Use of Information Communication Use of Information Communication Technology & HMIS to strengthen Technology & HMIS to strengthen

Management Systems and for Management Systems and for AdvocacyAdvocacy

Africa CHAs 4Africa CHAs 4thth biennial Conference 23 biennial Conference 23rdrd to 26 to 26thth Feb , 2009 Feb , 2009 UgandaUganda

Kirumira Kizza CharlesKirumira Kizza CharlesAssistant Data Management Advisor to UCMBAssistant Data Management Advisor to UCMB

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• The Private not for Profit Health Sector (PNFP):The Private not for Profit Health Sector (PNFP):

– 5252 PNFP hospitals (PNFP hospitals (42% of 12442% of 124 Hospitals in the Hospitals in the

country)country)

•4545 CHAs Hospitals UCMB & UPMB ( CHAs Hospitals UCMB & UPMB (36% of 12436% of 124 ) )

– 500500 functional lower level health units (20% of the functional lower level health units (20% of the

total LLUs in the country)total LLUs in the country)

– 2020 Health Training Institutions (over Health Training Institutions (over 60%60% of the total of the total

Training Schools in the country )Training Schools in the country )

– Estimated level of services provided to the Estimated level of services provided to the

population: range between population: range between 30-35%.30-35%.

The Private Not For Profit (PNFP) The Private Not For Profit (PNFP) Health Sector in UgandaHealth Sector in Uganda

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• The Catholic Health Sector is coordinated nationally The Catholic Health Sector is coordinated nationally

by UCMB and comprises:by UCMB and comprises:

• 2727 Hospital (2 more are registered but not yet Hospital (2 more are registered but not yet

accredited)accredited)

• 241241 lower level health units (LLU), lower level health units (LLU),

• 1212 Health Training Institutions – Nursing Training, Health Training Institutions – Nursing Training,

Midwifery and Laboratory SchoolsMidwifery and Laboratory Schools

• One of the Major stakeholders in the Uganda One of the Major stakeholders in the Uganda

national health systemnational health system

The Catholic Health SectorThe Catholic Health Sector

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UCMB Network Journey to Current ICT UCMB Network Journey to Current ICT positionposition

(2001 to date)(2001 to date)• 20012001: UCMB realized need for : UCMB realized need for ICTICT to to strengthen operations especially HMIS. strengthen operations especially HMIS.

• UCMB ensures that all Health Facilities UCMB ensures that all Health Facilities (HF) use HMIS properly(HF) use HMIS properly– Through a series of short courses in HMISThrough a series of short courses in HMIS– Training users in Microsoft Office Training users in Microsoft Office

applications, basic ICT skills and use of applications, basic ICT skills and use of ICT equipment.ICT equipment.

•Targeted:Targeted:– Records Officers in Hospitals & HCIVsRecords Officers in Hospitals & HCIVs– Diocesan Health Coordinators (DHCs)Diocesan Health Coordinators (DHCs)– Hospital managers Hospital managers

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UCMB Journey with ICT and HMIS UCMB Journey with ICT and HMIS

• 20022002: : Installing of internet / e-mail facilitiesInstalling of internet / e-mail facilities– Transmission of data and information from Transmission of data and information from

Hospitals & DHO to UCMB data base was effected.Hospitals & DHO to UCMB data base was effected.• Strengthened timeliness of compilation and feedbackStrengthened timeliness of compilation and feedback

– At facility level focus is on performance At facility level focus is on performance assessment & utilization of results.assessment & utilization of results.

• 2004:2004: Financial Accounting software (FIPRO ABC ) Financial Accounting software (FIPRO ABC ) was developed by UCMBwas developed by UCMB– Hospitals generate cost by Cost Centre Hospitals generate cost by Cost Centre – Able to analyse Economic efficiency of the Able to analyse Economic efficiency of the

HospitalHospital– Managers are able to relate input to output on a Managers are able to relate input to output on a

cost centre .cost centre .

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UCMB Journey with ICT and HMISUCMB Journey with ICT and HMIS

• 20072007: UCMB developed a Web site : UCMB developed a Web site ((http//www.ucmb.co.ughttp//www.ucmb.co.ug))– This enabled HF to access This enabled HF to access

managerial, financial, ICDM managerial, financial, ICDM guidelines and health survey guidelines and health survey reports.reports.

• 2008:2008: Health Training Institution Health Training Institution connectedconnected

– Internet and e-mailInternet and e-mail– enabled to manage data and informationenabled to manage data and information

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UCMB Journey with ICT and HMISUCMB Journey with ICT and HMIS

•20082008::Web-based HMIS was launchedWeb-based HMIS was launched

Link: Link: http://fs.ucmb.co.ug/UCMB2/web/index.phphttp://fs.ucmb.co.ug/UCMB2/web/index.php

– Links UCMB data base to Links UCMB data base to all hospitals all hospitals (indicators for evidenced decision (indicators for evidenced decision making).making).

