Accurate Assessment for a Better National Health Information

System: Bangladesh Experience

Muhammed Emranul Haq, GTZ, Bangladesh

AM Zakir Hussain, WHO, Bangladesh

September 01, 2009, Atlanta, USA1

Background• Bangladesh is located in the northeastern part of South Asia with land

area of 147,570 square kilometers. Most densely populated country in the world with a population of about 150 million, more than 920 persons per square kilometer.

• For administrative purposes, the country is divided into 6 divisions, 64 districts, and 496 upazilas (sub districts).

• Started HMN activities from December 2007

• Currently (2003-2011) the government of Bangladesh is implementing one of the biggest health sector programme named Health Nutrition and Population Sector Programme (HNPSP).

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Regional Context

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Unit Number

Division 6

District 64

Upazila (Sub district)

496(not shown in the map)

Union 4,490(not shown in the map)

Administrative Distribution

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Existing Health System• Bangladesh has made significant progress in recent times in many of its

social development indicators particularly in health.

• This country has made important gains in providing primary health care since the Alma Ata Declaration in 1978.

• Infant, maternal and under-five mortality rates have all decreased over the last decades, with a marked increase in life expectancy at birth.

• Due to a good health infrastructure and dedicated workers it has been possible to make those successes

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Existing Health System

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Ministry of Health and Family Welfare (MOHFW)

Director General of Health Services (DGHS)

Director General of Family Planning (DGFP)

National Nutrition Programme (NNP)

Directorate of Drug Administration (DDA)

Directorate of Nursing Services (DNS)

Line directors are the responsible for implementation of various programmes

Existing Health SystemThe Public Sector• Primary: It comprised of Upazila Health Complex (UHC) at sub-district

level which works as a health-care hub.

• Secondary: There are also field level personnel who are responsible for preventive healthcare services

• Tertiary: Above the sub district are the district hospitals, medical colleges, providing secondary care and national tertiary level care facilities.

The Private Sector• Both specialized and general hospital, clinic, diagnosis facilities are

provided

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Current Health Information System

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• Mostly vertical data collection, less integration, no quality control, lack of regular dissemination, less utilization for decision making

• Logical flow of data and availability is fairly absent

• Whereas, in other places, it needs attention

Health Information System Assessment : The HMN Tool

• The process of HMN for assessing country health information was useful to have some general picture of the whole system.

• Series of workshops were arranged with different level participants to get their input into the standard HMN Tool

• The process of assessment was useful which actually geared-up talking and thinking about the whole information system. This has created the opportunity for finding gaps and prospects

• Although all those workshop ended with fruitful outcome, the participants were not confident about the answers or they had lack of knowledge about the subject matter in most of the cases.

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Participants are working in the first workshop using HMN Tools

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More assessment initiatives• Later the HMN steering committee recommended to conduct more

intervention like:– In-depth review of existing system

• The participants took part in detail discussion in round table meetings. By active interaction it brought the real scenario

– Focus group discussion• Small meetings based on some selected topics helped to draw the insight

of the Health Information Status

– Field observation to key stakeholder organization• It gave the opportunity of verification of they discussed with the reality

– Small scale survey• The target group were 64 district level manager, who also gave valuable

answer of some simple questions.

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Roundtable discussion on different thematic topics

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Opportunity• The assessment process and subsequent initiatives made the opportunity

to start dialogue on Health Information and about the importance to build a efficient country health information system

• Created increased motivation among the data users, producers and among the donor community

• Add on activities (e.g. FGD, in-depth review, field observation, survey etc) helped to draw the real thrust sector, those needs to be improved further

• Identified the critical areas require immediate actions and long term actions

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Progress and Outcome : Some Evidence

• 2009 Annual Programme Review (APR) of Health sector took the assessment findings seriously and made comments and suggestions for future development

• GTZ (German Technical Cooperation Deutsche Gesellschaft für Technische Zusammenarbeit) came forward to help the country to build an efficient health information process thorough a participatory manner

• In March 2009 GTZ has initiated new initiative named Data Management Information System (DMIS) as a support to the Ministry of Health and Family Welfare Bangladesh

• This DMIS actively considering the HMN Assessment Result as a basis and they are also conducting more review and interview to know the actual need and finding out the gaps

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Planned DMIS Phases

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Inception

Analysis

Design

Implementation

Post Implementation

• Already completed the inception phase and analysis phase at final stage

• Phase wise dissemination and feedback will take place

• More participatory manner

• Always keeping close touch with the policy makers and fully considering their expectation

Conclusion• The democratic government has adopted a vision called “Digital Bangladesh”

• This positive and congenial environment from the policy makers will be helpful to implement such kind of information system for the health sector

• It needs to be mentioned here that during the first SWAP (Sector Wide Approach Programme) in the period of 1998-2003 some sort of unification initiatives named UMIS (Unified Management Information System) were taken but it failed finally

• DMIS is actively considering those lessons; they are trying to implement in previously requires very cautious steps to implement such kind of a system as this kind of initiatives were also taken and huge amount of money also been spent

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Conclusion• The HMN assessment process made the start, though it took a longer time

to really start the process due to some unavoidable situations

• With a careful eye the implementation of DMIS is taking place

• Ensuring more participation and suggestions from the policy makers have

• The government are very keen to see a fruitful outcome at the end

• More collaboration and support will be required

• For sustainability issue the government should come forward to implement and sustain it

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Thank you

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