Integrated Human Resources Information System (iHRIS)

UGANDA EXPERIENCE AND LESSONS I

MINISTRY OF HEALTH

Uganda Experience and Lessons

Integrated Human Resources Information System (iHRIS)

September 2014

THE REPUBLIC OF UGANDA

INTEGRATED HUMAN RESOURCES INFORMATION SYSTEM (IHRIS) II

iHRIS

UGANDA EXPERIENCE AND LESSONS III

Uganda Experience and Lessons

Integrated Human Resources Information System (iHRIS)

INTEGRATED HUMAN RESOURCES INFORMATION SYSTEM (IHRIS) IV

iHRIS TABLE OF CONTENTS

Acronyms and Abbreviations .......................................................................................................................................................................................................................vi1 Introduction and Background .......................................................................................................................................................................................................viii

1.1 What iHRIS? ................................................................................................................................................................................................................................1

1.1.1 HRIS main features ......................................................................................................................................................................................................2

1.1.2 Reports in the System ................................................................................................................................................................................................3

1.1.3 iHRIS Suite ......................................................................................................................................................................................................................3

1.2 The need for HRIS Strengthening in Uganda ................................................................................................................................................................4

1.2.1 Key issues from the June 2009 Evaluation report ...........................................................................................................................................6

1.2.2 The need to address key HRIS issues ...................................................................................................................................................................6

1.2.2.1 Data and Operations ............................................................................................................................................................................................61.2.3 User Access.....................................................................................................................................................................................................................7

1.2.4 Reporting ........................................................................................................................................................................................................................7

1.2.5 Training ............................................................................................................................................................................................................................8

1.2.6 Sustainability ..................................................................................................................................................................................................................8

2 The goal, objectives, and output .....................................................................................................................................................................................................92.1 Objectives .................................................................................................................................................................................................................................11

2.2 Output ........................................................................................................................................................................................................................................11

3 Strategic Approaches and Technical Solutions .......................................................................................................................................................................123.1 Open Source ............................................................................................................................................................................................................................12

3.2 Development of Supporting Documents .....................................................................................................................................................................12

3.2.1 HRIS Strengthening Plan ........................................................................................................................................................................................12

3.2.2 HRIS Strategic Plan ...................................................................................................................................................................................................13

3.2.3 HRIS User manuals ...................................................................................................................................................................................................14

3.2.4 HRIS Training Guide and Tools ............................................................................................................................................................................ 14

3.2.5 Development of HRIS Follow-up Guidelines .................................................................................................................................................. 15

3.2.6 Development of HRIS Data Quality Check List .............................................................................................................................................. 15

3.2.7 Multimedia HRIS DVD .............................................................................................................................................................................................15

3.3 Building Local Capacity for HRIS sustainability ..........................................................................................................................................................16

3.3.1 Internship Program ..................................................................................................................................................................................................16

3.3.2 Collaborate with Makerere University ............................................................................................................................................................... 16

3.3.3 HRIS Core Team .........................................................................................................................................................................................................17

3.3.4 Learning from each other ......................................................................................................................................................................................18

3.4 Training HRIS users ...............................................................................................................................................................................................................18

3.4.1 Training Objective .....................................................................................................................................................................................................18

3.4.2 Training Team .............................................................................................................................................................................................................18

3.4.3 Training Outputs ........................................................................................................................................................................................................18

3.4.4 Learning Strategies, Activities and Methods .................................................................................................................................................. 19

3.5 Training Materials and Tools ..............................................................................................................................................................................................19

3.5.1 Power point slides.....................................................................................................................................................................................................20

3.5.2 Evaluation forms and guides ................................................................................................................................................................................ 20

3.6 Different groups trained in HRIS .....................................................................................................................................................................................21

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UGANDA EXPERIENCE AND LESSONS V

3.7 Conducting training ..............................................................................................................................................................................................................23

3.7.1 Implementation Guides and Support documents ....................................................................................................................................... 25

3.7.2 Budget support ..........................................................................................................................................................................................................26

3.7.3 What was not done? ................................................................................................................................................................................................26

3.8 Rollout, Follow-up, Coaching, and online technical support................................................................................................................................26

3.8.1 Implementation Process .........................................................................................................................................................................................26

3.8.2 HRIS Rollout process to districts ......................................................................................................................................................................... 26

3.8.3 Coaching / online technical support ................................................................................................................................................................. 27

3.8.4 Customization of HRIS to meet user needs .................................................................................................................................................... 28

3.8.5 Development of iHRIS Train ..................................................................................................................................................................................29

3.8.6 HRIS Codes ..................................................................................................................................................................................................................30

3.8.7 Data cleaning and update in HRIS ..................................................................................................................................................................... 30

3.8.8 Launch of iHRIS ..........................................................................................................................................................................................................31

3.8.9 HRIS Interconnectivity .............................................................................................................................................................................................32

3.8.10 The use of Dropbox ..................................................................................................................................................................................................32

3.8.11 HRIS Frequently asked Questions ...................................................................................................................................................................... 31

4 Achievements ......................................................................................................................................................................................................................................364.1 HRIS Status in Uganda .........................................................................................................................................................................................................37

4.1.1 Implementation Status............................................................................................................................................................................................37

4.1.2 Implementing Partners in Uganda ..................................................................................................................................................................... 37

4.1.3 The iHRIS Manage ....................................................................................................................................................................................................41

4.1.4 iHRIS Qualify ...............................................................................................................................................................................................................44

4.1.5 iHRIS Train ....................................................................................................................................................................................................................44

4.1.5.1 The Pre-Service training database at MoES .............................................................................................................................................454.1.5.2 In-service training database for MoH.........................................................................................................................................................47

4.2 HRIS Standardization and Sharing in Uganda ............................................................................................................................................................48

4.2.1 Standard list ................................................................................................................................................................................................................48

4.2.2 Making data available to the public .................................................................................................................................................................. 48

4.2.3 Use of the Knowledge Management Portal (KMP) ...................................................................................................................................... 48

4.2.4 Website and Online CPD ........................................................................................................................................................................................49

4.3 Mobile Telephone Directory ..............................................................................................................................................................................................50 4.4 HRIS Collaboration, Cost sharing, and Sustainability .......................................................................................................................................................52

4.4.1 HRISincrementalbenefits .....................................................................................................................................................................................52

4.4.2 Equipment and Internet Support by user Organizations .......................................................................................................................... 54

4.4.3 Making HRIS part of the business process ..................................................................................................................................................... 54

4.4.4 Setting up iHRIS to answer HR questions ....................................................................................................................................................... 55

4.4.5 Global iHRIS Support to learn more .................................................................................................................................................................. 55

5 Future Priorities ...................................................................................................................................................................................................................................575.1 HRIS Transition to GOU/MOH or other local entity .................................................................................................................................................58

5.2 Strengthen capacity for data quality analysis and use at all levels ....................................................................................................................58

5.3 Improve HRIS interoperability with other eHealth systems ..................................................................................................................................59

5.4 Complete establishment of HRIS databases in all districts and central institutions ................................................................................... 59

INTEGRATED HUMAN RESOURCES INFORMATION SYSTEM (IHRIS) VI

iHRIS

ABBREVIATIONS AND ACRONYMS

AC/HRM : Assistant Commissioner – Human Resource ManagementAC/RC : Assistant Commissioner – Resource CentreBTC : Belgian Technical CooperationCAO : ChiefAdministrationOfficerCoCIS : Makerere University College of Computing and Information Sciences DBMS : Database Management SystemDG : Director General DHIS2 : District Health Information Software 2DHO : DistrictHealthOfficereHealth : Electronic HealthGPL : General Public LicenseHDD : Hard DiskHIE : Health Information ExchangeHIS : Health Information SystemHMIS : Health Management Information SystemHPAC : Health Policy and Advisory CommitteeHPCs : Health Professional CouncilsHR : Human ResourcesHRD : Human Resource DevelopmentHRH : Human Resources for HealthHRHIS : Human Resources for Health Information SystemHRH-TWG : Human Resources for Health Technical Working GroupHRIS : Human Resource Information SystemHRM : Human Resource ManagementHSD : Health Sub-DistrictHSSP : Health Sector Strategic PlanHTC : Health Tutors’ CollegeHU : Health UnitHW : Health WorkerHWR : Health Worker RegistryICT : Information and Communications TechnologyIFMS : Integrated Financial Management SystemsIHE : Integrating the Health EnterpriseiHRIS : integrated Human Resource Information SystemIPPS : Integrated Personnel and Payroll SystemsISCO : InternationalStandardClassificationofOccupationsIT : Information TechnologyLAN : Local Area NetworkM&E : Monitoring and EvaluationMAK : Makerere University KampalaMDG : Millennium Development GoalMIS : Management Information SystemMoES : Ministry of Education and Sports

UGANDA EXPERIENCE AND LESSONS VII

MoFPED : Ministry of Finance, Planning & Economic DevelopmentMoGLSD : Ministry of Gender, Labor and Social DevelopmentMoH : Ministry of HealthMoPS : Ministry of Public ServiceMoU : Memorandum of UnderstandingMs : MicrosoftNPA : National Planning AuthorityNRH : National Referral HospitalNU-HITES : Northern Uganda Health Integration to Enhance ServicesNUMAT : Northern Uganda Malaria AIDS & Tuberculosis ProgramOpenHIE HWR : OpenHIE Health Worker Registry OpenHIE : Open Health Information ExchangeOS : Operating SystemPEAP : Poverty Eradication Action PlanPEO : PrincipalEducationOfficerPEPFAR : US President’s Emergency Plan for AIDS Relief PHRO : PrincipalHumanResourceOfficerPHTO : PrincipalHealthTrainingOfficerPPO : PrincipalPersonalOfficerPRO : PublicRelationsOfficerPS : Permanent SecretaryRC : Resource CentreRRH : Regional Referral HospitalSMS : Short Message ServiceSQL : Structured Query LanguageTA : Technical AssistanceTNA : Training Needs AssessmentToT : Training of TrainersUBOS : Uganda Bureau of StatisticsUCI : Uganda Cancer Institute UCP : Uganda Capacity ProgramUHSSP : Uganda Health Services Strengthening ProjectUSAID : United States Agency for International DevelopmentVHT : Village Health TeamWAN : Wide Area NetworkWHO : World Health Organization

INTEGRATED HUMAN RESOURCES INFORMATION SYSTEM (IHRIS) VIII

iHRIS

Abstract: The implementation of HRIS in countries with no approved policies geared towards supporting its use and management has several challenges, but that should not over rid and prevent its implementation due to its advantages. In this paper we present the HRIS implementation process (strategies, approaches, and guidelines) that can be followed from inception, team formation, pre-visit, rollout out process, training users and data managers, support teams, standard operating procedures, budget issues, innovations used, sustainability, lessons learnt, and challenges in per Uganda case. We compare the different strategies used to implement the different iHRIS modules (Train, Manage, and Qualify)

Target audience: Technical and Policy makers in Ministries and Districts, Health development partners, health implementing partners, informatics and ICT implementers.

Purpose: The purpose of this documentation is to share experiences, innovations used, challenges, sustainability, and lessons leant in implementing HRIS in Uganda as an HRH management tool and make recommendations for continued support towards sustainability and how it can be adopted in other similar countries.

Document structure: the document has the following main sections

• What problem (challenges) did we set out to address? :- Background and Introduction

• Where did we plan to reach? :- The goal, objectives, output (installation and rollout)

• How (strategies) did we plan to get there? :- strategic approach and technical solutions (open source, internship, setting out networks, location of system, national database, online and audit and bi-annual report, reports page, functionalization of system like data importing and cleaning and quality guidelines,

• Where have we reached (achievements)? :- Achievements–overallandspecificachievementby objective and/or outputs

• What challenges did we encounter and what lessons did we learn? : - Challenges and lessons

• Looking ahead: - Future priorities – what have we learnt and should be done differently – we should share more, consolidate, partnership, data quality, usage, sustainability, and completing remaining districts and organizations

BACKGROUND

UGANDA EXPERIENCE AND LESSONS 1

A decision maker within the organization can analyze this data to answer key HR management and policy questions, such as:

• Areemployeesdeployedinpositionsthatmatchtheirqualificationsandeducation?

• Are employees optimally deployed in locations to meet needs?

• Howmanyworkersneedtoberecruitedtofulfillanticipatedvacancies?

• Are pay rates equitable across similar jobs?

• Are employees being promoted in alignment with competencies?

• What are the reasons for employee attrition?

Introduction and Background1Uganda previously relied heavily or exclusively on paper forms and had several weaknesses. Notably, the information was fragmented in different departments, incomplete, out of date and not regularly shared. A new, Human Resource Information System (HRIS) was developed and implemented by the Ministry of Health (MoH) with financial and technical support from the United States Agency forInternational Development (USAID) through the Capacity Project (2007 – 2009) and Uganda Capacity Program (2009 – 2014). The assistance provided by USAID and the projects entailed strengthening the capacity of the existing institutions through provision and installation of equipment, software and training to ensure technology transfer.Using HRIS, Human Resource (HR) professionals can create a centralized information base on all HR managementaspectssuchasstandardtitles,jobclassificationsandjobdescriptionsspreadingovergeographiclocations,offices,andfacilities.HRmanagerscansolicitjobapplicationsforopenpositions,assignemployeestofillpositionsandmaintainasearchabledatabaseofallemployees,theiridentifyinginformationandtheirqualifications;trackeachemployee’shistorywiththeorganization,includingtheirpositionandsalaryhistories,and record the reason for departure when the employee leaves.

1.1 What is iHRIS?The integrated Human Resource Information System (iHRIS) is a computerized HR management tool consisting of electronic databases for storing, reporting, and analyzing that enables to design and manage a comprehensive HR strategy. It links all HR data from the time professionals enter pre-service training to when they leave the workforce. It is built on free, open source software distributed under the General Public License (GPL), to minimize maintenance costs and ensure sustainability.

