scholarly journals Data for tracking SDGs: challenges in capturing neonatal data from hospitals in Kenya

2020 ◽  
Vol 5 (3) ◽  
pp. e002108 ◽  
Author(s):  
Christiane Hagel ◽  
Chris Paton ◽  
George Mbevi ◽  
Mike English
Keyword(s):  
Health Information ◽  
Neonatal Mortality ◽  
Low Income ◽  
National Level ◽  
Use Cases ◽  
Information Flows ◽  
Hospital Data ◽  
District Health ◽  
Policy Documents ◽  
Data Reporting

BackgroundTarget 3.2 of the United Nations Sustainable Development Goals (SDGs) is to reduce neonatal mortality. In low-income and middle-income countries (LMICs), the District Health Information Software, V.2 (DHIS2) is widely used to help improve indicator data reporting. There are few reports on its use for collecting neonatal hospital data that are of increasing importance as births within facilities increase. To address this gap, we investigated implementation experiences of DHIS2 in LMICs and mapped the information flow relevant for neonatal data reporting in Kenyan hospitals.MethodsA narrative review of published literature and policy documents from LMICs was conducted. Information gathered was used to identify the challenges around DHIS2 and to map information flows from healthcare facilities to the national level. Two use cases explore how newborn data collection and reporting happens in hospitals. The results were validated, adjusted and system challenges identified.ResultsLiterature and policy documents report that DHIS2 is a useful tool with strong technical capabilities, but significant challenges can emerge with the implementation. Visualisations of information flows highlight how a complex, people-based and paper-based subsystem for inpatient information capture precedes digitisation. Use cases point to major challenges in these subsystems in accurately identifying newborn deaths and appropriate data for the calculation of mortality even in hospitals.ConclusionsDHIS2 is a tool with potential to improve availability of health information that is key to health systems, but it critically depends on people-based and paper-based subsystems. In hospitals, the subsystems are subject to multiple micro level challenges. Work is needed to design and implement better standardised information processes, recording and reporting tools, and to strengthen the information system workforce. If the challenges are addressed and data quality improved, DHIS2 can support countries to track progress towards the SDG target of improving neonatal mortality.

scholarly journals Producing routine malaria data: an exploration of the micro-practices and processes shaping routine malaria data quality in frontline health facilities in Kenya

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
George Okello ◽  
Sassy Molyneux ◽  
Scholastica Zakayo ◽  
Rene Gerrets ◽  
Caroline Jones
Keyword(s):  
Information Systems ◽  
Data Collection ◽  
Health Information ◽  
Low Income ◽  
Health Workers ◽  
National Level ◽  
Health Information Systems ◽  
Health Facilities ◽  
Careful Examination ◽  
Data Generation

Abstract Background Routine health information systems can provide near real-time data for malaria programme management, monitoring and evaluation, and surveillance. There are widespread concerns about the quality of the malaria data generated through routine information systems in many low-income countries. However, there has been little careful examination of micro-level practices of data collection which are central to the production of routine malaria data. Methods Drawing on fieldwork conducted in two malaria endemic sub-counties in Kenya, this study examined the processes and practices that shape routine malaria data generation at frontline health facilities. The study employed ethnographic methods—including observations, records review, and interviews—over 18-months in four frontline health facilities and two sub-county health records offices. Data were analysed using a thematic analysis approach. Results Malaria data generation was influenced by a range of factors including human resource shortages, tool design, and stock-out of data collection tools. Most of the challenges encountered by health workers in routine malaria data generation had their roots in wider system issues and at the national level where the framing of indicators and development of data collection tools takes place. In response to these challenges, health workers adopted various coping mechanisms such as informal task shifting and use of improvised tools. While these initiatives sustained the data collection process, they also had considerable implications for the data recorded and led to discrepancies in data that were recorded in primary registers. These discrepancies were concealed in aggregated monthly reports that were subsequently entered into the District Health Information Software 2. Conclusion Challenges to routine malaria data generation at frontline health facilities are not malaria or health information systems specific; they reflect wider health system weaknesses. Any interventions seeking to improve routine malaria data generation must look beyond just malaria or health information system initiatives and include consideration of the broader contextual factors that shape malaria data generation.

