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The Health Information Systems Programme: Final Report

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The Health Information Systems Programme: Final Report The Health Information Systems Programme Final Report Submitted to the Norwegian Agency for Development Cooperation Submitted April 1, 2011 Revised April 29, 2011 MAIL PO Box 900922 Seattle, WA 98109 USA STREET 2201 Westlake Avenue, Suite 200 Seattle, WA 98121 USA Tel: 206.285.3500 Fax: 206.285.6619 www.path.org i Acknowledgements Agency responsible for this report: PATH Team leader: David Lubinski Team members: Noah Perin, Richard Anderson, Henry Mwanyika, Cecilia Makafu, Jeff Bernson, Jill Sherman-Konkle, Abbie Johnson Division of work between team members: David Lubinski 80 hrs. Noah Perin 520 hrs. Richard Anderson 480 hrs. Jeff Bernson 20 hrs. Henry Mwanyika 160 hrs. Cecilia Makafu 40 hrs. Stakeholders: Norad, University of Oslo, HISP-India, HISP-South Africa, Norwegian Embassy, National Health Systems Resource Centre, partner country ministries of health This report is the product of its authors, and the responsibility for the accuracy of data included in this report rests with the authors. The findings, interpretations, and conclusions presented in this report do not necessarily reflect the views of Norad. ii Table of Contents Acronyms and Abbreviations………………………………………………………………………... iv Executive Summary……………………………………………………………………..................... vi Introduction……………………………………………………………………………………….. vi Findings……………………………………………………………………………………………. vi Conclusions……………………………………………………………………………………….. vii Recommendations………………………………………………………………………………… vii Chapter 1—Background……………………………………………………………………………. 1 Introduction………………………………………………………………………………………………… 1 Purpose…………………………………………………………………………………………… 1 Objectives………………………………………………………………………………………… 1 Main questions……………………………………………………………………………………. 2 Scope……………………………………………………………………………………………… 2 Main users of the evaluation……………………………………………………………………… 2 Background on chronology, stakeholders, organizations, budgets, and policy documents………. 2 HISP research contribution………………………………………………………………………. 5 Chapter 2—Methodology and analytical framework........................................................................ 6 Research strategy………………………………………………………………………………….. 6 Method…………………………………………………………………………………………….. 8 Chapter 3—Findings………………………………………………………………………………… 12 Objective 1………………………………………………………………………………………… 12 Objective 2………………………………………………………………………………………… 19 Objective 3………………………………………………………………………………………… 20 Objective 4………………………………………………………………………………………… 24 Objective 5 ……………………………………………………………………………………….. 29 Objective 6…………………………………………………………………………………........... 35 Objective 7 ………………………………………………………………………………………. 42 Chapter 4—Conclusions and recommendations…………………………………………………… 50 Norad and other funders…………………………………………………………………………. 50 Global HISP Network…………………………………………………………………………….. 51 Annex 1—Definitions, data, and survey instruments Annex 2—Other information Annex 3—Details of field work Annex 4—Terms of reference References iii Acronyms and Abbreviations Acronym Definition BEANISH Building Europe Africa Collaborative Network for Applying Information Society Technologies in the Health Care Sector CBPP commons-based peer production CDC Centers for Disease Control and Prevention CHAI Clinton Health Access Initiative CHAT Cultural Historical Activity Theory CSSC Christian Social Service Commission DANIDA Danish International Development Agency DHIS District Health Information System ECOWAS Economic Community of West African States FOSS free/open source software GIS geographic information systems GLOBVAC Programme for Global Health and Vaccination Research HMIS health management information systems HMN Health Metrics Network HIS health information systems HISP Health Information Systems Programme IFI Institute of Informatics IHI Ifakara Health Institute IS information systems IT information technology JICA Japan International Cooperative Agency M&E monitoring and evaluation MCTS Mother and Child Tracking System MGD Millennium Development Goals MESI Monitoring and Evaluation Strengthening Initiative MOHSW Ministry of Health and Social Welfare MOU memorandum of understanding MSc masters of science MSH Management Sciences for Health nBits name-based tracking NHSRC National Health Systems Resource Centre NIPI Norway India Partnership Initiative NIMR National Institute for Medical Research iv Acronym Definition NOMA Norad’s Programme for Masters Studies Norad Norwegian Agency for Development Cooperation NRHM National Rural Health Mission NUFU Norwegian Programme for Development OSS open source software PMTCT prevention of mother-to-child transmission of HIV RCN Research Council of Norway SCOT Social Construction of Technology SIU Senter for internasjonalisering av høgre utdanning/Norwegian Centre