@article {1269, title = {Quality of routine facility data for monitoring priority maternal and newborn indicators in DHIS2: A case study from Gombe State, Nigeria.}, journal = {PLoS One}, volume = {14}, year = {2019}, month = {2019}, pages = {e0211265}, abstract = {

INTRODUCTION: Routine health information systems are critical for monitoring service delivery. District Heath Information System, version 2 (DHIS2) is an open source software platform used in more than 60 countries, on which global initiatives increasingly rely for such monitoring. We used facility-reported data in DHIS2 for Gombe State, north-eastern Nigeria, to present a case study of data quality to monitor priority maternal and neonatal health indicators.

METHODS: For all health facilities in DHIS2 offering antenatal and postnatal care services (n = 497) and labor and delivery services (n = 486), we assessed the quality of data for July 2016-June 2017 according to the World Health Organization data quality review guidance. Using data from DHIS2 as well as external facility-level and population-level household surveys, we reviewed three data quality dimensions-completeness and timeliness, internal consistency, and external consistency-and considered the opportunities for improvement.

RESULTS: Of 14 priority maternal and neonatal health indicators that could be tracked through facility-based data, 12 were included in Gombe{\textquoteright}s DHIS2. During July 2016-June 2017, facility-reported data in DHIS2 were incomplete at least 40\% of the time, under-reported 10\%-60\% of the events documented in facility registers, and showed inconsistencies over time, between related indicators, and with an external data source. The best quality data elements were those that aligned with Gombe{\textquoteright}s health program priorities, particularly older health programs, and those that reflected contact indicators rather than indicators related to the provision of commodities or content of care.

CONCLUSION: This case study from Gombe State, Nigeria, demonstrates the high potential for effective monitoring of maternal and neonatal health using DHIS2. However, coordinated action at multiple levels of the health system is needed to maximize reporting of existing data; rationalize data flow; routinize data quality review, feedback, and supervision; and ensure ongoing maintenance of DHIS2.

}, keywords = {Adolescent, Adult, Female, Guidelines as Topic, Health information systems, Humans, Infant Health, Infant, Newborn, Maternal Health, Middle Aged, Nigeria, Pregnancy, Quality Indicators, Health Care, Young Adult}, issn = {1932-6203}, doi = {10.1371/journal.pone.0211265}, author = {Bhattacharya, Antoinette Alas and Umar, Nasir and Audu, Ahmed and Felix, Habila and Allen, Elizabeth and Schellenberg, Joanna R M and Marchant, Tanya} } @article {1270, title = {Coverage of routine reporting on malaria parasitological testing in Kenya, 2015-2016.}, journal = {Glob Health Action}, volume = {10}, year = {2017}, month = {2017}, pages = {1413266}, abstract = {

BACKGROUND: Following the launch of District Health Information System 2 across facilities in Kenya, more health facilities are now capable of carrying out malaria parasitological testing and reporting data as part of routine health information systems, improving the potential value of routine data for accurate and timely tracking of rapidly changing disease epidemiology at fine spatial resolutions.

OBJECTIVES: This study evaluates the current coverage and completeness of reported malaria parasitological testing data in DHIS2 specifically looking at patterns in geographic coverage of public health facilities in Kenya.

METHODS: Monthly facility level data on malaria parasitological testing were extracted from Kenya DHIS2 between November 2015 and October 2016. DHIS2 public facilities were matched to a geo-coded master facility list to obtain coordinates. Coverage was defined as the geographic distribution of facilities reporting any data by region. Completeness of reporting was defined as the percentage of facilities reporting any data for the whole 12-month period or for 3, 6 and 9 months.

RESULTS: Public health facilities were 5,933 (59\%) of 10,090 extracted. Fifty-nine per Cent of the public facilities did not report any data while 36, 29 and 22\% facilities had data reported at least 3, 6 and 9 months, respectively. Only 8\% of public facilities had data reported for every month. There were proportionately more hospitals (86\%) than health centres (76\%) and dispensaries/clinics (30\%) reporting. There were significant geographic variations in reporting rates. Counties along the malaria endemic coast had the lowest reporting rate with only 1\% of facilities reporting consistently for 12 months.