The overall goal of the computerized iHRIS is to contribute to better management of workers to ensure to availability of the right number of the workers with the right competencies, in the right place, doing the right job at the right time. The objectives of the iHRIS are to:

• Improve timely availability of accurate and up to date HR data for policy, planning and management. • Track the workforce as they move through the training/education and employment system • Increaseefficiencyinthemanagementandmaintenanceofworkforcedata• Strengthen coordination of trainings of workers, reduce on duplication, and improve equity.• Quickeninformationflowandfacilitateregularreportingontheworkforce

INTEGRATED HUMAN RESOURCES INFORMATION SYSTEM (IHRIS) 2

iHRIS

1.1.1 HRIS main features

HRIS consists of several modules designed to store and report employee information. Using modules as “building blocks” for the system makes it easier to add more features as needs change or to disable unnecessary features.

• System Configuration: Install,enableandconfiguremodulestocustomizethesystemanditsfeaturesfromaweb-basedconfigurationscreen.

• User management: Create and manage password-protected user accounts to control access to the system. Assign roles limiting user activities to enforce data quality and management protocols. Accounts are role-based so that non-authorized user actions and data sets are hidden from the user.

• Database Management: Design a standard data structure by creating lists of items to be tracked in thedatabasesuchasgeographicallocations,officesandfacilities.

• Position management: Create positions with standardized descriptions, codes, and qualificationswithin the organizational structure and manage the hiring, transfer, and promotion process.

• Recruitment support: Record information about job applicants (including educational history, work history, and interview notes) and log hiring decisions.

• Employee management: Record important information and maintain a complete record of employees’ work history, including positions held, salary history, in-service trainings, and any workplace incidents resulting in disciplinary action.

• In-service training Management: Track in-service trainings that employees have registered for and completed, and assess competencies and continuing-education credits earned from training

• Leave Management: track leave days of employees, enable employees to apply online and HR managers to approve online

• Clock-in: enables to import clock in data and track shifts of worker, and relate it to over time management

• Banking management: tracks employees’’ banks, branch, salary, and recommended loans

• Decentralization support: Install iHRIS at the central and district level. Districts can send data to the central level for aggregate reporting.

• Data import and export and integration with geographic information systems

• Interoperability with other information systems: iHRIS easily links with DHIS2, OpenMRS, and other popular global-health technologies. iHRIS imports and exports data in different formats including xml, CSV, etc.

• Custom Reporting: Aggregate, analyze and export data in a variety of ways to answer key management and policy questions as well as generate staff lists and directories.

• Technical support: A global community of iHRIS developers and users provides support via an email group, an interactive website, and an online documentation

The following features ensure security and accuracy of data stored in the system:

• Error checking and data correction by authorized data managers to ensure data integrity.

• Automated logging of the username, date and time when data are entered or changed, for auditing purposes.

• Permanent archiving of all data changes to ensure a consistent record of each employee’s history with the organization.

• User role management to ensure that certain users access only information that is relevant


1.1.2 Reports in the SystemThere are several reports that come with system, but any customization report can be created using custom reporting module:

1.1.3 iHRIS Suite

• Staff List -- A list of all current staff with work contact information.

• Staff Album -- Shows Staff with passport photographs

• Retention Report -- Shows how long staff have been on there current Job

• Payroll Report -- A list of all employees with salary details.

• Establishment Levels --Aggregation showing staffing levels or staff Audit

• Retirement Planning -- Staff totals by retirement year.

• Retirement /Exit Report -- Shows the Exit/ retirement situation.

• Age Distribution -- Total of all staff by age range.

• Disciplinary Action -- Shows the current disciplinary cases for the staff

• Registration and Licensure status - The Status of current staff’s registration and license

• Former Staff -- A list of former staff

• Last Trainings and Mentorship -- A list of staff with their last training and mentorship

• Staff Trainings -- A list of staff with all their trainings

• Position Open Duration--The length in days a position was open before being filled.

• Classification Breakdown--A total of all staff by job classification.

• Hires per Year - Hire totals by year, Job Breakdown -Total staff by job, etc.

a) iHRIS Manage is a human resources management system that enables HR managers to collect , manage, andanalyzedataonHRaboutemployees’history,bio-data,employmentstatus,staffinglevels,andwhereemployees are deployed . Using the system, the HR manager can create a hierarchy of positions for an organizationbasedonstandardtitles, jobclassificationsandjobdescriptions,evenspreadoverdiversegeographic locations,officesand facilities.TheHRmanagercan thenhireemployees tofilleachopenposition and maintain a searchable database of all employees, their skills and qualifications. The HRmanager can track each employee’s history with the organization, including their performance, training and salary history, and record the reason for departure when the employee leaves.

The iHRIS Suite of health workforce information software and tools includes: iHRIS Manage (for HR manage-ment), iHRIS Qualify (for registration and licensure tracking), iHRIS Plan (a workforce planning and modeling tool), iHRIS Retain (a tool developed in collaboration with the WHO to cost health workforce retention strate-gies), and iHRIS Train (for managing data on the education of workforce). IntraHealth International, through the USAID-funded Capacity Project, launched in Uganda the first version of iHRIS in 2007. Capacity Plus continues to develop the core iHRIS software, release updates, and partner with countries to roll out the software and train people to use and maintain it.

b) iHRIS Qualify is the system that captures and aggregates data on a cadre of health workers from the time they enter pre-service training through registration and licensure. It can also track deployments, issue licenses for private practices and out-migration. Thus, it provides a complete country-level picture of

health


iHRIS

workers, whether in training or employment in the public or private sector. The data captured by iHRIS Qualifycanbeusedbypolicy-makers todetermine:Howmanytrainedstudentspass thecertification/accreditation exam? Of the students who pass the exam, how many register to practice? and Are health professionals meeting their continuing education requirements.

c) iHRIS Train is system facilitates the management of training programs and trainees including the entry, pipeline and graduation details by program area and linkages with each training institution for both in-service and pre-service training. It helps to track progress on curriculum implementation, performance of students on annually, training experience of individual health workers, tracking of credit hours for renewal of license. It also provides information on training opportunities of health workers. This system will strengthen coordination of trainings of health workers, reduce on duplication, and improve equity.

d) iHRIS Retain is an open source tool to cost health worker retention interventions. People living in rural and remote areas need more skilled health workers to care for their communities. However, attracting and retaining health workers to serve in these areas is a challenge. Developed by CapacityPlus in collaboration with the World Health Organization (WHO), iHRIS Retain is based on the WHO’s 2010 global policy recommendations on retention, which offer guidance on the different interventions in the areas ofeducation, regulation,financial incentives,andprofessionaldevelopment thatcan increaseaccess tohealth workers in remote and rural areas through improved retention. iHRIS Retain guides users through the costing process step by step, collecting necessary data, calculating the costs of interventions, and comparing costs to available funding. The resulting information can then be used to develop retention strategies at the district, regional, or national level.

e) iHRIS Plan uses data from iHRIS Qualify and iHRIS Manage as well as other sources of HR data to project workforce changes in the future based on known factors such as attrition and the number of trained health workers annually entering the workforce. This system is still under development and will be implemented soon.

1.2 The need for HRIS Strengthening in Uganda

The Capacity Project began HRIS strengthening work in Uganda in 2005. Several months prior, after attending a regional workshop presentation on the project’s work at the Kenya Nursing Council, the registrar of the UgandaNursesandMidwivesCouncil(UNMC)andthechiefnursingofficercontactedtheprojecttoexpresstheir need for improved data on nurses. At the time, most of the council’s data was paper-based, stored in differentlocationsandthereforedifficulttoaggregateoranalyze,andtheexistingHRdatasystemusedbytheMoH was unreliable.

The Project helped to establish the Health Workforce Advisory Board (HWAB), a stakeholder leadership group (SLG). The HWAB established a plan to implement an electronic HRIS at the four HPCs, starting with the UNMC. Working closely with the HWAB and the UNMC, the project conducted an assessment of the situation in 2006 anddevelopedaprototypeoftheiHRISQualifysoftwarebasedoniHRISsuite.ThefirstversionofiHRISQualifywas piloted at UNMC in early 2006 after the project purchased equipment and installed a local area network (LAN)attheoffice.Theprojectcontractedandtrainedfourdataentrantstokeyinallofthecouncil’shistoricalrecords.

Inearly2007,theprojectinstallediHRISQualify1.0intheotherthreeHPCsfollowingasimilar,office-wideITstrengthening process, including the establishment of a LAN. In December 2007, the UNMC held an event to launchtheiHRISQualifysystem.ThiswasalsoacelebrationbecausethecouncilwasthefirstHPCtocomplete


data entry of its historical registry records.

In February 2008, the four HPCs upgraded to iHRIS Qualify 3.0. This version of the software offered increased capabilitiesforsearching,reportingandcustomizing.Newfeaturesincludedtheintroductionofconfigurablemodules that could be easily installed or disabled, and the ability to export reports into Excel for further analysis. Uganda upgraded to version 3.1 in September 2008. The development team customized iHRIS 3.1 to meet the country’s need for entering licensure information by person, and trained data entrants on new customized report builder and export features.

In May 2008, the project installed its HRM software (iHRIS Manage) at the central MOH, in the department of HRM. The MoH had requested the software to monitor the number of health workers by cadre and district. The software was also piloted in two northern districts, Lira and Oyam, with the intent of eventually rolling out the software to all of Uganda’s districts.

At the time of the evaluation in Sept 2009, respondents from the MoH-HRM said that the system was “not yet operational” and reported data entry had just been completed and they were in the process of verifying records. Standing in the way, one staff member suggested, was the development of proper security levels, so the HRM staff could access employee records and verify them: “They’re still in the process I think of developing security levels so it’s after they have developed security levels that we, the key users, like in HRM who shall be able to make the changes that we are supposed to make. But I think at this point they need to move a little faster because you need to verify the data, we cannot verify it now”.

Similar to the four HPCs, the two districts were at different stages of implementing the iHRIS Manage. Oyam was a new district that did not have a complete and functioning paper system in place prior adopting the software, and had serious infrastructure issues hindering use of the electronic system. Lira, on the other hand, was much further along, having entered all the data on health workers in the district except for new hires, and was using the system to produce reports.

In September 2009, the USAID Uganda Capacity Program (UCP) started and took over the HRIS support from Capacity project and started by addressing the issues raised in Evaluation of Uganda Human Resources Information System Strengthening report produced in June 2009

1.2.1 Key issues from the June 2009 Evaluation reportSeveral key were raised in evaluation report that included

• The HPCs were at different levels of implementation with only UNMC functionalizing

• The security levels were not developed especially the need for more sophisticated access levels

• The HPC systems were not sharing data and reports

• There was need to share the HPC reports with the public and districts

• Standardizationofcodesandfieldswasnecessaryforenhancednationalandinternationaldatause.

• There was a lack of understanding of the systems’ ability, security, backup plan and the existence of a non-Internet based version.

• Users’ desire for additional training on all functions of the software.

• StaffinglevelsandcomputerliteracywerelimitingHRISusage.

• HPC workforce reports were including staff who were not practicing, have recently died, have left the health care sector or have migrated, which meets the needs of the HPCs, but not the MoH’s workforce information needs.


iHRIS

• The HPCs wanted more standard reports.

• Keyusersfoundthatthecustomreportingtoolwastoodifficulttouse.

• Users desired further training in data-driven decision-making.

• Thenumberofinformationtechnologyanddataentrystaffforallinstallationlocationswasinsufficientforcontinuedefficientdataentryandsystemmaintenance.

• The HR management department required a permanent HRIS support position.

• Additional equipment, such as computers and printers were required for systems to be fully operational.

• There was need for system to evolve to meet users’ developing requirements, a particular challenge after the Capacity Project ends.

• Furtherstandardizationofsystemwasneededinorderforuserstofullybenefit.

• HPCs needed to make information available on the Internet so that employers can verify practitioners’ qualifications

• Policies and procedures should be implemented to assure that health care professionals are properly registered.

• Inter-ministerial agreement was required on standardization of codes, and the HRIS should interface electronicallywiththepayrollsystemtoimproveefficiency

• Limited availability of technical staff to support the system

• Ensuring sustainability requires a combination of leadership, strategy and resources.

• The components that needed development in Uganda were training and monitoring and evaluation

1.2.2 The need to address key HRIS issuesFrom September 2009 when UCP commenced, there was need to address the above

1.2.2.1 Data and Operations

• Set up a system administrator role in the HR department of the MOH

• Resolveissuesofincompatiblecodestomakeoccupationcodesinternationallyconsistent;giveahighpriority to codes that need to be common among departments and ministries

• Implement standardization of software, communications and backup

• Set up a technical support group to recommend solutions to problems brought by the HWAB. It should provide mutual support and promote knowledge-sharing among group members, and recommend standard reports to be written for them, acting as a user group. This group should consist of hands-on user representatives from all HPCs, MoH departments and other users such as district personnel as the system is rolled out, and should be chaired by the HRIS manager.

• Developafile-trackingsystemforMoHrecords

• Implement a feature to identify duplicate records in all iHRIS implementations. A warning message shouldbeaddedwheneveranewrecordiscreatedwhenthatsamesurname,firstnameisalreadyanexisting record.

• Use the system to generate data collection forms as word documents that allow end users to revise


them, e.g., by adding to whom they should be returned and by when

• Hideorremovefieldsinthesoftwarethatarenotrequired

• Rectify errors in data entry, such as date of birth. One way to do this is via an annual printout of the employee’s record that is signed off on during the annual performance appraisal.

• Createoccupationalgroupingcodesthatreflectinternationalclassifications

• ProvideguidanceonhowtoreflectorganizationalstructureiniHRISManage

• Establish the ability for the HRIS to interface electronically with an electronic payroll system to reduce the possibility of ghost workers and to ensure that employees are paid on time

• House all HPCs in the same building in order to keep information up to date in the face of staff losses due to sickness, annual leave and resignations. This would allow input staff to be a common resource working for all HPCs and so achieve economies of scale. However, the professional staff will continue tohaveseparateidentities.Thishasresourceimplications,asitwouldrequiresomeformoffinancialassistance from the MoH.

