HMIS OVERVIEW

BOYD MWEEMBA, BSC., MSC.

EPIDEMIOLOGY AND
BIOSTATISTICS, M&E SPECIALIST
Introduction
• HMIS strives to provide managers (at all levels –
facility, district, provincial, and national levels)
with relevant, timely information that can be
used in the decision making process.
• In order to be able to achieve this aim, all the
components of an information system need to be
working effectively.
• If one or more of the components do not work
properly, managers will have difficulty in
accessing information to inform their decision
making.
Introduction
• We will look at the key components of the HMIS in
Zambia, and explore how these components work
together.
• There are Six main components to explore. The first
four components lay the foundations on which the
information system is built.
• The fifth and sixth component is in fact the information
process to generate meaningful information out of raw
data.
• The efficient functioning of this process is premised on
the other five components being functional.
The information cycle
• Information cycle is the process by which data
is collected, collated and analysed to provide
meaning full information.
• This information is used for planning and
assessment. The successful completion of this
cycle is dependent on a number of tools as
shown below:
Data handling processes in the info
cycle

1.
Collection
2.
Processing

6.
Information use

3.
Analysis
5. 4.
Interpretation Presentation
Data handling processes in the info
cycle
• 1. Data collection
• Indicator based essential dataset
• Data elements - standard definitions
• Data sources & tools are also well defined
• Data capturing streamlined
Tools used
• Clients cards, tally sheets, registers e.t.c
Data handling processes in the info
cycle
• 2. Processing
• Collation
• Data quality checks (manual)
• Data validation (computer)
Tools:
• Validation rules
• Collation tools
Data handling processes in the info
cycle
3. Analysis
• Calculations following the outcome of
interest-indicators
Tools:
• Calculation formulas
Data handling processes in the info
cycle
4. Presentation
• Flow of information
• Feedback mechanisms
• Format of tables, graphs & reports
Tools:
• Tables
• Graphs
• Discussions
• Feedback
Data handling processes in the info
cycle
• 5. Interpretation
• Making sense of information
• Possible interpretation
• Explore
• Tools:
• Explore
• Ask questions
• Research
Data handling processes in the info
cycle
6. Information use
• Regular review of data
• Relate to operational plans
• Monitor service coverage & quality
Tools:
• Programme Management
• Planning
• Budgeting
Data handling processes in the info
cycle
• Data collation tools: Provide a means to
summarise and combine data from different
sources
• Data analysis tools: Provide facilities to detect
patterns, trends and/or inconsistencies in the
data
• Data presentation tools: Provide for easy data
display and understanding for decision making
HMIS based Principles
There are four principles on which HMIS is
based:
• Decentralization
• Action-Oriented
• Responsive
• Transparency
HMIS based Principles
1. Decentralisation
• A key to good District management is the
presence of a functional and robust District
Health Information System (DHIS) that enables
local monitoring and analysis of coverage and
quality.
• Data analysis and self-assessment should be
carried out at the level where data is collected
and information should be used for decision
making and action at that level.
HMIS based Principles
• Data should be collected for local management
and not merely for upward reporting for higher‖
levels and to ensure that donors pay out money.
• This will need revision and simplification of
reporting and analysis tools to suit the needs of
workers
• Local managers and program coordinators have
the right to demand high quality data from the
routine HMIS and that adequate resources are
allocated for this purpose.
HMIS based Principles
2. Action oriented
• Data should be collected for local action, self
assessment and decision-making, not for
filing.
• The HMIS should collect information for action
according to the information pyramid and
there should be a clear differentiation
between the scope of decisions taken by each
level.
HMIS based Principles
This in turn will:
• 1. Health Management Boards require
operational information for day-to-day
management and supervision;

• 2. Different health information needs also

exist for the community, health post, health
centre, hospitals as well as the Regional
Boards of Health.
HMIS based Principles

• 3. Specialised programs have some

information needs which fall outside the
boundaries of the routine HMIS.
• These should be collected through integrated
use of sentinel surveillance, surveys and other
techniques, rather than burdening the routine
system.
HMIS based Principles
• 4. Central Ministerial level requires
information for longer term strategic
management and support, and for setting
national policy.

