HEALTH MANAGEMENT INFORMATION SYSTEM IN UGANDA

A Patient beneficiary

Introduction

Health Management Information System (HMIS) is a set of integrated components and procedures used during routine health related data collection with an objective of generating information which will improve health care management decisions at all levels of health system. Through its indicators, it can provide warning signals and is also used during monitoring and evaluation processes.

Mubende Comprehensive Eye health Project had five objectives to implement and also link them to the 4th country’s National Eye Care Strategic plan and Vision 2020 priorities.

  1. Improve access to high quality comprehensive eye care services that are integrated into the national health systems.
  2. Build capacity of the Ministry of Health (MOH) to effectively and efficiently deliver comprehensive eye health services to adults and children in four districts that comprise Mubende Health Region (MHR)
  3. Advocate for the recognition of avoidable blindness as a public health problem and for Ministry of Health to develop national eye health policies, plans and programs for enhancing universal eye health
  4. Improve the evidence base for comprehensive eye care in the country

Outputs of those objectives would not be possible without evidence through appropriate data collection, analysis, interpretation and utilization during baseline surveys/situation analysis, planning, implementation, monitoring, reviews and evaluation.

SIB East Africa Child Eye Health project

The previously completed SIB East Africa Child Eye Health project supported by IAPB, an Eye health HMIS data collection tool was developed and adapted by MOH that resulted into an increase from 9 Eye health indicators to now about 50 indicators collected from the data source health facility and submitted to Ministry of Health data collection centre for analysis, interpretation and utilisation.  The conditions captured include all the Outpatient and Inpatient major blinding and non-blinding eye condition, surgical, rehabilitation as well as refraction, low vision and blind disaggregated by gender. This was followed by training of eye workers in its utilization with support from other stakeholders.

Mubende Comprehensive Eye health Project

The SIB Mubende Comprehensive Eye health Project (MCEHP) then supported its functionality in the project area by patching up gaps e.g. by getting timely and complete data through providing airtime to Bio-Statisticians at district level to be able to communicate to all levels of data collection but also use internet data to submit collected data electronically to the centre. Eye departments were also provided with airtime as well as Inspectors of schools for communication and quick transmition of school screening data from schools to the District Education department at the district headquarters. The districts then submit the compiled district data to Ministry of Education and Sports, Ministry of Health and the Project Office.

The Education Management Information System [EMIS]

The Education Management Information System [EMIS] is not well developed as the Health Management Information System [HMIS]. MCEHP project supported the development of eye health screening data collection system from schools to the district through developing referral forms, summary sheets and registers in which all children screened, failed and referred are recorded by gender.

At the end of the month summaries are made at the school which are picked by the Inspector of schools via phone calls. There are about 3-5 inspectors of school per district, each covering a demarcated area. The Inspectors of schools then summaries data for his catchment areas and submits it to the District Education Officer at the district. Monitoring activities by Inspectors of school during which school activities including screening activities are supported by government and project funds

At the district, the information is supposed to be relayed to the Ministry of Education data collection centre every month but this is not the case for all education related information because the system is not yet fully developed due to some challenges like lack of an agreed upon data collection tool and system to relay it to the Ministry of Education.

Therefore most of this data remains at the district headquarters and for that reason screening data is directly transmitted to the project office by phone or internet and entered into the project data collection tool every month for analysis and interpretation. The results are shared for guidance and further action during Ministry of Education Technical Working group, Project Steering Committee and Project Quarterly review meetings in which Ministry of Education and Sports is a member.

The Health Management Information System

Eye health data is collected from the Eye clinic Out Patient Registers and entered into the HMIS tools every month by health facility In-charges or Records officer at bigger health facilities. It is relayed to Bio-Statisticians at the District headquarter before the 15th day of the month.

District are being governed under a decentralized system and at this level, Bio-Statisticians analyze and interpret the data for health planning purposed but also enter the data into DHIS II system for onward electronic submission to Ministry of Health Resource centre for further analysis, interpretation and utilization especially in planning for eye health service delivery, monitoring the Eye health strategic plan and Health development plan. Monitoring HMIS activities by the Ministry of health, District Health Management Team [DHMT] are supported by government and project funds

Because of administrative related beaucracy of getting timely eye health data from the MOH Resource centre, the project agreed with districts to have eye health data from eye clinics submitted directly to the project as the same data is also submitted to the MOH headquarters through DHIS II system. Ophthalmic Clinical Officers and Bio-Statisticians are facilitated with airtime to submit this data.

The Community Management Information System

At community level, Community health workers known as Village Health Team members [VHTs] exist, Community data collection system is not fully developed yet due to motivation related challenges, logistics, illiteracy levels etc. data from VHTs is therefore not collected. The policy requires this data to be collected by VHTs and submitted to nearby Health facilities to be entered into the HMIS via DHIS II system. Data collection of blind community members and those with low vision is supposed to be captured through this arrangement but is therefore not captured. The project therefore simply printed and provided VHTs with official government referral forms and requested them to refer patients identified with eye problems to the nearby health facility with a hope that those eye patients and conditions would be captured at that level.

Having realised that community members who are blind and those with low vision were not being captured through that arrangement, the project  through the District Community Development Offices and District Health Inspectors offices developed a data collection tool to identify the blind and those with low vision with support from related Eye health IEC materials. The VHTs were trained on the tool and requested to identify those with low vision and those who are blind, line list them and submit the lists to sub county Health offices. These were then summarised and submitted to the District Community Development Offices for onward submission to the project offices for action.

The same lists were shared with District Ophthalmic Clinical Officers (OCOs) for data capture into the HMIS but at the same time organise eye health outreaches to those areas to assess the line listed community members and provide appropriate advice and service. Arrangements with the District Education Office were made for the identified blind children to be recruited into appropriated integrated schools.

Monitoring and sustainability

During supported project monitoring activities Ministry of Health, Ministry of Education, Ministry of Gender Labour and Social Development, Mulago National Referral Hospital, Mubende Region Referral Hospital, District Health Officers, Education Officers, Chief administrative Officers, Ophthalmic Clinical Officers, Standard Charted bank and BHVI officials among other activities they conduct, is monitoring the established data flow and monitoring systems. Monitoring plans embedded into the Ministry and District plans using an integrated approach for sustainability.

Kaggwa Godfrey

kaggwagoddfrey@gmail.com

g.kaggwa@brienholdenvision.org.za

PROJECT DEVELOPMENT OFFICER – BRIEN HOLDEN VISION INSTITUTE UGANDA