J.14_Additional_Information_on_USAID_HMIS_Scale-up_Project.pdf

Annual Work Plan FY 2018-19: JSI HMIS Scale-up Project

I - General Information

Project Title: HMIS Scale up project

Prime partner sub-partner(s):

JSI Research and Training Institute

Cooperative agreement number: AID-OAA-A-12-00047

Project Start & Completion date: May 01, 2014

September 30, 2019

Period of implementation: Oct 01, 2018– Sept 2019

Submission Date: Sept 6, 2018

Name & contact address of the COP:

Hailemariam Kassahun

Chief of Party

Winta Building, 4th Floor, Bole Sub city, Addis Ababa, Ethiopia hailemariam_kassahun@et.jsi.com hailekw2@gmail.com, mailto:hailemariam_kassahun@et.jsi.com mailto:hailekw2@gmail.com

Annual Work Plan FY 2018-19 JSI HMIS Scale-up Project

II- Back ground

A. Program Area / project description:

USAID HMIS Scale-up Project is an implementing partner (IP) with the overall goal of providing technical assistance to the Government of Ethiopia for HMIS scale-up in the country.

USAID Foreign Assistance Framework

Functional Objective Investing in People

Program Area Health

Program Element Maternal and Child Health

Program Sub Element Host Country Strategic Information Capacity

The Health Management Information System (HMIS) and Monitoring and Evaluation

(HMIS/M&E) strategy is part of the pivotal components of the Information revolution agenda in the Health Sector Transformation Plan (HSTP) of the Federal Ministry of Health (FMOH) With the objective to make HMIS as one of the core components of the “One Plan, One Budget, One

Report” policy. John Snow, Inc. (JSI) reformed the HMIS in 2006-7 with technical assistance and the guiding principles for the HMIS reform were Standardization, Integration, Simplification and

Institutionalization.

B. Objectives/Purpose:

The USAID-funded Health Management Information System (HMIS) Scale-up Project commenced its implementation with the overall goal of providing technical assistance to the

Government of Ethiopia to produce quality data using HMIS information for planning, management and informed decision making at all levels of the health system with the specific objectives of:

1. Providing technical support to the Policy, Planning and Health information technology

(HIT) Directorates of FMOH in coordinating the multi-partner scaling up of the

HMIS/M&E

2. Scaling up of DHIS2 (HMIS) at Administrative heath unit and health facilities of regions and support with Health Net, IT equipment to FMOH/HITD

3. Establishing/maintaining a computerized HMIS/M&E data processing and reporting system at national, Regional, Zonal, Woreda and Health facility levels.

4. Providing technical support to Federal HAPCO in scaling up of multi- sectoral response information system at Federal level, SNNPR and Oromia regions.

C. Achievements to date by result areas

Program area 1: Technical Assistance to FMOH

JSI HMIS scale up project continued its financial and technical assistance to FMOH to strengthen

HMIS/Dhis2 and M&E system as part of our ongoing commitment and dedication to strengthen evidence based decision making and health system performance. Major activities performed during the period under review were:

1. Development of electronic Community Health Information System (eCHIS):

Our project is actively engaged in the development of eCHIS software under the leadership of FMOH by ensuring continued availability of Eight IT professionals to support Health

Informatics and Technology Enhancement Directorate of FMOH to further accelerate the development of electronic community health information system with goal of “automating existing manual reporting processes to reduce time, for efficient resource utilization and avoid potential reporting errors”. This allows HEWs and other staff to easily review household status and individual data for better decision making and health service delivery.

To date:

Documentation of eCHIS workflows and requirements analysis and design completed, eCHIS architecture and deployment strategy developed (including the database design), Development of the Digital Family Folder Module of eCHIS finalized, eCHIS Web and Backend –all the above features plus monthly and quarterly report of eCHIS completed.

All APIs required by the mobile APP developed.

2. Dhis2 Customization and Deployment: - Following the decision of FMOH to use Dhis2 software as an official HMIS national electronic HMIS system in Mid -March, 2017, JSI

HMIS project has been engaged in various system development and capacity building efforts such as, customizing Dhis2 to Ethiopia context to serve as a national electronic HMIS system by mobilizing and hiring international consultant to support core national customization team in areas of code level customization, meta-data review and capacity building (training).

