Disruptive innovations in health information systems in Bangladesh

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Ezra Jefferson
5 years ago
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Jannatul Ferdous Saiful Islam Solving public health

1 Disruptive innovations in health information systems in Bangladesh Iqbal Anwar Masud Parvez Jannatul Ferdous Saiful Islam Solving public health problems through innovative scientific research

2 Outline 1. Importance of health-mis 2. DHIS2 in Bangladesh 3. Data for decision making 4. Implications 2 [Insert presentation title]

3 Importance of MIS One of the 6 Health System Building Blocks Routine monitoring system comprising of data collection, collation, analysis, feedback and action Global experience suggests - rarely used in management decision support - quality is poor, upward bias - policy planners rely on survey data 3 [Insert presentation title]

4 Bangladesh Facts! A small country! High population density! Remarkable progress in health indicators! Good health at low cost! Epidemiological and demographic transition! Tiered health system! Paper-based to web-based HMIS in 2009 Bangladesh Rangpur Division CHW 8 divisions Avg. pop. 22 mill. 64 districts Avg. pop. 2.4 mill. 485 upazilas Avg. pop mill. 4,501 unions Avg. pop. 33,400 13,503 wards Avg. pop. 11,133 SSH MCH DH UHC UHFWC CC

All tires of health system are using DHIS2 Aggregate data

5 DHIS2: a decision making tool Bangladesh is using DHIS2 since 2009 DHIS2 is an open source software. All tires of health system are using DHIS2 Aggregate data from facility, Individual data from community 5 [Insert presentation title]

6 Other ICT tools used in HMIS 6 [Insert presentation title]

ICT infrastructure Super-specialized Hospitals Tertiary Hospital / Medical

(Pop. ~150 million) Divisions (7) Pop. 23

5 million Internet connected April 2009 About 600 hospitals About 19,000

Community Clinic (Day care) Community Health Workers Sub-districts (483)

7 ICT infrastructure Super-specialized Hospitals Tertiary Hospital / Medical College Hospital District Hospital / Medical College Hospital Bangladesh (Pop. ~150 million) Divisions (7) Pop. 23 million) Districts (64) Pop. 2.5 million Internet connected April 2009 About 600 hospitals About 19,000 day-care facilities Sub-district Hospital Union Health Center (Day care) Community Clinic (Day care) Community Health Workers Sub-districts (483) Pop. 0.3 million Unions (4,501) Pop. 35,500 Wards (13,503) Pop. 12,000 About 100,000 health workforce 7 [Insert presentation title] 3,500 13,000 community clinics 3,500

8 DHIS2 Data system Aggregate EOC IMCI EPI Logistics Hospital statistics Cervical cancer HIV/AIDS Individual (COIA+) Mother Child Kala Azar patients NCD " Hypertension " Diabetes Mellitus 8 [Insert presentation title]

9 Data visualization: how it helps managers It is possible for health manager to examine Completeness of data Accuracy of data Monitor OP indicators Track own performances Find bottleneck Compare facilities Immediate action 9 [Insert presentation title]

10 Data for action 10 [Insert presentation title]

11 Divisional monitoring, Reporting status (%), April Organisation units / Data Monthly EmOC DataSet with Genital Fistula Daily OPD and Monthly IMCI Emergency Visits, Dataset Admission Data Set Monthly HMC meeting Monthly Hospital Bed Statement Monthly Major Equipment Information Cervical and Breast Cancer Screening Programme Report Faridpur District Hospital, Faridpur Gazipur District Hospital, Gazipur Gopalganj District Hospital, Gopalganj Jamalpur District Hospital, Jamalpur Kishoreganj District Hospital, Kishoreganj Madaripur District Hospital, Madaripur Manikganj District Hospital, Manikganj Munshiganj District Hospital, Munshiganj Narayanganj 300 bed Hospital Narayanganj General (Victoria) Hospital (100bed) Narsingdi District (Development) Hospital, Narshingdi Netrokona District Hospital, Netrokona Rajbari District Hospital, Rajbari Shariatpur District Hospital, Shariatpur Tangail District Hospital, Tangail [Insert presentation title]