1.2.3 User Access • Ensure more sophisticated levels of security for the MoH HR department in order to access and amend

certainfields

• Establish a “view only” role for support staff who do not enter data but need to access records.

1.2.4 Reporting• Provide ongoing support and guidance to develop an information-driven culture

• Review the content of National Health Services web-based statistics (www.ic.nhs.uk) for applicability within Uganda

• Share widely standard reports, particularly among the four HPCs

• Redesign the ad hoc reporting tool to increase functionality and improve ease of use. One HPC suggested that it should resemble Epi-Info.

• PlaceallworkforcereportsontheKnowledgeManagementPortal,unlessconfidentialitymakesthisinappropriate

• Produce monthly, quarterly and annual reports by each HPC including registrations, and recognize that data quality will improve over time

• Produce workforce summaries that review workforce trends, explaining movements, in April and October to coincide with the planning and review cycle

• Review the websites of HPCs of other countries to see whether they provide useful lessons

• Publishon theweb thenamesandqualificationofdoctors,nurses, alliedhealthprofessionals andpharmacists,eitheronanHPC’swebsiteorontheKnowledgeManagementPortal;doctors’namesandqualificationsarealreadypublishedashardcopy.Thiscouldbeextendedmorewidelytobecomeasource of information on health care services.


iHRIS

• Monitor and evaluate the operational effectiveness of computer systems by the number of users logged on and the duration which they are in a particular period coupled with manual systems being abandoned for day-to-day usage

• Monitor and evaluate the strategic effectiveness of computer systems by the number and frequency of reports that are produced and analyzed by the level of the hierarchy that receives them.

1.2.5 Training• Ensure that input staff achieve a reasonable standard of touch typing before they are trained on HRIS,

using computer-based training, if necessary, to achieve the standard. They should also have basic computer operating skills.

• Provide continuous training in Excel tables as well as charts and reports from the iHRIS software so that senior decision-making staff can analyze information and present it in written reports

• Train the hands-on iHRIS users on all aspects of iHRIS to review data entry, quality, reports, etc., which should be available when needed for new users.

• Conduct a second Data-Driven Decision-Making (DDDM) workshop with a focus on analyzing data for all HPCs and MoH-HRM

• Provide additional support to develop the analytical and information presentation capability at the MoH.Therewouldbebenefits in sharingexamplesof reports to seniormanagementproduced inother countries, which might include a training element.

1.2.6 Sustainability• Give project ICT staff permanent contracts, as this would not represent a long-term liability to the MoH,

due to the high mobility of ICT staff

• Ensure that the MoH has the capability to resolve computer virus problems, either by developing these skills in-house or by having a budget to access this service from the private sector

• Provide a district ICT support team in conjunction with the central helpdesk, as it will not be possible to support it from the MoH in Kampala

• Create a post of input clerk to be shared among the four HPCs, as there are currently too few input staff to cover for sickness and absence of such staff

• Consider housing the HPCs in the same building in order to achieve economies of scale for equipment and technical staff. This move would need to be incentivized by the building rental being funded or subsidized by the MoH.


2 THE GOAL, OBJECTIVES, AND OUTPUT


iHRIS

2. The goal, objectives, and output

The goal of UCP was to enhanced capacity for HRH Policy and Planning, Strengthened Systems for an Improved Quality, Performance Based Workforce, and Improved Health Workforce Management Practices

2.1 ObjectivesThe objectives of UCP under the goal of Enhanced Capacity for HRH Policy and Planning included

a) Expand the HRIS to 3 central ministries (MoH, MoES, and MoPS)

b) Expand the HRIS to another additional 40 districts

c) Support HRIS functionality in HPCs, Ministries, and districts

d) Improve on HRIS reports and sharing

e) Build skills in the use and management of HRIS

2.2 OutputAt end of UCP in September 2014, the following outputs were expected

a) A functional and sustainable HRIS in 3 central Ministries and 40 districts

b) National or sub-national level workforce data systems developed

c) HRIShascapacitytotrackCPDofMoHqualifiedhealthstaff


3STRATEGIC APPROACHES AND

TECHNICAL SOLUTIONS


iHRIS

3. Strategic Approaches and Technical SolutionsTo accomplish the tasks and goals, several approaches and strategies both managerial and technical solutions were devised to help us get there including the use of open source software and technologies, developing internship program, international and local collaborations with different partners and stakeholders, setting up a national HRIS core technical team, setting out networks in the organizations where HRIS was deployed, strategic location of system in the organizations, developing HR standards and codes, setting up a national database, developing data quality guidelines, creating buy-in through pre-visits, developing and using standardized training materials and approach, use of Dropbox for sharing and backup, online and audit and bi-annual report, setting up open access reports page, immediate functionalization of system through data importing and cleaning and using and following quality guidelines, building capacity by providing the necessary ICT equipment and improving skills of users and data managers through training and mentoring via technical visits to each organization.

3.1 Open SourceiHRIS is an open source software released under the GPL V3 license and is free for anyone to download, use, and modify. iHRIScanbecustomizedtomeetthespecificrequirementsofthe country or organization. There are many options for getting help with customizing iHRIS and can download the latest version of the software package of your choice. iHRIS requires an Apache Webserver, MySQL database, and PHP and runs on LINUX (Ubuntu). All are free open source applications and tools with accompanying installation instructions

3.2 Development of Supporting DocumentsSeveral documents were developed to support the process of HRIS use and rollout in Uganda and these included HRIS strengthening plan, HRIS strategic plan, HRIS manuals, HRIS training guide and tools, data quality guidelines, HRIS follow-up guide lines, and the HRIS Multimedia CD. All the documents are available the MoH Knowledge management portal (KMP) at http://library.health.go.ug/

3.2.1 HRIS Strengthening PlanHRIS strengthening plan provided Uganda’s’ HRH status as per 2009 and what needed to be done to have proper and effective rollout of HRIS in Uganda.

The plan highlighted the main challenges facing HRIS in Uganda that emanated from fragmented massive paper based records accumulated over many years. The users of these records were scattered all over the place in all health facilities both at national and sub-national levels throughout the country. Information collected had not been aggregated and shared meaningfully with the key HRH stakeholders.

The second challenge results from inadequate structure and staff at the HPCs and MoH to implement and maintain the computer based databases. There was lack of full time Information Technology (IT) experts to provide ongoing support for data management and sharing. Data was not regularly entered, cleaned, updated and shared in form of reports with managers. There was also inadequate capacity for system maintenance and keeping the databases up to date.

The third main challenge for HRIS resulted from inadequate internal capacity to analyze data and produce processed information for decision making.


In summary, HRIS strengthening plan included the current status, HRIS rollout plan, the HRIS budget ateachlevel,theequipment,training,andthedataflowchartsandusageatvariouslevelsandbythedifferent stakeholders. HRIS access rights and the data sharing between the different sub-systems. It had the evaluation matrix and what will show progress at the different stages during implementation, the needed HRIS core team to support the process, and how the different partners will play their roles duringrollout,follow-up,andprovidingsupportbothfinancialandadministrative.

3.2.2 HRIS Strategic PlanAfter rolling out HRIS for two years, HRIS strategic plan was developed to enforce the HRIS rollout framework and provide guidance on future rollout and HRIS sustainability. The strategic plan focused on three major strategic objectives:

i. To have a state of the art HRIS in place by 2016

ii. Government and all other stakeholders are committed to using the system

iii. Improved health service delivery through improved HR management and development (as a result of the improved HRIS).

Theplanhadspecificdesiredresultstocontributetotheachievementofeachofthoselargerstrategicobjectives and outlined strategies and activities to achieve the aim. It recognized that the MoH and other stakeholders would be assuming all of the technical and operational responsibilities for HRIS functions and activities over time as UCP phase out. The plan had recommendations on how to position the HRIS group and how it will work with HRH-TWG. As a result HRIS group and the Director of Planning -MoH agreed upon a path to formally situate and launch the group. Ultimately, it was determined that the group would become HRIS task force under the eHealth sub-committee after completion of the national eHealth policy and strategy.

Figure 1: HRIS partners viewing the flow of desired results during the development of strategic plan


iHRIS

TheplandefinednextstepsandprioritiesfortheHRISTaskForceas:

a) Strengthen national and sub-national data-system to enhance information sharing and feedback in decision-making

• Improve connectivity

• Implement the infrastructure recommendations of the MoH-RC modernization Committee (including call a center)

• Develop skills of existing staff and address HR gaps that are preventing effective support to the system

• Support formation of a national database of health workforce information

• Collaborate with other partners, donors and projects to address power-related issues.

b) Strengthen capacity to sustain the system

• Conduct a situation analysis to identify gaps in staff and skills to support the system addressing especially programming capacity, capacity for database administration, and pay structure

• Oncestaffplanisapproved,supportpopulationofthestaffingplan.

• Strengthen skills of users and managers to use the system

c) Interoperability with other existing systems ensuring support for integrated national health information system (HIS)

• Consolidate interface with IPPS to eliminate dual data entry

• Ensure integration with DHIS2, mTrac and other approved national eHealth systems.

3.2.3 HRIS User manualsUganda national HRIS core technical team, MoH-UHSSP, and UCP HRIS team developed manuals to support HRIS data managers and users to understand and use the system after trainings. The manuals were designed in a user focused approach according to how the system should be navigated and managed. A manual was developed for each iHRIS component (Manage, Qualify, and Train), they were printed and given to each data manager and user trained in the use and management of the system.

3.2.4 HRIS Training Guide and ToolsAs a way of streamlining and standardizing HRIS training and providing guidance to HRIS Core Team and Regional Support Teams, UCP HRIS team developed HRIS Trainers Guide and Tools were used by HRIS trainers throughout the country to enforce the proper understanding and usage of HRIS. The guidelines give step by step what a trainer has to go through during the different trainings – for data managers, decision makers, and during on-job training. It gives tools to use during any HRIS training and it makes reference to experiences encountered during the previous implementation of HRIS rollout highlighting key HRIS implementation lessons and challenges.

The tools include the training program, the different power point slides to be used during the training, exercises to be carried out, pre-training assessment form, daily assessment form, end of training evaluation form, the individual data capture form for feeding into iHRIS Train, how the training should be conducted, the grouping of trainees during training, how to accomplish different exercise, the requirement in the training venue, and the different materials that have to be used during the trainings.


3.2. 7 Multimedia HRIS DVDUCP developed iHRIS multimedia CD that is interactive and easy to use as a guide in the management and use of iHRIS. The iHRIS Multimedia CD has several features and functionalities including

Information about the iHRIS (Qualify, Manage, and Train).

Administrative management of iHRIS

End user guidance in use of IHRIS

End user navigation and usage of iHRIS

Linkage to Registration and practicing license information.

Linkages to iHRIS materials and tools like e-learning site, iHRIS website, etc.

Frequently Asked Questions (FAQ)

iHRIS Multimedia navigation guide both on the CD and hard copy

Auto run function

Has both audio and video explanation

Provision for screen capture and printing

search functionality that return relevant results, consistently and reliably

easy to navigate features to access the different contents on CD

3.2.6 Development of HRIS Data Quality Check ListUCP developed HRIS data quality check list to help in improvement and maintenance of HRIS quality. The checklist has data quality activities that have to be carried out on monthly basis. Quality check list should be used to accomplish a number of objectives such as knowing what has been changed in the system, missing data, if the system is being used, and making information available to users.

3.2.5 Development of HRIS Follow-up GuidelinesAfter rolling out HRIS in each district or organization, it had to be followed up to ensure the system is put to use, handle any technical issues, setup up LAN, share HRIS data, connect the database to HRIS Dropbox, and provide on-job training. UCP developed HRIS follow-up guidelines for HRIS core team, MoH and partners supporting HRIS. The guidelines have steps that should be taken by follow-up teams before, during and after the follow-up visits to the districts. These guidelines provide a detailed check listforthevisitsuchasknowingwhatwillbeneededinthefieldduringthecoachingvisit,contactingthedistrict HRIS focal persons, communicating the purpose of the visit in advance, procuring and preparing fieldrequirements,preparingteamsbeforetheyvisitthedistrictandteamsknowingwhatisexpectedfrom the visit.


iHRIS

3.3 Building Local Capacity for HRIS sustainability

3.3.1 Internship ProgramUCP launched the internship program in 2010 to help carry out its iHRIS initiatives and to build OpenSourcedevelopment capacity inUganda. The interns came from thefinal year universitystudents. It is important to note that although the universities produce graduates per year, they arenotprovidedwithspecifictraininginOpenSourceprogrammingneededtodirectlyjumpintoand work with iHRIS. With additional hands-on training provided by the UCP internship program, some of the graduates became experts that they adequately provided the necessary support for the iHRIS software and help ensure its sustainability after UCP ends.

The UCP HRIS team trained a total of 15 interns (three groups - one group per year, and each group trained for over six months period) to build their skills in trouble shooting the HRIS in the different institutions, completing any outstanding data entry for the MoH and HPCs, cleaning and analyzing data, training users in data analysis, and assisting with the iHRIS Manage rollout.

3.3.2 Collaborate with Makerere University UCP collaborated with the Makerere University College of Computing and Information Sciences

(CoCIS) to further build capacity for HRIS. Makerere being key training institution provided a good opportunity to create a critical mass of people who know how to use the HRIS. In addition to the internship program, UCP trained 8 lecturers in HRIS. UCP also collaborated with CoCIS to have IT students attached to UCP for industrial placement. Six students completed a two month industrial placement with UCP and were trained in the HRIS customization and administration. UCP is also

UCP in line with it's mandate of focusing on building in country capacity to manage the HRIS so that the system can be fully sustainable even after the project ends, UCP used a three prolonged approach to achieve this: Train ICT graduatesin HRIS;develop a pool of resourcepersonsat the center and in the districts to manage HRIS and collaborate with Makerere University to train/orient their students and staff in the HRIS.

UCP built over 50 local technical persons (HRIS resource persons) to support in the HRIS rollout, follow-up, and training. The resource persons came from the UCP internship program and from training of HRIS Core team. These can be called upon to support any district to implement HRIS.