CONCLUSION: Current coverage and completeness of reporting of malaria parasitological diagnosis across Kenya{\textquoteright}s public health system remains poor. The usefulness of routine data to improve our understanding of sub-national heterogeneity across Kenya would require significant improvements to the consistency and coverage of data captured by DHIS2.

}, keywords = {Health Facilities, Health information systems, Humans, Kenya, Malaria, Mandatory Reporting, Public Health Surveillance}, issn = {1654-9880}, doi = {10.1080/16549716.2017.1413266}, author = {Maina, Joseph K and Macharia, Peter M and Ouma, Paul O and Snow, Robert W and Okiro, Emelda A} } @article {1276, title = {A Mobile-Based Community Health Management Information System for Community Health Workers and Their Supervisors in 2 Districts of Zambia.}, journal = {Glob Health Sci Pract}, volume = {5}, year = {2017}, month = {2017 09 27}, pages = {486-494}, abstract = {

INTRODUCTION: Effective community health management information systems (C-HMIS) are important in low-resource countries that rely heavily on community-based health care providers. Zambia currently lacks a functioning C-HMIS to provide real-time, community-based health information from community health workers (CHWs) to health center staff and higher levels of the health system.

PROGRAM DESCRIPTION: We developed a C-HMIS mobile platform for use by CHWs providing integrated community case management (iCCM) services and their supervisors to address challenges of frequent stock-outs and inadequate supportive supervision of iCCM-trained CHWs. The platform used simple feature mobile phones on which were loaded the District Health Information System version 2 (DHIS2) software and Java 2 platform micro edition (J2ME) aggregation and tracker applications. This project was implemented in Chipata and Chadiza districts, which supported previous mHealth programs and had cellular coverage from all 3 major network carriers in Zambia. A total of 40 CHWs and 20 CHW supervisors received mobile phones with data bundles and training in the mobile application, after which they implemented the program over a period of 5.5 months, from February to mid-July 2016. CHWs used the mobile phones to submit data on iCCM cases seen, managed, and referred, as well as iCCM medical and diagnostic supplies received and dispensed. Using their mobile phones, the supervisors tracked CHWs{\textquoteright} reported cases with medicine consumption, sent CHWs feedback on their referrals, and received SMS reminders to set up mentorship sessions.

OBSERVATIONS: CHWs were able to use the mobile application to send weekly reports to health center supervisors on disease caseloads and medical commodities consumed, to make drug and supply requisitions, and to send pre-referral notices to health centers. Health center staff used the mobile system to provide feedback to CHWs on the case outcomes of referred patients and to receive automated monthly SMS reminders to invite CHWs to the facility for mentorship. District- and central-level staff were able to access community-level health data in real time using passwords.

LESSONS LEARNED: C-HMIS, using simple feature phones, was feasible and viable for the provision of real-time community-based health information to all levels of the health care system in Zambia, but smartphones, laptops, or desktop computers are needed to perform data analysis and visualization. Ongoing technical support is needed to address the hardware and software challenges CHWs face in their day-to-day interaction with the application on their mobile phones.

}, keywords = {Community Health Services, Community Health Workers, Delivery of Health Care, Health information systems, Humans, Mobile Applications, Referral and Consultation, Zambia}, issn = {2169-575X}, doi = {10.9745/GHSP-D-16-00275}, author = {Biemba, Godfrey and Chiluba, Boniface and Yeboah-Antwi, Kojo and Silavwe, Vichaels and Lunze, Karsten and Mwale, Rodgers K and Russpatrick, Scott and Hamer, Davidson H} } @article {1019, title = {Strengthening district-based health reporting through the district health management information software system: the Ugandan experience.}, journal = {BMC Med Inform Decis Mak}, volume = {14}, year = {2014}, month = {2014}, pages = {40}, abstract = {

BACKGROUND: Untimely, incomplete and inaccurate data are common challenges in planning, monitoring and evaluation of health sector performance, and health service delivery in many sub-Saharan African settings. We document Uganda{\textquoteright}s experience in strengthening routine health data reporting through the roll-out of the District Health Management Information Software System version 2 (DHIS2).

