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By Stacy T. Nelson

Health Care Information System. DHIS

The paper is going to envisage one of the health care information systems, such as District Health Information System (DHIS) and its implementation in the Primary Health Centers (PHCs) in the developing countries. Beside that, the work will discuss whether the DHIS is brought into accordance with the needs and requirements of the users and whether this type of the information system can be used in the operation of various health care institutions.

According to Elaine Byrne, the participant of the Public Health Program in the University of the Western Cape, South Africa and Sundeep Sahay, the member of Dept. of Informatics at the University of Oslo, Norway, “[p]rimary health care is a crucial element of national health care delivery, especially in developing countries where the majority of the population live in rural areas relying on governmental systems of health care. Primary health care systems are responsible for providing various outreach facilities to the community… A variety of programs fall under the ambit of primary health care requiring routine reporting of information. In addition to routine monthly information, the primary health care sector needs to also deal with large amounts of extraordinary data arising from, for example, epidemics and deaths that require immediate response and action.” (Byrne, E. Sahay, S. n.d.) As health care workers spend a lot of time collecting, recording, and transmitting the necessary data the governments of the developing countries have been recognizing the potential and the value of the information and communication technologies use in the health care institutions. Thus, this paper is going to concentrate on the discussion of such information technology as the District Health Information System and its implementation in the rural areas of India.

The DHIS represents the software “addressing vital issues such as user friendliness, data accuracy, adaptation to local language (Kannada,Telugu, Hindi,etc) and design and use of indicators based on local need. This software allows data to be transmitted to other users, both horizontally at PHC, tehsil or district levels or vertically up the hierarchy.” (An Overview of the District Health Information System Software (DHISv1.3) 2005) The system is designed to gather, transmit and store data, as well as to analyse and then use the health information that is gathered. The DHIS software was created by the international HISP team and it corresponds with the philosophy of the ‘Free and Open Source Software’ and so it is available to everyone who is intended to use this software. “DHIS supports functions of accurate and valid data collection, aggregation, storing, sharing, transmission, analysis, reporting, display and use of health data at and between every level of a district health system from sub centre to district and at the state level. It allows drilling down or aggregation of data at any and every level of the health system such as sub center, PHC, taluka, district and state.” (An Overview of the District Health Information System Software (DHISv1.3) 2005)

As for more details connected with the functioning of the DHIS, they are the following. The health centers at various levels have the possibility to enter data and generate reports connected with the services these institutions provide. And the data can be both hospital and primary health care data. To guarantee the data accuracy the validation checks can be conducted as they are built in the software. Beside that, the transmission of the data in various levels is also allowed. The export and import of the data can be realized with the help of the floppies, CDs and e-mail. And what is important is that the data transmission can be held both horizontally and vertically in the organization. Due to the system mechanism when the data is sent the system allows to choose only that information that is supposed to be sent. Also, the system is very adaptable and flexible and thus it allows being adapted to the needs of the users at any level. Beside that, trained users have the possibility to add, for instance, new facilities or validation rules when the need for the change and upgrading arises. What is very important in the system operation is that it allows receiving feedback on all the data that is contained in the system. The reports can be generated and customized to the needs of the system users. The reports can contain graphs and charts that are easy to read and work with. There can also be semi-permanent data (population estimates, survey data, staff position, and infrastructure). So the system can function in “calculation of population based indicators, equipment management and personnel management. Some data only need to be collected annually or six monthly and can be updated as and when changes occur.” (An Overview of the District Health Information System Software (DHISv1.3) 2005) Use of the local language is also important as the local language is often used in the smallest units of the health care. Thus, the local language support is included in the software.

These are the possibilities that the DHIS provides for the local rural health care institutions.

And hereinafter the paper is supposed to discuss the implementation of the software in India provinces as well as the challenges and the positive sides of the implementation.

In India HISP started the implementation of the software in December, 2000 in Chittoor in Andhra Pradesh. And since then the software has been continuously adapted for the field. (About HISP India. n.d.) And later on, until 2006 the implementation of the upgraded DHIS 2 was held in Kerala, Gujarat and Jharkhand. It was the process of the pilot installation of the software in some of the PHCs that under the condition of the successful operation was supposed to continue in other areas. (Implementation of the District Health Information Software version 2.0. n.d.)

