Week 2 Community assignment

Mr. Nurudeen Lanre Rasheed

For answering the assignment questions, I would like to give example of my country Nigeria, we are using DHIS2 (District Health Information Software Version 2.0) for Immunization data reporting and monitoring. I am well oriented with system myself as I am using it from its inception 2014 till today for the last 4 years from field reporting level to monitoring level.

In response to Nigeria’s multi focused and multi requirement health priorities, the Federal Ministry of health as at the 56th council on health in 2013 passed a resolution on the use of a single and integrated dataset and database for the collection and collation of all health-related data in the country. This heath database is currently the DHIS2 instance located at: https://dhis2nigeria.org.ng.

In aligning with the Nigeria Health Council’s directives, the National Primary Health Care Development Authority and CDC in collaboration with AFENET facilitated the customization and configuration of RI Module on DHIS2 National Instance, specialized for use by all the Routine Immunization stakeholders at levels. It is configured to accommodate the core components of routine immunization in clinical and vaccine management situations. The DHIS2 routine immunization (RI) module was launched in 2014 to facilitate access to timely and accurate RI data for effective decision-making. A second goal was to strengthen the overall health management information system in the country.

Following the calendar approved by the Immunization Coordination Committee (ICC) through NPHCDA, the DHIS2 RI module rollout was completed in all states in December 2017.

See figure 1:

Procedures on data collection, processing and dissemination cycle for ri data management

These procedures are being followed during the implementation of DHIS2 RI module in the country and it’s expected that all RI partners in the country should channel their data management resources and support towards its sustainability. These procedures cover four key areas listed below:

1.) Data collection and capture processes

2.) Data validation and approval processes

3.) Post data approval processes

4.) Maintenance procedures

These processes represent the full cycle of iterative steps needed to complete the data collection, processing and dissemination cycle for the R.I data currently residing on the instance.

Routine Immunization Data Collection Processes

Preparing and Submitting Monthly Data

At the end of every month the Local Government Immunization Officer (LIO) will work with the Local Government Monitoring and evaluation officer (M&E) to ensure that every health facility records in their local government area correctly aggregates the daily use routine immunization register into the approved monthly summary forms. The process of completing this task involves the following steps:

1.) Accurate tabulation of administered antigens and doses i.e. recorded accurately from the tally sheets to the register.

2.) Accurate calculation i.e. accurately summing administered doses into a monthly total.

3.) Accurate transcription i.e. accurately transcribing the above onto the monthly summary form.

The following approved forms are currently configured on the national instance:

1.) The NHMIS Monthly Summary (Version 2013)

2.) The Health Facility Immunization Microplan

3.) The Health Facility Vaccines Utilization Summary

4.) The Routine Immunization Supplementary Form

The LIO and LGA-M&E officer will ensure that all health facilities have sent these forms into the LGA headquarters BEFORE the 5th working day of the following month.

Process of Routine IMMUNIZATION DATA Capturing on DHIS2

Local Government Immunization Officers have been provided with data entry and view rights on the DHIS2 Nigeria instance. Before the 15th Calendar day of the month LIO will ensure that collected data for the following datasets captured onto the DHIS2;

1.) The Health Facility Immunization Microplan

2.) The Health Facility Vaccines Utilization Summary

3.) The Routine Immunization Supplementary Form

The NHMIS Monthly Summary Form (2013) which captures data on number of children immunized is done by the LGA M&E OFFICER – who has data capture and view rights

NB: Kindly note that four RI specific data sets have currently been reviewed to two data sets. The two main data sets for routine immunization that will be in use after HDGC approval will be NHMIS version 2018 and Vaccine Utilization Monthly Summary.

Data Locking

In order to enforce data timeliness rules and by extension enable a strict and best practice in change management and data integrity system, the data entry component of the RI Module will be “locked” for data capture. The lock feature is automated and will be enabled on the server by the FMoH appointed system administrators. The current lock policy is activated on the16th calendar day of every month. Steps to unlock the capture feature are spelt out below.

See figure 2:

LGA-level Data Review and approval process

Data Validation: At the end of monthly data capture, the LGA M&E officer will run validation on all the datasets. Validation violations are highlighted in the DHIS2 as a printable report. This report is to be used as feedback to all the facilities highlighted as showing errors. Because of database locking policy, it is advised that validation be done as soon as data is entered by the facility. However, even if it is done after each facility is entered; it is still recommended that their LGAs data are batch validated when all facilities have been captured.

Data approval: is to be done every month. This is a prerequisite for data reports i.e. data is approved before it can become available for analysis and other allied reports in the DHIS. A designated member of the LGA health data management has been given view and approval rights on the DHIS. Approval happens per dataset and is required as the last step in validating captured data.

The above is repeated at state level with the relevant stakeholders.

Feedback Mechanism

The formal feedback is provided as errors after data entry – this is the first line feedback and can be regarded as an absolute validation and serves as feedback to the service level and simply highlights entry errors which are often purely arithmetic in nature. Second line feedback is provided – this is more expert level and is a track of the key indicators being monitored every month. It is expected that an LGA monthly RI data review will be held. At this meeting DHIS data is printed out, discussions are then being held around the key messages that can be drawn from the data. Below;

Figure 2: Cycle of existing monthly RI data feedback mechanism

[Description: Data flow from the community to the federal ministry of health (The National Health Management Information System (NHMIS) Branch, FMOH, 2009) ]

Figure 3

 

SWOT ANALYSIS

Strengths

-Successful harmonization of various programme data collection tools

-Availability of DVD-MT which helps in migrating historical RI data and from DVDMT into DHIS2, and program the main performance and process indicators into the DHIS2 platform.

Weaknesses

-The present policy focuses on routine health service data only

-No level of government was able to meet the minimum requirement for HIS in terms of human resources, infrastructure and funding

-The roles and responsibilities of all stakeholders in the DHIS2 were not clearly defined in the policy

-Non availability of data reporting tools

-Lack of adherence to Standard Operating Procedures (SOPs)

- Duplication and inconsistencies update of health facilities on DHIS2 platform

- Non availability of social responsibility role of the major telecommunication companies (e.g. MTN, 9mobile, Airtel. Glo etc.) on the modalities to access cost free access to DHIS2 national instance URL in in Nigeria.

Opportunities

-Stakeholders consensus to strengthen the HIS

- Existence of funds within vertical programmes that can be leveraged upon to strengthen the DHIS2

- Availability of a National Strategic Health Development Plan and an M&E Framework which provides overall policy guidance for HIS

Threats

-Lack of sense of ownership of data (production and usage)

-No guidelines for coordinating activities of all stakeholders in DHIS2

-Data quality assurance not reflected in the previous policy

SUMMARY

From the answers for assignment questions it is evident that Nigeria is having a well-established mechanism for Immunization monitoring such as DHIS2 and it is evolving day by day ,But establishment and configuration of DHIS2 RI Module help desk system which will enhance user experience on the use of DHIS2 national instance need to be put in place ,so the data from field can be used for current strengthening of immunization planning.

References

Standard Operating Procedures (SOPs) for the optimization of DHIS2 IN Nigeria.
National Health Information system Strategic Plan (2014-2018)
Towards Implementing a Nationwide Electronic Health Record System in Nigeria Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/Data-flow-from-the-community-to-the-federal-ministry-of-health-The-National-Health_fig1_264422732 [accessed 6 Nov, 2018]