– Each hospital can access its data from Each hospital can access its data from UCMB on line and order specific analysesUCMB on line and order specific analyses

– Compare with locally analyzed informationCompare with locally analyzed information

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What have been strengthened as a What have been strengthened as a result?result?

• Governance and Governance and Management in generalManagement in general– Use of data for management decisionsUse of data for management decisions– Informed Strategic decisionsInformed Strategic decisions

• Finance Management SystemFinance Management System– Hospitals moving to international accounting Hospitals moving to international accounting

standards standards • Most hospitals using Cost-based accounting (accrual) Most hospitals using Cost-based accounting (accrual)

based on Cost-centrebased on Cost-centre

– Timely production of financial reportsTimely production of financial reports– Fipro used by 12 hospitals nowFipro used by 12 hospitals now

• It is modularIt is modular

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What have been strengthened as a What have been strengthened as a result?result?

• Analytical outlook of informationAnalytical outlook of information– Comparison of performance over timeComparison of performance over time

• Individual hospital trendsIndividual hospital trends– Comparison against others in the networkComparison against others in the network

• Human Resources Management and Human Resources Management and Development Development – Access to HR guideline on the UCMB web siteAccess to HR guideline on the UCMB web site– Monitor staff attrition & retention regularly Monitor staff attrition & retention regularly – Receive information on Training Scholarship Fund Receive information on Training Scholarship Fund

via UCMB web site & e-mailvia UCMB web site & e-mail– Information used for:Information used for:

• Planning recruitmentPlanning recruitment• Planning capacity buildingPlanning capacity building• Investigating reasons for high turnoverInvestigating reasons for high turnover

• Advocacy Advocacy

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Using the HMIS as a tool for Monitoring & Using the HMIS as a tool for Monitoring & EvaluatingEvaluating

Access, Equity, Efficiency, QualityAccess, Equity, Efficiency, Quality

of Health Servicesof Health Services

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The data source: HMISThe data source: HMIS

• UCMB hospitals collect UCMB hospitals collect data based on the MoH data based on the MoH Health Management Health Management Information System (HMIS)Information System (HMIS)

• from a Summary Annual from a Summary Annual Report Format (activities Report Format (activities and financial information)and financial information)

• E-reports are then forwarded to UCMB (via e-mail)

• stored in a central databank

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• What is possible with What is possible with the system is to auto-the system is to auto-generate information generate information – graphs or tabular graphs or tabular

formatsformats– right at health facility right at health facility

levellevel

The auto-generated The auto-generated information: examplesinformation: examples

• Make basic trends analysis– Health Facility

performance indicators, Epidemiology, Specific indicators to monitor the implementation of the National Health Sector Strategic Plan

O PD attendance

0

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Ju ly A u g S ep t O ct N o v D ec Jan F eb M ar A p r M ay Ju n

Total new cases Tota l A ttendance (New + R eattendance)

InP atien ts A ttend ance

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Tota l Admision M ale Fem ale

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IPD UTILISATION July August September October November DecemberTotal Admision 879 1023 830 782 817 726Male 327 400 334 260 330 263Female 552 623 496 522 487 463From within Catchment Area 682 624 576 508 522 450Outside Catchment Area 197 399 254 274 295 276Tot. Inpatient Days 2748 2454 2539 2768 2587 2537ALS 3 2 3 4 3 3BOR 59% 53% 55% 60% 56% 55%

The auto-generated The auto-generated information: examplesinformation: examples

IP trend

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September

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April MayJune

Total Admision Male Female

IP trend

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Total Admision Male Female

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Hint on Composite Indicators used by Hint on Composite Indicators used by ManagersManagers

• The Standard Unit of Output (SUO)The Standard Unit of Output (SUO)**

– SUO is a standardized measure of output that SUO is a standardized measure of output that allows comparisonallows comparison

– Computation formulae Computation formulae •Hospital – Hospital – (15*IP)+(1xODP)+(5*DEL)+(0.5*ANC/MCH/NFP)(15*IP)+(1xODP)+(5*DEL)+(0.5*ANC/MCH/NFP)

+(0.2* IMM.)+(0.2* IMM.)

•Dioceses - Dioceses - (5*IP)+(1xODP)+(2*DEL)+(0.3*ANC/MCH/NFP)(5*IP)+(1xODP)+(2*DEL)+(0.3*ANC/MCH/NFP)+(0.2* IMM.)+(0.2* IMM.)