scholarly journals Perceptions and experiences with District Health Information System software to collect and utilize health data in Bangladesh: A qualitative exploratory study

2019 ◽  
Author(s):  
Tahmina Begum ◽  
Shaan Muberra Khan ◽  
Bridgit Adamou ◽  
Jannatul Ferdous ◽  
Muhammad Masud Parvez ◽  
...  
Keyword(s):  
Information System ◽  
Health Information ◽  
Program Effectiveness ◽  
National Level ◽  
Digital Data ◽  
Quality Data ◽  
Health Management Information System ◽  
District Health ◽  
Frequent Change ◽  
Implementation Framework

Abstract Background: Accurate and high-quality data are important for improving program effectiveness and informing policy. Bangladesh Health Management information System (HMIS) has adopted District Health Information software 2 (DHIS) in 2009 to capture real-time health service utilization data. However, routinely collected data are being underused because of poor data quality. We aim to understand the facilitators and barriers on implementing DHIS2 as a way to retrieve meaningful and accurate data for the Reproductive, Maternal and Child Health (RMCAH) services. Methods: This qualitative study was done among two districts of Bangladesh from September 2017 to 2018. Data collection method were key informant interview (n=11); in-depth interview (n=23); focus group discussion (n=2). Study participants were individuals involved with DHIS2 implementation from the community level to the national level. The data were analyzed thematically. Results: DHIS 2could improve the timeliness and completeness of data reporting over time. The reported facilitating factors were strong government commitment, extensive donor support and positive attitude of staffs. Quality checks and feedback loops at multiple levels of data gathering points was helpful to minimize data errors. Introducing dashboard makes the DHIS2 compatible to use as monitoring tool. However, the barriers to DHIS 2 implementation were lack of human resources, slow Internet connectivity, and frequent change of DHIS 2 versions, maintaining both manual and electronic system side by side. The collected data remains incomplete as private health facilities are not covered. The parallel presence of two MISs to report same RMNCAH indicators is a threat to achieve quality data and increases workload. Conclusion: The overall insights from this study are expected to contribute to the development of effective strategies for successful DHIS 2 implementation and building responsive HMIS. To sustain the achievements of digital data culture, focused strategic direction is needed. Periodic refresher trainings, incentives for increased performance, automated single reporting system for multiple stakeholders could make the system more user friendly. A national electronic health strategy and implementation framework can facilitate creating a culture of DHIS 2 use for planning, setting priorities, and decision making among stakeholder groups

scholarly journals Perceptions and experiences with district health information system software to collect and utilize health data in Bangladesh: A qualitative exploratory study

2020 ◽  
Author(s):  
Tahmina Begum ◽  
Shaan Muberra Khan ◽  
Bridgit Adamou ◽  
Jannatul Ferdous ◽  
Muhammad Masud Parvez ◽  
...  
Keyword(s):  
Information System ◽  
Data Quality ◽  
Health Information ◽  
Program Effectiveness ◽  
National Level ◽  
Digital Data ◽  
Quality Data ◽  
Health Management Information System ◽  
District Health ◽  
Implementation Framework