This was to expand on the experience of supporting the iHRIS software beyond UCP’s small HRIS team. As more installations were added (iHRIS Manage is now rolled out to 92 districts, 14 RRH, 2 NRH, 32 UCMB hospitals and Health Facilities, 25 UPMB hospitals and Health Facilities, Health Tutors’ College, In-Service Training database at MoH-HRD, Pre-Service Training database at MoES headquarters, Examination Management System at UNMEB, Ministry of Health, and 4 of its affiliatedinstitutions(UVRI,UCI,NMSandUBTS).UCPrecognizedthatmorepeoplearerequiredto provide timely and reliable technical assistance to users throughout the country. To this end, UCP leadership reached out to Universities to create the internship program and also to the public and user organizations to form the HRIS core team with advanced HRIS skills in HRIS installation, customization, training, data cleaning, and training.


collaboratingwithCoCIStoencouragetheirfinalyearstudentstocarryoutprojectsinHRIS.AMoUto achieve the above aspirations was drawn between UCP and CoCIS, but yet to be signed.

3.3.3 HRIS Core TeamTo further build in country capacity to manage the HRIS, in 2011 UCP developed a core team of 32 resource persons capable of training and implementation of HRIS. This team’s capacity was developed in depth in the management and use of the HRIS software. The creation of this team was a very big achievement that enable to speed up HRIS rollout and in providing technical to organizations already using iHRIS.

To be able to maintain all the databases there was need for continuous technical support and capacity building. Given the few program staff, UCP trained more 21 resource persons in Oct 2011 to provide HRIS technical support to the districts and hospitals. Participants were drawn from the MOH, districts, partner organizations like STAR-E, STAR–SW, STAR–EC and Baylor. The participants also included the resourcepersonstrainedinthefirstTOT.

Figure 2: Participants at HRIS Resource Persons training in March 2013

In preparation for the massive HRIS rollout to the remaining 38 districts by World Bank funded UHSSP and to be able to maintain all the databases at the MoH, Mulago, Butabika, UVRI, 14 RRHs, HPCs, 28 UCMB afflictedhospitals, and 81 districts functional there was need to refreshand expand HRIS technical team (HRIS Core Team). UCP partnered with UHSSP in 2012 to train resource persons to provide technical support to the districts and hospitals and support in the rollout out. Participants were drawn from the MoH, districts, and partner organizations like UCMB, UHSSP, NU-HITES, UCI, and CoCIS. The two weeks HRIS training of 22 resource persons was funded by UHSSP while UCP provided TA.


iHRIS

3.3.4 Learning from each otherTo foster sustainability, UCP set up to become part of the global iHRIS community managed by CapacityPlus. CapacityPlus created a global iHRIS community intended to become self-sufficient insupporting iHRIS users. The iHRIS community is effectively growing on its own, reaching 150 members who work across time zones to resolve issues raised on the community e-mail list. Because this open source community provides ongoing updates and support, countries that use iHRIS are collectively savinginsteadofpurchasingthesametypeofupdatesandsupportfromafor-profitsource.

3.4 Training HRIS users

• Be able login HRIS

• Manage people (add and edit person details)

• Work with administer database part of the HRIS

• Generate and export reports

• Create custom reports in HRIS

• IT personnel

• HR person

• Administrator

• Data Quality person

3.4.3 Training OutputsAt the end of the training, the following should be fully accomplished

• Fully installed HRIS

• Participants able to use HRIS

o login and log out

o Add/Edit person’s details in HRIS

There were several HRIS trainings conducted at different levels, but the steps below details the initial HRIStrainingforeachuser/group/district/organizationgoingtostarttousetheHRISforthefirsttime.

3.4.2 Training TeamA minimum of one trainer per every 5 participants is required in a particular training session during the initial rollout of HRIS because this is a practical training and participants needs special attention while having their hands on experience. For new participants, the training team should comprise of at least one of the following

3.4.1 Training ObjectiveBy the end of the training, participants should be able achieve the following as a result of the learning activities


o Able to generate and customize reports

o Able to administer the database

• ParticipantsabletofullyunderstandthefunctionsandbenefitsofHRIS

• HR Data is imported into the HRIS

• HowHRISwillbeusedintheorganizationaccordingtoworkflow

• Participating organization should return with fully functional HRIS, user manual, user guide, training multimedia CD

• Final competency documented on each participant

• iHRIS Train data collected from participants

• Training Report

3.4.3 Learning Strategies, Activities and MethodsWhat you will do in order to achieve the learning objectives

• Hands on the system

• Carry out an individual task/exercise/ Assignments

• Individual evaluation

• HR Brain teasers

• Group Discussions / brain storming

• Q & A sessions

• Daily training assessment

3.5 Training Materials and ToolsThe materials and any tool which will assist to carry out learning

• Power point slides

• Assessment/Evaluation forms (pre, daily and end of training)

• Task/Exercise

• Training Program

• User Manuals

• HRIS Server/Computers

• Training Computers/Laptops

• Printer

• Digital Camera


iHRIS

• Scanner

• Projector and tripod projector screen

• Stationery (Flip charts, note pads, pens, markers, photo copying papers, masking tape, stapler,)

• Internet Connectivity

• Network cables and wireless Switches

• Extension Cables with power surge Protection

• Externalbackupdisks,flashdisks,andDVDs

3.5.1 Power point slidesIt should have a title comprising of the topic

Page 1: Topic or Title

Page 2: Objectives

Page 3-6: Compress the course content

Page 7: Illustration of what is has been taught

Page 8: Conclusion

At the end of the session, should allow a Q & A session not exceeding 4 questions

Presentation Format

• Font Type & Size: Arial 12

• Slide Background: Use the standardized theme

• Time: 30 minutes Q&A 15 minutes

3.5.2 Evaluation forms and guides

Pre evaluation Form - This is aimed at assessing the participants on HRIS knowledge, attitude and computer literacy.

Daily evaluation Form - This is aimed at getting feedback from participants on the day’s training, trainer’s performance and areas of improvement.

End of training evaluation Form - This is aimed at informing the trainers if the objectives of both the trainer and trainee have been achieved.

Training program - A program gives the timing and the activities

User Manuals - Detailed explanation of how to use and navigate through HRIS

Attendance Form – help to keep a record of the people trained


Individual HRIS Training Skill Assessment – used to determine the level of HRIS for each participant

iHRIS Train data collection form – collects details on trainees to feed into in-service iHRIS Train

3.6 Different groups trained in HRIS

Data mangers – these do the day to day management of the system to make sure it is updated, up running,havetheneededreports,andgenerateandsharereports.Theseincluderecordsofficer,bio-statisticians,humanresourceoffices,andhospitaladministrators.

District HR managers – here the CAO, DHO, and PHRO and trained for three days to use HRIS. The objective is enable them be able to generate reports from HRIS and for them to support HRIS maintenance and monitor the updating of the system.


iHRIS

Figure 3: Trainees from 28 UCMB Hospitals having hands on sessions on the HRIS in 2012


Health Senior Managers - this targeted decision makers like ministers, commissioner, directors at MoH, central organizations, PNFPS, NRH, and RRH. The objective to enable them to know what information can be obtained from the system and how to interpret it to inform policy and decision making.

3.7 Conducting training

Day one: Objective: Build rapport between participants and facilitators, spell out the objectives and expected outputs of the training and give the participants an overview of the HRIS.

HRIS overview: Give a picture of the entire HRIS manage

• What is HRIS?

o DefineHRISastoolandwhatitdoes

o DefineHRISabilitiesaccordingtotheusermanualunderbackgroundsection

• Why have HRIS in organization?

o Explain the situation analysis (challenges) before HRIS

o Explain how HRIS will improve HR management (handle the challenges)

• Why use HRIS?

o Benefitstotheuser,manager,organization,country

• Future of HRIS

o Tool used for today to today management of HR

o Global access, secure, automated, and interactive

o Interoperable with other system

o Lead HR management tool (one stop centre for HR data and Information)

Day Two: Objective: Teach participants how to search and update records within the HRIS database as

Figure 4: Participants during the Health senior managers’ HRIS orientation

The training is conducted in five days according to the developedtraining program and the following is covered


iHRIS

well as displaying the different reports the system can generate

Day Three: Objective: Teach participants how to manage HRIS database and customize the system

Day Four: Objective: Teach participants how to analyze report and demonstrate skills learnt

Day Five: Presentations of the different HRIS functions and discussions of the future

Group participants according to their roles e.g. leaders (CAO and DHO), implementers (PHRO, SHRO, HRO, planners), data managers (RO, Bio-stat, Secretary)

Leaders handle the following

• Opening and logging into the system

• Components of the system

• Search records: Recent changes, Search Positions and Search people

• Generation of all the main reports and explaining the importance of each

• Howtousedifferentfilters(onthestafflist).

• Exporting reports into Excel and Pdf

• Generating charts and graphs

• Inserting graphs, tables, and charts into a word document

• Changing password, and recovering passwords

Implementers/Data Managers handle the following

- Opening and logging into the system

- Components of the system

- Manage people – add person

- Search records: Recent changes, Search Positions and Search people

- Updating individual sections of records

- Cropping images and attaching them to someone’s data.

• Generation of all the main reports and explaining the importance of each

• Howtousedifferentfilters(onthestafflist).

• Exporting reports into Excel and Pdf

• Generating charts and graphs

• Inserting graphs, tables, and charts into a word document

• Administrator the database and explaining each section

• Creating new accounts, changing password, and recovering passwords

• How to create a new report

• Howtoaddfieldstoareport

- Howtoarrangethefieldsinareportstartingwithaparticularfield.


- Creatingstaffestablishmentandgeneratingstaffingnormsreport.

On the second last day of the training, participants are grouped and each group is given an assignment totesttheirskillsinHRISmanagementandusage,Assesdifficultieswithinthesystem,advantages,and creativity brought in by different participants.

The following are the functions and topics to be discussed by each group

a) Group 1

- Opening and logging into the system

- Components of HRIS and why each HRIS

- Manage people and add person

b) Group 2

- Search records: Recent changes, Search Positions and Search people

- Updating individual sections of records - phone + education

- Cropping images and attaching them to someone’s data.

c) Group 3

- Generation of all the main reports and explaining the importance of each report (facility, staff, Album,

- Howtousedifferentfilters(onthestafflist).

- Exporting reports into Excel and Pdf

d) Group 4

- Generating charts and graphs

- Inserting graphs, tables, and charts into a word document

e) Group 5

• How to create a new report

• Howtoaddfieldstoareport

- Howtoarrangethefieldsinareportstartingwithaparticularfield.

- Definestaffestablishmentfortwopositionsandgeneratestaffestablishmentreport.

f) Group 6

- Administrator the database and explaining each section

- Creating Jobs, Positions in HRIS and assigning them to people

- Creating new accounts, changing password, and recovering passwords

3.7.1 Implementation Guides and Support documentsDifferent tools and manuals were developed to support in the implementation of HRIS in Uganda,

HRIS strengthening plan

user manuals,


iHRIS

administrator manuals,

training guide and tools,

data dictionary,

user multimedia CD-ROM

Standard Operating Procedures

3.7.2 Budget supportCore rollout equipment - Computers, UPS, scanners and cameras

Pre-visit to Identifying data managers and users

Training Users and Managers in regional centers

Data importing, cleaning and standardizing

Internet connectivity

Setting up LAN and sharing reports

Follow-up support, mentoring and on-job training

Online remote support

3.7.3 What was not done?Central backup of other HRIS databases – traditional and education

Linkage with university

3.8 Rollout, Follow-up, Coaching, and online technical support

3.8.1 Implementation ProcessStandard needs requirement assessment

Development of HRIS Core Team and Resource Persons

Pre-visitandidentificationkeypersons

Centralized Regional Training of users and data managers

Follow-up, on-job training, and mentoring

Data importing, cleaning and standardizing

Internet connectivity and putting databases online

Setting up LAN and sharing reports

Online remote support

Bringing on board other donors and support for national coverage

The internship program

Share reports online

Implementation approaches used at different levels (PNFPs, MoH, Train, Districts, Examination bodies, etc.)


3.8.2 HRIS Rollout process to districts• Carrying out pre-visit to the districts before HRIS rollout helped to the get the right people to

train, to know each district organizational approach and who matters at the strategic level (Top Management), departmental level (Middle Management), and operations level (operations management like HRIS focal persons).

• Training the districts at the initial rollout in clusters in central places in the various regions helped to build a pool of HRIS users within regions who can help each other.

• Supporting the districts to format their staff list and importing HR data into HRIS ensured that the districts started to use the system immediately after the training

• Allowing the districts to use the HRIS for all the HR data (Health, Traditional, and education) helped to ensure that the HRIS was for the whole district not only for health department.

• Carrying out individual district follow-up to provide on-site training and mentoring and supporting the districts in cleaning up their database improved on the quality.

• DevelopingHRIScostedstrengtheningplanforthewholecountryinthefirstyearoftheUCPhelped to market HRIS to other donors and partners who came on board to support in the rollout and follow-up.

• Training resource persons as trainers has provided a big pool of knowledgeable persons in the country both at the central and in the districts who are supporting and working with other partners to rollout the systems and to provide follow-up technical skills

• The MoU made with districts during the initial setup of the internet services in the districts were not followed up by the districts’ administration as after one year most of the districts did not include internet provision in their budgets

• Failure of CAO to appoint in writing HRIS focal persons. This led to the responsibility of managing the HRIS shifting from one person to another and in the end no one taking on full responsibility. We are of the view that if CAO had appointed in writing, it would have boosted the moral of HRIS focal person and improved on ownership.

• Formostdistricts,theCAOandDHOwerehousedindifferentbuildingmakingitdifficulttoshare the internet and LAN to access the HRIS.

• The issue of staff turnover has led to having to train new persons every two years to manage the system.

• To take care of staff turnover and to ensure that districts within various regions communicate and share experiences and challenges, there is need for centralized regional HRIS training every two years.

• Most districts especially the HRIS focal persons pick interest, master the system, and understand the role HRIS plays in evidence based decision making after several follow-up and working with them.

