The Chadian Ministy of Health and Prevention replaces a legacy Health Information Management System with DHIS2 to achieve a decentralized, high data quality system.
The Chadian Ministry of Public Health and Prevention (MSPP), through the Department of Statistics and Health Information System (DSSIS) has the mission to improve health data collection in the country. To achieve this goal, the Ministry had set up a hybrid paper-based and digital Health Management Information System (HMIS) for data collection, collation and analysis. The digital component of this system was implemented using a software called Gesis. After many years of using Gesis, the Ministry has decided to transition to DHIS2 in response to observed limitations of the Gesis platform. Some of the shortfalls noticed by the MSPP revolve around data completeness and timeliness which the Ministry noted, would be significantly improved by the new DHIS2 platform.
Prior to the adoption of DHIS2 in Chad, healthcare data was entered into paper registries at the health facilities. At the end of the month, these registry entries were then collated and forwarded to the districts. The districts would subsequently compile the reports from the health facilities and send them to the provincial health delegations which consolidate them using harmonized reporting outlines. The collated records are further shared with designated officials of the Ministy at the central levels either on external storage media, in paper format or by telephone. At the end of the year, the Department of Statistics within the Ministry compiles the reports from all the provinces, calculates the various indicators and consolidates the national database.
This method of data collection poses problems that range from security concerns, logistics, to poor data completeness, making statistical analysis tedious and limiting access to data in real time. These challenges therefore highlighted the need for a robust and efficient system, tha enables secure, speedy and decentralized simultaneous data entry and transmission from health facilities to all levels of healthcare management in the country.
In response to these needs, the MSPP in 2019 set up a national DHIS2 team comprised of data managers, programs, technical departments and IT specialists and tasked with implementing DHIS2 as an information management system to facilitate the collection and analysis of data between the different actors of the health sector. The team, with the help of HISP Rwanda, implemented the new DHIS2 HMIS in phases: revision of data colleciton tools through standardized reporting frameworks; implementation of necessary technologies and infrastructure; and capacity building through training of facility managers and end users.
In June 2021, the Health District Support Program (PADS), which is in charge of supporting the districts for issues relating to the Health Information System, in collaboration with the DHIS2 team of the Ministry of Public Health lauched a pilot of the new DHIS2 HMIS in the provinces of Moyen-Chari and Batha. This pilot focused on data entry into DHIS2 using the DHIS2 data entry application, reporting functionality and tables. Following encouraging results of this pilot, the Ministry approached HISP Rwanda, to support the central authorities in scaling up the project to the national level. At the same time, data entered into the Gesis from January 2021 were imported into DHIS2. As at November 2022, significant improvement in the completeness and availability of data has been observed and this has encouraged the authorities to officially launch DHIS2 throughout the country. At the end of the first reporting year, 96.4% of districts in Chad now enter their data directly into DHIS2. In addition, the DHIS2 EMIS has made it easier for the central level to identify the causes of problems related to data reporting downstream.
Nevertheless, some challenges still affect the efficiency of the system. Thes include internet speed, unstable internet connectivity in certain regions of the north of the country among others. The Ministry, therefore, plans to take advantage of the offline data entry capability of DHIS2 by purchasing tablets to enable offline data entry using the DHIS2 Android Capture application.
As part of the policy of decentralizing the use and analysis of data to health facilities, the Ministry of Public Health plans to train district and provincial data entry officers on data analysis through the functionalities of DHIS2 including data quality, the management of dashboards and the use of the Maps application.
Other health information system programs such as TB, HIV, Malaria are considering using DHIS2 Tracker to capture individual patient data in support of long-term follow-up of users, as well as the integration of other programs such as routine monitoring, vaccine-preventable diseases and other programs to allow an overall statistical view of the nation’s healthcare data.
Read this article in French here: DHIS2 en tant que système de gestion de l’information sanitaire au Tchad