for International Cooperation in Higher Education STI sexually transmitted infections UAA Addis Ababa University, Ethiopia UDSM University of Dar es Salaam UEM Eduardo Mondlane University UIO University of Oslo UN United Nations USAID United States Agency for International Development UWC University of Western Cape, Mozambique VCT voluntary counseling and testing VERDIKT Core Competence and Value Creation in Information and Communication Technologies WAHO West Africa Health Organization WHO World Health Organization v Executive Summary Introduction The Health Information Systems Programme (HISP) is a global project to strengthen public health systems by improving the collection and use of health indicators. The network of users has grown to include over 20 countries in Africa and Asia with over 1.3 billion people potentially covered by its services—making it one of the largest and most successful global health information system (HIS) initiatives in existence. The main activity of the HISP Network has been the development of the District Health Information System (DHIS) software for collecting and aggregating health statistics. However, it is critical to recognize that HISP is much more than a software development project; it is responsible for shaping the culture of information use through training of local technologists, decision-makers, and health managers, as well as contributing to the global body of knowledge through academic research and dissemination. Findings • The achievements, impact and value created by HISP are unquestionably significant. These can be measured along two axes: (1) the contribution to the global body of academic knowledge through the advancement of nearly 100 graduate students, and (2) the impact of in-country implementation and use—with nearly 20 active University of Oslo (UIO)/Norad- supported deployments of DHIS, potentially covering 1.3 billion people. • UIO is a strong advocate to the ministries of health to strengthen management capacity and support development of health management information systems (HMIS). Students, faculty and staff from UIO provide critical technical resources for core software development and rapid in-country support for start-up. • Key ingredients for success were identified among the successful HISP deployments. They include: local governance and ownership; HISP involvement in training and indicator selection; HISP staff embedded within the ministries of health; evolution to a service-based business model; ability to demonstrate that DHIS aligns with national goals; growing spheres of influence beyond country borders; and experienced management. • Agency funding of HISP is complicated and fragmented. Four key findings emerged. (1) Approximately 130 million NOK have been spent on HISP. (2) Funding was nearly evenly split between development/deployment activities and academic capacity building. (3) Funding sources from within Norway are interwoven making attribution difficult. (4) Norwegian government funding is critical for core software development and is leveraged by other financial contributors for local deployment. • DHIS is at risk of losing momentum without clear management of the core product with regard to product development, messaging, and strategy. Lack of clarity around distinct product requirements addressed by DHIS, the lack of a product road map for the next 36 months, as well as product divergence among regional nodes, increase the risk of fragmentation and loss of momentum. • HISP is at a critical point in its evolution and funding as it transitions from market seeding activities to management of a mature, scaled HMIS product. vi Conclusions • HISP is having a significant, worldwide impact. • Masters and PhD students from UIO have had an important role in the development of DHIS v2 and in the introduction, deployment, and strengthening of DHIS in a wide range of countries. • Software development resources are limited; and due to the success of the program there is a need to leverage enterprise-level service, product management, and development tools to meet the growing needs of partner countries. Additional full-time developer resources are needed for maintenance and new features and to provide continuity of services beyond the average term of a masters student. The flexibility of DHIS to be customized for local requirements has allowed the core software platform to meet the needs of partner countries. One key need of the existing DHIS platform is expansion, integration or interoperability with other eHealth initiatives. Success in broader eHealth will require integrating other systems and working with partners, as well as building on a strong DHIS core. • There is a need to identify a strategy for working synergistically with other HMIS software packages and organizations and develop capacity to align DHIS deployments
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