12 Divisional monitoring, Bed Occupancy Rate (%), April [Insert presentation title]

13 Trend: Bed Occupancy Rate (%), last 11 month Faridpur District Hospital, Faridpur Jamalpur District Hospital, Jamalpur Kishoreganj District Hospital, Kishoreganj Madaripur District Hospital, Madaripur Munshiganj District Hospital, Munshiganj 0 13 [Insert presentation title]

14 Trend: delivery and Cesarean Section, last 11 month 14 [Insert presentation title]

15 Trend: OPD, IPD, Emergency Patient, last 11 month 15 [Insert presentation title]

16 COIA+, Type of delivery, last 12 month Organisation units Bangladesh Type of delivery / Peri ods June 2015 July 2015 August 2015 September 2015 October 2015 November 2015 December 2015 January 2016 February 2016 March 2016 April 2016 May 2016 Total NVD Cesarean section Forcep Vacuum Destructive operation Vaginal breech delivery Vaginal face delivery Total [Insert presentation title]

17 COIA+, Place of delivery, last 12 month Organization units Bangladesh Place of delivery June 2015 July 2015 August 2015 Septembe r 2015 October 2015 November 2015 December 2015 January 2016 February 2016 March 2016 April 2016 May 2016 Total Medical College Hospital District Hospital Upazila Hospital MCWC UH & FWC / USC Community Clinic Private Hospital / NGO clinic Home Own Facility Others Total [Insert presentation title]

18 Complain Box 18 [Insert presentation title]

19 Human Resource Management 19 [Insert presentation title]

20 Human Resource Management 20 [Insert presentation title]

Attendance System Those who recorded presence by bio metric machine Organization Name Total Employee Total Attendance Dhamrai Upazila Health Complex 95 66 Dohar Upazila Health Complex 50 21 Savar

21 Attendance System Those who recorded presence by bio metric machine Organization Name Total Employee Total Attendance Dhamrai Upazila Health Complex Dohar Upazila Health Complex Savar Upazila Health Complex Alfadanga Upazila Health Complex Sadarpur Upazila Health Complex Tongi 50 Beded Hospital Gazipur District Hospital Kaliakair Upazila Health Complex Kaliganj Upazila Health Complex Active sending data Active not sending data 21 [Insert presentation title]

SHARE Baseline study, 2015 Current status Online system is established Computers,

trained Data input is customized Real-time data available Success factors Strong

A team-work approach Key challenges Internet connectivity Data quality Motivation

22 SHARE Baseline study, 2015 Current status Online system is established Computers, laptops, tablets, supplied, installed and in operation All data operators are trained Data input is customized Real-time data available Success factors Strong leadership (Champion) Effective collaboration Donors support Political commitment A team-work approach Key challenges Internet connectivity Data quality Motivation of managers Skills and knowledge Little use at local level 22 [Insert presentation title]

Way forward! Capacity development of health manager for data analysis, interpretation, feedback and use for better resource allocation and decision making!

23 Way forward! Capacity development of health manager for data analysis, interpretation, feedback and use for better resource allocation and decision making! Create online training module so that user can learn from distance! Create dashboard for each layer of user so that they can visualize and use data improving governance and stewardship! Development of web portal, using TABLEAU, CLICDATA etc.! Technical assistance to neighboring countries 23 [Insert presentation title]

24 Conclusions A Disruptive Innovations in the field of on-line Health-MIS Now real time data are available for - monitoring and evaluation - measurement and accountability - enhance competition - benchmarking for evaluation - research All these were possible due to strong collaboration and presence of a benevolent leader Showcase for neighboring countries Need for further strengthening and regional collaboration to support achieving health SDG targets 24 [Insert presentation title]

25 Orientation of Line-Directors of Health Department on DHIS2 data visualization 25 [Insert presentation title]

26 Divisional training for district mangers 26 [Insert presentation title]

27 Divisional training for district mangers 27 [Insert presentation title]

28 Measurement and Accountability for Health 28 [Insert presentation title]

29 29 [Insert presentation title]

I. Background. Figure 1. Objectives of the health sytems strengthening initiative

I. Background. Figure 1. Objectives of the health sytems strengthening initiative I. Background Bangladesh has established an extensive network of health facilities to provide health services to the population. The four different levels of health facilities and their management are