Abstract Background: Accurate and high-quality data are important for improving program effectiveness and informing policy.In 2009 Bangladesh’s health management information system (HMIS) adopted the District Health Information Software, Version 2 (DHIS2) to capture real-time health service utilization data. However, routinely collected data are being underused because of poor data quality and reporting. We aimed to understand the facilitators and barriers to implementing DHIS2 as a way to retrieve meaningful and accurate data for reproductive, maternal, newborn, child, and adolescent health (RMNCAH) services. Methods: This qualitative study was conducted in two districts of Bangladesh from September 2017 to 2018. Data collection included key informant interviews (n=11), in-depth interviews (n=23), and focus group discussions (n=2). The study participants were involved with DHIS2 implementation from the community level to the national level. The data were analyzed thematically.Results: DHIS2 could improve the timeliness and completeness of data reporting over time. The reported facilitating factors were strong government commitment, extensive donor support, and positive attitudes toward technology among staff. Quality checks and feedback loops at multiple levels of data gathering points are helpful for minimizing data errors. Introducing a dashboard makes DHIS2 compatible to use as a monitoring tool. Barriers to effective DHIS2 implementation were lack of human resources, slow Internet connectivity, frequent changes to DHIS2 versions, and maintaining both manual and electronic system side-by-side. The data in DHIS2 remains incomplete because it does not capture data from private health facilities. Having two parallel HMIS reporting the same RMNCAH indicators threatens data quality and increases the reporting workload. Conclusion: The overall insights from this study are expected to contribute to the development of effective strategies for successful DHIS2 implementation and building a responsive HMIS. Focused strategic direction is needed to sustain the achievements of digital data culture. Periodic refresher trainings, incentives for increased performance, and an automated single reporting system for multiple stakeholders could make the system more user-friendly. A national electronic health strategy and implementation framework can facilitate creating a culture of DHIS2 use for planning, setting priorities, and decision making among stakeholder groups.

scholarly journals Completeness of malaria indicator data reporting via the District Health Information Software 2 in Kenya, 2011–2015

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Sophie Githinji ◽  
Robinson Oyando ◽  
Josephine Malinga ◽  
Waqo Ejersa ◽  
David Soti ◽  
...  
Keyword(s):  
Health Information ◽  
District Health ◽  
Data Reporting ◽  
Indicator Data

scholarly journals Unlocking fiscal space of expanding the health workforce in district health systems in Uganda in the context of PEPFAR transition  

2021 ◽  
Author(s):  
Henry Zakumumpa ◽  
Joseph Rujumba ◽  
Amde Woldekidan ◽  
Respicius Damian Shumbusho ◽  
Freddie Ssengooba
Keyword(s):  
Low Income ◽  
Health Workforce ◽  
Implementation Research ◽  
Health Workers ◽  
National Level ◽  
Transition Process ◽  
Sub Saharan Africa ◽  
District Health ◽  
Wage Bill ◽  
Fiscal Space

Abstract Although expanding fiscal space for health worker recruitments could reduce workforce shortages in Sub-Saharan Africa, effective strategies for achieving this are still unclear. We aimed to understand the process of transitioning health workers (HWs) from PEPFAR to Government of Uganda (GoU) payrolls and to explore the facilitators and barriers encountered in increasing domestic financial responsibility for absorbing this transitioned workforce. We conducted a multiple case-study of 10 (out of 87) districts in Uganda which received PEPFAR support between 2013 and 2015 to expand their health workforce. We purposively selected eight districts with the highest absorption rates (‘High absorbers’) and two with the lowest absorption rates (‘Low absorbers’). A total of 66 interviews were conducted with high-level officials in three Ministries of Finance, Health and Public Service (n = 14), representatives of PEPFAR implementing organizations (n = 16), District Health Teams (n = 15) and facility managers (n = 22). Twelve focus groups were conducted with 87 HWs absorbed on GoU payrolls. We utilized the Consolidated Framework for Implementation Research (CFIR) to guide thematic analysis. At sub-national level, facilitators of transition in ‘high absorber’ districts were identified as the presence of transition ‘champions’, prioritizing HWs in district wage bill commitments, host facilities providing ‘bridge financing’ to transition workforce during salary delays and receiving donor technical support in district wage bill analysis- attributes which were absent in ‘low absorber’ districts. At national-level, multi-sectoral engagements (incorporating the influential Ministry of Finance), developing a joint transition road map, aligning with GoU salary scales and recruitment processes emerged as facilitators of the transition process. Overall, PEPFAR support acted as a catalyst for increasing GoU and facility-level budget allocations towards expanding the health workforce in focus districts in Uganda. Our case-studies offer implementation research lessons on effective donor transition and insights into pragmatic strategies for expanding fiscal space for health in a low-income setting.

scholarly journals Perceptions and experiences with District Health Information System software to collect and utilize health data in Bangladesh: A qualitative exploratory study

