2017 DHIS2 Symposium

Symposium Program: https://www.dhis2.org/symposium2017-programme

Presentations Link: https://drive.google.com/drive/folders/0B6ablhPQZu2bY1M5UXBHT0YyTWc

Notes by section

Key Follow ups :

Follow up with Patrick on reviewing and participating in drafting use cases for the DHIS2 Implementer Guide
Follow up with contacts in Guinea about the roadmap and OpenLMIS version 3 features

Day 1 - Thursday, March 23

Opening Remarks - Nicola Hobby

University of Oslo - National engagement in DHIS2 Projects - Knut Staring

Knut - provided a good background to the system, focus on integration with other systems, staying open. Referred to logistics systems as a system to integrate with and not do.

Aggregate Data Exchange (ADX) for direct system to system integration
OpenHIE (health information exchange) act as national backend resources for all 'front systems'. Recommends a gradual approach given the complexity. Essentially use one system as the facility registry until the full registry is implemented? Not sure each system needs a server and support team for each registry. There are ways to reach improved integration gradually.

Looking forward

integrating surveillance (between social media and health systems) across the region, not just nationally
integrate case level data in some places and aggregate in others
How to sustain systems on the ground - encourage partners to support personal growth through:
- Academies, mentoring, regional experts, academic scholarships
- Equally important to collaborate on human resources
Interoperability Implementer Guide: Supported by UNICEF/GAVI
- Target group: Implementers, decision-makers
- Guidance on system choices
- Success stories
- Contributions to OpenHIE discussion
Online living implementation guide - not yet developed, may live in a wiki - haven't yet decided on format CONTRIBUTIONS WANTED! How do we get involved with this? Follow up.
- Concepts of integration
  - eg. OpenHIE
  - Integration vs. interoperability
- Step-by-step
- Functional and disease specific topic pages
When asked on how to approach sharing data, Knut advises on first publishing meta data. Then slowly working towards sharing more and more data.
Is there going to be one national database for HMIS data? Countries would like this but not NGOs.
- Interoperability is one way of approaching that - allows organizations to keep their autonomy while still encouraging collaboration.
Question: Have you seen a leadership organization (ex. PEPFAR) having success in moving forward conversations on integration?
- One hurdle to changing national systems: Have printed many paper forms, spent $ on printing, distributing and training - to change that will take a few years.
- Digitizing and using tablets and mobile phones makes it technically feasible, but it goes back to what the organizations want to do.
- Have seen a few countries where key donors have managed to pull together MOH, WHO, and other key stakeholders (example, CHAI, malaria consortium) into a room and get them to collaborate. Slow process.

FHI360 Nigerian national DHIS2 implementation

Nigeria FHI360 Office (570 million dollar budget)

GF, USAID, BMGF, UNICEF are the donors
have projects in all states within Nigeria

Actors

Government is driving
Implementers are navigators (direction from donors) but there to support the government. Big role in advocacy
Donors
UN agencies

Data governance over the HMIS falls to the statics department (DPRS) on paper but in practice it is more complicated. There are three national DHIS2 instances (see slides for the diagram). Great example of parallel reporting.

Reporting % are up in the 60 - 70%.

Key Challenges

parallel reporting systems (drain on data capture) due to
- multiple stakeholders,
- multiple program/disease areas
- multiple KPIs
- varying reporting schedules PEPFAR is before National reporting process
- ownership, want more instances to 'own' the entire process and control

How to solve it?

Single platform
Tool harmonization (included a 2 year review process)
Migration to DHIS2 for all program (outside of HIV)
2013 focus multi level data reporting (using mobile)
Committee to focus on data quality and integration

Roles of implementing partners

usually where there are NGOs the reporting rates are higher

Data Use

one focus is on reporting rates (data capture/operational) - usually the first step. Likes to see performance versus other districts to promote improvements.
quarterly newsletters using charts and graphs

Future

integrated health data management
data quality initiatives
EMR/dhis2 interoperability (scale up EMR use to ease the burden of data capture)

E8 - Southern Africa Development Community - Malaria Elimination 8

EAC - East African Community

ICAP Headquarter and Country Integration

ICAP
Laura Lincks

Why they chose DHIS2

Community support
Open source
enhanced visualizations
APIs
Simplified organization of data elements

DHIS2 Informs Management of Results-Based Financing in Tanzania

Broad Branch Academy
Jenna Wright

USAID

Results Based Financing (RBF)
Cyclical process, verification of results determines payment
Different from input-based financing

Public Sector Systems Strengthening (PS3) Activity

Tanzania is rolling out a national RBF system

Still in development - will be in 9/30 regions within the next year

Multiple actors, requires coordination, management, adaptability and DATA

RBF runs on data

number of services delivered at HFs (reported)
number of services delivered at HFs (verified)
Results of facility quality assessment
Results of council and regional performance assessment
Invoices (derived)

DHIS2 critical to successful roll out and management

TZ has adapted the DHIS2 system to meet the RBF functions

DHIS2 developers in-country still working to adapt the system

Data quality still poor (incomplete, erroneous, manual entry)
- Ongoing data cleaning efforts. Unable to replicate payment invoices at a later date.