• For HRIS sustainability, as long as the HR managers at the districts get the culture of demanding forHRreportsandusingthemforevidencedbaseddecisionmaking;thiswillensurethatHRISis maintained and updated.


iHRIS

3.8.3 Coaching / online technical supportUCP used to provide extensive technical support to the districts either directly through coaching visits or online trouble shooting. The interns and HRIS resource persons at the center and at the regional level played a pivotal role in this support as a way to further build their capacity in the management of the HRIS. Key areas of support included retraining data users and mangers in cases where there were staff movements and as a refresher to those who were trained. The data managers were further coached on how to keep the system up to date and how to generate different reports from the system, removing duplicate client information. The coaching visits were also used as an opportunity to discuss in detail with users the different reports and gain a deeper understanding of their unique needs and providing license and registration information on HRH from health professions council (HPC) databases.

3.8.4 Customization of HRIS to meet user needsUnderstanding and responding to the needs of the users was a key factor in data use. UCP customized HRIS as a strategy to improve data use. With help of the senior informatics developer from IntraHealth and workingwiththeusersatdifferentlevels,additionalrequireddatafieldsandreportviewswereidentifiedandpre-formatted into the system according to different organizations. For HRIS manage, a standard staff list as per public service, the staff retention report, gender report, and HR audit reports were added. For HRIS Train, the examination tracking, student results, pass slip, examination card were added. The iHRIS Qualify system for the professional councils was also further customized to better meet the needs of the councils, reports like internship report, health units report, etc. were added.

Table 1: Some reports and customization in iHRIS

Report/Change Description

Public Service Staff list TheoldstafflistwasmodifiedtolooklikethepublicservicestafflistthatHRpeopleareused to. The report gives staff details combined with the establishment per post

Retention Report A report with details of how long a staff has been in an organization

Gender report Gives the staff according to gender per post, department, and facility

Audit Report Itgivesasummaryofestablishmentperpostperfacility-approvedposts,filledposts,and vacant or excess

Examination Tracking Examination tracking for iHRIS Train was added that provides provision to add marks for the pre-service training students to support the Ministry of Education and the Nursing Exam Board.

Students Results This gives the result per each pre-service student whose examination marks have been capture in the system

Examination Card It is formatted according to the needs of examination boards and it can be printed for each student who has paid and is going to sit the examinations

Standard data lists Other changes in HRIS included the addition of standard data lists (National HRIS Codes) and these have been created as modules for iHRIS sites to enable merging of data from differentsystems.AstaffingnormsmodulewasalsocreatedandstandardizedforallLevels of the HRIS

Staff Accommodation Report

Gives details about whether staff are accommodated by the institution or not. It helps to determine who gets housing allowances

Appraisal Reports Gives details about staff that have been appraised and those that have not and the action points for improvement

File tracking report Givesthelocationofastaffpersonalfilei.e.towhichofficethefilehasbeentakenandfor what purpose


Report/Change Description

Staff Employment Status Report

Itgivestheemploymentstatusofastaff–ifprobation,confirmed,orcontract

Leave management For planning and management of leave being taken by staff

Staff Album Showsthecurrentstaffbydepartmentwiththeirrecentphotosforeasyidentification.

Temporary registration certificate

Itsummarizespeoplewhohavetemporaryregistrations;thisismostlyforeignhealthworkers in Uganda and Ugandan who have just completed studies.

Certificateofgoodstanding

Report about people who have been working in Uganda but going to work outside the country.

Internship report It keeps track of the interns – where they are employed, their contacts and registration status

Health Units report It keeps track of private health facilities owned by the doctors. It gives the registrations status, the supervising health worker, ownership, category (mental, maternity, medical)

3.8.5 Development of iHRIS Train

The introduction of iHRIS Trainmarked a significantmilestone in realizing two core iHRIS principles: localownershipofhealthsolutionsandnationalinnovation.iHRISTrainwasthefirstoftheiHRISapplicationstobedeveloped in the country where it will be used.

In response toaneed identifiedbyMinistryofHealth tomanageprofessionaldevelopment for thehealthworkforce, Nobert Mijumbi (HRIS developer) and Ismail Wadembere (HRIS manager) of IntraHealth’s Uganda Capacity Program developed the new software by adapting the core iHRIS code. As members of the iHRIS Global Support Community, the Uganda developers shared their work with other iHRIS developers worldwide for feedback.


iHRIS

After receiving input from the Ministry of Education and Sports and the Uganda Nurses and Midwifery Examination Board, Mijumbi and Wadembere expanded the initial plans for the software to include information on pre-service education and ex-amination results. They also ensured that iHRIS Train could easily share training data with existing information systems.

The iHRIS Train was launched by Minister of Education and Sports Jessica Alupo. Key stakeholders attended the launch event, including, Permanent Secretary of the Min-istry of Education and Sports Francis X. K. Lubanga and Director of Planning of the Ministry of Health Dr. Isaac Ezati.

The Ministry of Education and Sports in Uganda began using iHRIS Train in June 2013. To get the software up and running quickly, 42 ministry staff were trained to manage and update the system, and 60 senior managers learned how to produce their own reports for planning and decision-making. 32 partner organizations implementing trainings in Uganda have also learned the system and have agreed to use iHRIS Train to manage their training programs.

iHRIS Train helped the UCP to have a deeper picture on HRH in Uganda as it col-lects and reports data on the number of health professionals being trained in neces-sary skills and important cadres. Used together, iHRIS Train, iHRIS Manage, and iHRIS Qualify offer a complete health workforce solution.

3.8.6 HRIS CodesUCP worked with different stakeholders to code health cadres, jobs, and positions. This was a key achievement which took UCP nearly three years to achieve. The process of developing the codes was very consultative and UCP engaged different stakeholders including the MoPS, HPCs and MoH particularly the nursing department and HRM. The national framework for grouping health workforce cadres was then submittedtotheHRTWGforfinalreviewandapproval.Theframeworkimprovedthestandardization, description and nomenclature of health workforce position titles. It also provided standard cadre grouping codes and descriptions. The codes are being implemented in both HRIS qualify and manage systems to replace the existing ones and also iHRIS Train was based on those codes.

3.8.7 Data cleaning and update in HRISTo enhance use of information from the databases for decision making, UCP supported districts,RRHs,NRHs,UCMB,UPMB,HPCs,MoHanditsaffiliatedinstitutionstoupdatetheir databases as well as provided hands on training on how to generate reports. All were supported to clean and update their databases. This particularly enhanced data use since the reports generated from the system were complete, accurate and up to date.

The commonest reports used in the districts/ hospitals were found to be the staff list andstaffingestablishmentreport.Theseareusedonadaytodaybasisformakingmanagement decisions and planning. For big hospitals like Mulago, the staff album report was the most used report since it gave the different managers e.g. the nurse manager who has more than 700 staff to know their staff by linking the name to a face.


The system was officially launched by the His Excellency Edward Kiwanuka Ssekandi whorepresented the president.

3.8.8 Launch of iHRISHRISwaslaunchedinahighprofileeventatHotelAfricanaon7thFebruary2012.ThekeyobjectivesofthelaunchweretomobilizesupportfortheHRIS;aswellasraiseawarenessofhealthmanagersand leaders on availability of HR data and how it can be accessed.


iHRIS

At the launch HRH managers from different institutions shared experiences with guests on how HRHIS has transformed HRH management at their respective institutions. The most important success of the launch was government taking on the stewardship of HRHIS. The HRIS preferably called the HRHIS by the MOH was declared the human resource information system for managing the human resources in the health sector.

3.8.9 HRIS InterconnectivityInterconnectivity of the different databases done to improve data sharing and use, UCP contracted the ISP providers MTN and Orange to implement the interconnectivity within districts and between districts and the MOH. A total of 57 institutions (48 districts and 9 Regional Referral Hospitals) were supported to get Internet to enable data sharing. 40 sites have public IP addresses that allow remote access and these sites are able to send their HRIS data directly to the MOH server for aggregation and backup. All the Regional Referral Hospital databases were centralized and the HR managers at the hospitals access them online. UCP also supported Jinja Regional Referral Hospital, Mbale RRH, and the Uganda Nurses and Midwives Council to upgrade their bandwidth in order to improve their internet speed.

With this interconnectivity, all HRH data for the connected districts is accessible at national level negating the need for one to travel to the districts to get HRH information. This greatly improved data use and access. The iHRIS site http://hris.health.go.ug became a hub for HRH information and the number of visitors to the site increasing by day. UCP used the information from the web site in developing the HRH staff audit reports for the different years as well as in supporting the MoH in developing the HRH advocacy paper to parliament.

ItshouldbenotedthatfinancialsupportfordistrictlinksforHRISinterconnectivityendedinAugust 2013, however UCP HRIS team continued to work with the districts to identify district based partners that can continue with this support while the districts reorganize their budgets to cater for the subscription fees.

3.8.10 The use of DropboxDropbox,afilesharingtoolwassettohelpinbackingupthedatabasesandtosharetheiHRIStechnical instructions like how to upgrade, how to accomplish follow-up, how to share reports, and store iHRIS documents like user manuals, data quality guideline, training guidelines and tools.

Asharedfoldercalleddistrictisusedtosynchronizefilesanddatabasesespeciallyfordistrictswith no public IPs. This enables access to important files evenwhen the users are offlinebecauseacopyofthefilesisstoredontheusers’localcomputeranditiskeptup-to-date.

3.8.11 HRIS Frequently asked Questions The UCP HRIS team came up with a list of frequently asked questions to help the public understand iHRIS and how it contributes and works with already existing HR system

a) Who owns integrated Human Resource Uganda Information System (iHRIS)? HRIS is a system that is owned by the government of the Republic of Uganda.

b) Differences between IPPS and HRIS

IPPS (Integrated Payroll and Personal System) is payroll system for the government of Uganda while HRIS is a day to day human resource management for the health workforce.


c) Why are we using both IPPS and HRIS to capture the same information on a Health worker?

Currently, both systems are capturing information on health worker. However, with time IPPS will be exporting data on payroll to HRIS on a monthly and HRIS informing IPPS who has joined and who need to be added to the payroll.

d) Differences between HMIS and HRIS

HRIS is an information management tool designed specifically for managing humanresources in the sector while HMIS is an aggregate of all health management information systems within the health sector. HRIS is a sub system that contributes to HMIS like other sub systems e.g. LMIS, DHIS.

e) Differences between DHIS and HRIS

DHIS is an information management tool designed specifically for aggregating patientrecords in the sector while HRIS is designed to manage human resources.

f) Differences between OPEN MRS and HRIS

OPENMRSisaninformationsystemdesignedspecificallyforhealthfacilitymanagementwhile HRIS is designed to manage human resources.

g) How do I change someone’s position information,

i. If he/she has been transferred within the same organization?

First create the new position in that facility where the person has been transferred to

ClickonConfiguresystem Click on Administer database Click on position by facility

Click on Add New Position Select the new job of the person If the position name is different from the job then change it Select the facility of the person Select the department of the person Clickonconfirmandsave

Second we search for the person and record the transfer

Click on search records Click on search people Type the person’s name and click search Click on the person’s name in the report to open his/her page Click on Position information on the left menu or scroll down to position information Click on change position, Select the new position Fill in the salary, Terms of employment and DSC minute if known Choose a reason for transfer Select what happens to the status of the current position Click on confirmandsave

ii. If he/she has left the organization’s service?

Click on search records Click on search people Type the person’s name and click search Click on the person’s name in the report to open his/her page Scroll down to position

information Click on record a departure, Select what happens to the status of the current position Fill in the end date Choose a reason for departure Clickonconfirmandsave.

h) How do I assign a position for a new person in the service?

First create the new position in that facility where the person has been posted


iHRIS

Click onConfigure system Click on Administer database Click on position by facility

Click on Add New Position Select the new job of the person If the position name is different from the job then change it Select the facility of the person Select the department of the person Clickonconfirmandsave

Second we search for the person to assign the position

Click on search records Click on search people Type the person’s name and click search Click on the person’s name in the report to open his/her page Scroll down to position information - Click on record a departure Select what happens to the status of the current position - Fill in the end date Choose a reason for departure Clickonconfirmandsave

i) What happens to the old positions when people change, transfer or depart

There are three options that can happen to any position

Open - Meaning it’s free, it’s in the system and no one is occupying it

Closed - Meaning it’s taken up by someone

Discontinued–Meaningithasbeeneliminatedfromthestaffingnorms/establishment.

When a position is left, by default the position become open, but one can decide to discontinue during the process when you are changing position. If it stays open then when a new employee comes into service we do not have to create it again.

To view open positions: Click on view reports Click on position reports On the filtersdownselectopenandclickonApplylimits.

j) HowdoIpopulate(addfieldsin)thedropdownmenus?

ClickonConfiguresystem Click on Administer database (There is a list of all the fieldsinthedropdownmenus)-Clickontheoneyouwanttopopulate Click on Add New … Entertherequiredfields Clickonconfirmandsave

k) How do I add a new person in the system?

Click on Manage People Click on Add Person FillinthefirstindividualinformationClickonconfirmandsave.ClickonAddDemographicinformationwhichistab

Fillintherequiredfields Clickonconfirmandsave.Beforeyouclickonsetpositionmakesureyoufirstcreateit.

After creating the position then assign it to the person. Then add all the necessary information on the person’s page

l) Can the system work without internet?

Yes, the system can work without internet.

The system can run on a computer that is not connected to internet.


ItcanalsobeaccessfromseveralofficeswithinthebuildingthroughtheLANwithor without internet.

HRIS can also be accessed globally through the internet as while as send updates to the MOH server on a weekly basis

m) How is the system backed up and where is it done?

The system does an automatic backup on the local computer and sends a copy to the MOH server on a weekly basis.

n) How do I resize my photo? Go to the folder where your photo is stored, right click on the photo, select resize image, choose the option of custom and enter the standard size of passport photo i.e. 200 (height) by 150 (width). Then proceed to update the photo section of person’s information with the resized photo.

o) Deleting records This function is currently reserved for advanced systems administrator and is subject to approval by PPO.

p) What to put in comments and notes sections Any information deemed to be useful in relation to that section and is not capturedbyanyofthefielddesignedinHRIS.

q) Why do I continue to see a person in the system when I recorded a departure? When you record a departure, the person’s record is not permanently deleted from the database but is deactivated from the staff list. This simply means that the person’s record is removed from the active staff list. To view active staff, go to “view report” and select “staff list”.

