Transcript Use of Info Technology

Use of Information Communication
Technology & HMIS to strengthen
Management Systems and for Advocacy
Africa CHAs 4th biennial Conference 23rd to 26th Feb , 2009 Uganda
Kirumira Kizza Charles
Assistant Data Management Advisor to UCMB
The Private Not For Profit (PNFP)
Health Sector in Uganda
• The Private not for Profit Health Sector (PNFP):
– 52 PNFP hospitals (42% of 124 Hospitals in the country)
• 45 CHAs Hospitals UCMB & UPMB (36% of 124 )
– 500 functional lower level health units (20% of the total
LLUs in the country)
– 20 Health Training Institutions (over 60% of the total
Training Schools in the country )
– Estimated level of services provided to the population:
range between 30-35%.
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The Catholic Health Sector
• The Catholic Health Sector is coordinated nationally by
UCMB and comprises:
• 27 Hospital (2 more are registered but not yet accredited)
• 241 lower level health units (LLU),
• 12 Health Training Institutions – Nursing Training,
Midwifery and Laboratory Schools
• One of the Major stakeholders in the Uganda national
health system
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UCMB Network Journey to Current ICT position
(2001 to date)
• 2001: UCMB realized need for ICT to
strengthen operations especially HMIS.
• UCMB ensures that all Health Facilities
(HF) use HMIS properly
– Through a series of short courses in HMIS
– Training users in Microsoft Office applications,
basic ICT skills and use of ICT equipment.
• Targeted:
– Records Officers in Hospitals & HCIVs
– Diocesan Health Coordinators (DHCs)
– Hospital managers
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UCMB Journey with ICT and HMIS
• 2002: Installing of internet / e-mail facilities
– Transmission of data and information from Hospitals &
DHO to UCMB data base was effected.
• Strengthened timeliness of compilation and feedback
– At facility level focus is on performance assessment &
utilization of results.
• 2004: Financial Accounting software (FIPRO ABC ) was
developed by UCMB
– Hospitals generate cost by Cost Centre
– Able to analyse Economic efficiency of the Hospital
– Managers are able to relate input to output on a cost
centre .
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UCMB Journey with ICT and HMIS
• 2007: UCMB developed a Web site
(http//www.ucmb.co.ug)
– This enabled HF to access managerial,
financial, ICDM guidelines and health
survey reports.
• 2008: Health Training Institution
connected
– Internet and e-mail
– enabled to manage data and information
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UCMB Journey with ICT and HMIS
• 2008:Web-based HMIS was launched
Link: http://fs.ucmb.co.ug/UCMB2/web/index.php
– Links UCMB data base to all hospitals
(indicators for evidenced decision making).
– Each hospital can access its data from
UCMB on line and order specific analyses
– Compare with locally analyzed information
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What have been strengthened as a result?
• Governance and Management in general
•
– Use of data for management decisions
– Informed Strategic decisions
Finance Management System
– Hospitals moving to international accounting standards
• Most hospitals using Cost-based accounting (accrual) based
on Cost-centre
– Timely production of financial reports
– Fipro used by 12 hospitals now
• It is modular
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What have been strengthened as a result?
• Analytical outlook of information
– Comparison of performance over time
• Individual hospital trends
– Comparison against others in the network
• Human Resources Management and
Development
– Access to HR guideline on the UCMB web site
– Monitor staff attrition & retention regularly
– Receive information on Training Scholarship Fund via
UCMB web site & e-mail
– Information used for:
• Planning recruitment
• Planning capacity building
• Investigating reasons for high turnover
• Advocacy
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Using the HMIS as a tool for Monitoring &
Evaluating
Access, Equity, Efficiency, Quality
of Health Services
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The data source: HMIS
• UCMB hospitals collect data
based on the MoH Health
Management Information
System (HMIS)
• E-reports are then forwarded to
UCMB (via e-mail)
• stored in a central databank
• from a Summary Annual
Report Format (activities and
financial information)
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The auto-generated information:
examples
• What is possible with the
system is to auto-generate
information
– graphs or tabular formats
– right at health facility level
1,500
Total Admision
Total new cases
Total Attendance (New + Reattendance)
3,500
3,000
2,500
2,000
1,500
1,000
InPatients Attendance
1,400
OPD attendance
4,000
Male
500
Female
1,300
0
1,200
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
1,100
1,000
• Make basic trends analysis
900
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– Health Facility performance
indicators, Epidemiology,
Specific indicators to
monitor the
implementation of the
National Health Sector
Strategic Plan
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The auto-generated information:
examples
IPD UTILISATION
Total Admision
Male
Female
From within Catchment Area
Outside Catchment Area
Tot. Inpatient Days
ALS
BOR
July
August September October November December
879
1023
830
782
817
726
327
400
334
260
330
263
552
623
496
522
487
463
682
624
576
508
522
450
197
399
254
274
295
276
2748
2454
2539
2768
2587
2537
3
2
3
4
3
3
59%
53%
55%
60%
56%
55%
IP trend
1,200
1,100
1,000
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200
100
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Ju
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Au
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tob
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No
Total Admision
er
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De
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nu
Ja
Male
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bru
Fe
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Ap
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Female
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Ju
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Hint on Composite Indicators used by Managers
• The Standard Unit of Output (SUO)*
– SUO is a standardized measure of output that
allows comparison
– Computation formulae
• Hospital –
(15*IP)+(1xODP)+(5*DEL)+(0.5*ANC/MCH/NFP)+(0.2* IMM.)
