Health Management Information System

Murali Krishna

Frame work

• Introduction• Need of HMIS• Subsystems of HMIS• Steps of HMIS • HMIS –Maharashtra

– Sub centre – PHC – District Level– State Level

• Draw backs • References

Introduction-Definitions System - Any collection of components that work together to

achieve a common objective.

Health System - All the activities whose primary purpose is to promote, restore or maintain health.

Information - Meaningful collection of facts or data.

Information System - Systems that provide specific information support to the decision-making process at each level of an organization.

Health Information System - A set of components and procedures organized with the objective of generating information which will improve health care management decisions at all levels of the health system.

HMIS

• A system which provides a required information to each level of management at the right time, in the right form, covering the desired quantity and quality so that it may form basis for decision making.

• HMIS: process of – Collection, – Transmission, – Storage retrieval, – Analysis, – Interpretation and preparation for utilization and – Presentation of information which is necessary for decision

making for effective management.

HMIS- Subsystems• Epidemiological surveillance: Identification/notification of diseases

and risk factors, Investigation, follow-up, control measures• Routine service reporting: Hospital/health center based indicators

on performance of the various services• Specific program reporting: Various programs in operation in a

particular country, topically include; RCH, AIDS, Malaria , TB, Leprosy, Integrated Child health and many other programs under different departments

• Administrative systems: Account and financial systems Drugs management (procurement, storage and delivery) Personnel management Asset management (equipment/buildings etc) Maintenance system

• Vital registration: Birth, deaths, migration etc

Need of HMIS

HIS makes information which is necessary for the following purpose

1. Measurement of Community Health2. Community Diagnosis3. Finding solution to health problems4. Prioritization5. Planning of interventions6. Directing and controlling health programmes

Need of HMIS

8. Development of procedures, definitions, classification and methods of collection analysis, storage and retrieval of data.

9. Establishing administrative standards10. Carrying on performance appraisal 11. Determination of met and unmet health needs12. Monitoring and evaluation of health programmes13. Carry out IEC activities for community and decision makers14. Demand social support for health activities15. Social health Legislation

Choice of information

• Relevant: related to what is being studied and related to the particular programme, activity or service.

• Sensitive: should change with the changes in the situation under scrutiny

• Valid: expression of the degree to which information enables a measurement to be carried out of what it purpose to measure

• Specific: Information should reflect changes only in the variable concerned

• Sufficiently accurate:• Capable of proper analysis and interpretation : Should lend

itself for analysis and interpretation• Timely

Steps involved in HMIS

Step 1: Identifying information needs and feasible indicators

Step 2: Defining data sources and developing data collection instruments for each of the indicators selected

Step 3: Developing a data transmission and processing system

Step 4: Ensuring use of the information generatedStep 5: Planning for health MIS resourcesStep 6: Developing a set of organizational rules for health

information system management

Responsibilities & Flow of Information

Sub centre-ANM

PHC-Pharmacist, computer(designation of a statistical assistant)

District-District statistical officer- health, family welfare Dt. TB, Malaria, Leprosy officers

State Level-Dy/Joint director Statistics- Family welfare –Dy/Joint director- Vital statistics Surveillance Unit, SRS

Central level: CBHI, Statistics Division Department of Family Welfare, CGHS, Statistics Division- Department of Health SRS- head quarter

Subcentre level

• Sub-center to PHC: The person responsible for maintaining HMIS at sub centre level ANM.– Home-based records: Immunization cards,

Growth-monitoring card, Maternal health card– Health worker based records: Pregnancy/birth

card, death report form, child records, women’s register, workers work form.(most of times)

Records at sub centre1. Eligible Couple Register including

Contraception2. Maternal and Child Health Register:

1. Antenatal, intra-natal, postnatal2. Under-five register:

1. Immunization2. Growth monitoring

3. Births and Deaths Register4. Drug Register5. Equipment Furniture and other accessories

Register

Records at sub centre

6. Communicable diseases/ Epidemic Register7. Passive surveillance register for malaria cases.8. Register for records pertaining to Janani Suraksha

Yojana9. Register for maintenance of accounts including untied

funds.10. Register for water quality and sanitation11. Minor ailments Register12. Records/registers as per various National Health

Programme guidelines (NLEP, RNTCP, NVBDCP, etc.)