3. Health Net: Supporting the ongoing effort of MOH of enhancing the use of ICT in health care delivery by ensuring availability of ICT infrastructure (network tool kits and network equipment) to facilitate the implementation of Local area network (LAN) at primary health care units’ level. Accordingly, during the reporting period the following ICT Network equipment delivered to FMOH that will cover more than 3000 Administrative health unit and facilities.

150 piece (100%) of Network tools, 2000 Roll (100%) of Cat 6 UTP Cable, 255,000 meters (100%) of Tranking with connector, 43,000piece (100%) of wall outlet, 300,000 piece (100%) of RJ 45 with jacket, 2800 pack (100%) of Fisher and 2800 pack (100%) of Screw.

Network installation training provided for 194 ICT Small and Medium Scale

Enterprises (SME) organized by the regions (Tigray-22, Amhara-52, Oromia-80 and

SNNP-40). According HITD/FMOH update 1,469 (40.4%) Health centers are connected using Health Net

ERIS Development: Technical and financial assistance was given to Medical

Service Directorate of MOH by availing one server for eRIS implementation, installation of Emergency and Referral Information System and training of hospital and RHB staffs (44 participants from Hospitals and RHB staffs from Afar, Gambella and Benishangul Gumuz Regions trained on ERIS). The ERIS software has the following key features- National Service Directory, Bed Management and Referral

System, Emergency Service, Decision Support System(DSS) and Reports. To date

ERIS application (National Service Directory, Referral and Emergency Modules are completed and ready to be piloted in Addis Ababa hospitals. ERIS training to

Hospital and RHB staffs

4. Technical Assistance to RHBs: JSI HMIS Scale up project has continued its technical assistance to RHB by assigning 22 HIS and IT officers in Tigray, Afar, Amhara, AA, Gambella and Benishangul Gumuz RHBs.

5. Engaged in National HSTP Midterm review;

6. Customization of PRISM tool to Ethiopian context, training of data collectors, pilot testing and supporting universities in the implementation PRISM assessment in their respective catchment areas,

7. Support to health sector woreda based planning assessment and 2011 woreda planning process.

8. Providing logistics support to FMOH - printing of revised HMIS tools (registers and Tallies), National Classification of Diseases (NCOD) booklets, and annual core woreda based plan and health sector performance report.

9. Donation: 200 Tablets and accessories for eCHIS piloting, 3000 flash disks for distribution of final DHIS2 offline version to health facilities, three servers and 150 Desktop computers for DHIS2 implementation and complete set of two cubicles were donated.

10. Participating in various technical working groups at FMOH level: Development of electronic community health information system (eCHIS) that supports the agrarian, pastoralist and urban settings, DHIS2 core customization, Self-learning material development, Agrarian

Community health Information System revision, DHIS2 customization, revision of Self-learning materials, PRISM tool customization, revision of information use and data quality manuals and IR road map revision, (11)Participated in joint FMOH (PPD and HITD) and

RHB consultation and joint planning forums on DHIS2 deployment, cascaded implementation plan preparations, and rollout in Tigray, Afar and Ethiopian Somali and

SNNP RHBs. (12) Engaged in eCHIS validation, Rural FF revision and finalization process

(13) Technical and financial support given to MOH for the assessment of woreda based planning approach and documentation of success stories, encountered challenges and next steps and participated in national resource mapping exercise workshop that was organized by

FMOH-Resource Mobilization Directorate and submitted estimated budge for EFY 2011 as per the request made by FMOH.

Program Area 2: HMIS Scale –UP in SNNPR

Since 2009, JSI HMIS scale up project has been engaged in capacity building efforts, improving data quality and information use and keenly devoted to enhance ownership and institutionalize the reformed HMIS throughout the region by supporting multidimensional activities technically and financially. During the year 2017/18 JSI/HMIS SU project continued its technical assistance and support to SNNP RHB to further strengthen Routine health information system by nurturing accountability and ownership. As part of ongoing HMIS/CHIS strengthening efforts the following activities were executed during this reporting period.

