Strengthening health information systems through DHIS2
Untimely, incomplete, and inaccurate data are common challenges to effective health information management in many health systems worldwide, especially those that are under-resourced and/or reliant on paper-based information systems.1 2 Despite the advent of many innovative technologies for improving data reporting and use, including eHealth and mobile-based strategies, it remains a challenge for many countries to harness the potential of these technologies. Over 100 countries have implemented and adapted a web-based Health Management Information System platform called District Health Information Software 2 (DHIS2) to meet their unique needs and support better decision making for health at all levels.3 4 DHIS2 was developed in 2006 by the Health Systems Information Programme at the University of Oslo, in Norway to improve data collection and use. DHIS2 is a free and open-source health management data platform that provides a comprehensive system for capturing timely, accurate, and complete data at all levels and across different sectors.3 4 5 6 7 Its key features include “data warehousing, visualization features, and the possibility for data users and policymakers to generate analyses from live data in real-time.”4 A well-functioning DHIS2 platform hosts myriad health data from multiple sources (both public and private and health and non-health sectors),5 to support interoperable, integrated, and comprehensive information systems. The platform can be customized for a variety of different health information management purposes and integrated into existing in-country health information platforms,5 making it a cost-effective and flexible solution for countries looking to improve the effectiveness of their health information system.
Bangladesh’s approach: creating an interoperable digital health system using DHIS2
In recent years, Bangladesh has used DHIS2 to strengthen its health information system as a part of a broader push to transform its healthcare system using digital technologies. In 2009, after transitioning from paper-based to electronic reporting, the Ministry of Health and Family Welfare (MOHFW) introduced DHIS2 as the national health information system as has been using it nationwide since 2011.2 This prompted other vertical programs (i.e. the National Tuberculosis Control Program) to use it for health information management purposes.2 8 However, not all existing digital health initiatives and data systems were compatible to link with DHIS2, for example, the e-TB Manager remained standalone.2 8 Fragmented and disjointed health information system initiatives across different health programs (public, private, and NGO) with poor coordination among the different stakeholders led to poor quality of standardized data reporting and use.8 This posed challenges to creating a completely interoperable and integrated health information system for digital health initiatives and data systems in Bangladesh. In 2015, the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) conducted a comprehensive mapping of existing health information system tools to assess their scopes and performances and to identify opportunities to streamline the tools and better coordinate siloed health information system initiatives.2 This scoping included an assessment of the DHIS2 platform’s capacity, robustness, data security, and interoperability. It was determined that the adaptability and security of DHIS2 and its ability to be integrated into existing information systems made it a powerful way forward for strengthening the interoperability of information systems. As a result, it was recommended that Bangladesh continue using DHIS2 for data aggregation, analysis, and reporting and that stronger action be taken to integrate the platform with other data systems, such as the e-TB Manager tool, to improve the integration and coordination of health data for better decision making.2
Supporting the sustainable implementation of DHIS2
Through planning and partnerships, SIAPS has worked to develop DHIS2 as an overarching platform to aggregate information from contrasting health information system initiatives and make this data accessible by both data producers and users.2 A set of dashboards is being built in the DHIS2 systems with integrated tools for managers and planners at different levels of the health system to monitor and evaluate their programs and improve service delivery.2 In the case of the e-TB Manager, SIAPS collaborated with HISP Bangladesh to link the e-TB Manager and DHIS2 tools using a master facility and data structure mapping system, then added an interoperability feature using a standard web application programming interface. DHIS2 implementation at the national scale (within the MOHFW) in Bangladesh has resulted in more timely, comprehensive, and quality data. To support the ongoing management and maintenance of this system, the MOHFW has allocated a budget and worked to create the necessary IT infrastructure to sustain the system without donor support. However, to avoid fragmentation and ensure data quality in the long-term, it will be important for Bangladesh to continue to make different data systems compatible with DHIS2 through an interoperability framework that facilitates effective coordination and collaboration among MOHFW and its partners.8
When used effectively, DHIS2 is a powerful tool for improving the capacity of information systems to provide timely, accurate and complete information needed to improve population health outcomes. However, the effectiveness of this platform in the Bangladeshi context, and worldwide, is dependent on the existence of factors that underpin supportive and organization information systems, such as strong governance, supportive policies, and local capacity building, for example, skills training on DHIS2 use for health workforce at the facility level.5 6 8 Users can interact with communities of DHIS2 users and experts, including their experience with deployment and strategies for implementation in the DHIS2 Online Academies and more information on DHIS2 can be found here.