– SUO documents/literature available at SUO documents/literature available at http://http://www.ucmb.co.ugwww.ucmb.co.ug//

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Cont: Composite Indicators used Cont: Composite Indicators used by Managersby Managers

•The The quality health carequality health care**– This composite indicator consists of This composite indicator consists of

7 indicators: 7 indicators: •fresh Still birth rate, fresh Still birth rate, •maternal Death Rate, maternal Death Rate, •recovery Rate on discharge, recovery Rate on discharge, •infection rates for caesarean section,infection rates for caesarean section,•proportion of qualified staff , proportion of qualified staff , •patients satisfaction & patients satisfaction & •drug prescription practices.drug prescription practices.

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Applications : a Monitoring System Applications : a Monitoring System used by Managers.used by Managers.

• The electronic HMIS system developed by UCMBThe electronic HMIS system developed by UCMB

• Uses HMIS information to monitor Annual Health Units’ Uses HMIS information to monitor Annual Health Units’ performanceperformance

• Based onBased on

– ACCESSIBILITY: using indicator called Standard Unit ACCESSIBILITY: using indicator called Standard Unit of Output (SUO)of Output (SUO)**

– EQUITY: using as indicator Values of Fees charged EQUITY: using as indicator Values of Fees charged per SUOper SUO

– EFFICIENCY: using as indicator Number of SUO per EFFICIENCY: using as indicator Number of SUO per Staff and Cost per SUO producedStaff and Cost per SUO produced

– Quality of Health Care (Hospitals): using 7 indicatorsQuality of Health Care (Hospitals): using 7 indicators** • These are composite indicators / indicesThese are composite indicators / indices

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Applications : a Monitoring System Applications : a Monitoring System used by Managers.used by Managers.

• Managers can analyse data at sourceManagers can analyse data at source

• But can also access tabulated data and graphs on the But can also access tabulated data and graphs on the web by logging onto UCMB data server and running web by logging onto UCMB data server and running some queriessome queries

• The next 5 slides show trends of these composite The next 5 slides show trends of these composite indicators / indices used to measure how UCMB indicators / indices used to measure how UCMB network remains faithfulness to its Mission Statementnetwork remains faithfulness to its Mission Statement

• Using box-whisker plotUsing box-whisker plot– Show individual trend and trend against the rest in the Show individual trend and trend against the rest in the

networknetwork

• Trends are used for management decisions and Trends are used for management decisions and informing governanceinforming governance

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Monitoring Access:Monitoring Access:Composite Activity Indicator: Hospital Trend of SUO op (blue line) Composite Activity Indicator: Hospital Trend of SUO op (blue line) against UCMB network (box-plot graphs)against UCMB network (box-plot graphs)

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Monitoring Equity:Monitoring Equity:Level of patients’ fees: Hospital Trend of Fees values (blue line) Level of patients’ fees: Hospital Trend of Fees values (blue line) against UCMB network (box-plot graphs)against UCMB network (box-plot graphs)

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Monitoring Efficiency:Monitoring Efficiency:Total Cost per Output: Hospital Trend of Cost per SUO values (blue Total Cost per Output: Hospital Trend of Cost per SUO values (blue line) against UCMB network (box-plot graphs)line) against UCMB network (box-plot graphs)

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Monitoring Efficiency:Monitoring Efficiency:Staff Productivity: Hospital Trend of SUO OP per Staff values Staff Productivity: Hospital Trend of SUO OP per Staff values (blue line) against UCMB network (box-plot graphs)(blue line) against UCMB network (box-plot graphs)

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Monitoring Quality:Monitoring Quality:Quality of health care: Hospital Trend of Quality of services (blue Quality of health care: Hospital Trend of Quality of services (blue line) against UCMB network (box-plot graphs)line) against UCMB network (box-plot graphs)

96100

106 108 109

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Total Quality Score03/04

Total Quality Score04/05

Total Quality Score05/06

Total Quality Score06/07

Total Quality Score07/08

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HMIS as a tool for HMIS as a tool for accountabilityaccountability

• The system’s application has been used as tool The system’s application has been used as tool

– for internal accountability: managers to the Boardfor internal accountability: managers to the Board• Report to boards on trend annually is mandatoryReport to boards on trend annually is mandatory

– for external accountability: other stakeholders in for external accountability: other stakeholders in

Health Sector Health Sector

(Ministry of Health, Development Partners, (Ministry of Health, Development Partners,

Donors…)Donors…)

• For self-appraisal and performance analysis of For self-appraisal and performance analysis of

hospitals and diocesan health departmentshospitals and diocesan health departments

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Using HMIS Information for Using HMIS Information for AdvocacyAdvocacy

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Internal Advocacy –UCMB Internal Advocacy –UCMB NetworkNetwork

• For equitable charges in all hospitals & LLUs For equitable charges in all hospitals & LLUs (Fees /SUO) on behalf of users (esp. the poor)(Fees /SUO) on behalf of users (esp. the poor)– Based on trends of fee / SUO compared to that of Based on trends of fee / SUO compared to that of

access, cost and productivityaccess, cost and productivity

• For consolidation instead of unnecessary For consolidation instead of unnecessary expansion / scale upsexpansion / scale ups– Due to macro-economic challengesDue to macro-economic challenges