HMIS/Dhis2 Training - Capacity Building of health care providers, Mangers, HIT and HEWs

3,602 (840 Female and 2,762 Male) health workers and experts have received Training on Revised HMIS tools, Community Health Information System(CHIS) pre service training conducted for a total of 1,214(1,204 Fenale,10 Male) graduating health extension workers from health sciences colleges before starting their duty as a practitioner;

Pastoral CHIS training given to a total of 150 (117 Female ,33 Male) health Extension workers from pastoral communities;

Pastoral CHIS training given to a total of 100 (12 Female ,88 Male) Health workers and

Managers from Woreda health offices and health centers of pastoral communities;

2,414 (613 Female, 1,801 Male) managers, experts, health care provider and HIT professionals from HC, hospital and Woreda health office received Dhis2 training.

71 Managers and experts (5 Females ,66 male) have received orientation and training on Community Health Information System.

Dhis2 and Health Net deployment, Implementation and follow-up

Actively engaged in DHIS2 offline and VPN orientation and training programs for HIT professionals and Woreda ICT agency staffs and local enterprise group members organized to implement local area network (LAN) at health centers and primary hospital, cloning and upgrading of old computers so that DHIS2 software’s can be installed for offline data entry, VPN connectivity and functionality assessments.

Dhis2 offline installed in all ZHDs (15) and woreda health offices (162) and

26% of hospitals

122 woreda health offices, 14 ZHDs and 86 health facilities have online connection

Network installation training provided for 40 Small and Medium Scale

Enterprises (SME) organized by the regions and agreement signed with respective zone health departments

To date 215 sites (15 ZHDs,113 Woreda health offices,22 hospitals and 65 health centers) were reached with VPN (22%), among them 110(51%) AHUs and Health institutions (9 ZHDs,57 woreda health offices, 10 hospitals and 34 health centers) have functional VPN

Ongoing Dhis2 Deployment, updating and implementation follow up, technical support to zone health departments (ZHDs), woreda health offices and health facilities, VPN training for professionals and woreda ICT agencies and level.

Entering backlog data at cluster sites, data importing, compiling and generating reports conducting VPN functionality and connectivity assessment and follow up support, Provide technical support on the preparation of woreda based planning and actual woreda based planning process together with RHB staffs, JSI HMIS project together with RHB M&E experts conducted supportive supervision of representative health facilities and woreda health offices. Accordingly, 421Administrative Health Units (103 Woreda health offices, 41 hospitals, 160 Health

Centers and 117 HPs) were visited.

Technical and financial support was given to 6 zone level review meeting and one Regional

HMIS consultative forum with RHB management & staff, ZHD Heads & M&E Experts that was held during the reporting period. During this reporting period SNNPR JSI HMIS staff held their quarterly review meeting. During this period Regional office reviewed EFY

6-month performance of the project and three-month performance of FY 2017/18 independently.

Central office project team together with HIS field level experts conducted supportive supervision to Silte zone of SNNPR. The purpose of the visit was to assess field level JSI

HMIS project technical assistance / support and its execution, implementation of reformed

HMIS, encountered challenges, and best practices. The supervision was conducted jointly with M&E coordinator of Silte zone. During field visit data was collected using two types of structured checklists to assess the overall implementation of reformed HMIS, data quality and information use. The team conducted in-depth discussions with zone, woreda and health facility leaderships using the checklist designed for this purpose. The supervision team visited a total of 16 AHUs (7worHOs,5 HCs, and one health post.

Program Area 3: Technical Assistance to Oromia Health Bureau

HMIS scale up project has continued its technical and financial support to Oromia regional health

Bureau as part of ongoing commitment to strengthen routine health management information system in Oromia region. During the reporting period of oct,1st, 2017 to September, 30,2018:

HMIS Training - Capacity Building of health care providers, Mangers, HIT and HEWs

A total of 2,748 (228 Female, 2,520 Male) managers, experts and health workers have received trainings of Revised HMIS tools;

DHIS2 training for a total of 3,954 (973 Female, ,981 Male,) participants who came from regional Health Bureau, Zonal Health Offices and health facilities

Pastoral CHIS training for a total of 1,877 (1,712Females, 165 Male) health Extension workers from pastoral communities

Pastoral CHIS training for a total of 459 (108 Females,351 Male) experts and workers and

Managers from Woreda health offices and health centers of pastoral communities;

Dhis2 and Health Net deployment, Implementation and follow-up

Actively engaged in DHIS2 offline and VPN orientation and training programs for HIT professionals, local enterprise group members organized to implement local area network (LAN) at health centers and primary hospital, cloning and upgrading of old computers so that DHIS2 software’s can be installed for offline data entry, VPN connectivity and functionality assessments.