• Dioceses (5*IP)+(1xODP)+(2*DEL)+(0.3*ANC/MCH/NFP)+(0.2* IMM.)
– SUO documents/literature available at http://www.ucmb.co.ug/
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Cont: Composite Indicators used by
Managers
• The quality health care*
– This composite indicator consists of 7
indicators:
• fresh Still birth rate,
• maternal Death Rate,
• recovery Rate on discharge,
• infection rates for caesarean section,
• proportion of qualified staff ,
• patients satisfaction &
• drug prescription practices.
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Applications : a Monitoring System used
by Managers.
• The electronic HMIS system developed by UCMB
• Uses HMIS information to monitor Annual Health Units’
performance
• Based on
– ACCESSIBILITY: using indicator called Standard Unit
of Output (SUO)*
– EQUITY: using as indicator Values of Fees charged per
SUO
– EFFICIENCY: using as indicator Number of SUO per
Staff and Cost per SUO produced
– Quality of Health Care (Hospitals): using 7 indicators*
• These are composite indicators / indices
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Applications : a Monitoring System used
by Managers.
• Managers can analyse data at source
• But can also access tabulated data and graphs on the web by
logging onto UCMB data server and running some queries
• The next 5 slides show trends of these composite indicators /
indices used to measure how UCMB network remains
faithfulness to its Mission Statement
• Using box-whisker plot
– Show individual trend and trend against the rest in the network
• Trends are used for management decisions and informing
governance
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Monitoring Access:
Composite Activity Indicator: Hospital Trend of SUO op (blue line) against
UCMB network (box-plot graphs)
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Monitoring Equity:
Level of patients’ fees: Hospital Trend of Fees values (blue line) against
UCMB network (box-plot graphs)
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Monitoring Efficiency:
Total Cost per Output: Hospital Trend of Cost per SUO values (blue line)
against UCMB network (box-plot graphs)
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Monitoring Efficiency:
Staff Productivity: Hospital Trend of SUO OP per Staff values (blue line)
against UCMB network (box-plot graphs)
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Monitoring Quality:
Quality of health care: Hospital Trend of Quality of services (blue line)
against UCMB network (box-plot graphs)
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106
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96
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100
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60
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Total Quality Score
03/04
Total Quality Score
04/05
Total Quality Score
05/06
Total Quality Score
06/07
Total Quality Score
07/08
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HMIS as a tool for accountability
• The system’s application has been used as tool
– for internal accountability: managers to the Board
• Report to boards on trend annually is mandatory
– for external accountability: other stakeholders in Health
Sector
(Ministry of Health, Development Partners, Donors…)
• For self-appraisal and performance analysis of hospitals and
diocesan health departments
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Using HMIS Information for
Advocacy
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Internal Advocacy –UCMB Network
• For equitable charges in all hospitals & LLUs
(Fees /SUO) on behalf of users (esp. the poor)
– Based on trends of fee / SUO compared to that of
access, cost and productivity
• For consolidation instead of unnecessary
expansion / scale ups
– Due to macro-economic challenges
• To provoke efficiency measures
– Based on trends of efficiency (economic and staff
productivity)
• To guide recruitment and management of HR
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Advocacy – Outside the UCMB network
• Together with UPMB and UMMB
• Produced “Facts and figures of PNFP” and shared with
•
– Ministry of Health
– Members of Parliament
– Development Partners (including CORDAID, AVSI,
IICD, CUAMM, etc)
– Also shared with ARHAP
Feb 2008: Made presentation to members of
Parliamentary Social Services Committee – advocating
for more government support
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Advocacy – Outside the UCMB network
• Include report on PNFP in the Annual
Health Sector Performance report (AHSPR)
• Analyses showing the difference in
remuneration between Govt & PNFP Health
workers – advocacy for support to HR
– Advocate for PHC–Wage grant for PNFP
Health workers
•
In May 2005: Religious leaders used
information to advocate to government for more
support to PNFP
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Advocacy at International fora
• Relationship between Church Health Services
(CHSs) and respective governments
• WHO-NGO Consultation Sept. 2008 Geneva
(Br. Dr. Daniel Guiste-UCMB.)
• C.C.I.H. June 2006 Annual Conference –U.S.A –
– Addressing the human resource in Health crisis.
(Marieke Verhallen-UCMB.)
• Uganda Catholic Bishops appealed to CIDSE
•
to influence decisions at the revision of the
Paris Declaration to enable more funding to
CSO (Accra – Ghana 2008)
Annually share information with Cordaid
– Carry out advocacy where possible
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Conclusion
• The Uganda National HMIS provides enough data
to perform basic & trend analysis at the HF
– to help managers to take decision ( based on sound
information)
• ICT applications have been very helpful
– analysis easier at Health Facility levels
(periphery)
– the system auto-generates information
– and connectivity and applications enable data
transfer and report viewing right at the
periphery
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Conclusion
• Trends analysis can be done at the periphery
– Does not require “high expertise levels”
– Just look at the graphs and draw conclusion.
• Consolidated sector analysis done at the center
– as it requires the aggregation of the complete data set
and higher levels of “expertise” ( only possible with IT )
• Punctual feed-back mechanisms were enabled at
the centre.
• Generated information is being used to strengthen
various aspects of management and governance
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CONCLUSION
• UCMB has also used HMIS information for
advocacy
• Internally
– Within the catchment's area of the health
facilities to influence health seeking behaviour.
– At Diocesan Level
– At Hospital
• National level
• International level
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