Health Information System Strengthening. Under this component, USAID defined the main topics to be prioritized and geographical areas of interest as follows: • Support the MOH in developing/improving DHIS2 as the national platform for health information system, in coordination with other partner/stakeholders; • Strengthen the municipal, provincial and central level capacities in data insertion, data analysis, and data use in DHIS2 for decision making.
Health Information System Strengthening. PMP indicators on Health Systems Strengthening are presented in the table below. They reflect the key efforts of DHIS2 implementation in all 61 municipalities of the six PMI provinces. The foundations for DHIS2 implementation were set up during Q1 of FY18 with the development of the DHIS2 Road Map. In the remainder of Year 2, HFA intends to: • Roll out DHIS2 and develop a capacity building plan for municipal, provincial, and central levels to be implemented in Q2 and Q3; • Make DHIS2 fully functional by Q4 in the six PMI provinces; • Monitor DHIS2 data entry, analysis, and data use for decision making. Performance Indicators Baseline 2015-16 Target 2018 Quarter targets for FY2 Achieved in Quarter 2 / Quarter 2 Target Achieved in Quarter 2 / Year Target Q1 Q2 Q3 Q4 Number of DHIS2 users trained within MOH with USG assistance * N/A 142 N/A** 8 50 84 8 / 8 (100.0%) 8 / 142 (5.6%) Percent of municipal HMIS reports submitted on time and complete (every quarter) *** N/A 70% N/A** N/A** N/A** 70% N/A N/A Number of municipal authorities meeting quarterly to review HMIS data and incorporate feedback in reports *** N/A 43 ⱡ N/A** N/A** N/A** 43 N/A N/A * It assumes training 2 people at municipal level (2 x 61=122), 2 at provincial level (2 x 6=12), 2 at central level (GEPE/GTI), and 6 trainers of trainers (TOT); ** Not targets for some indicators in Q1, Q2 and/or Q3 due to the roll out phases of DHIS2; *** Targets were changed with respect to PMP to go in line with recent developments of DHI2 Road Map and HFA implementation plans; ⱡ It corresponds to 70% of 61 municipalities (total number of municipalities in 6 PMI provinces).
Health Information System Strengthening. DHIS2 and Health Digital Systems During Q2 FY18, HFA focused its efforts in doing prep work for the roll out of DHIS2 in PMI provinces. To that end, it developed a set of manuals and systems that will facilitate training and daily use of DHIS2: ➢ User manual ➢ Supervisor manual ➢ Admin and support system (in progress) ➢ DHIS2 governance rules (helping draft the MOH manual) ➢ DHIS2 form configuration (recently approved malaria form with iCCM key indicators, as well as daily collection forms for outbreaks of measles and Xxxx virus (requested by the MOH) ➢ Capacity building of GEPE/GTI: on-job coaching of GTI technicians on a weekly basis ➢ Support of DHIS2 Academy (one person from GTI and 1 from HFA participated in the Maputo Academy Level 1) ➢ Got the overall approval of the Roll Out plan for the first three provinces, regarding timeline, target population for training, etc. HFA also hired six IT professionals and trained them in DHIS2. These personnel will play the role of TOT trainers and will be based in the PMI provinces during the first year of the DHIS2 roll out, providing daily support to municipal and provincial level health personnel in IT and DHIS2 problems they may encounter. It is expected that, with this strategy, health personnel will develop faster its DHIS2 skills and will be more likely to using DHIS2 as the platform for data reporting, analyses, and decision making. In addition to the six IT, two internal HFA personnel were trained, reaching a total of eight persons as expected in the PMP. In March 2018, HFA, in coordination with USAID-PMI Angola, organized a three-day Health Tech Camp with funds from the US State Department. The Health Tech Camp gathered participants from the MOH, donors, and private sector5 who identified current problems of interoperability between DHIS2, Open-LMIS, and other digital health information systems, and discussed strategies to overcome such problems. By the end of the Tech Camp, participants agreed that one key step to reaching interoperability is to develop a master facility registry and use OpenHie as a platform through which DHIS2, Open-LMIS, and other digital system can talk to each other. It is expected that a follow-on activity will take place during Q3-Q4 to develop an interoperability prototype. As planned in the previous quarter, HFA presented the MOH and partners with a PSI supervision tool to measure the quality of health service provided to the MOH and partners (HNQIS: Health Network Quality Impr...
