January 2010

We have a much stronger information base in place now

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Dr. Sundeep Sahay
Advisor- Health Management Information
Systems and Monitoring, NHSRC

National Health Systems Resource Centre (NHSRC) provides technical support to the NRHM, which works towards strengthening Indias public health systems. The NHSRC has been actively involved in assisting states and national centres in establishing functional, effective, state-of-theart health management information systems.

A Professor of Informatics at University of Oslo, Dr. Sundeep Sahay is the Advisor “ HMIS at NHSRC. From conceptualization to implementation, Dr. Sahay gives an overview of the entire HMIS project, in an interview with eHEALTH. Excerpts from the interview.

How did the genesis of HMIS project take place?

The first step was to bring architectural corrections under NRHM, which required thorough uation of the system that was already running in place. There was a need to identify the data being collected, the method being used for collection of data and finally its usage.

Further, there was a need to identify the challenges and problems being faced, on the basis of which a situation analysis of the existing system was done and a procedure to reform the entire system was devised. This marked the beginning of the project in early January 2008.

What were the challenges faced during the integration of this project?

Some of the major issues faced were” collection of too much data, g e n e r a t i o n of very few indicators, weak utilization  of data for planning and action and extreme fragmentation of information systems running independently of each other, and so on. A major problem was to collect data available in different formats and include it in files of different formats. We  felt that the only way to address these issues was to redesign the entire system.

The first step to redesign the system was to study it and identify the problems. The next step involved the process of consultation at the Ministry with various program managers, who were directly overseeing these consultation processes and various directors from different states, who had direct knowledge of these programmes. Our role was to mobilise different relevant stakeholders and consultations.

What steps did you take to ensure the quality of data, especially in terms of transferring data already available in paper format?

Data, available, was in a non standardised format”excel files, word docs, papers, etc., which made it extremely difficult to transfer it into a standardised electronic format. Further, the files were not named in a consistent format, which made it difficult for us to identify the file just by looking at its name. Prior to the implementation of software in October 2008, the legacy data was required to be imported into the new format.

Also, we needed to map the existing data into the new format. Mapping was a very difficult step because converting the data into the revised format was a big issue.

What are the key features and highlights of the HMIS project?

A significant progress has been made in getting data from sub-state levels which was not possible earlier. In contrast to the state consolidated reports being sent earlier, we re now getting district reports from almost 99 percent of the districts. From 10- 12 states, we are getting data from the block level, while from 5-6 states we are getting data from the primary health centre level. Thus, there is scaling down in terms of origin of data, which is a part of decentralization as we are getting data from several levels below the state. A number of states are now getting involved in analysing information and the quality of data.

I think we have moved in a positive direction but there is still a lot of work left to be done.

What is the total budget outlay of the project?

There are different components to this project. The web portal has been developed by the Ministry of Health and Family Welfare and they have funded this component.

NHSRC has been providing customization services to the states as per their local needs. The states have free access to these services and the funding for this comes from the national budget. Further, the national budget provides funding for the training and capacity building activities, which are again free for the states. Thus, for the states did not have to make any investment except for providing local logistics / accommodations during training and capacity building programmes.

The HMIS has been integrated across various states. How did you design and customize the system to meet the needs of different locations?

It is basically a server based software, so, there is one application running on the server and various districts have access to it. Thus, in that way the programme gets integrated in terms of access.

I think the whole idea was to enforce the incorporation of uniform standards and formats across all districts of the country.

What is the current status of the project?

As of now, data is on flow from all districts including 30 percent of block and 10 percent of PHCs. Our next step focusses on strengthening data quality and utilization of information to allow data to go through planning, monitoring and uation processes. Much more work is required to be done on integration with other programmes.

A new system has, now, been made mandatory by the government which involves tracking the entire data. This will include tracking of data pertaining to pregnant women, child immunizations, etc. by capturing data name-wise.

As of now, this is a major step that we have in front of us.

What benefits has the project provided so far and is expected to provide in future?

A significant benefit has been to get a broader picture of the entire situation across the country. For instance, we now have data on child immunizations, deaths in a particular area and availability of funds for the improvement of such conditions. The program managers can effectively use this data to improve the interventions, be it improved immunization coverage, reduced maternal deaths, or reduced infant deaths.

We, now, have a much stronger information base in place. However, we still need to build that culture in which people learn to use the information available, which will be a major job for us.

What is the usage right now and how can it be enhanced in the future?

Right now the usage is very limited and only a few states are making use of the data available. We believe the usage can be increased by training, capacity building, providing better tools so that people can easily look at drafts, charts, maps, etc.. People are only used to sending information up the hierarchy but they dont really use it for themselves and for their local actions. A change in mindset is required which can actually come through long term education and training and capacity building programs.

Is the government organising any programmes right now for enhancing data usage?

As of now, some states like Kerala, Gujarat and Manipur are using it. So, we can actually see examples now of states using the data. Various states are now looking at customized data while planning ahead and that, I think, is a big step forward.

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