Prof. Dr A. K. Azad

Additional Director General &

Director, Management Information System

Directorate General of Health Services

Ministry of Health & Family Welfare

21 November 2011

IndiaIndia

Myanmar

Bay of Bengal

Indian Ocean

A small country A small country A small country A small country in Southin Southin Southin South----East AsiaEast AsiaEast AsiaEast Asia•Land Area:

147,570 sq. km.•Population:

~150 million•Population density:

964/sq. km.

AchievementAchievementAchievementAchievement

•MDG4MDG4MDG4MDG4 – Well on track; UN MDG4 Award 2010

•MDG5MDG5MDG5MDG5 – On track; 2/3rds MMR Reduction from 1990

•eHealtheHealtheHealtheHealth - UN Digital Health for Digital Development Award 2011 for contributing to MDGs

� We believed - ICT could help improve HIS for measurement of health sector progress

� But, we had resource constraints

� So, we undertook a model of ICT deployment, that is:

◦ Simple

◦ Low cost

◦ Innovative &

◦ Locally appropriate

� This presentation captures some of the glimpses

Super-specialized Hospitals

Tertiary Hospital /Medical College Hospital

District Hospital /Medical College Hospital

Sub-district Hospital

Union Health Center (Day care)

Community Clinic (Day care)Community Health Workers

About 600 hospitals

About 19,000 day-care facilities

About 100,000 health workforce

Internet Internet Internet Internet connectedconnectedconnectedconnectedApril 2009April 2009April 2009April 2009

To be To be To be To be connected connected connected connected from this from this from this from this fiscalfiscalfiscalfiscal

Device: Wireless Internet – Edge Modem

DHIS 2.0 DHIS 2.0 DHIS 2.0 DHIS 2.0 ---- Open Source SWOpen Source SWOpen Source SWOpen Source SWWe are using

Data entered at sourceData entered at sourceData entered at sourceData entered at source

• Same platform for public & private;• End users need no software ; Inherent interoperability; • Data gathered quickly; Better quality; No need for compilation at any level

We can checkwho sent data, who not

Dash boardDash boardDash boardDash board

We can produce automatic reportWe can produce automatic reportWe can produce automatic reportWe can produce automatic report

We can produce GIS mapWe can produce GIS mapWe can produce GIS mapWe can produce GIS map

� By DHIS 2.0, currently we collect only aggregate data

� But, we are moving to case by case data collection

Household InformationHousehold InformationHousehold InformationHousehold Information

•House code: Division-District-Upazila-Union-Ward-Household

•Drinking water source

•Latrine

•Economic situation

•Important mobile phone numbers (3)

Household Member(s) InformationHousehold Member(s) InformationHousehold Member(s) InformationHousehold Member(s) Information

•Serial No. & Name

•National ID

•Date of birth

•Sex

•Marital status

•Education

•Occupation

•Religion

•Chronic disease

•Date of death

•Cause of death

Basic data setBasic data setBasic data setBasic data set

Unique ID

Ambitious Program

Verbal Verbal Verbal Verbal AutopsyAutopsyAutopsyAutopsy

85% data collection completed

Population data: new birth (live or still), birth weight, maternal death, other death, pregnancy, ANC, NCD, Economic condition, water source, latrine

Community health service: domiciliary visits, medication, immunization, Vit A cap, albendazole, ANC, PNC, Newborn care

Sub-district

District

Health worker

Community Clinic

Health service Health service Health service Health service informationinformationinformationinformation

Population Population Population Population datadatadatadata

FY2011-2016

Union Health Facility

National

CloudCloudCloudCloud

CIDA is a CIDA is a CIDA is a CIDA is a partnerpartnerpartnerpartner

Supported by WHO & Health Metrics Network

A partnership of public-private-NGO-local organizations

Field implementation: March 2011

Data maintained by MOH

MOVE-IT Electronic Health Record

Web-Based Electronic System

Bangladesh Bureau of Statistics

Data entry by health worker at the community

Data entry by health personnel at the facilities

MOVEMOVEMOVEMOVE----IT: IT: IT: IT: to capture data at point of contact or careto capture data at point of contact or careto capture data at point of contact or careto capture data at point of contact or care

� Our routine HIS is already providing lot of current

data

� We adopted HMN Framework for HIS

� We hope that our efforts will:

◦ minimize needs for health surveys

◦ provide information on all core elements almost real time

to support evidence based planning & decision

making

1. An attempt of Prime Minister’s Office

2. Aims to harmonize & inter-operate data use & services

3. One common Govt. authority will provide

o Unique ID

o Citizen’s Core Data Structure (13 fields textual)

o Biometrics (photo, finger prints (10), iris, face)

4. Service ministries will feed & use service data

Bangladesh National e-Governance Architecture

Open e-Services Bus

BB

S

M0

H

National Statistics

Director, Health MISPregnant

Mothers,

Newborn

Deaths

MoX

Other Countries

NGOs

Global Health IS

Standards by

Government

National Population

Register

MO

VE

-IT

Other

Health

Systems

Conceptual framework of National eConceptual framework of National eConceptual framework of National eConceptual framework of National e----Health ArchitectureHealth ArchitectureHealth ArchitectureHealth Architecture

� Mobile phone given to every district & sub-district hospital

� Total 482 hospitals

� Women & people can call 24h/7days & get freemedical advice from on-duty doctor

Easier for women to seek health care for herself & children from home

Watch video at www.dghs.gov.bd>Video gallery

Mobile Phone Health Service ExampleExampleExampleExample----1111

More doctors in work place: better health for women & children

Watch video at www.dghs.gov.bd>Video gallery

The system uses:The system uses:The system uses:The system uses:

ExampleExampleExampleExample----2222

Tele-medicineExampleExampleExampleExample----3333

Telemedicine for rural people, women & Telemedicine for rural people, women & Telemedicine for rural people, women & Telemedicine for rural people, women & children (in 18,000 Community Clinics)children (in 18,000 Community Clinics)children (in 18,000 Community Clinics)children (in 18,000 Community Clinics)

FirstFirstFirstFirst TrimesterTrimesterTrimesterTrimester

InstantInstantInstantInstant

≥≥≥≥60 to 60 to 60 to 60 to ≤≤≤≤90 90 90 90 daysdaysdaysdays

Pregnancy Care Advice by SMS

Send Send Send Send <<<<LMP: ddmmyyyy> <Mobile No.> <Name>>>>

Second TrimesterSecond TrimesterSecond TrimesterSecond Trimester

180 180 180 180 daysdaysdaysdays

Third TrimesterThird TrimesterThird TrimesterThird Trimester

240 240 240 240 daysdaysdaysdays

255 days255 days255 days255 days

ExampleExampleExampleExample----4444

PPPPPPPPPPPPVoiceVoiceVoiceVoiceIVRIVRIVRIVR

Mobile phone in BangladeshMobile phone in BangladeshMobile phone in BangladeshMobile phone in Bangladesh

� Empowered women

� Scaled up Internet connectivity

We leveraged this opportunity for improving health of citizens.