• Well performing units should be rewarded and

poorly performing units given technical and
managerial support to improve skills and
infrastructure.
HMIS based Principles
3. Responsive
• Data collection should react to changing
needs, with data reported in an appropriate
timeframe according to its use, and be flexible
in terms of adaptation to changing local
needs.
HMIS based Principles
• This responsiveness should be ensured by a
high level internal ―steering committee‖, e.g.
the Monitoring & Evaluation Subcommittee,
and regular reviews of the HMIS involving all
role players that ensure that each level
collects standardised data in a flexible, locally
empowering way.
HMIS based Principles
4. Transparent
• A see-through system was envisaged where obtaining
information would be easy and dissemination facilitated by
the created District, Provincial and National Resource
Centres.

• All stakeholders should be able to easily access anonymous

analysed information on key basic programs and the public
should be honestly informed of progress and achievements
of the health sector through regular press releases and
annual publication of comprehensive reports that critically
analyse information and give a realistic picture of successes
and constraints.
HMIS based Principles
• In addition, correlation of data collected by the
various subsystems will be greatly facilitated by
an integrated, centralized and web-based data
warehouse to which health workers, managers
and the public should have selective access.

• The HMIS will require that all health information

gathering be coordinated through the Monitoring
and Evaluation Unit in the Ministry of Health to
avoid repetition of effort and unnecessary burden
of data collection at the health facilities.
Information Use
• The HMIS aims to develop a culture of
information use in health facilities and
communities, using the built in reporting
functions in the DHIS and to use their analysis
of this data to improve services.
•
Information Use
• Performance appraisals will be made more
functional, linking service delivery, financial
management and human resource data to
provide a realistic assessment of performance
and real accountability for use of funds to
MoH and Cooperating Partners.
Information Use
• Quarterly information reviews of clusters of
hospitals of similar sizes will provide further
analysis of PA data and provide opportunities
for institutions to present their data and
discuss how it can be used to improve service
delivery.
Information Use
• Managers will have access to DHIS data on the
intranet. They will be able to interrogate the
information for quality and will use the
information to make good management
decisions.
• The HMIS also aims to support clinicians in the
use of information for patient management.
Nurses and doctors will get training to ensure a
good understanding of the system.
Information Use
Feedback Mechanisms
The best way to improve the quality of information is to
ensure that the individuals submitting the data get
feedback from those using the information on indicators.
Feedback reports will be provided at an early stage on.
• Quality of the data
• Performance of the unit.
This encourages use of information at the lowest possible
level and inculcates a drive to improve the quality of
submitted data so that the outcomes can be monitored.
Information Use
Sustainability
• The processes described above should be
developed with sustainability in mind, as a key
focus from the start of the Integrated HMIS.

• This will be achieved through active

involvement of relevant counterparts as well
as health staff early in the process.
Information Use
• An essential aspect of sustainability is the
investment by management in availability of
adequate human resources in numbers and
skills at all levels.

• All users and producers of information must

be trained and retained for the sustainability
of the HMIS.
Information Use
A developmental approach to improving
systems
• A key aspect of a sustainable HMIS is that a
developmental and participatory approach is
adopted as the means to build on existing
skills of staff working in the health facilities
and in partner organisations.
Information Use
• Through participatory methods, reporting
needs will be merged with the users‘
immediate perceived needs (e.g. patient
management, patient monitoring, facility
management, including financial
management).
• The intention is to identify the strengths and
weaknesses of existing systems and with the
staff to initiate steps to improve the systems.
Information Use
• This approach should include the introduction
of new technology or systems where relevant,
but essentially it aims to support staff in
initiating new measures that will improve the
quality of their work.