However, the person’s record will continue to be available in the system and can be viewed through searching the database via “search records”.

r) Search records and staff lists gives a different number Numbers on staff list and search list will vary because of the explanation given in the question q).

s) How do I know the records entered on a particular day To get information on record entered on a particular day i.e. not more than one week, click on search records, select recent changes and choose the option of your interest.

t) How can I tell who accessed the system and what they did The system keeps a log of all operations and it’s accessible by the system administrator


iHRIS4ACHIEVEMENTS


4. Achievements

4.1 HRIS Status in Uganda

4.1.1 Implementation StatusHRIS has been established in the four Health Professional Councils (HPCs) – Uganda Nurses and Midwives Council (UNMC), Uganda Medical and Dental Professionals Council (UMDPC), Pharmacy Council, and Allied Health Professional Council (AHPC), Ministry of Health (MoH) – HRM and HRD, Two National Referral Hospitals (NRH) - Butabika and Mulago, 14 Regional Referral Hospitals (RRH), Uganda Virus Research Institute (UVRI), National Medical Stores (NMS), Uganda Blood Transmission Services (UBTS), Uganda Cancer Institute (UCI), 32 Uganda Catholic Medical Bureau (UCMB) hospitals and facilities, 25 Uganda Protest Medical Bureau (UPMB), Uganda Nurses and Midwife Examination Board (UNMEB), Health Tutors’ College - Mulago and 92 districts by MoH and Intrahealth managed USAID Uganda Capacity Program (UCP) in collaboration with partners including WHO, Baylor-Uganda, NU-HITES, SDS, World Bank founded UHSSP, BTC, UCMB, UPMB, and MoES. Bringing the number organizations with HRIS to 178 (170 have iHRIS manage, 4 have iHRIS Qualify, and 4 have iHRIS Train). The total records is 135,090 managed in 115 databases with pre-Service Train having 29,302 records, In-Service Train having 6,578, Qualify has 58,655, and Manage has 40,555.

Table 2: Summary of records in iHRIS

iHRIS No. of Records

No. of Databases

Institutions No. of Institutions

Pre-Service Train 29,302 3 MoES, UNMEB, and HTC 3

In-Service Train 6,578 1 MoH – HRD and HMDC 1

Qualify 58,655 4 UNMC, UMDPC, AHPC, Pharmacy Council 4

Manage 40,555 107 MoH – HRM, 2 NRH, 14 RRH, UVRI, UBTS, NMS, UCI, 32 UCMB, 25 UPMB, and 92 districts

170

Total 135,090 115 178

HRIS systems in Uganda can be accessed at http://hris.health.go.ug/, UCMBaffiliatedhospitalsathttp://hris.ucmb.co.ug/ , UPMB health facilities at http://hris.upmb.co.ug:8080/upmb . The registration and licensure status reports for all health workers in Uganda provided by HPCs are freely available at http://hris.health.go.ug/reports/

4.1.2 Implementing Partners in UgandaUCP developed the HRIS strengthening plan at the beginning of UCP that outlined the different activities that needed to be accomplished and it laid ground how HRIS can be supported different stakeholders and donors. This was shared with different partners who came on board and supported HRIS in different ways in addition to support provided by the user organizations.


iHRIS

Table 3: HRIS Partner support

Partner Support Institutions supported

UCP • Managing the implementation of HRIS

• Customizing HRIS

• Staff as part of HRIS Core Technical Team

• HRIS documentations and Manuals

• Rolling out HRIS

• Training users and data managers

• Follow-up and mentorship

• HRIS data entry and updating

All 178 institutions were supported

MoH

(HRM, HRD, HMDC, Registry, RC)

• Staff as part of HRIS Core Technical Team

• Policy support for HRIS

• Online hosting of HRIS


All 178 institutions were supported

WHO • Rolling out HRIS

• Logistics for Follow-up and mentorship

10 districts

Baylor-Uganda • Rolling out HRIS



15 Districts

BTC • Follow-up and mentorship 8 districts

NUMAT • Rolling out HRIS




3 districts

NU-HITES • Rolling out HRIS




15 districts

UHSSP • Rolling out HRIS


• HRIS user manuals

11 districts

UCMB • Logistics support in rolling out HRIS




32 Hospitals and Health facilities


Partner Support Institutions supported

UPMB • Logistics support in rolling out HRIS




32 Hospitals and Health facilities

MoES • Policy support for HRIS


MoES

UNMEB • Logistics support in rolling out HRIS

• Logistics for training users and managers

• Hosting of HRIS


UNMEB

UNMC, Pharmacy Society, NMS,

Mulago, Butabika UVRI, HTC

• Logistics for training users and managers



For respective institutions

UMDPC, UCI, UBTS, 14 RRH • HRIS data entry and updating For respective institutions

All districts • Hosting HRIS


For respective district


iHRIS

Figure 5: Map showing the districts with HRIS and Partner support

N

KEY

DR CONGO

SOUTH SUDAN

KENYA

RWANDABURUNDI

ETHIOPIA


4.1.3 The iHRIS ManageTheiHRISmanagehasbeenrolledouttoMinistryofHealth(MoH)headquarter,fourMoHaffiliatedorganizations (UVRI, Blood Bank, NMS, and Uganda Cancer Institute), two National Referral Hospitals (NRH) – Butabika and Mulago, 14 Regional Referral Hospitals (RRHs), 32 UCMB hospitals and health facilities, 25 UPMB hospitals and health facilities, and 92 districts as detailed below

Figure 6: Map showing Districts with iHRIS

N

KEY

DR CONGO

SOUTH SUDAN

KENYA

RWANDABURUNDI

ETHIOPIA


iHRIS

Table 4: Names of the districts according to numbers displayed on the map above

Id Name HRIS Supported Established Id Name HRIS Supported Established

1 KAMPALA No 57 MPIGI Yes UCP 2011

2 ADJUMANI Yes UCP 2011 58 MUBENDE Yes WHO 2010

3 ARUA Yes UCP 2011 59 MUKONO Yes UCP 2009

4 BUNDIBUGYO Yes Baylor 2011 60 MITYANA Yes WHO 2010

5 BUSIA Yes WHO 2010 61 NAKASEKE No

6 BUTALEJA Yes UCP 2011 62 NAKASONGOLA Yes UCP 2011

7 KABALE Yes UCP 2010 63 RAKAI Yes UCP 2011

8 KANUNGU Yes UCP 2011 64 SSEMBABULE Yes UCP 2011

9 KASESE Yes Baylor 2011 65 WAKISO Yes Capacity 2009

10 KISORO Yes UCP 2010 66 HOIMA Yes WHO 2010

11 KOBOKO Yes UCP 2011 67 KIBAALE Yes UCP 2011

12 MANAFWA Yes UCP 2011 68 MASINDI Yes UCP 2011

13 MBALE Yes WHO 2010 69 BULIISA No

14 MOYO Yes UCP 2011 70 AMURIA No Baylor 2012

15 NEBBI Yes UCP 2011 71 BUKEDEA Yes Baylor 2012

16 PALLISA Yes UCP 2011 72 KABERAMAIDO No Baylor 2012

17 BUDAKA Yes UCP 2011 73 KUMI Yes UCP 2011

18 RUKUNGIRI Yes UCP 2011 74 SOROTI Yes UCP 2011

19 SIRONKO Yes UCP 2011 75 KATAKWI No Baylor 2012

20 TORORO Yes WHO 2010 76 KABAROLE Yes Capacity 2009

21 YUMBE Yes UHSSP 2014 77 KAMWENGE Yes Baylor 2011

22 ABIM No 78 KYENJOJO Yes WHO 2010

23 KAABONG No 79 BUDUDA Yes UCP 2011

24 KOTIDO No 80 AMUDAT No

25 NAKAPIRIPIRIT No 81 BUIKWE No

26 MOROTO No 82 BUYENDE No

27 BUKWA Yes Baylor 2012 83 KYEGEGWA Yes Baylor 2011

28 KAPCHORWA Yes UCP 2011 84 LAMWO Yes NU-HITES 2013

29 AMOLATAR Yes Capacity 2009 85 OTUKE Yes NU-HITES 2013

30 APAC Yes UCP 2011 86 ZOMBO Yes UHSSP 2014

31 LIRA Yes Capacity 2009 87 ALEBTONG Yes NU-HITES 2013

32 OYAM Yes Capacity 2009 88 BULAMBULI Yes Baylor 2012

33 DOKOLO Yes UCP 2011 89 BUVUMA No

34 GULU Yes NUMAT 2009 90 GOMBA Yes UHSSP 2014

35 AMURU Yes NU-HITES 2013 91 KIRYANDONGO No

36 PADER Yes NUMAT 2009 92 KYANKWANZI No

37 KITGUM Yes NUMAT 2009 93 LUUKA No

38 BUGIRI Yes UCP 2011 94 NAMAYINGO No

39 IGANGA Yes UCP 2011 95 NTOROKO Yes Baylor 2011

40 JINJA Yes UCP 2010 96 SERERE No Baylor 2012

41 MAYUGE Yes UCP 2011 97 KALUNGU No

42 KALIRO Yes UCP 2011 98 BUKOMANSIMBI Yes UHSSP 2014

43 NAMUTUMBA Yes UCP 2011 99 BUTAMBALA Yes UCP 2011

44 KAMULI Yes UCP 2011 100 LWENGO Yes UHSSP 2014

45 MBARARA Yes WHO 2010 101 MITOOMA Yes UHSSP 2014


Id Name HRIS Supported Established Id Name HRIS Supported Established

46 BUSHENYI Yes WHO 2010 102 RUBIRIZI Yes UHSSP 2014

47 NTUNGAMO Yes UCP 2011 103 SHEEMA Yes UHSSP 2014

48 IBANDA Yes WHO 2010 104 BUHWEJU Yes UHSSP 2014

49 ISINGIRO Yes UCP 2011 105 NGORA No Baylor 2012

50 KIRUHURA Yes UCP 2011 106 NAPAK No

51 KAYUNGA Yes UCP 2011 107 KIBUKU Yes Baylor 2012

52 KALANGALA Yes UCP 2011 108 NWOYA Yes NU-HITES 2013

53 KIBOGA No 109 KOLE Yes NU-HITES 2013

54 LUWERO Yes UCP 2010 110 AGAGO Yes NU-HITES 2013

55 LYANTONDE Yes UHSSP 2014 111 MARACHA Yes UHSSP 2014

56 MASAKA No 112 KWEEN Yes Baylor 2012

Figure 7: Map showing the geographical roll-out of HRIS according to year of Establishment

N

KEY

DR CONGO

SOUTH SUDAN

KENYA

RWANDABURUNDI

ETHIOPIA


iHRIS

4.1.4 iHRIS QualifyThe iHRIS Qualify has been rolled out to the four Health Professional Councils (HPC) – Uganda Nurses and Midwives Council (UNMC), Uganda Medical and Dental Professionals Council (UMDPC), Pharmacy Council and Uganda Pharmaceutical Society, and Allied Health Professional Council (AHPC).

The HPCs were also supported to link the databases onto to the open access Health workers Registration and Licensure Status page at http://hris.health.go.ug/reports and also to their websites.

4.1.5 iHRIS TrainThe iHRIS Train Pre-service has been rolled out to ministry of education and sports (MoES) headquarters, Health Tutors’ College (HTC) – Mulago, and Uganda Nurses and Midwifery Examination Board (UNMEB). The iHRIS Train in-service is at ministry health human resource development (MoH-HRD) and HMDC departments.

The system supports a holistic view of health worker training, from pre-service education at a health training institution through regular in-service trainings. iHRIS Train helps governments and facilities gauge the pipeline of upcoming graduates who could be available to enter the workforce, meeting health worker shortages and replenishing the workforce that is exiting by retirement or attrition. Governments can use iHRIS Train to estimate overproduction and undersupply of health worker cadres as well. iHRIS Train enables training institutions to track progress on curriculum implementation and student performance, and collect information on faculty and tutors, and training experience of individual health workers.

iHRIS Train tracks in-service training for individual health workers and helps in identifying areas of in-service training needed they can maintain and learn new competences relevant to their environment. The system improves coordination for in-service training among various partners and stakeholders to improve efficiencies of in-service training, reduce on duplication, and improve equity among healthworkers. Furthermore, iHRIS Train helps professional councils track approved credit hours under continuous professional development (CPD) for licensure renewal.

Pre-Service Training Features

• Intake capacity: Track applicants by name, gender, location, cadre, and training institution.

• Graduation: Track graduates by name, gender, training institution, location, cadre, and length of training.

• Measure attrition of students: Track dropout rates by student, gender, training institution, location, cadre, and reason for attrition.

• Student progress: Track student progress against curriculum and grades.

• Faculty and tutors: Record information such as areas of expertise, number of years teaching, and professional history.

In-Service Training Features

• In-service training instances: Record training content areas, location of training, length of training, modality, cost, and evaluations.

• Manage tutors:Managequalifiedtutorsandfacilitatorsfortraining.

• Coordinate training instances:Toimproveefficiencyfor in-servicetraining,highlighttrainings


supported by multiple partners or stakeholders with overlapping content, tutors, training dates, and participants.

• Manage and coordinate training participants: Track name, gender, cadre, employer, location, previous in-service training courses taken, and in-service courses needed.

• Track CPD credits: Access in-service training courses that qualify for CPD/CME credits.

• Easy reporting for donors: Export reports as graphs, Excel spreadsheets or in other formats for donors and reporting sites.

4.1.5.1 The Pre-Service training database at MoESThe Pre-service training database for MoES was completed and launched in May 2013 by the Minister of Education and Sports, Hon. Jessica Alupo. The database is intended to provide data on the current supply of the health workforce, existing training capacity to inform pre-service training decisions and more rational use of training capacity to improve availability of the most critical health cadres.

