ICAP Tanzania’s Experiences
Implementing an Aggregate
Database: District Health
Information System (DHIS)
Joshua Chale, Data Manager
July 28, 2010
Why DHIS?
• Prior to implementing DHIS, NACP used multiple systems at district level i.e MS
Access and EPI info. Data most commonly submitted to regional and national
level with excel spreadsheets.
• In 2008, University of Dar es Salaam (UDSM) received funding from JICA and
technical support from University of Oslo to pilot DHIS as a component of the
Health Information System Program (HISP)
• Pilot launched in Coast region with 2 program areas: STIs and VCT.
• In 2009, a 3rd program area PMTCT was added and ICAP was invited to a
meeting to review initial pilot results (as HIV implementer for this region)
• As of the end of June 2010, UDSM rolled out DHIS to 27 of 122 districts.
• Currently DHIS contains the following program areas PMTCT, VCT, MTUHA
(HMIS), EPI, population data
DHIS Benefits
• Can run as a web-based and as an
offline application.
• Relatively easy to learn and adapt
(does not require high level of
programming knowledge)
• Allows multiple levels of
organization units to be entered
and data can be aggregated
accordingly (POS (dept) →Site →
District → Region → National level)
• Incorporates data checks during
data entry and after data collection
DHIS Benefits
Cont….
• Facilitates data analysis within DHIS or with reporting
tools such as iReport, Birt, or pivot tables
• Maintains Security through defining user levels
• Allows user to tailor indicators
• Streamlines data and site census management because all
program areas data are kept in one place
• Facilitates data use because all staff can access data at any
time from office
Sample charts from DHIS 2 (iReports)
ICAP DHIS Implementation to Date
• ICAP customized DHIS to include:
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PEPFAR and ICAP NY indicators and disaggregations not in national system
Data entry screens consistent with data indicators
Customized reports in line with data tables for QR
Points of service within facility (for HTC)
Data checks in line with URS
Export files for submission of data to NY
• Phased Roll Out:
– December 2009: HTC; data entry in 2 regions
– March 2010: HTC +TB/HIV; data entry in 2 regions + central data entry for 2
additional regions
– June 2010: HTC, TB/HIV, PMTCT; data entry at regional level by all 4 regions
• Training:
– All M&E staff were brought together and trained in DHIS basics
– Data managers receiving advanced training in system upgrades, reports,
import/export and Installation
MOHSW Implementation Challenges
• Limited:
– computer skills & infrastructure
– culture of data use
– technical support
– Feedback of data to site
• Weak M&E systems; worker overload
• Poor data quality
• Poor guidelines for DHIS use
ICAP-TZ Challenges in adopting DHIS
• Training offered by UDSM for TZ pilot focused on data entry
for district level users; training isn’t targeted for local
adaptation or customization
• UDSM did not receive training in how to adapt or program
DHIS, therefore there is limited support for ICAP in our
customization
• Developing reports with BIRT is complex; iReport just added
is easy to use
• Importing historical data from old databases (TB, PMTCT, and
VCT) into DHIS is challenging
• Setting up multiple points of service for HTC for one facility is
time consuming.
• Terminology used in DHIS is not always intuitive
Additional training needs
•For users
 Understanding the database components
Using data checks, and checking data completeness
Data import/export and analysis
Pivot tables and iReport
• For developers
 Training on the understanding of database schema
 JAVA- So that one can have capability to modify the
database
Lessons learned
• DHIS 2 is a flexible, easy, system to adapt for local data
collection tools
• Despite limited support UDSM is able to provide, it is helpful
to have a local firm to assist in problem solving and
troubleshooting
• DHIS has been adapted in numerous countries around the
world and there are several online communities and
resources for additional information exchange
How will DHIS help promote high
quality care?
• DHIS will save time, facilitate reporting,
freeing up M&E to spend more time on
supervision and mentoring
• DHIS will help M&E team communicate results
better to clinical team
• DHIS facilitates feedback to sites for program
improvement
Way Forward/Next Steps
• With advanced knowledge of DHIS (through
ICAP adaptation and use) ICAP is poised to
support districts in roll out
• Can focus ICAP support on routine feedback to
DHMT and sites rather than data collection
• Can help District mgmt teams focus
supervision visits on sites with weaker
programs and facilitate information use in
supportive supervision
ASANTENI SANA