2019 ◽  
Author(s):  
Tahmina Begum ◽  
Shaan Muberra Khan ◽  
Bridgit Adamou ◽  
Jannatul Ferdous ◽  
Muhammad Masud Parvez ◽  
...  
Keyword(s):  
Information System ◽  
Health Information ◽  
Program Effectiveness ◽  
National Level ◽  
Digital Data ◽  
Quality Data ◽  
Health Management Information System ◽  
District Health ◽  
Frequent Change ◽  
Implementation Framework

Abstract Background: Accurate and high-quality data are important for improving program effectiveness and informing policy. Bangladesh Health Management information System (HMIS) has adopted District Health Information software 2 (DHIS) in 2009 to capture real-time health service utilization data. However, routinely collected data are being underused because of poor data quality. We aim to understand the facilitators and barriers on implementing DHIS2 as a way to retrieve meaningful and accurate data for the Reproductive, Maternal and Child Health (RMCAH) services. Methods: This qualitative study was done among two districts of Bangladesh from September 2017 to 2018. Data collection method were key informant interview (n=11); in-depth interview (n=23); focus group discussion (n=2). Study participants were individuals involved with DHIS2 implementation from the community level to the national level. The data were analyzed thematically. Results: DHIS 2could improve the timeliness and completeness of data reporting over time. The reported facilitating factors were strong government commitment, extensive donor support and positive attitude of staffs. Quality checks and feedback loops at multiple levels of data gathering points was helpful to minimize data errors. Introducing dashboard makes the DHIS2 compatible to use as monitoring tool. However, the barriers to DHIS 2 implementation were lack of human resources, slow Internet connectivity, and frequent change of DHIS 2 versions, maintaining both manual and electronic system side by side. The collected data remains incomplete as private health facilities are not covered. The parallel presence of two MISs to report same RMNCAH indicators is a threat to achieve quality data and increases workload. Conclusion: The overall insights from this study are expected to contribute to the development of effective strategies for successful DHIS 2 implementation and building responsive HMIS. To sustain the achievements of digital data culture, focused strategic direction is needed. Periodic refresher trainings, incentives for increased performance, automated single reporting system for multiple stakeholders could make the system more user friendly. A national electronic health strategy and implementation framework can facilitate creating a culture of DHIS 2 use for planning, setting priorities, and decision making among stakeholder groups

scholarly journals A data quality assessment of the first four years of malaria reporting in the Senegal DHIS2, 2014–2017

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Pierre Muhoza ◽  
Roger Tine ◽  
Adama Faye ◽  
Ibrahima Gaye ◽  
Scott L. Zeger ◽  
...  
Keyword(s):  
Data Quality ◽  
Health Information ◽  
National Level ◽  
Health Information System ◽  
Poisson Model ◽  
District Health ◽  
Quality Of Reporting ◽  
Facility Level ◽  
Over Time

Abstract Background As the global burden of malaria decreases, routine health information systems (RHIS) have become invaluable for monitoring progress towards elimination. The District Health Information System, version 2 (DHIS2) has been widely adopted across countries and is expected to increase the quality of reporting of RHIS. In this study, we evaluated the quality of reporting of key indicators of childhood malaria from January 2014 through December 2017, the first 4 years of DHIS2 implementation in Senegal. Methods Monthly data on the number of confirmed and suspected malaria cases as well as tests done were extracted from the Senegal DHIS2. Reporting completeness was measured as the number of monthly reports received divided by the expected number of reports in a given year. Completeness of indicator data was measured as the percentage of non-missing indicator values. We used a quasi-Poisson model with natural cubic spline terms of month of reporting to impute values missing at the facility level. We used the imputed values to take into account the percentage of malaria cases that were missed due to lack of reporting. Consistency was measured as the absence of moderate and extreme outliers, internal consistency between related indicators, and consistency of indicators over time. Results In contrast to public facilities of which 92.7% reported data in the DHIS2 system during the study period, only 15.3% of the private facilities used the reporting system. At the national level, completeness of facility reporting increased from 84.5% in 2014 to 97.5% in 2017. The percentage of expected malaria cases reported increased from 76.5% in 2014 to 94.7% in 2017. Over the study period, the percentage of malaria cases reported across all districts was on average 7.5% higher (P < 0.01) during the rainy season relative to the dry season. Reporting completeness rates were lower among hospitals compared to health centers and health posts. The incidence of moderate and extreme outlier values was 5.2 and 2.3%, respectively. The number of confirmed malaria cases increased by 15% whereas the numbers of suspected cases and tests conducted more than doubled from 2014 to 2017 likely due to a policy shift towards universal testing of pediatric febrile cases. Conclusions The quality of reporting for malaria indicators in the Senegal DHIS2 has improved over time and the data are suitable for use to monitor progress in malaria programs, with an understanding of their limitations. Senegalese health authorities should maintain the focus on broader adoption of DHIS2 reporting by private facilities, the sustainability of district-level data quality reviews, facility-level supervision and feedback mechanisms at all levels of the health system.

