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Mozambique Health Information Network (MHIN) AED-SATELLIFE Center 30 California Street Watertown, MA 02472 USA www.healthnet.org Final Technical Report November 2010 Published by: AED-SATELLIFE Location: 30 California Street, Watertown, MA 02472, USA IDRC Project No: 103746-001 IDRC Project Title: Mozambique Health Information Network Country: Mozambique By: Berhane Gebru, Holly Ladd, and Andrew Sideman 30 California Street, Watertown, MA, 02472 USA. www.healthnet.org and www.aed.org Members of Research Team: Holly Ladd Berhane Gebru Dra. Gertrudes Dra. Celia Gonçalves Dr. Jose Leopoldo VP/ Director, AED-SATELLIFE Director of Programs, AED- National Director, MISAU Deputy National Director, Universidade Eduardo Mondlane 30 California Street SATELLIFE Planning and Cooperation MISAU Planning and Director, Academic Registration Watertown, MA 02472, USA 30 California Street Directorate Cooperation Directorate Directorate 617.926.9400 Fax: Watertown, MA 02472, USA Av. Eduardo Mondlane, Av. Eduardo Mondlane, 1008 Praça 25 de Junho, C. P. 257 617.926.1212 [email protected] 1008 Maputo, Mozambique Maputo, Mozambique [email protected] Maputo, Mozambique [email protected] [email protected] [email protected] This report is presented as received from project recipient. It has not been subjected to peer review or other review process. To the extent possible under law, AED-SATELLIFE has waived all copyright and related or neighboring rights to Final Technical Report of Mozambique Health Information Network. November 2010 AED-SATELLIFE 30 California Street Watertown, MA 02472, USA Abstract The MHIN project was designed to support health data collection and reporting through a two–way communications system utilizing the existing cellular telephone network and low-cost, simple-to-use, and energy-efficient handheld computers (also known as Personal Digital Assistants or PDAs.) The project developed the Mozambique Epidemiological Surveillance System (officially called Sistema de Vigilância Epidemiológica or SIS-VE) – an electronic system combining mobile, wireless, and fixed technologies for improving epidemiological surveillance data collection, reporting, and analysis. All eleven provinces and 43 districts in Gaza, Inhambane, and Zambezia provinces are utilizing SIS-VE for epidemiological surveillance data gathering and reporting as a cost-saving alternative to paper-and-pen- based approaches. The system developed by the project is enabling the districts and provinces to receive and analyze high-quality data on time, to track outbreak prone diseases, and to respond in a timely manner to disease outbreaks. A cost-effectiveness study showed that the MHIN system reduced the cost of managing epidemiological data by 20% compared to traditional paper-based manual systems. The key lessons learned include addressing in the design of research projects the value of testing innovations and research versus the costs represented by “pilot project fatigue”; institutionalizing the crucial role of champions; and the dependence of sustainable outcomes on long term investment, partnership, and consistent support. Continued user support and improvement of the system to include additional features and functionalities is sine qua non to the sustainable use of the system. AED-SATELLIFE and MISAU recommend continuing building the capacities of the technical personnel of the Ministry of Health to manage and enhance the system. Expanding the use of the system for other data collection needs of the health sector is also recommended. Keywords: Integrated Disease Surveillance and Response, mHealth, cost-effectiveness, epidemic-prone diseases surveillance and response Mozambique Health Information Network, November 2006 – October 2010. IDRC Grant No: 103746-001.Final Technical Report 2 Table of Contents 1. SYNTHESIS ..................................................................................................................................... 3 2. RESEARCH PROBLEM ................................................................................................................ 5 3. MAJOR FINDINGS ........................................................................................................................ 7 4. FULFILLMENT OF OBJECTIVES ............................................................................................. 7 4.1 MHIN JUNE 2009 – OCTOBER 2010 ................................................................................................... 9 4.1.2 Improving Timeliness and Quality of Epidemiological Data Collection and Reporting......... 9 4.1.3 Determining the Cost-Effectiveness of MHIN for Epidemiological Data Collection, Transmission, and Reporting ............................................................................................................... 18 4.1.4 Key Findings .......................................................................................................................... 21 4.2 MHIN NOVEMBER 2006 – MAY 2009 .............................................................................................. 23 4.1.5 Strengthening Health Information Systems in Pilot Districts ................................................ 24 4.3 INCREASING ACCURACY AND TIMELINESS OF HEALTH DATA REC EIVED FROM RURAL HEALTH WORKERS ......................................................................................................................................... 26 4.4 PROVIDING HEALTH WORKERS WITH RELEVANT HEALTH INFORMATION ....................................... 32 4.5 COST-EFFECTIVENESS ASSESSMENT................................................................................................. 33 4.6 OUTCOME MAPPING ......................................................................................................................... 34 5. SUMMARY OF PROJECT ACTIVITIES ................................................................................. 35 6. PROJECT OUTPUTS AND DISSEMINATION ....................................................................... 38 6.1 SUMMARY OF PROJECT OUTPUTS ..................................................................................................... 38 6.2 CAPACITY BUILDING ........................................................................................................................ 39 6.3 DISSEMINATION................................................................................................................................ 42 7. PROJECT OUTCOMES AND LESSONS LEARNED ............................................................. 43 7.1 PROJECT OUTCOMES ........................................................................................................................ 43 7.2 LESSONS LEARNED........................................................................................................................... 47 8. OVERALL ASSESSMENT AND RECOMMENDATIONS .................................................... 48 9. LIST OF APPENDICES AND ATTACHMENTS ..................................................................... 54 Mozambique Health Information Network, November 2006 – October 2010. IDRC Grant No: 103746-001.Final Technical Report 3 1. Synthesis The primary goal of Mozambique Health Information Network (MHIN), Centre Grant Number 103746-001, was to support the actions of the Ministry of Health of the Republic of Mozambique in equipping various levels of the health system and frontline health care practitioners with reliable, fast, and cost-effective data collection and communication tools necessary to achieve the improved standards of national health care articulated by the country’s Health Sector Strategic Plan 2007-12 (Plano Estratégico do Sector Saúde or PESS)1. The period of performance of MHIN was November 2006 – October 2010. The project initially focused on improving routine Health Management Information System (HMIS) data gathering and reporting processes. During the initial deployment of MHIN (2007-2008), the project successfully developed, deployed, and supported a system for daily collection of routine HMIS (Sistema de Informação para Saúde or SIS) data using handheld computers (also known as Personal Digital Assistant or PDA) at the point of care and subsequent transmission of this data through the wireless telecommunications network to a server at the Ministry of Health (Ministério da Saúde or MISAU). Health workers in five pilot districts collected SIS data on both paper and PDA. However, simultaneous use of both the paper-based and handheld-based collection processes proved to be an added burden on the health system. MISAU determined that the system could be more useful if employed solely for the collection and reporting of epidemiological surveillance data. Therefore, beginning in June 2009, in accordance with MISAU needs and priorities, the project had the following objectives. 1. To improve the timeliness and quality of epidemiological data collection and reporting in districts and provinces by providing access to the MHIN services, including the use of handheld computers, African Access Points (AAPs), and the existing cellular networks for the capture, transmission, and reporting of epidemiological data. 2. To develop the processes and determine the organizational requirements for the national rollout of MHIN for epidemiological data collection, transmission, and reporting. 3. To determine the cost-effectiveness of MHIN for epidemiological data collection, transmission, and reporting compared to paper-based approaches.
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