Dhis2 offline installed in all ZHDs and towns (39), all woreda health offices (316), all hospitals, except newly opened ones(96%) and 55% health centers;

122 woreda health offices, 14 ZHDs and 86 health facilities have online connection

To date VPN reached 648 sites (42%), among them 562 AHUs and Health institutions have functional VPN;

Network installation training provided for 80 Small and Medium Scale Enterprises

(SME) members organized by the regions, and 12% health centers have function

LAN

Ongoing Dhis2 Deployment, updating and implementation follow up, providing technical support to ZHDs, woreda health offices and health facilities, VPN training for professionals and woreda ICT agencies and, entering backlog data at cluster sites, data importing, compiling and generating reports, VPN functionality and connectivity assessment and follow up support, were done over te reporting period.

Project staffs together with RHB M&E Experts have conducted supportive follow up visit to 377 sites (77 woreda health offices, 56 Hospitals, 135 health centers and 109 Health posts). two Regional HMIS staff meeting was held during the reporting period.

Logistics Support: The project has printed and distributed CHIS tools for health posts in the pastoralist communities which includes 413 Family Planning, Maternal and New-born

Health Registers, 413 EPI/GM, Nutrition Screening and TFP Register, 413 Curative care

Register, 1239 Household catch registers, and 275,000 Health Service Reminder Card

(Maternal & Child Health). Additionally, purchased and donated 345 shelves purchased and distributed to hospitals and health centers to strengthen medical record Units (MRU)

Program area 4: Electronic System Maintenance

As part of ongoing support during the reporting period regular onsite software maintenance support was given as per the request made by woreda health offices and health facilities and problems identified during planned scheduled visits to the woreda health offices and health facilities by project and RHB staffs. During the reporting period a total of 710 AHUs have received IT maintenance support throughout SNNP region (243 hospitals and health centers, 392 woreda health offices and 75 zone health departments). 362 (87female,275 male) professionals trained in ERIS eHMIS/eIDSR/eMCs .

Program area 5: Multi Sectoral Response Information System (MRIS)

During this reporting period 88 woreda health offices (56 SNNPR and 32 Oromia Region) have received supportive supervision and maintenance support on eMRIS.

D. Lessons learned

It is essential to promote and maintain ownership at all levels of the health system for sustainability of HMIS with special emphasis to engage Health Science Colleges and universities in capacity building of the health staff and managers.

E. Implementation and coordination strategies

i. Sustainable HMIS Scale-up

The ultimate goal of HMIS scale-up is to ensure sustainability of a high performing (in terms of data quality & information use) HMIS in the country. This requires not only technical inputs like

DHIS2 or developing HMIS skills of health managers and health facility staff, but it also requires shifts within the organizations, i.e. FMOH, RHB, ZHDs & WorHOs towards enhanced ownership and leadership capacity, installing culture of information and taking more responsibility to assure

HMIS sustainability. The project will continue to support such cultural shift through its capacity building and mentorship activities as well as through engagement of the health managers and staff in the design, implementation and M&E of HMIS strengthening interventions.

ii. Geographical Coverage

The technical support will be provided at two levels:

At the Federal level, necessary support will be provided for capacity building, coordination and collaboration for nationwide implementation of HMIS and for improving M&E system using

HMIS.

At regional level, the Project will continue provide support to SNNPR, Oromia, Amhara, Addis

Ababa, Tigray, Afar, Benshangul Gumuz, Gambela and other regions as per the guidance from the ministry for sustainable well-performing HMIS through organizational capacity building in regions.

iii. Coordination strategy

The project will continue to maintain close coordination and collaboration with the PPD/HITD/

FMOH, Regional Health Bureaus and the Zonal Health Departments. Development and implementation of the work plan will be on the basis of consensus, coordination and collaboration with the RHBs. The Project will also participate in various working groups established by the

FMOH and RHBs for broader coordination among all the development partners.

For scaling-up Emergency and Referral Information System (eRIS), the Project will work in collaboration with FMOH/Medical service directorate according to the activity plan agreed through a consultative process.

iv. Project Management

The HMIS Scale-up Project established excellent rapport with the Regional Health Bureaus of

SNNPR and Oromia, Federal HIV/AIDS Prevention Control Office (FHAPCO) and PPD/HITD of

FMOH.