The database was initially installed at MoES headquarters. UCP conducted training of MoES staff in managing the database including regular update of information. The database was planned to be updated by MoES at headquarter as they carry out monitoring of the different trainings taking place in the schools.

A national wide data collection was conducted and data about the health tutors and different training schools and the programs and number of students was collected and imported into the database.

However, as the implementation went on, it was realized that the MoES staff at the headquarter were having access to secondary data about trainings taking place in Uganda as the primary sources of the two main datasets for the pre-service system come from examination bodies.

The two main datasets are

a) Pre-service students

b) Health tutors and instructors

The primary sources of the two main datasets are

a) The Uganda Allied Examination Board (UAHEB) that examines and grades pre-service students fromallthe48alliedhealthprofessionaltrainingschoolsthatoffercertificatesanddiplomacourse

b) The Uganda Nurses and Midwifery examination board (UNMEB) that examines and grades pre-service students from all 65 nursing andmidwifery schools that offer certificates anddiploma course

c) The six universities (Makerere University, Islamic University in Uganda, Uganda Martyrs, University – Nkozi, Mbarara University of Science and Technology, Busitema University, and Gulu University) that teaches, examines, and grades pre-service students for degrees leading to medical, dental, and nursing professionals


iHRIS

Because these were the primary sources and they use the data for decision making process like UNMEB has to examine students and the results indicating who has passed and who has failed has to be released, that means their database has to be updated to accomplish. The same applies for HTC and UAHEB. The reports from system are shared with MoES headquarters. That implied providing the primary data source organization with databases and those databases will in turn update system at MoES headquarters so that reports are available to users in MoES.

The data flow and usage of the system

iHRIS Train has two subcomponents – in-service training and pre-service training. The development of the in-service training subcomponent was primarily guided by the MoH in consultation with other stakeholders. It is hosted by the MoH, with links to professional councils, districts, key institutions, and programs providing in-service training.

The development of the pre-service subcomponent was guided by the MoES in consultation with other stakeholders. It is hosted by MoES with links to training institutions and examination boards.

Figure 8: iHRIS Train data flow in Uganda

Fromtheabovefigure,databaseshavebeeninstalledatUNMEBfornursesandmidwives,HTCforthe health tutors. To have a complete picture, databases will be installed at UAHEB for all the allied health professionals, and the data about physicians (medical and dental) and degree nurses will be picked from the six universities that graduate them.

Pre-Service iHRIS Train UNMEB

UNMEB has pre-service iHRIS Train that is uses to track and manage pre-service trainings for certificatesanddiplomacourseinUganda.Thesystemwascustomizewithsupportfromseniorsystem developer, informatics – intrahealth with following unique functions in addition to standards iHRIS Train


• To generate examinations cards for students who have fully paid

• Give examination results book with grading like destination (D), credit (C), pass (P), and Fail (F) for each student.

• To generate results slips for each students

• Togeneratecertificateforeachsuccessfulstudents

4.1.5.2 In-service training database for MoHUCP supported MoH (HRD) to build an In-service training database to track information on In-service training and CPD access by health workers to effectively manage In-service training in the health sector. The database captures information on the number of health workers that completed In-servicetraining/CPDwithinaspecifiedperiodoftime,typeoftrainingandimplementerofthetraining. This helps MoH managers to effectively coordinate and streamline In-service training in the country by understanding which in-service courses are being offered, where and by whom. Development of the In-service training database was completed and is hosted on the MoH HRIS server through the link, http://hris.health.go.ug/.

18ManagersatMoH,HPCsandHMDCwerethefirstgrouptobetrainedforoneweekinusingandmanaging the database. UCP later extended the training to health implementing partners (IPS). 78datamanagers(Recordsofficer,ITpersons,M&E,andHRpersons)from32IPsweretrainedoniHRIS Train in-service. They are now accessing and adding their trainings online to system.

IPs trained included AHPC, Makerere University, AMREF, MUKSPH, BAYLOR, MULAGO NRH, BUTABIKA NRH, MUWRP, Butabika NTS, NUHITES, CDC, PACE (Program for Accessible health, Communication and Education), CUFH-Naguru, SDS, Health Service Commission, Star-E, Health Tutor’s College, Mulago, TASO, HMDC, UAC, IDI, UAHEB, JCRC, UCI, JHU/SMP, UCMB, Makerere University Joint AIDS Program (MJAP), UNMC, MILDMAY Uganda, UNMEB, MOH, UPMB, and Monitoring and Evaluation of Emergency Plan Progress (MEEPP) II

The IPs were trained for two days on how to use the iHRIS Train in-service, importance of HRIS Train In-Service system, how it improves on training planning and decision making process, how to add trainings, schedule trainings, add trainees, and how to analysis and generate reports from system.

Figure 9: Chief of Party, UCP welcoming and introducing importance of iHRIS Train In-Service to IPs


iHRIS

At the end of training, it was agreed the IPs will access the system online and will be given training provider access rights. UCP working with MoH mapped out the different in-service trainings per IPs and these have been implemented in system.

4.2 HRIS Standardization and Sharing in Uganda

4.2.1 Standard listUganda developed standard codes for health facilities, cadre and job and these were implemented in HRIS. They were based on the international standards by theInternationalStandardClassificationof Occupations (ISCO) and WHO. For iHRIS, we based the list on iHRIS manage since it is the ultimate aim and the end product in HR process and management. The iHRIS Train lists were tuned to be in line with iHRIS manage as the trainees after graduating have to be deployed according to cadres in iHRIS manage. Before they are deployed their competencies both at the start and annually at their work stations is assessed and handled by iHRIS qualify using the cadre lists as per their work stations managed in iHRIS manage.

4.2.2 Making data available to the public

Uganda’sfourhealthprofessionalcouncilsareusingiHRIStoensurehealthworkers’qualificationsare up to date. The councils have all made their data freely available to the public by posting it on the Ministry’s website.

The Medical and Dental Practitioners Council has even gone a step further and created a mobile directory,whichallowsanyonetousetextfeaturesontheirphonetofindoutifahealthclinicorhealthworkerisproperlyqualified.

4.2.3 Use of the Knowledge Management Portal (KMP)To improve communication and information sharing with the public, the MoH KMP website was revamped. The new KMP provides users with easy access to the documents and use of the system with a new feature where none KMP administrator can request their document to be uploaded on the KMP was incorporated in the website. The site can also make reference of multimedia being

Figure 10: Principle Human Resource Officer - MoH explaining how HR is handled in iHRIS Train In-Service


streamed on other websites for MoH KMP client to access and use as required. The KMP is currently being updated and widely publicized http://library.health.go.ug/

Figure 11: New Knowledge Management Portal interface

4.2.4 Website and Online CPDUMDPC was further supported to redesigned UMDPC website and include the CPD Module http://www.umdpc.com/

Figure 12: The UMDPC Redesigned Website Homepage


iHRIS

4.3 Mobile Telephone DirectoryUCP supported the Health professional councils to develop a Mobile Telephone Reference Directory (MTD) which was intended curb the key challenge that the councils faces i.e. fraudsters / imposters posing as health professionals and putting patients at risk. This innovation aimed at protecting the public from quacks and illegal clinics as well as imposters. The tool allows members of the public to verify that a clinic and/or a health professional is registered and licensed to practice.

Health workers in Uganda are legally required to register and obtain an annual license, with practice regulated by four nationally mandated health professional councils. With funding from USAID, the Uganda Capacity Program, led by IntraHealth International, collaborated with the councils to develop the Health Workforce Mobile Directory, a system that allows the public to use mobile phones to check health workers’ registration and licensure status. The system was developed in response to the councils’ need to identify and eliminate quack health workers—on the rise due to a high health-worker-to-patient ratio of above 600 and lack of a proper monitoring system. The system was launched formedicalcouncil-affiliatedhealthworkersin2011andextendedtohealthworkersregisteredunderthe nursing council and allied health worker council in 2013.

The system allows individuals to send a message about a given health care provider to a short code. In response, senders receive a brief message with the health worker’s full name, registration number, licensure status for the current period, and specialization. If the health worker is not found in the councils’ databases, senders get a message indicating that the person they are searching for doesn’t exist. At the same time, councils can log into the system through a web portal to view messages being sentandresponsesreceived.Thisallowsthemtofollowuponhealthworkersreportedasnotexisting;these may turn out to be quacks or simply providers taking a long time to update their records. All cases are thoroughly investigated before the councils take action.

Thedirectoryhasbenefitedthepublic,thecouncils,healthworkers,andhumanresourcesmanagers.First, the system has empowered the public to make informed choices about health workers and actively participate in their health care. Second, it has helped the councils reduce the number of cases reported to the legal system regarding unprofessional behavior, incompetency, and even loss of lives. Third, health workers have quick access to their licensure status, which allows them to be more proactive in renewing their annual licenses and ensures greater compliance with health regulations. The proportion of registered physicians who had renewed their licenses increased from 42% in 2011 to 57% in 2012. Finally, the system supports health worker recruitment by allowing service commissions toquicklyverifyanapplicant’slicensurebeforemakinghiringdecisions.Theneteffectisasignificantimprovement in health care quality in Uganda.

To know if a clinic or doctor is licensed to practice, follows the steps - type the key word “Doctor” plus the doctor’s name (or “Clinic” plus the clinic name + location) in the message function of the phone and send to 8198. They then receive a reply with the Doctor’s full names, registration number, qualificationandlicensestatus.Ifitisaclinic,thepersonreceivesaresponsewiththecliniclicensurestatus plus the supervising doctor’s name.


To check if a health work worker is registered or licensed to practice

• To check for a doctor or dentist, type: doctor <space> full name of doctor and send to 8198.

• To check for a clinic type: clinic <space> name of clinic and send to 8198.

• To check for an allied health professional type: allied <space>full name of health worker and send to 8198

• To check for a midwife type: midwife <space> full name of midwife and send to 8198

• To check for a nurse type: nurse <space> full name of the nurse and send to 8198

In case someone need help or support, send hris <problem/issue> to 8198

Usage

ThesystemforthemedicalcouncilbecamefunctionalinOctober2011butwasofficiallylaunchedon 2nd December 2011while the system for the nursing council and allied healthwas officiallylaunched on the 16th of May 2013.

Figure 13: Launch of MTD in Uganda

On the part of the councils, they are able to log into the system through a web portal and view the messages being sent by the users and the responses they received. This allows the councils to follow-up cases that are reported as not in existence. Sometimes these are people who have taken long to update their records with the councils so the councils have to carryout thorough investigations into the cases before they take action.

Thesystemwasdesignedwiththegeneralpublicinmind,interestingly;theHealthWorkershavealsofound it useful in keeping track of their license expiry dates. The analysis of the statistics generated from the system indicated pick usage during the months of February and March which is the period within which most health workers renew their annual practicing license, this gives an impression that the health workers themselves are using the system to ensure they are in good standing with the councils and make the councils accountable in case of errors

Impact

The HPCs have realized an improvement in the number of health workers renewing their licenses and contacting the councils to ensure their records are up to date. With the establishment of the District Health Supervisory Authorities (arms of the Health Professional Councils based at the district level to help with the enforcement of the councils’ mandate), the system has been welcomed by the


iHRIS

DHSAs as a tool that is aiding their supervisory work as it is cheaper to check for a person or clinic’s status using an SMS rather that making a call to the councils. The system has also received a lot of support from the District Service Commissions (the committees in charge of recruitment at the district level). They are using the system to verify the status of the health workers they are recruiting into the service.

Table 5 : For the last year (2013) when the service was implemented, the summary of access are

Year Doctors Nurses Midwife AHPC

2011 1532

2012 1527 44 4 4

2013 258 172 25 18

June 2014 646 192 2 3

Total 3963 408 31 25

Table 6: Registration for the last three years

Cadre Registered (Dec 2011) Registered (Dec 2012) Registered (Dec 2013)

Pharmacy 364 471 578

Doctors and Dentists 3841 4093 4361

Allied Health 11026 13319 16017

Nurses and Midwives 29847 33417 36641

All Cadres 45078 50829 57597

Table 7: licensure for the last three years

Cadre Licensed (Dec 2011) Licensed (Dec 2012) Licensed (Dec 2013)

Pharmacy 127 265 460

Doctors and Dentists 2175 2523 2607

Allied Health 3562 5026 7257

Nurses and Midwives 17328 24090 26615

All Cadres 23192 31639 36939

4.4 HRIS Collaboration, Cost sharing, and Sustainability

4.4.1 HRIS incremental benefits For sustainable use of iHRIS in Uganda, the UCP HRIS team involves in several activities and other partners came to support the Nobel cause of improving HRIS in Uganda.

As the Honorable State Minister of Health said at the national HRIS launch event on 7 February, 2012: “The importance of the HRIS cannot be over emphasized. The key health workforce challenges in Uganda are shortages of health workers both in numbers and skills, inequitable distribution of the available health workers, and low productivity. More than 60% of the few health workers available are concentrated in urban areas serving less than 20% of our population, while over 80% of the population living in the rural areas is served by less than 40% of the available health workers. Underpinning these health workforce challenges are weak personnel and performance management systems, and


Clearly, HRIS has grown and the use of the system has rapidly expanded. Users of the system experienceitsbenefitsandcontinuetoenvisionwaystoincreaseitsfunctionalityandimproveitsease of use. As with any evolving technology system, HRIS challenges remain to be addressed. Additionally, theexternalprojects thathavebeenproviding technical andfinancial support tothe Ministry of Health (MoH) to develop and run the system will be ending over the next several years, increasing the need to strengthen MoH capacity to further develop, maintain and sustain the system independent of external assistance. This strategic plan aims to address these concerns through short and medium term planning of strategies and activities the MoH can implement to roll out and sustain the use of HRIS.

