DHIS 2 Symposium Explores Future of Global Health Data Management

On March 22 and 23, stakeholders from a number of global organizations (NGOs, USAID, Ministries of Health [MOHs], and others) met at a symposium in Washington, DC, to discuss progress and future capabilities of DHIS 2, the open-source web platform that helps governments and organizations collect, manage, and analyze health data.

The symposium, which MSH co-sponsored along with BAO Systems and the University of Oslo (UiO), was an opportunity for participants to learn about the development roadmap of the software, meet the development team, and learn about UiO initiatives in advancing the DHIS 2 learning environment.

DHIS 2 runs in more than 60 countries to date. It provides a wide range of possibilities for building integrated yet customized information systems. The system was developed and is managed by the Department of Informatics at UiO and supported by the Health Information Systems Programme network. Since 2013, DHIS 2 has become the management information system of choice for many international NGOs working across a variety of sectors.

A number of MSH staff presented at the symposium. Randy Wilson, team leader for MSH’s Rwanda Health Systems Strengthening (RHSS) Project, spoke about how the program was used to support the creation of a health data warehouse in Rwanda. DHIS 2 was used to power the country’s health management information system (HMIS), which now collects data from more than 700 health facilities. Its use has improved timeliness, completeness, and accuracy.  

“With the popularity of the DHIS 2 platform in Rwanda, we faced a new issue of many parallel DHIS 2 instances. The health data warehouse was created to pull together key indicators from each of them and serve a one-stop-shop for health sector indicator data,” Wilson said.

DHIS 2 is also being used in Bangladesh to manage TB case reporting in conjunction with e-TB Manager, an electronic TB case management program. Andre Zagorski, Senior Principal Technical Advisor, detailed the process of integrating the systems.

“With any big interoperability efforts like that, when you’re trying to link big systems, they really need a broad consensus dialogue. It’s important to educate the ministry and donors. Often they think [information systems] are apples and oranges, but we’ve proven they can be interoperable. It’s often not a matter of resolving software issues, but data management and data governance,” he said.

Yohana Dukhan, Senior Health Economist at MSH, led a discussion about using data from a national HMIS built on DHIS 2 to adequately mobilize and allocate sufficient financial resources to ensure universal health coverage. In Uganda, for example, MSH supported the MOH’s plan and costed health services for better funds allocation and to ensure that providers, medicines, supplies, and other resources are available as needed.    

A study of government and private health facilities in Uganda was conducted to estimate the cost of providing services and the financial resources needed to establish a national health insurance scheme. Using MSH-developed costing tools and models, the team was able to ascertain both utilization levels and the costs required to improve and scale up care.

“Complete, accurate, and timely health information is absolutely critical to achieving universal health coverage,” said Dukhan. “Using this data for planning, costing, and distribution of resources will help Uganda’s government understand trade-offs, and ultimately, it will increase accountability by ensuring timely reporting on the use of those resources.”

Moussa Traore, working in the Democratic Republic of Congo (DRC), gave an overview of how the USAID-funded IHPplus Project in the DRC contributed to improving the availability of routine health data by supporting the MOH’s DHIS 2 integration in project-supported health zones. He pointed out the importance of interoperability between MOH and project DHIS 2 instances instead of double data entry and reporting.

“It’s better to align a project information management system with a country’s national [health information management] system. The work in DRC reduced the burden of parallel reporting, made for better data quality, and made data more consistent sharing among health sector stakeholders. Plus, it reinforces the national system,” he said.

Vidya Mahadevan, Senior Monitoring, Evaluation, and Research Advisor, presented a hybrid DHIS 2 architecture that MSH developed to bring different projects, portfolios, and databases into a single system, the Data Repository Engine for Analytics and Management, or DREAM@MSH.

“As an M&E person, I like to slice and dice data in different ways to see what is actually happening. Collecting data that will let us do that is one of the things that’s driving DREAM@MSH forward,” Mahadevan said. “While aligned with donor demands for individual projects, we wanted to streamline data collection processes across projects in the field. Additionally, as an organization, we also designed DREAM@MSH to measure and describe our achievements on the global level.”

The project has been a learning process for MSH, she added. “Take change management–we, and many of the others in this room are larger organizations. What’s the best way to get all of our staff up to speed, ensuring that everyone knows how to use this new tool and starts using it regularly to actually improve the way that they do their job? And more broadly, how do all of us in this room, as the international NGO and DHIS 2 community, make sure we are increasing efficiency across our sectors, and that we are responsible data stewards?”

Other presenters talked about the development of a mobile app for the program, its use with PEPFAR projects, and how biometrics can be used to improve tracking for patient treatment, and be incorporated into DHIS 2.