hotline for reporting
service delivery issues to strengthen community
participation in monitoring.
❖ mTrac is based on RapidSMS, a free and open source
framework for dynamic data collection, logistics
coordination and communication, leveraging basic short
message service (SMS) mobile phone technology
 INTEGRATION OF HEALTH
INFORMATION SYSTEMS
❖Important in order to reduce workload for the
data collectors and entrants
❖Provides decision makers with a one stop
center for all information needed to take a
decision.
❖Ease of management

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 Web Portal

Data
from capture
p
form aper
s

-Data mart Dashboard

Data from Data -Meta data
Mobile devises warehouse -Visualising
tools
DHIS 2
LM t r act rm
IS Ex nsfo Graphs
Tra d
a
EM Lo
HR R Maps
Mobile

Getting data in - Data warehousing Getting data out - Decision support

systems – ‘Business intelligence (BI)

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Integration and interoperability
DHIS : Data Data transfer
Data transfer
warehouse from iHRIS to
from OpenMRS
DHIS, e.g.:
To DHIS, e.g.: Statistical #midwifes
#deliveries data @health centre X
@health centre X
for month of May
for month of May
DHIS is calculating
the indicator:
Interoperability Deliveries per midwife Interoperability
Per facility per month

OpenMRS : Integration iHRIS: Human

Medical records Resource records

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 STRENGTHS OF THE HMIS IN UGANDA
❖The Government has maintained strong stewardship
❖Several local innovation programs exist and can be leveraged to
build country ownership and reduce the total cost of ownership
❖E-health has become a stronger area of focus, with the national
e-health technology framework completed and draft e-Health
strategy developed
❖Development of the web based systems that are easy to manage
centrally and accessible from multiple locations – including DHIS 2

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 CHALLENGES OF THE HMIS IN UGANDA
❖inadequate supply of the HMIS tools in all facilities is still hampering data
collection and reporting
❖data generation is resource driven, as opposed on need driven
❖Poor network coverage (Internet services are poor in several locations
across the country yet it is critical for most systems)
❖Limited computer skills among the health workforce
❖Staff turnover
❖Information utilization at all levels.

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 CHALLENGES OF THE HMIS IN UGANDA
❖Inaccurate reporting
❖Sustainability especially at the district level
❖Limited technical support

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EFFORTS TO IMPROVE HMIS USE IN
UGANDA
To ensure accuracy of HMIS information, data is collected
using standard methods, Users are encouraged to correctly
follow procedures for compiling data, continuously cross
check to eliminate errors and make corrections where
necessary, and store data in a format ready for analysis at
any time.

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 EFFORTS TO IMPROVE HMIS USE IN
UGANDA….....
To ensure timeliness of HMIS information, all levels of reporting
are required to comply with the agreed deadlines. A DATABASE
BOOK is required at the health units, HSDs and the Districts to
record and monitor aggregated information in one central place.
To ensure relevance of HMIS information, HMIS is regularly
reviewed to ensure that it is in-line with the goals and objectives
of the major health policies and programmes, and that the
collected information is actually utilized and or consumed by the
stakeholders.
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EFFORTS TO IMPROVE HMIS USE IN
UGANDA….....
Establishment of a national call center to provide technical
support to the end users

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 CONCLUSION
❖Access to information is key in making
critical decisions that impact service
delivery in the health sector
❖Every manager, regardless of level, needs
information in that is organized and easy to
understand

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SDG Goal 9. Build resilient infrastructure,
promote inclusive and sustainable
industrialization and foster innovation
9.b support domestic technology development,
research and innovation in developing countries
including by ensuring a conducive policy
environment for inter alia industrial
diversification and value addition to commodities
9.c significantly increase access to ICT and strive
to provide universal and affordable access to
internet in LDCs by 2020

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