Breakout 1: Data integration technical - DHIS2

Configuration of systems are often not harmonized. Things which can differ :

Mismatch between national systems, NGO systems, donor systems
Metadata codes - indicators
organizational hierarchy levels
Age groups

Problem 1 - Metadata codes are not harmonized between systems

National system	NGO system (ex. PEPFAR ID)
HIV_CARE	CARE_CURR

DHIS2 - Identifier schemes. Can add multiple codes to an individual element

Maintenance application - configuration

Attributes

Data Element: HIV_CARE

Changes parameter and code to CARE_CURR

Q: Can all attribute IDs be in one JSON dump?
A: Yes

Data Collection Frequencies

How to take monthly data and turn it into quarterly

Analytics export as raw data, using the Analytics API

All data mapping happens in the source system

Pivot table app - Data is monthly

Using the analytics function in DHIS2, it aggregates the data from months to quarters

Organizational Hierarchy Levels Vary Across Systems

Repeat the process using Analytics

Data element definitions are not equal across systems

Data elements: used to store data

Indicators: Used to express data

Program Indicators

To count individual records

Data collected using Tracker.

Connecting the Systems

Source system <--> Destination System
Integration Driver - Automated data integration → Proprietary, developed by BAO
- Cloud hosted
- Pull channel that makes a request to the source system - fetches and stores temporarily, then pushes into the destination system
- Allows to schedule, also allows logging
- Transformation, aggregation, mapping happens in DHIS2
- Pull and Push channels - just enter URL for source and destination systems

Using DHIS2 as a Business Intelligence Platform for a Health Insurance Provider

NHIF - Kenya

Great presentation on the theory of BI and approach to doing the business anslysis

Broad architecture of DHIS2 is a good.

Decided to use DHIS2 for pivot table, data sets, data elements and categories.

Pentaho Data Integration "Kettle" for ETL and Scheduling

first column - Straight writing, direct reporting
Independent Data warehouse, more structured data, improves performance, different cubes means you may find different results
Bus architecture - you think hard about reports you need and only have cube
EDW - operational data store (ODS) improves ability to update/change the cube

Cubes are dimensional data and all need to be represented in the cube

Business perspective

Design of reports/dashboards
Key figures
Dimensions
Hierarchies

Tech

Design data modal
Etl
Etc….
See slide

ETL process:

source is the transaction data and updates DHIS2
constantly checks for new organizations.
Takes a full night (6pm to 5am) to upload data into DHIS2
Extracts DHIS2 and Source data, transforms (compare old and new) - old data is removed, discarded
Then loads back up into DHIS2 the subset of new valid records

DHIS2 starts acting weird or not working around 300,000 data associations, which is a downfall. Normally professional data warehouses can handle many more (millions).

Data analysis is mainly done in pivot tables and only 50% of needs being met.

Question : will an additional investment of X KSH justify an increase of Y% covered reporting needs?

He would like to see DHIS2 as a tool for Enterprise Data Warehouse.

Challenges faced using open source:

more software packages, the harder to maintain (different versions, etc)
hard to have two maintain to open source systems
wants ETL within DHIS2
Enhance batch processing
Enhance import of data (overwrite, aggregate info, delete)
Enhance indicators (filter on attributes, re-usability)
Enable mast er data
Enhance use of dimensions

Day 2 - Thursday, March 23

Tanzania MOH and partner integration

by Wilfred Senyoni from HISP TZ at Dar es Salaam

End users found DHIS2 is easy to use and end up putting data into DHIS2 for dashboards. Sometimes facilities have their own instances and sometimes uses the national instance.
Problems :
- High reporting rates with DHIS2
- District are committed to using HMIS but not really clear on how to use the data.
- Data quality is quite low (40%). Data wasn't matching the paper registry or summary.
- Limited data interpretation and planning (not using the data).
webportal launched hmisportal.moh.go.tz to promote transparency and innovation (for partners to access data). Story was a partner for a specific program ended up getting the entire national system web portal up and publishing quarterly. He appreciated that the partner decided to support the national program from focusing on their own programmatic needs.
Strengthening HIS is a continuous process
Cultivate local capacity
strengthen existing local infrastructure
partners have a major role in routine information use

OpenLMIS Breakout Session

Good turnout for the session.