There are limited efforts to collect and manage health data of vulnerable populations in Tanzania particularly people living with disabilities and women with high-risk pregnancies. Data management in some of the country’s healthcare settings is paper-based which poses several challenges. Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) collaborated with Vrije Universiteit Brussel (VUB) to improve the quality of care for women and people with disabilities in Tanzania through use of Health Management and Information Systems (HMIS). With support from SPIDER this work could be taken further.
The expected returns of using the HMIS were:
- to increase data quality and data use
- the delivery of quality clinical services at the hospital in terms of improved data-driven decision making
- simplify managing and tracking patients’ records
The hospital uses OpenClinic, an integrated software package for HMIS developed on an open source platform. The project also aimed at building capacity of healthcare workers at CCBRT to use HMIS.
College of Business Education (CBE) in Tanzania was contracted to conduct research on the project. The research team carried out a baseline assessment using semi-structured interviews, focus group discussions and literature review. The literature review included use of HMIS in Tanzania. Primary data was collected from clinical staff, non-clinical staff and technical ICT staff at CCBRT. The baseline presented the following findings:
Use of HMIS and its implications on quality of care
The baseline shows that use of electronic records in the health care sector in Tanzania dates back 1993 although the use has been mainly for data collection, management and analysis. This has kept many systems non-interoperable since other operations and processes at hospitals, clinics and drug dispensaries are not integrated to function as a single system. For example, hospitals had implemented Electronic Medical Records (EMR) and HMIS in clinical operations, but the two systems are not integrated and thus operated manually when reporting data to district health information systems. A national e-health strategy focused on strengthening the integration of electronic HMIS with other existing systems was created but systems are still fragmented.
In the case of OpenClinic used at CCBRT the quality of service delivery improved. Use of this software increased productivity and efficiency, eliminated fraud, among other hospital management needs. In 2015, CCBRT used the system’s SMS functionality to reach out to 7,800 clients. The hospital introduced mobile money transfer technology to facilitate referral of patients unable to afford transportation to the hospital. This system is currently used for referrals of women and girls with obstetric fistula and children with cleft lip. About 240 computers were connected to the hospital’s local area network and made accessible to both clinical and non-clinical staff. As a result, the orthopaedics and physical rehabilitation staff saw OpenClinic change their day-to-day operations. With digital x-rays in every surgical theatre, doctors and nurses can now see their patients’ imaging results stored in OpenClinic. OpenClinic has also been useful in the management of inventory at the hospital pharmacy and the management of records at finance and human resource units.
Challenges of using HMIS in health care settings
The baseline found that electronic capture of data alone cannot improve the quality of data and care. Other initiatives are required to improve data accuracy and reliability in HMIS. This requires training of users of the system. Before the introduction of the national e-health strategy 54% of health workers didn’t know who is supposed to use the information collected through HMIS and 42% of health workers did not use the collected data for planning, budgeting and evaluation of services provision. For the case of CCBRT, training increased perceived usefulness and perceived ease of use of OpenClinic. The baseline indicates that some users resist adopting HMIS and most decision makers inadequately use HMIS data to improve health system performance and delivery of quality services. The research highlights training as a solution to these challenges. Other challenges presented in the baseline report were technical for example lack of reliable electricity, internet connectivity and enough ICT facilities. These challenges interrupt the delivery of service.
%
Don't know who is supposed to use HMIS information
%
Didn't use the collected information
Tips for healthcare providers based on HMIS use case at CCBRT
- Ensure provision of continuous training and support to build capacity of health workers and to improve data quality. The dissemination of regular updates on HMIS developments to health workers also increases awareness.
- Involve staff in the design of HMIS. User-centered design will not only help with increasing awareness and readiness, but it will also help to change the mind-set of users.
- System integration is important for interoperability and convergence of different functionalities performed by different units.
- A reliable ICT infrastructure and resources, for example internet connectivity, enhance use of HMIS and maintaining such an infrastructure and resources require a budget allocation.