Report to PHC

Frequency: Monthly (The report has to be sent to PHC by 3 rd of month, during the monthly visit to PHC in format provided consisting of 16 pages-rather a book )

Performance report –report on all aspects of performance Family planning, immunization, Diarrheal diseases, Malaria, leprosy, Blindness, Deaths of all types

Inventory report – Malaria drugs, Family planning, vaccines, ORS, Basic drugs and others. it has column on consumption, balance and whether it is sufficient or not

Basic equipment facilities –It shows the list of 20 basic equipment and in case they are out of order from a particular date-quarterly

Contents of ReportSafe motherhood: ANC registration Anemia (IFA distributed) ANC Treated of complicated pregnancies Pregnancy outcome Order of live Birth Birth weight, Low birth weight babies, PNC RTI/STI Janani Suraksha Yojana Expenditure of JSY

Family planning Family planning method Cu T Insertions Other FP methods Information regarding newly married

couple (one Year) Stock of Important Medicine

Child care Vaccination Vitamin A IFA Surveillance of Vaccine preventable

Diseases Neonate and infant deaths and

reasonsNew Sanjeevani Yojana Financial assistance to mothers Dai Meetings Check up of children Malnourished children check up Changes in grades of Malnourishment Nutritional Status of Neonate and infants

IECNVBDCP

Primary Health centre

• The data thus obtained from the sub centre’s and from the PHC are compiled at PHC in the provided format for PHC

• Entered online on http://phd.nic through Block computer operator (In Wardha all 8 blocks have been provided with computers with internet and Block supervisor, who got a training of one day at district level).

• Every PHC is provided with an ID and a password for this purpose.

• The data has to be entered by 6th or 7th of the month.

PHC

• If the data entry is delayed it is discussed in the monthly Medical officers meeting at district level on 8th 9th or 10th.

• The persons responsible for MIS at PHC level are – Medical officer– computer (designation of a statistical assistant), – Pharmacist

Contents of reportSafe motherhood: ANC visits Prevention and treatment of

Anemia Pregnancy beyond 28 weeks –

caste and religion wise Treatment of complicated

pregnancies Caesarian deliveries Outcome of pregnancies Order of Live births Birth weight Low Birth weight babies

Home visits during PNC MTP RTI/STI Wet Mount Test JSY Financial assistance and

expenditure under JSY Maternal Deaths Reasons of maternal deaths Family Planning-methods ,

Age wise, sex wise surgeries, deaths , Cu T follow up

Contents of reportChild care • Vaccination• Vitamin A• Morbidity of Under Five • Neonate, infant under Five

deaths • Reasons of deaths • Adolescent care /health services • Health campe arranged• Reports of Ashram School check

upStock of Important MedicinesDai Meetings

Nutrition: • Health check up malnourished

children• Changes in grades of malnourished

childrenSanitation: Water sample examAdministrative detailsVehiclesIEC• National programmes • NLEP• RNTCP• IDDCP• NVBDCP• Epidemic if any

Contents of report

• Equipment , stock, Material• Minimum Need programme • Report of Communicable and Identified non

communicable diseases • Report of Snake Bite• Birth / Death registration details

Data quality

The degree to which the data or statistics measure what was intended to be measured when the data collection system was designed– Inappropriate data collection– Failure to report data– Unintentional recording and reporting of inaccurate

data– Intentional recording and reporting of false data– Errors in processing data - Editing, Coding, Data

entry, Tabulating

Monitoring mechanism (IPHS) Monitoring

Internal mechanisms: 1. Supportive supervision and Record checking at

periodic intervals by the Male and Female Health supervisors from PHC (at least once a week) and by

2. MO of the PHC (at least once in a month) etc. as per check list for Sub-centre.

External mechanism: Village health and sanitation committee, Evaluation (by an independent external agency, client satisfaction survey etc. by NGOs)

District to state HQ

• The persons responsible for HMIS at District level is District statistical officer- health, family welfare Dt. TB, Malaria, Leprosy, Blindness officers etc.,

• Each program sends a summary of program statistics • District Statistical officer: (Mr. Sanjay Rathod for Wardha)

trained at Pune for two days. He ensures that all PHC level data entry and also the district level data for various programmes.

• The data from the district should be completed by 15th of month. . He also generates a district level report Every month.

• Every Month a meeting is held at DHS, Mumbai of all the District Statistical officers .

State level

• State level: Dy/Joint director Statistics- Family welfare –

• Dy/Joint director- Vital statistics • Surveillance Unit• Sample Registration system

Advantages of Computerization

– More speedy communication of data – At national, state & district levels, processing can be

done for valuable information Obtaining coverage levels for various activities

– Age-specific & area-specific figures– Check suspect data from PHCs– Identification of problems requiring research– Prompt reporting of results– Achieve data standards– Data for comparative purposes

September report is already availablehttp://maha-arogya.gov.in/hmis/default.htm

Drawbacks of HMIS 1. Exhaustive report2. Not utilized at local level 3. poor quality of data collected 4. Poor utilization of data at all levels

References

• Epidemiology and Management for all: PV Sathe and AP Sathe• URL: http://maha-arogya.gov.in/ • Mrs. M kataria : Strengthening of health

Management information system 1995-96:NIHFW• Ranganayakulu Bodavala:Evaluation of Health

Management Information System in India: Need for Computerized Databases in HMIS. Harvard School of Public Health