• To provoke efficiency measures To provoke efficiency measures – Based on trends of efficiency (economic and staff Based on trends of efficiency (economic and staff

productivity) productivity)

• To guide recruitment and management of HRTo guide recruitment and management of HR

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Advocacy – Outside the UCMB Advocacy – Outside the UCMB networknetwork• Together with UPMB and UMMBTogether with UPMB and UMMB

• Produced “Facts and figures of PNFP” and Produced “Facts and figures of PNFP” and shared withshared with– Ministry of HealthMinistry of Health– Members of Parliament Members of Parliament – Development Partners (including CORDAID, Development Partners (including CORDAID,

AVSI, IICD, CUAMM, etc)AVSI, IICD, CUAMM, etc)– Also shared with ARHAPAlso shared with ARHAP

• Feb 2008: Made presentation to members of Feb 2008: Made presentation to members of Parliamentary Social Services Committee – Parliamentary Social Services Committee – advocating for more government support advocating for more government support

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Advocacy – Outside the UCMB Advocacy – Outside the UCMB networknetwork• Include report on PNFP in the Annual Include report on PNFP in the Annual

Health Sector Performance report Health Sector Performance report (AHSPR)(AHSPR)

• Analyses showing Analyses showing the difference in the difference in remuneration between Govt & PNFP Health remuneration between Govt & PNFP Health workersworkers – advocacy for support to HR– advocacy for support to HR– Advocate for PHC–Wage grant for PNFP Advocate for PHC–Wage grant for PNFP

Health workersHealth workers

• In May 2005: Religious leaders used In May 2005: Religious leaders used information to advocate to government for information to advocate to government for more support to PNFP more support to PNFP

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Advocacy at International foraAdvocacy at International fora• Relationship between Church Health Services Relationship between Church Health Services

(CHSs) and respective governments(CHSs) and respective governments• WHO-NGO Consultation Sept. 2008WHO-NGO Consultation Sept. 2008 Geneva Geneva

(Br. Dr. Daniel Guiste-UCMB(Br. Dr. Daniel Guiste-UCMB..))

• C.C.I.H. June 2006 Annual Conference C.C.I.H. June 2006 Annual Conference –U.S.A – –U.S.A – – Addressing the human resource in Health crisis. Addressing the human resource in Health crisis.

(Marieke Verhallen-UCMB.)(Marieke Verhallen-UCMB.)

• Uganda Catholic Bishops appealed to CIDSE to Uganda Catholic Bishops appealed to CIDSE to  influence decisions at the revision of the Paris  influence decisions at the revision of the Paris Declaration to enable more funding to CSO Declaration to enable more funding to CSO (Accra – Ghana 2008)(Accra – Ghana 2008)

• Annually share information with Cordaid Annually share information with Cordaid – Carry out advocacy where possibleCarry out advocacy where possible

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ConclusionConclusion

• The Uganda National HMIS provides enough The Uganda National HMIS provides enough data to perform basic & trend analysis at data to perform basic & trend analysis at the HFthe HF– to help managers to take decision ( based on to help managers to take decision ( based on

sound information)sound information)

• ICT applications have been very helpfulICT applications have been very helpful– analysis easier at Health Facility levels analysis easier at Health Facility levels

(periphery)(periphery)– the system auto-generates informationthe system auto-generates information– and connectivity and applications enable and connectivity and applications enable

data transfer and report viewing right at data transfer and report viewing right at the peripherythe periphery

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ConclusionConclusion• Trends analysis can be done at the peripheryTrends analysis can be done at the periphery

– Does not require “high expertise levels”Does not require “high expertise levels”– Just look at the graphs and draw conclusion.Just look at the graphs and draw conclusion.

• Consolidated sector analysis done at the centerConsolidated sector analysis done at the center– as it requires the aggregation of the complete data set as it requires the aggregation of the complete data set

and higher levels of “expertise” ( only possible with and higher levels of “expertise” ( only possible with ITIT ) )

• Punctual Punctual feed-backfeed-back mechanisms were enabled at mechanisms were enabled at the centre.the centre.

• Generated information is being used to strengthen Generated information is being used to strengthen various aspects of management and governancevarious aspects of management and governance

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CONCLUSIONCONCLUSION

• UCMB has also used HMIS information UCMB has also used HMIS information for advocacyfor advocacy

• InternallyInternally– Within the catchment's area of the health Within the catchment's area of the health

facilities to influence health seeking facilities to influence health seeking behaviour.behaviour.

– At Diocesan Level At Diocesan Level – At HospitalAt Hospital

• National levelNational level• International levelInternational level