METHODS: DHIS2 was adopted at the national level in January 2011. The system was initially piloted in 4 districts, before it was rolled out to all the 112 districts by July 2012. As part of the roll-out process, 35 training workshops targeting 972 users were conducted throughout the country. Those trained included Records Assistants (168, 17.3\%), District Health Officers (112, 11.5\%), Health Management Information System Focal Persons (HMIS-FPs) (112, 11.5\%), District Biostatisticians (107, 11\%) and other health workers (473, 48.7\%). To assess improvements in health reporting, we compared data on completeness and timeliness of outpatient and inpatient reporting for the period before (2011/12) and after (2012/13) the introduction of DHIS2. We reviewed data on the reporting of selected health service coverage indicators as a proxy for improved health reporting, and documented implementation challenges and lessons learned during the DHIS2 roll-out process.

RESULTS: Completeness of outpatient reporting increased from 36.3\% in 2011/12 to 85.3\% in 2012/13 while timeliness of outpatient reporting increased from 22.4\% to 77.6\%. Similarly, completeness of inpatient reporting increased from 20.6\% to 57.9\% while timeliness of inpatient reporting increased from 22.5\% to 75.6\%. There was increased reporting on selected health coverage indicators (e.g. the reporting of one-year old children who were immunized with three doses of pentavelent vaccine increased from 57\% in 2011/12 to 87\% in 2012/13). Implementation challenges included limited access to computers and internet (34\%), inadequate technical support (23\%) and limited worker force (18\%).

CONCLUSION: Implementation of DHIS2 resulted in improved timeliness and completeness in reporting of routine outpatient, inpatient and health service usage data from the district to the national level. Continued onsite support supervision and mentorship and additional system/infrastructure enhancements, including internet connectivity, are needed to further enhance the performance of DHIS2.

}, keywords = {Health Information Management, Health information systems, Health Services, Humans, Inpatients, Outpatients, Uganda}, issn = {1472-6947}, doi = {10.1186/1472-6947-14-40}, author = {Kiberu, Vincent Micheal and Matovu, Joseph K B and Makumbi, Fredrick and Kyozira, Carol and Mukooyo, Eddie and Wanyenze, Rhoda K} } @conference {MEJIA:2011:INRIA-00567598:1, title = {Invasive composition for the evolution of a health information system}, booktitle = {Variability \& Composition (VariComp)}, year = {2011}, note = {{ACM} 978-1-4503-0646-1/11/03 {D}.: {S}oftware/{D}.3: {PROGRAMMING} {LANGUAGES}/{D}.3.3: {L}anguage {C}onstructs and {F}eatures}, month = {03}, address = {Pernambuco Brazil}, abstract = {{I}n this paper we show that some of the evolution tasks in {O}pen{MRS}, a health information system, may require the invasive modification of interfaces and implementations in order to offer an appropriate modularization. {W}e introduce a new composition framework in {J}ava that supports the definition of expressive pattern-based invasive compositions. {F}ur thermore, we show that the composition framework allows us to concisely define an evolution scenario of {O}pen{MRS} that supports the consolidation of patient data from differ- ent remote instances.}, keywords = {Aspect-oriented programming, Distributed systems, Health information systems, Invasive software composition}, url = {http://hal.inria.fr/inria-00567598/PDF/mejia-sudholt-benavides_varicomp-AOSD2011.pdf}, author = {Mejia, Ismael and S{\"u}dholt, Mario and Benavides Navarro, Luis Daniel} }