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Bangladesh Health Information System

2nd IFHRO SEAR Conference Perth, Australia, Tuesday, October 13, 2009

GTZ Health ProgrammeMuhammed Emranul Haq, M&E Advisor (emranul.haq@gtz.de)

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Background

• Bangladesh is located in the northeastern part of South Asia with land area of 147,570 square kilometers. Population of about 150 million, more than 920 persons per square kilometer.

• Administratively, the country is divided into 6 divisions, 64 districts, and 496 upazilas (sub districts).

• Currently (2005-2011) the government is implementing one of the biggest SWAP Health Nutrition and Population Sector Programme (HNPSP) of estimated 3.5 - 4 Billion USD.

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Reg

iona

l Loc

atio

n

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Unit Number

Division 6

District 64

Upazila (Sub district)

496(not shown in the map)

Union 4,490(not shown in the map)

Administrative Distribution

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Significant progress in recent times in many of its social development indicators particularly in health.

Achieved important gains in providing primary health care since the Alma Ata Declaration in 1978.

Infant, maternal and under-five mortality rates have all decreased over the last decades, with a marked increase in life expectancy at birth.

Due to a good health infrastructure and dedicated workers it has been possible to make those successes

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Existing Health System

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Ministry of Health and Family Welfare (MOHFW)

Director General of

Health Services (DGHS)

Director General

of Family Planning (DGFP)

National Nutrition Programme (NNP)

Directorate of Drug

Administration (DDA)

Directorate of Nursing Services

(DNS)

38 Line directors for programmes implementation

64 District Level Facilities

469 Upazila Level Facilities

Union and Community Services and Facilities

Civil Surgeon

Upazila Health Officer

Director

Director General

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The Public Sector Primary: Upazila Health Complex (UHC) at sub-district level

which works as a health-care hub.

Secondary: Responsible for preventive healthcare services

Tertiary: Above sub district are district hospitals, medical colleges, providing secondary care and national tertiary level care facilities.

The Private Sector Both specialized and general hospital, clinic, diagnosis facilities

are provided

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Existing Health System

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• Mostly vertical data collection, less integration, no quality control, lack of regular dissemination, less utilization for decision making

• Logical flow of data and availability is fairly absent

• Whereas, in other places, it needs attention

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Current Health Information System

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HMIS Assessment using the HMN approachOverall assessment of Data Sources

Data Source Overall Score

Census 66% Adequate

Vital Registration 77% Highly Adequate

Population-based surveys 65% Adequate

Health and disease records(incl. surveillance)

46% Present but not adequate

Health service records 25% Present but not adequate

Resource record 28% Present but not adequate

TOTAL 51% Adequate

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Use of MIS by type of health facility(Health Facility Survey, 2009)

Facility type Mean score (%) N (weighted) Std. Deviation

District Hospitals 74.67 60 .16901

Upazila Health Centre 82.12 413 .17528

MCWC 34.13 97 .12539

UnHFWC 27.11 1506 .11050

UnHFWC, upgraded 28.84 924 .14025

Union Sub-centre 20.57 1134 .13090

Private 24.42 789 .20196

Total 30.83 4923 .22166

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Existing MISs in Health Sector

• MIS of Directorate General Health Services (DGHS)

• MIS of Directorate General Family Planning (DGFP)

• MIS National Nutrition Program (NNP)

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Realizing the need currently GTZ is providing support to bridge the gap

Through building a national data warehouse Following a participatory process Increased inter collaboration within the system Meet the need to the policy makers level Create a model for future HIS Supporting the existing M&E Unit under the

MOHFW

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GTZ Support in HIS

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“Data Management and Information System (DMIS) is a technical support to Ministry of Health and Family Welfare (MOHFW) which has started its activities on the 1st of March, 2009.

Critically analyze and identify the need, provide training and capacity building

Phased basis implementation

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GTZ Support in HIS

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Conceptual Diagram of DMIS

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Different Phase of DMIS

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Remaining weaknesses / challenges

Lack of coordination between Departments, Programmes, and Directorates

Multitude of reporting forms and requirements Focus on activity (input) reporting Lack of ownership (at service / facility level) and

consequently poor quality of data Limited use of indicators (percentage, rate or ratio with a

clearly defined denominator, allowing for setting targets and eventually performance measurement with regard to outputs and outcomes)

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Leading to…

Programme and sector M&E mainly based on non routine (e.g. survey) data

Non availability of data for (comprehensive and continuous) M&E of programme activities and results

Lack of use of data and information in decision making process at all levels

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Use of large numbers of forms and data elements, slow down processes and reduce data quality

Manual data compilation at District and below levels and centralised entry into the data base is a main source for errors

Training in data management and analysis is almost absent across all MISs;

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Present HIS Problem

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Lack of understanding or reluctant about ICT among the most of the health professionals

Less use of data for policy decision

Lots of computer and related equipments have been procured but there is no presence of an efficient system

Acute shortage of IT efficient technical Human Resources both at operator and specialized level

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Existing problems

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Manual data collection mechanism is predominant

Even data is collected but those are not properly analyzed as per need or requirement

Weakness of national sector programme not be able to indicate specifically about the ICT in Health sector

Individual or donor level interests are not well coordinated or facilitated by the high level decision makers

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Existing HIS Problem

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Commitment from the present democratic government to implement “Digital Bangladesh” vision by 2021

Increased global network e.g. HMN, PHIN, HIMAA, IFHRO, e-Health etc.

Interest among the donor community e.g. DMIS initiative, WHO’s mandate

Data demand from the highest policy makers Present development of ICT in local market & availability of

skilled manpower World class system have been introduced by several

private Hospital level, who are eager to collaborate Increased motivation of data use

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Opportunities

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Thank you all

Bangladesh HIS Update