Improved performance of the health workforce

Ensure health workers are properly trained and

certified

Fill open positions

Managers are able to recruit and pay health workers

Monitor the licensure status

HRIS data collected

and analysed

Figure 14: A snapshot of the HRIS incremental benefits

inadequate resources to support the health workforce. Without a system that continuously provides data on available health workers, their distribution and productivity it was nearly impossible to quantify and analyze the human resource gaps and develop focused interventions to solve the human resource problems. The establishment of the HRIS is a key step in tackling the HRH crisis in Uganda.”


iHRIS

By accessing HRIS, the professional councils can now monitor the licensing status of health practitioners, and anyone can verify the licensure status of a particular health worker by texting to the councils. Similarly, the district service commissions can verify registration and licensure status of applicants for jobs. The M0H can better monitor performance against HRH indicators and advocate for funding.

To be able to use the HRIS for national planning, national uptake is essential. HRIS is now being used in all four professional councils, the MoH, all four national health institutions (Mulago and Butabika national referral hospitals, Uganda Virus Research Institute, and Uganda Blood Transfusion Services) and all 14 regional referral hospitals.

4.4.2 Equipment and Internet Support by user OrganizationsUCP worked with different districts and organizations where HRIS was rollout to cost shared equipment and internet procurement and maintained. Organizations like NMS, UVRI, 10 RRHs (Arua, Soroti, Gulu, Lira, Fortportal, Mbarara, Hoima, Masaka, Mubende, and Mbale), UPMB, UCMB, UBTS, Pharmacy Society, and others provided computers for HRIS. Others like Rukungiri, Mbale, Kabale, Pallisa, UVRI, UBTS, UPMB, UCMB, Pharmacy Society and other provided their own internet to help in sharing HRIS. In-service IPS supported in accessing iHRIS and using their own computers during the different trainings. In the different trainings during rollout and follow-up, UCP provided only a standard per diem and different organizations provided top ups and technical allowances. A case is point is UPMB and UCMB that supported their health facilitates with per dim during the different trainings. MoH has always provided staff to work with UCP and partners to follow-up and rollout without giving them technical allowances.

4.4.3 Making HRIS part of the business processUCP HRIS team analyzed the business process of all organizations during the rollout of iHRIS and setupiHRISinsuchawaythatitcontributesandbecamepartofthebusinessflowoforganizations.This is helping in HRIS sustainability as organizations ensure that the system is up and running in ordertofulfiltheirmandate.

HRIS is now part of the business process for HPCS, NRH, and many districts. For example Mulago NRH uses HRIS to monitor their part of the payroll managed by MoPS as on monthly basis they compare the payroll list from MoPS with the HRIS staff list and generate the pay change report.

Districts like Rukungiri, Namutumba, Mityana, Mbale, Butaleja, Rakia, Mpigi, Kisoro, etc. use HRIS to analysis the wage bills and vacancies to inform their recruitment process. All use the iHRIS staff list to come up with their monthly payroll submission to MoPS to be effected through IPPS.

UNMEB uses the system to process examinations as the system quickens the process of managing theworkflowasallthedepartmentslogintoaccomplishtheirpartandthisinformsthenextaction.What UNMEB does is the upload the students details and enter the marks from the marks sheets and thesystemgeneratesforthemtheexaminationnumber,theresultbook,passslip,andcertificate.

HPCs(Pharmacysociety,UNMC,AHPC,andUMDPC)havemadeiHRISpartoftheirdailyworkflowprocess. For example, the use iHRIS to determine for which period a health professional should be paying by looking at the expiry date for each as they review their licenses. Also for every health workergoingtorenewalicenseorneedingarecommendation,thefirststageistocheckwithdatapersons to make sure their data is up to date and has no standing disciplinary issue. This has helped to keep the system updated.


4.4.4 Setting up iHRIS to answer HR questionsUCP setup HRIS so that is response to the needs of HR managers and decision makes. As one HR manage put it “myoffice is likeaweb,all informationabouthumanresourcesisneededinmyoffice,”explainsOjulunJoreme.He’stheprincipalhumanofficerforDokolodistrict.“Leftand right I have to keep giving out information about each individual.” Ojulun is in charge of supplying human resources information to district decision makers and leaders so they can make decisions about the health workforce. Uganda’s health workforce managers previously relied on a paper filing system that madeit almost impossible to compile and analyze health

workforceinformation.“Itwasverydifficultforme,”admitsOjulun.“Mybiggestchallengewashowto memorize who has gone to school, who is on interdiction, which employee is continuously absent, and which employee is to retire.”

Health workforce managers like Ojulun use the system to manage employed health workers. They produce reports such as staff lists that are compared with approved staffing norms to identifyvacanciesoroverstaffing,andwithpayroll systemsto recognizeandeliminate“ghostworkers”—those who remain on the payroll but are not actually working. Managers can also generate detailed profilesofanindividualhealthworker’semploymenthistoryandrunreportstoprojectstafflossesdue to retirement.

All this information is shared with the Ministry of Health, which uses it to produce annual health workforce reports, inform the country’s health workforce strategic plan, influence funding forpreservice education, and advocate for the recruitment of more health workers.

HRISmakesHRmanagereasyasOjulunJoreme,principalhumanofficerforDokolodistrictOjulun’sputs it. “A click of a button, I am able to see all about one employee and make a decision,” he exclaims. He’s now able to supply information to district health leaders so they can make better decisions, like how to plan for the health workers that will soon retire. He’s able to process their retirementpackages so theyget their benefits on time.He’s also able to ensure healthworkersareproperlyqualified,becausehecancomparetheirphotographsandinformationtowhat’sbeenentered by health professional councils. Ojulun is even able to track and follow up on any disciplinary issues, something that was previously a liability for the district: “Many cases of disciplinary nature which we made after some period of time, the staff would go to court and win cases and this would mean huge costs for the district. But now with this intervention we are able to make decisions very fast and timely, within the time of the law.”

Dr.SamuelOjok,districthealthofficerforDokolo,alsousestheHRHIS.“Byaclickyoucanknowthatthis health center has this many nurses, this one has this number, and you can compare the services within them and do a redistribution according to the workload they have. So this has made work pressures for our staff reduced—the work pressure that could make staff run away.”

4.4.5 Global iHRIS Support to learn moreUCP has supported the global community by developing the User manuals for iHRIS train and power point look like iHRIS manage user manuals, these in addition to the data quality guidelines, and global iHRIS strengthening tool kit basing on the lesion learnt through implementing the three iHRIS


iHRIS

components (Train, Manage, Qualify, and Manage). Feed backs from those using them helped UCP HRISteamtofinethem.

In addition, UCP enhanced the global general understanding of iHRIS and rollout management by hosting different team from other countries through visit program like the Kenya team in 2013. “We came [to Uganda] to learn what can we borrow from them and use in Kenya to make our implementation successful,” Nguni Robert said. “We want to know what lessons they have learned so that we can avoid some of the challenges they have faced.

This has been supplemented by online publication of the different UCP HRIS activities and success like the HRIS Manage launch by MoH, iHRIS Train launch by MoES, MTD launch by MoH and other blogs by UCP HRIS team. The UCP HRIS team, Former interns, and the Uganda HRIS Core team are members of the global iHRIS google group that discusses and supports members in different iHRIS functions.

• Helping to customize for other countries like the reports in IHRIS Train for Kenya where UCP HRIS developer and HRIS Manager worked with Kenya Team to kick start them with customization

• Support to global iHRIS core team through customization of iHRIS like visits by HRIS developer to Namibia in 2012, feedback on new releases of iHRIS, etc.

Nineteen countries are now using iHRIS, a free and open source human resources information system, to support over 810,000 health worker records. It would cost more than $149 million in licensing fees alone for these countries to support a similar number of records with a proprietary system purchased from for-profit companies. Botswana, Chad, DR Congo, Ghana, Guatemala, India, Kenya, Lesotho, Liberia, Malawi, Mali, Namibia, Nigeria, Rwanda, Senegal, Sierra Leone, Tanzania, Togo, and Uganda are using iHRIS to track,manage,andplanfortheirhealthworkforces.Theyhavemovedbeyondinefficientpaper-basedfilingsystemsinfavorofrobustdataandelectronicrecords,whichallowuserstoeasilyfind,share, organize, and manage their information.


5FUTURE PRIORITIES


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5. Future Priorities

5.1 HRIS Transition to GOU/MOH or other local entityThere is need to support Uganda stakeholders to establish an HRIS Transition Taskforce with joint participation and leadership by both the HRH and eHealth TWGs, who represent users and implementers of HRIS respectively. This taskforce will also invite participation of other key HRH and Health stakeholders and partners, including the health professional councils, MESAU, Ministry of Education, PNFPs, CDC, UNICEF, and others. The purpose of the Taskforce will be to develop, review, and implement the HRIS workplan with increasing responsibility in each of the years and with full transition to MoH within three years. University departments and private-sector organizations should be supported to develop their capacity in the core iHRIS software so they may serve as technical resources to the GOU/MOH. District-based USAID programs (STARs, NU-HITES, and R-HITES) and district-based CDC Partners (Mildmay/Baylor/IDI/TASO) should be encouraged to develop plans to support and sustain their respective districts.

• Establish a Uganda HRHIS community of users, implementers and developers: A national information system requires a large variety of skills and collaboration to ensure sustainability and success. There is need to support the GOU/MOH/Resource Center to establish the necessary community and collaboration technologies in conjunction with its partners to facilitate a national community of practice for the national HRIS.

• Build capacity to maintain HRIS: There is need for more training in HRIS use, implementation, and development, building face-to-face relationships, fostering exchange of best practices, and strengthening the national HRIS support network. District-based partners should be requested to train HRIS users and implementers in their respective districts. The HRIS Transition Taskforce and the GOU/MOH/Resource Center need to be supported to organize and lead the trainings in collaboration with partners and universities.

• Establish national HRIS helpdesk at the MoH: GOU/Mo/Resource Center need to be supported to setup a helpdesk in alignment with their existing helpdesks for other national HIS systems using existing MoH staff and no-cost contact methods. This helpdesk will provide inexpensive and timely support to districts and central health organizations to address HRIS challenges as they emerge and minimize system issues in a timely manner, as well as support analysis of quality and encourage use of data to resolve HR issues.

5.2 Strengthen capacity for data quality analysis and use at all levelsData will only be used if the quality is high and stakeholders have the capacity to effectively analyze and use it to support health workforce policy, planning, and management. There need to support the HRIS Taskforce to help eliminate barriers to effective data quality, analysis, and use for HRH planning, policy, management, and support.

• Consolidate measures for data quality control: There is need to work with a HRIS Taskforce to develop and distribute critical documentation and data quality procedures to facilitate ongoing data quality audits. Guidelines for all central organizations and districts need to be established, and HRIS to be made part of the MoH district league table to align with larger Uganda HIS data quality control efforts. Also to develop and conduct quarterly data quality reporting in alignment with existing national HIS procedures.

• Strengthen capacity for data analysis at the central and district levels: There need to support HRIS TaskforcetoimproveHRISusageforHRHplanning,managementandsupportthroughspecificneedsassessments and training. Training may include generation and prioritization of key HRH indicators, recruitment plans, performance plans and appraisals, retention analysis, gender, age and other demographic analyses, and importing into WISN for consistent routine workforce needs analysis. Further technology can be supported to allow for triggered alerts based on events, GIS mapping of health worker deployment data, linking GIS HRH data with DHIS2 to inform national and district-level dashboards and open sharing of appropriate data via web and other technologies to support


transparency and open access. District-level support can include establishment of a reward and recognition program to encourage timely updating of data, encouraging completeness and accuracy.

For data governance policy and sharing framework, it varies from country to country depending on the mandate of key stakeholders. Like in Uganda, none of the existing iHRIS manage, qualify, or train databases can be used as the basis for sharing for all stakeholders as in each there are sections of data which each stakeholder do not want share. So will set up a national database that will pull the agreed open access data sections from different databases for sharing purpose. So the Ugandan data sharing framework should follow that trend for easy and sustainable implementation.

5.3 Improve HRIS interoperability with other eHealth systemsThe value of HRIS data is strong, but can be made even stronger through linking the data to DHIS2, mTRAC, and other systems to show the relationship between the health workforce and health services. There need to coordinate and encourage active participation in the national eHealth TWG, working with the MOH, CDC, MTA, mTrac (UNICEF), and MEEPP teams to plan and implement the national eHealth architecture so that HRIS can interoperate smoothly with DHIS2, mTRAC, and other national eHealth systems, bring health worker data into these systems, and eliminate redundancy.

• Establish a national health worker registry: Many subcomponents of HRIS do not share health worker data efficiently, includingthepublicandprivatesectormanagementsystems,thehealthprofessionalcouncilregulatory systems, pre- and in-service training information systems, and MESAU graduate tracking. There is need to support the TWGs, the HRHIS Transition Taskforce, other local partners (such as the planned KOICA-funded UNICEF-led CHW Registry project), and global initiatives such as the PEPFAR OpenHIE consortium to develop a national health workforce information architecture for a national authoritative health worker registry.

• Customize and implement HRIS and DHIS2 interoperability: There is need to work with the eHealth TWG and TaskforcetoensuretheHRISandDHIS2cansharedataefficiently.TheHRIScanutilizehealthorganization,facilityandotherdatafromDHIS2orotherregistrysystemsasdefinedbythenationalarchitectureandin turn contribute HRH indicator data into the DHIS2 system for aggregate reporting and high-level monitoring.

5.4 Complete establishment of HRIS databases in all districts and central institutionsThere need to rollout HRIS to the remaining 31 districts, PNFPs, and other central organizations

• Complete HRIS rollout to remaining 31 districts: Working with district-based partners to support rollout teams established by the Taskforce to conduct pre-visits to the districts, procure equipment and tools (with partner support), train district staff in use and management, and support the establishment and reinforcement of quality guidelines that will include data updating, completeness, and effective use for data-driven decision-making.

• Complete HRHIS rollout to remaining key central organizations: There need to established HRIS in regional public and private sector health organizations, such as the Uganda Muslim Medical Bureau, the Uganda Allied Examination Board, the Department of Education Standards, HTC-Mulago, the Uganda Blood Transfusion Service, supporting each organization with training on implementation and use of the system.

iHRIS

Uganda capacity program