Designing, Implementing, and Managing a National Emergency Medical Service in Sierra Leone

2020 ◽  
pp. 1-6
Author(s):  
Luca Ragazzoni ◽  
Marta Caviglia ◽  
Paolo Rosi ◽  
Riccardo Buson ◽  
Sara Pini ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medical Service ◽  
Sierra Leone ◽  
Low Income ◽  
Medical Service ◽  
Joint Venture ◽  
National Level ◽  
Emergency Medical ◽  
National Emergency ◽  
Operation Center

Abstract Sierra Leone is one of the least developed low-income countries (LICs), slowly recovering from the effects of a devastating civil war and an Ebola outbreak. The health care system is characterized by chronic shortage of skilled human resources, equipment, and essential medicines. The referral system is weak and vulnerable, with 75% of the country having insufficient access to essential health care. Consequently, Sierra Leone has the highest maternal and child mortality rates in the world. This manuscript describes the implementation of a National Emergency Medical Service (NEMS), a project aiming to create the first prehospital emergency medical system in the country. In 2017, a joint venture of Doctors with Africa (CUAMM), Veneto Region, and Research Center in Emergency and Disaster Medicine (CRIMEDIM) was developed to support the Ministry of Health and Sanitation (MOHS) in designing and managing the NEMS system, one of the very few structured, fully equipped, and free-of-charge prehospital service in the African continent. The NEMS design was the result of an in-depth research phase that included a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries. From May 27, 2019, after a timeframe of six months in which all the districts have been progressively trained and made operational, the NEMS became operative at national level. By the end of March 2020, the NEMS operation center (OC) and the 81 ambulances dispatched on the ground handled a total number of 36,814 emergency calls, 35,493 missions, and 31,036 referrals.

scholarly journals CAF and CAMM analyses on the first 10 years of national Kanta services in Finland

2020 ◽  
Vol 12 (4) ◽  
Author(s):  
Vesa Jormanainen ◽  
Jarmo Reponen
Keyword(s):  
Health Information ◽  
Large Scale ◽  
National Level ◽  
Health Information System ◽  
Strong Support ◽  
Evaluation Framework ◽  
Macro Level ◽  
State Budget ◽  
Study Results ◽  
Clinical Adoption

We report the large-scale deployment, implementation and adoption of the nationwide centralized integrated and shared Kanta health information services by using the Clinical Adoption Framework (CAF). The meso and macro level dimensions of the CAF were incorporated early into our e-health evaluation framework to assess Health Information System (HIS) implementation at the national level. We found strong support for the CAF macro level model concepts in Finland. Typically, development programs were followed by government policy commitments, appropriate legislation and state budget funding before the CAF meso level implementation activities. Our quantitative data point to the fact that implementing large-scale health information technology (HIT) systems in practice is a rather long process. For HIT systems success in particular citizens’ and professionals’ acceptance are essential. When implementation of the national health information systems was evaluated against Clinical Adoption Meta-Model (CAMM), the results show that Finland has already passed many milestones in CAMM archetypes. According to our study results, Finland seems to be a good laboratory entity to study practical execution of HIT systems, CAF and CAMM theoretical constructs can be used for national level HIS implementation evaluation.

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