The strengths or the success factors for the implementation of the DHIS are the following. First, the participatory and prototyping approach is supposed to be used. “Such an approach takes time – more than 12 months in total – but significantly improves the quality and acceptance of e-health applications.” (Quraishy, Z. B. 2004) All the interfaces and data sets are supposed to be demonstrated to, used by, and discussed with the health staff and district administration. Second, it is very important if such innovations as the implementation are supported by the high levels within the public sector. Third, the flexibility of the system is the key factor for the successful implementation of the DHIS as it is able to match local needs, and the customization of the system can be constantly continued.

The weaknesses of the implementation of the DHIS lie not in the drawbacks of the software itself but in the constraints from the side of the health stuff and the governments. Here these challenges are going to be enumerated. First, bureaucratic policies can be a serious barrier for the software implementation as even if the process is supported from the top level of the political tree the middle-level institutions can be not very supportive that can significantly slow the implementation process down. Second, there can be the competition between the priorities of the health staff and higher-level officials on one hand and the HISP staff intended to train the workers on the other hand. The officials can prevent the health staff from the training as they do not want them to be diverted from their health work. Third, because of the frequent staff transfers the project team of HISP often cannot train the staff quickly and efficiently. Fourth, the infrastructural shortcomings such as, for instance, supply problems with electricity can cause serious problems with training.

Fifth, there may appear vendor support issues connected with the hardware. Guarantees of maintenance, repair or replacement of the equipment can be quite expensive; and in practice the PCs can break down very soon. Sixth, it can be quite difficult to make the health staff get used to work with the new equipment as they can soon return to their manual ways of working in spite of their being much more time-consuming. The reason for it is simple – “under the new computerized system, staff are unable to manipulate the figures before they are submitted to higher authorities, as has been their norm.” (Quraishy, Z. B. 2004)

The recommendations for the successful implementation of the DHIS in the rural areas of India can be the following. The participatory and prototyping approach is to be used as the feedback from the health staff is necessary to improve system quality and to make the whole DHIS work in the actual conditions. Beside that, social issues have to be considered because without this consideration the success of the implementation of the DHIS can be short-dated. The bureaucratic system has to be involved into the process of implementation as otherwise it can prevent the innovators from the DHIS implementation.

It is also important to mention that the DHIS can be used in many kinds of the health care institutions such as “sub centers, primary health centers, taluk and district health offices and hospitals such as taluk hospitals and community health centers administered by the district health officer, state health departments…” (An Overview of the District Health Information System Software (DHISv1.3) 2005)

Consequently, the DHIS is a great innovation helpful for the health care institutions in the developing countries.

References

1. About HISP India. (n.d.) Retrieved June 13, 2007 from http://www.hispindia.org/index.php?section=2

2. An Overview of the District Health Information System Software (DHISv1.3). (September, 2005). Retrieved June 13, 2007 from http://www.hispkerala.org/docs/An%20Overview%20of%20the%20District%20Health%20Information%20System%20Software%20V1.3.doc

3. Byrne, E., Sahay, S. (n.d.) Health Information Systems for Primary Health Care. Retrieved June 13, 2007 from http://209.85.135.104/search?q=cache:khDijqxIHUEJ:www.ifip.org/TESTIFIP/WebPages/openbiblio/opac/viewDocument.php%3Fid%3D84%26PHPSESSID%3Dff38181250ee3a1270b92c675988965f+District+Health+Information+System+implementation+in+india.+interviews&hl=ru&ct=clnk&cd=1&gl=ru

4. Implementation of the District Health Information Software version 2.0. (n.d.) Retrieved June 13, 2007 from http://www.hisp.info/confluence/download/attachments/7586/DeliverableD3.2.pdf?version=1

5. Quraishy, Z. B. (March, 2004). A Health Information System for Indian Districts. Retrieved June 13, 2007 from http://www.egov4dev.org/dhis.htm