Currently, the Project has over 57 permanent staff, except the central office in Addis Ababa others are embedded within the government offices.

The Project pursues a visionary approach for its management, with the staff motivated to take charge of their tasks and work in teams to implement agreed upon strategies and priorities.

Aligning and harmonizing with the overall objectives of the FMOH and RHB has been the cornerstone of the project approach where our staff shall be an input for the effective and efficient implementation of planned activities. Thus, every staff member has the inspiration and is committed to achieve the project goals of contributing towards improving the health of the people in Ethiopia.

v. Project Work Plan based on HSTP-Information revolution

Activities in this work plan are extracted from the two pillars of information revolution transformation agenda and geared with the overall objective of improving utilization of quality health service through evidence-based monitoring and management decision making at every level which is broader Result Framework of USAID | Ethiopia

Major activities planned for the year 2018-19

1. Strengthening Human Resources for Health (FMOH, Regions) Through capacity building

Electronic Health Management Information System

Electronic Medical Catalog System (eMCS) maintenance to Health Center and hospital

Revised HMIS training for private Health facilities in regions

Project staff capacity building and review meeting

2. Strengthening Strategic Information for evidence based Decision-making

Printing of Registers and Tally sheets for all regions

Supportive Supervision to administrative health units & health facilities (hospitals, health centers, clinics and health posts)

Technical support to develop guidelines

3. Strengthening policy development, health system management and governance

Digitization: Development, Customization and Rollout of electronic applications

• Deploy High-level professionals for IT support, HIS and software Development

Provide Health Net equipment to 50% of health facilities in the country

Annual Work Plan FY 2017-18: JSI HMIS Scale-up Project

HMIS Scale-up Project Result Framework

Project

Intermediate

Results

Project Outputs

HMIS contributing to increased utilization of quality health services

HMIS scaled up & used for planning and management decision making at RHB, Zonal, Woreda and Health Institutions leading to improved Health Systems management

Strengthened Human Resources for

HMIS

Strengthened Strategic Information access for evidence based decision making

Improved capacity of government entities to plan, manage & support service delivery

Staff trained on /HMIS, CHIS and information use

Staff trained on electronic

HMIS (eHMIS/DHIS2, eIDSR, eMCS, eRIS, eMRIS)

(eHMIS/DHIS2, eIDSR eMCS, and eRIS are installed and functional

Supportive follow up conducted

HMIS/CHIS review meetings

(workshops) conducted

Performance Review Teams (PRT) at every

Health Administrative Unit meeting regularly and using HMIS information for performance monitoring and decision-making

Support from & commitment of FMOH &

RHB available for Performance review & decision-making based on HMIS information by Regions, Zones, Woreda & Health Facilities

Staff trained on Supportive

Supervision and connected woreda

Overall Goal

Project Objective

Health Net/ IT equipment made available

Project Implementation Work Plan Matrix

Project Title: HMIS Scale up project

Period covered Oct 2018-Sept 2019

(Q1 = Oct-Dec 2018; Q2 = Jan-Mar 2019; Q3 = Apr-Jun 2019

Result / sub-result

Major Activities Output Indicators Annual

Target

Target by quarter Assumption / Remarks

Q1 Q2 Q3 Q4

DO2: Increased Utilization of Quality Health Services

IR : Improved Health Systems Management & Integration at the National & Community Levels

Sub-result 1: Strengthened Human Resources for Health

1.1 Electronic community health information system

master TOT and Regional ToT Number of participants trained

90 90 11 experts from MOH,4 officers from Tigray, AA Amhara, Oromia, SNNP, Somali. 2 Experts from Gambella, Harari, Dire Dawa, Afar and Benishangul Gumuz. A total of 90 officers. Training will be given in two rounds. 35 officers will attend the first training and 55 experts will attend the 2nd.round.

1.2 Trainings on DHIS2 and eCHIS for Health care

providers and health managers

Number of personnel trained

506 506 A total of 506 officers from 169 HCs and Hospitals (3 staff per HC, (3*169) will be trained for a duration of 3 days.40% (202) will be trained on Oct.30%(152) in November and the remaining 30%(152) in December.

