DHIS customization Tanzanian experience

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DHIS customization Tanzanian experience

• Dr H. M. Twaakyondo

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Outline

• Background Information
• Customization of DHIS
• Problems encountered
• Implementation of DHIS
• Problems encountered
• Concluding remark

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Background Information

• Ministry of Health has Health Management
  Information System (HMIS) which has been
  operational since 1994 and is know in Kiswahili
  acronym as MTUHA.
• The system goes in hand with MTUHA software which
  has been deployed in all districts around
  Tanzania Mainland.
• DHIS was introduced in 2002, by master students
  while doing their research

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Customization of DHIS

• Started in 2005
• Mimicked the forms and reports in MTUHA system
• This is according to Ministry and districts
  staffs requirements in order to simplify data
  entry in the current forms and reports

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Customization of DHIS

• Other argument was that the current system has
  been in place for a number of years and user are
  familiar with it.
• Introducing new system will require intensive
  training hence costly.
• We have been able to replicate four (4) forms in
  DHIS

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Customization of DHIS

• Other forms are on review and it is expected that
  the data will be collected on survey basis.
• The data file has been developed in Kiswahili
  language following the MTUHA system

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Customization of DHIS

• As per requirement by the district people,
  development of a separate module to take care of
  reports was necessary.
• The existing atmosphere in Tanzania Mainland
  entails us to work out a system which has to
  cover most of the functionalities offered by
  existing MTUHA system.

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Problems encountered

• During customization, technical
  challenges/problems were encountered, these
  include
• Different definition of data in DHIS and MTUHA.
• Different type according to DHIS definitions
  some of the data in the forms are
  quarterly/yearly and some of them are semi
  permanent data

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Problems encountered

• This was a problem in defining set of rules which
  should be applied to manipulate data in the
  forms.
• Problems which resulted from the structure of the
  MTUHA system such as

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Problems encountered

• Source of information Book ten which is used in
  preparation of reports to be submitted to the
  district level has less information
• Some of the data are missing in book ten while
  they are available in book two as a result some
  districts have very live local forms.
• Creating indicators is chaos because the raw data
  for its creation are dispersed in different
  places, for example, some of the numerators are
  found in the yearly datasets while the numerators
  are in quarterly datasets.

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Problems encountered

• In part of data collection, there are some of the
  vertical program which bring data direct to the
  district, both aggregated from the hospitals and
  some not, there is no clear line how the data is
  collected and how is it to be used.
• The current system had its own ways of producing
  the reports one click reports.

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Problems encountered

• Budget constraining, there is a great need for
  the team to be on the field implementing and
  giving out support and training the district
  focal personnel on how to use DHIS and produce
  the report that they need.

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Implementation of DHIS

• Since the ministry gave us a go ahead (assigning
  the pilot areas and gave us a letter of
  introduction to the pilot area, installation and
  training of the health workers in three different
  districts in the same region was conducted.

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Implementation of DHIS

• Installation and training of the health workers
  in three districts Kibaha town council, Kibaha
  district council and Bagamoyo Municipal in the
  Pwani region was conducted.
• 3 officers trained in each district
• Data was imported from MTUHA software from the
  year 2003 and implemented in the DHIS 1.4

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Implementation of DHIS

• The created Data file for the Pwani region was
  used to teach the HMIS course which was complete
  in the mid September 2006
• It was found out that students were impressed
  with the software to the extent of asking CDs
  which they can use to install in their working
  areas.
• The same impression was obtained during training
  in the districts.

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Problems encountered

• Missing data Among the three districts we have
  as pilot areas, only one of them had data on
  population (catchments area), and the remaining
  two had no idea what the catchments area was
• Ineffective Training The focal personnel whom we
  were training (in-house training) on DHIS also
  have other duties in providing service to the
  hospital clients and they also have to report to
  the regional the data entered to the other system
  (MTUHA).

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Concluding remark

• Our recommended areas are
• Developer manual We are proceeding with the
  development of well defined developers manual for
  the new users who come to the world of DHIS for
  the first time so that they find there way
  through the system easily.
• DHIS design While users are creating the forms,
  there should be an option where users will be
  able to choose the number of columns and rows in
  the forms template depending on their
  requirements. We are also implementing this

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Concluding remark

• Common data elements Since diseases are mostly
  common around the word, there should be common
  data elements in the system so as to have some
  uniformity and give the general ideas and help
  others in reforming their data elements, though
  there should be a room for other to include some
  of the elements that they seem feet in their
  environment.

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Thank you!!!!!!