Health Information System Strengthening. Although the development of the DHIS2 Road Map in Q1 2018 was a corner stone to align partners and MOH in timelines and most activities, subsequent coordination by the MOH has not always been strong, creating the following challenges: ➢ Lack of equipment for DHIS2 roll out: delays in approvals for Global Fund (GF) procurement by the MOH can jeopardize the roll out in several provinces. According to the DHIS2 roll out, GF money could be used to purchase one computer for almost every municipality in the country (161 municipalities out of 164), covering all the 61 municipalities in the six PMI provinces. Nevertheless, the MOH has barely started the procurement process and this can take several months. So far, GTI has offered 21 computers donated by the World Bank to start the roll out, out of the 43 that had originally been promised to cover the initial three provinces: Uige, Malanje, and Lunda Norte. ➢ Synergies among partners not always reached: implementers have their deliverables, indicators, and workplans that they have to meet, making harmonization challenging. This is accentuated by the lack of strong coordination by the MOH. ➢ Level of capacity of people: people from MOH assigned to accompany HFA to provinces and DHIS2 trainings at municipal and provincial level do not always have the necessary skills to do so. XXX has assigned some personnel who have not participated previously in any DHIS2 academies, leaving aside those who have actually attended. This requires greater prep work from HFA in order to train the assigned MOH personnel at central level, before going to the provinces.
Health Information System Strengthening. DHIS2 Roll Out and Interoperability among Different Digital Systems Roll out of DHIS2 will initiate in 3 provinces in Q3 and will be expanded to the other 3 provinces in Q4. The expansion will be in a phased way, starting with one province and learning from it to improve the roll out in subsequent provinces. HFA will be accompanied by GTI-GEPE and other MOH personnel (NMCP), who will be responsible for leading certain sessions of the training. The roll out will start in provinces where GEPE has already provided training on basic monitoring and evaluation competencies (existing data collection forms and how information is used) using funding from the Global Fund ATM. The idea is that, by starting in these provinces, the health personnel at municipal and provincial level will be better prepared to understand the use and benefits of DHIS2. It is expected that, by the end of the FY18, DHIS2 will be fully implemented and that 70% of the municipalities will be submitting reports through this platform on time. It is also expected that at least 70% of the municipal authorities in the six PMI provinces will meet at least quarterly with provincial level authorities to analyze reports and to make decisions based on DHIS2 information.
Health Information System Strengthening. PMP indicators on Health Systems Strengthening are presented in the table below. Over time, yearly or quarterly targets need to be adjusted due to recommendations from GTI/GEPE to increase the number of persons to be trained or to change the order of provinces due to strategic purposes (e.g. start with provinces already trained by GEPE on Monitoring and Evaluation or provided with computers from another donor/partner). These changes are sometimes difficult to foresee in advance, given the decision-making processes of the MOH. Here, we present the targets as they were set up by the beginning of the quarter, before the changes occurred. In section 5.6 (proposed targets for Q4), we suggest new targets based on these changes. As observed in the table 1 below, the number of people trained in DHIS2 in Q3 were almost double the quarterly targets, due to a substantial increase in the number of trainees per municipality, as recommended by GEPE-GTI. Table 1- DHIS2 performance indicators during Q3 PerformanceIndicators Baseline 2015-16 Target 2018 Quarter targets for FY2 Achieved in Quarter 3 / Quarter 3 Target Achieved in Quarter 3 / Year Target Q1 Q2 Q3 Q4 Number of DHIS2 users trained within MOH with USG assistance * N/A 142 N/A** 8 50 84 93^ / 50 (186.0%) 101^ / 142 (71.2%) Percent of municipal HMIS reports submitted on time and complete (every quarter) *** N/A 70% N/A** N/A** N/A** 70% N/A N/A Number of municipal authorities meeting quarterly to review HMIS data and incorporate feedback in reports *** N/A 43 ⱡ N/A** N/A** N/A** 43 N/A N/A ^ 93 users reported as trained in DHIS2 in Q3 include 70 users trained in Uige in May-June, and 23 users trained in Malange in June-July 4th. An additional 49 users were trained in July 11th -24th, which will be included in the Q4 report. * After DHIS2 road map and implementation plan (Q1-Q2) it was assumed that 2 people would be trained at municipal level (2 x 61=122), 2 at provincial level (2 x 6=12), 2 at central level (GEPE/GTI), and 6 trainers of trainers (TOT), making a total of 142. This assumption will be revised in proposed targets for Q4. ** Not targets for some indicators in Q1, Q2 and/or Q3 due to the roll out phases of DHIS2. ***It corresponds to 70% of 61 municipalities (total number of municipalities in 6 PMI provinces).
