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UNIVERSITY OF OSLO Department of Informatics HEALTH INFORMATION SYSTEMS INTEGRATION A Data Warehouse Architecture Model for the Ministry of Health in Mozambique Teotónio G. S. Fumo Master Thesis nd 2 May 2003 HEALTH INFORMATION SYSTEMS INTEGRATION: A Data Warehouse Architecture Model for the Ministry of Health in Mozambique By Teotónio Glória dos Santos Fumo Supervised by Dr. Jens Kaasbøll A dissertation submitted in partial fulfillment for the degree of Master of Science in Information Systems (IS). Department of Informatics University of Oslo, Norway May 2003 Copyright Teotónio Glória dos Santos Fumo, 2003 All rights reserved. Declaration I, Teotónio Glória dos Santos Fumo, declare that this thesis embodies only my original work, except where acknowledgement indicates otherwise, and that no part of it has been, or is being submitted for a degree at this or any other University. Signature………………………………… Place and Date…………………………… Dedicated to, My parents Teófilo Fumo and Serafina Matavel, who brought me up and gave me the value of education, my sisters Natércia Fumo and Maria Fumo, my brother Eládio Fumo and my girlfriend Guilhermina Banze, I will always love you. Does not exists a difficulty that resists to the attack of the persistence. Unknown author Abstract Abstract This thesis presents a study about a data warehouse architecture model for the Ministry of Health (MoH) in Mozambique. The study combines two areas: health care and information systems areas. It was conducted using two research methodologies: system development and case study of the Ministry of Health. The model aims at integrating data from different sources in the Ministry of Health. The fieldwork was carried out in the southern area of Mozambique, in the Ministry of Health in Maputo province and in two districts of Gaza province: Manjacaze and Chibuto. The choice of these sites for the fieldwork was based on the implementation of the District Health Information System project. This research is a contribution to the current process of data and information integration in the Ministry of Health. Integration of information and data warehouse (DW) technology are tools that offer resources to obtain managerial information needed to establish control over management process. Data warehousing aims at providing, managing and exploiting a set of integrated data for decision support within an organization. The research methods applied to this study include interviews, observations, questionnaires, document analysis and analysis of existing systems. During the development of the model I applied part of the data warehouse life cycle. Taking into account the system development phases, I covered the first three phases of the data warehouse life cycle, in order to document the existing legacy systems, to create a model of data warehouse and to clean the data. As a result, I present a data warehouse architecture model for the Ministry of Health. The proposed model integrates different heterogeneous systems and provides integrated information for health workers (administrative personnel and managers). i Abstract The empirical findings proved that for the data warehouse project the Ministry of Health will need to put more effort on the data quality control, because the quality of data influence the decision-making process. Keywords: Health Information Systems, Database, Data Warehouse, Data Mart, Data Integration, and Legacy Systems. ii Acknowledgements Acknowledgements First, to my Lord. Secondly to many people who contributed to and helped me shape this thesis, I owe them all a debt of gratitude. Those listed below deserve special mention and thanks. My sincere thanks to Dr. Jens Kaasbøll, my supervisor, who supervised my work from the very beginning – from collection of vague ideas to the completion of the project as it stands now, for his guidance, advice, comments, suggestions and criticisms during this work. My thanks to my colleagues from the Masters in Public Health course for their support. Special thanks go to my colleagues at the Eduardo Mondlane University and University of Oslo, Gertrudes Macueve, Juma Lungo, Faraja Mukama, Emílio Mosse, Virgílio Culpa Leopoldo Nhampossa, Baltazar Chilundo and Carlos Mavimbe, for their support. I would also like to express my gratitude to NORAD (Norwegian Agency for Development Cooperation) for the financial support during my study and to the coordinator of the Masters Course in Information Systems in Mozambique, Dr. Esselina Macome, for her trust and availability. To all my teachers during the Masters Course: Dr. Judith Gregory, Dr. Sundeep Sahay, Dr. Jorn Braa, Dr. Knut Roland, Dr. Arthur Heywood, Dr. Yussuf Adam, Dr. Humberto Mukingue, for their support, trust and guidance during the