1.3 Revised HMIS training for private Health facilities in

SNNPR

Number of of HEWs trained on pastoral

CHIS

65 65 A total of 65 health professionals from private /NGO health facilities will be trained for 2 days

1.4 Project staff review meeting Number of of Review 2 1 1 a Total of 60 staff will review

Target

Target by quarter Assumption / Remarks

Q1 Q2 Q3 Q4 meetings conducted annual performance meeting for 2 days 2 times a year 1st Meeting will be held on November and the 2nd. on April

Sub-result 2: Strengthening Strategic Information for evidence based Decision making

2.1 Print and distribute FMOH Annual Review meeting

documents/ guidelines ( Woreda base planning guideline, performance report... …)

Number of guidelines printed

6,000

6,000

Print 6,000 various documents ( Annual performance report, Woreda based planning guideline…) with an estimated unit cost of $3.127

2.2 OPD Abstract register Number of OPD

Abstract register printed

21,733

21,733 print 21,733 OPD abstract registers with pad of 200 pages with an average unit cost of $5.82 for FMOH-national

2.3 IPD/Admission discharge register Number of

IPD/Admission discharge register

8,660 8,660 print 8,660 IPD/Admission discharge registers with pad of 200 pages for FMOH-national with an average unit cost of $5.82

2.4 Client attendance tally sheet Number of Client

attendance tally sheet printed

10,525 10,525 print 10,525 Client attendance tally sheet with pad of 200 pages with an average unit cost of $5.82 for FMOH-national

2.5 IPD service tally Number of IPD service

tally printed

3,580 3,580 print 3,580 IPD service tally with pad of 200 pages with an average unit cost of $3.51

2.6 Printing of Male card (Revised) Number of Male card

printed

4500 4,500 print 4,500 revised male cards with an average unit cost of $

0.11 for SNNP and Oromia

2.7 Printing of Female card (Revised) Number of Female

cards printed

4500 4,500 print 4,500 revised Female cards with an average unit cost of $

0.11 for SNNP and Oromia

2.8 Printing of Integrated MCH card (Revised) Number of Integrated 4500 4,500 Printing 4500 Integrated MCH

Target

Target by quarter Assumption / Remarks

Q1 Q2 Q3 Q4

MCH cards printed card (Revised) with an average unit cost of $0.11 for SNNP and Oromia

2.9 Family Folder Pouch (Revised) Number of Family

Folder Pouches printed

32000 32,000 Print 32,000 Family Folder Pouch (Revised) with an average unit cost of $0.36 for SNNP and Oromia

2.10 Printing of health system Registers Number of health

system registers printed

5,000 5,000 Print 5,000 of health system Registers with an average unit cost of $ 2.91 for SNNP and Oromia

2.11 Assign full time HIS officers Number of HIS officers

assigned

30 30 full time officers are assigned in SNNP,Oromia, Afar,A.A, Amhara, Tigray

Sub-result 3: Strengthening policy development, health system management and governance

3.1 Deploy eCHIS Developers at FMOH Number of developers

deployed

5 5 full time IT developer hired and working at FMOH

3.2

Deploy IT support officers at regional and zonal level Number of IT support assigned

17 17 full time IT professionals are deployed and working at regional level

3.3 Supporting Regions to establish DHIS2 help desks Number of RHB with functional help desk

4 4 IT professional hired and working at FMOH

3.4 Provide regional/National support on DHIS2, eCHIS, eRIS ,eMCS implementation and onsite support and follow up

No of regions supported

9 A total of 14 health units( 2worHO,4HCand 8 HPs ) per officer every four month for 15 days (39*14*3times)=1638

3.5 Health Net equipment,( Wall outlet, Trunk for

facilities, CISCO access, RJ-45 with jacket, Fisher Screw and network cable) for Health administrative unit and Facilities

Number of Health facilities received network equipment

1,500 1,500 Health Net: equipment will be purchased for the remaining 1500 health facilities [50% of 11 Regions, 109, Zone 905 woreda, 303 Hospital and 3,636 health center)

3.6 Documentation Dhis2 and Health Net implementation

and development of SOP and Job Aid

SOP and Job Aid 1 1

Target

Target by quarter Assumption / Remarks

Q1 Q2 Q3 Q4

3.7 Technical Assistance from HQ Number of TA

provided

2 1 1

3.8 Project closeout Detail implementation plan (DIP)

is prepared