Health Information System Strengthening. DHIS2 and Health Digital Systems Major achievements in Q3 FY2018 included the kick off of the DHIS2 training in the PMI provinces (Annex 2 – Success Story). Two criteria influenced the order in which the provinces were chosen to be trained. The first criterion was to start with provinces for which the World Bank would provide computers (covering every municipality and provincial health department), while the MOH purchased computers for the remaining provinces with funds from the Global Fund. The second criterion was to start with provinces where XXXX had already trained health personnel on monitoring forms using funds from Global Fund, so trainees could be better prepared to understand DHIS2. With this criteria Uige was selected as the first province to be trained, followed by Malanje. DHI2 Training Province Implementation Period # Municipalities covered # Computers for distribution # technicians trained at municipal level # technicians trained at province level Total # of Technicians trained Uíge May-June 16 17 64 6 70 Malanje June-July (4th) 5 6 19 4 23 Total 21 23 83 10 93
Health Information System Strengthening. During the remainder of Q4, HFA recommends continuing to work together with other partners (EU, WHO, PSM, etc.) to support GTI/GEPE and reinvigorate the Extended Technical Working Group meetings, as well as to continue having bilateral meetings with partners to have a closer look at what they are doing and how to jointly improve DHIS2 implementation. Increase involvement of NMCP, through one of its staff members and through the HFA M&E advisor to improve the culture of data analyses at all levels of the MOH. This means to initiate meetings with municipal and provincial level officials (where DHIS2 training already occurred), in order to analyze data for decision making. At the central level, support GTI-GEPE to have DHIS2 data available for presentation at each of the regular meetings with the MOH, so high level officials also increase their positive perception of DHIS2 and endorse their support of DHIS2 as the national health information platform.
Health Information System Strengthening. Section 5.2.2 targets were presented in the beginning of Q3. In the following table, increased targets are being proposed and submitted to PMI-USAID for consideration, in line with GEPE/GTI suggestions to increase the number of people to be trained in each municipality. Performance Indicators Target FY2018 Target Q4 Number of DHIS2 users trained within MOH with USG assistance * 278 177 Percent of municipal HMIS reports submitted on time and complete 70% 70% Number of municipal authorities meeting quarterly to review HMIS data and incorporate feedback in reports 43** 43** *Revised: It assumes training 4 people at municipal level (4 x 61=244), 4 at provincial level (4 x 6=24), 2 at central level (GEPE/GTI), 2 at NMCP, and 6 trainers of trainers (TOT). **It corresponds to 70% of 61 municipalities (total number of municipalities in 6 PMI provinces). Specific dates for DHIS2 training in remaining provinces and supervision are presented on Annex 5 - DHIS2 Training and Supervision Chronogram for Q4 FY2018.
Health Information System Strengthening. During FY2, HFA will continue participating in meetings with the DHIS2 Technical Working Group led by GEPE/GTI to work on the National DHIS2 Roadmap. The roadmap will prevent duplication of efforts with partners working on the same geographic or health areas, and will serve as a joint planning and accountability tool. The roadmap will also enable GEPE-GTI and its TWG to track progress and come up with solutions to any problems encountered during the DHIS2 deployment. With support from PMI, HFA will also lead a workshop on October 2017 with all partners to finalize the National Roadmap for DHIS2, bringing on board PSI/Global experts and local staff. HFA will coordinate and work closely with the PSM project, who leads on the eLMIS system, so that the integrated HMIS system is developed and implemented in Angola from the start. Based on the Roadmap developed and validated at the Roadmap workshop, by the end of FY2 Q1, HFA will have developed a detailed DHIS2 implementation plan that will be executed along the year. After the system is completely set up, an evaluation of the DHIS2 platform will be programmed to adjust for improvement and fix errors.