different courses. To my dearest family and friends for their understanding and unconditional support. My special thanks to my girlfriend, for her patience and good will. Last but not least, I would like to thank all individuals who directly or indirectly helped me in this work. iii Table of Contents Table of Contents Abstract i Acknowledgements iii Table of Contents iv List of Figures xi List of Tables xiii List of Acronyms xiv CHAPTER 1: Introduction 1 1.1 Introduction 1 1.2 Problem statement and research questions 4 1.3 Target group of interest 5 1.4 Personal motivation 5 1.5 The main objective and the research method in brief 6 1.6 Structure of the report 7 CHAPTER 2: Research Methods 9 2.1 Research problem 9 2.2 Research settings 10 2.2.1 The Ministry of Health 12 2.2.2 Gaza province 12 2.2.3 Manjacaze district 13 2.2.4 Chibuto district 14 2.3 Additional field research 15 2.3.1 Field research on Internet forums 15 2.3.2 Training health workers 16 2.4 Data Collection 17 2.4.1 Primary data collection 17 iv Table of Contents 2.4.1.1 Interviews 18 2.4.1.2 Observations 20 2.4.1.3 Use of questionnaires and interviews schedules 21 2.4.2 Secondary data collection 22 2.4.2.1 Review of documents 22 2.4.2.2 Analysis of existing systems 23 2.4.3 Data analysis 23 2.5 Research constraints 24 2.6 Ethics 24 2.7 Summary 24 CHAPTER 3: Literature Review on Data Warehouse 26 3.1 Data Warehouse methodology 26 3.2 Basic Concepts 27 3.2.1 Data warehouse 27 3.2.2 Basic elements of data warehouse 29 3.3 Data Warehouse characteristics 31 3.3.1 Subject oriented 31 3.3.2 Integrated 32 3.3.3 Time variant 32 3.3.4 Non-volatile 34 3.4 Data Warehouse architecture 34 3.4.1 Top-Down architecture/Inmon architecture 38 3.4.2 Bottom-Up architecture/Kimball architecture 39 3.4.3 Different data warehouse implementation approaches 41 3.5 Data warehouse life cycle 43 3.6 Data warehouse development issues 45 3.7 Data model 46 3.7.1 Star model 47 3.8 Metadata 49 3.9 Data mart 51 v Table of Contents 3.10 Data warehouse key component areas 53 3.11 Data warehouse challenges in the area of public health 54 3.12 Data warehousing advantages and disadvantages 55 3.13 Deadly sins of data warehousing 59 3.14 Tools for data warehouse implementation 60 3.15 Medical data warehouse 62 3.16 Epidware: A medical data warehousing framework 63 3.17 Summary 64 CHAPTER 4: Health Information Systems in Mozambique 66 4.1 Profile of Mozambique 66 4.2 The Ministry of Health 71 4.2.1 Health structures in the Ministry of Health 71 4.2.2 Decision process at Ministry of Health 73 4.3 The Sistema de Informação de Saúde (SIS) 74 4.4 Information flow among different levels of Sistema de Informação de Saúde 78 4.4.1 Health facility level 79 4.4.2 District level 82 Chibuto district 82 Manjacaze district 83 4.4.3 Province level 89 4.4.4 National level: The Ministry of Health 92 4.5 Brief description of existing computer systems 92 4.5.1 Computerized Sistema de Informação de Saúde (CHIS) 93 4.5.1.1 Data entry 95 4.5.1.2 Data storage 95 4.5.1.3 Data entry in the computerized Sistema de Informação de Saúde 96 4.5.1.4 Analysis 98 4.5.1.5 Control 98 4.5.2 Computerized Weekly epidemiological bulletin (CBES) 100 4.5.2.1 Data reporting and infrastructure 100 vi Table of Contents 4.5.3 District health information systems (DHIS) 101 4.6 Summary 101 CHAPTER 5: Information Flow at District, Province and National Levels 106 5.1 Introduction 106 5.2 The information cycle 107 5.3 Findings 109 5.3.1 Data collection phase 109 5.3.1.1 Data collection: Sources of data 109 5.3.1.2 Essential data set 117 5.3.1.3 Essential data set definition 118 5.3.1.4 Tools used 119 5.3.1.5 Quality 121 5.3.2 Process phase 123 5.3.2.1 Computerize data 124 5.3.2.2 Collate report 125 5.3.2.3 Target population 126 5.3.2.4 Data validity 128 5.3.2.5 Data accuracy 130 5.3.3 Analysis phase 130 5.3.3.1 Indicators 131 5.3.3.2 Coverage 132 5.3.4 Presentation phase 132 5.3.4.1 Tables 133 5.3.4.2 Graphs 133 5.3.4.3 Reports 134 5.3.4.4 Feedback 135 5.3.5 Interpretation phase 135 5.3.5.1 Comparison 135 5.3.5.2 Supervision 136 5.3.5.3 Epidemiological thinking 137 vii Table of Contents 5.3.6 Use phase 137 5.3.6.1 Planning 138 5.3.6.2 Decision-Making 138 5.4 Summary 139 CHAPTER 6: Data Warehouse Architecture Model 140 6.1 Initial development of the model 141 6.1.1 Define data sources 142 6.1.2 Document the existing legacy systems 142 6.1.2.1 Analysis of existing systems 144 6.1.3 Extract, transform and clean data 144 6.1.3.1 Extraction process 144 6.1.3.2 Cleansing and data transformation processes 145 6.1.4 Data warehouse model and data warehouse architecture 146 6.1.4.1 The data warehouse model 146 6.1.4.2 The data warehouse architecture model 148 6.2 Description of the proposed data warehouse model 150 6.2.1 The different stages of the data warehouse model 150