Taking into account all the above elements on system architecture and data types, DHIS2 implementers have several options on how to approach implementations:
Focus on transactional or aggregate data
Focus on data integration or systems interoperability
Given the efforts required to implement systems interoperability, many Ministries of Health are going for the pragmatic shortcut of integrating data such as basic stock level data directly into their existing national DHIS2. As a rapidly evolving platform, DHIS2 has been adding a lot of functionality over the last years, especially in DHIS2 Tracker. Taking the example of logistics data, the following main functions are currently available:
Data entry form mirroring the widely used Report and Requisition (R&R) paper form. Data entry by facilities is possible through the desktop browser or a mobile app, including in offline mode. These electronic forms can be filled by staff based on the paper stock cards, that are normally placed next to the commodity in the store room.
DHIS2 can then produce reports for central level performance monitoring, giving commodity and program managers an understanding of how the logistics system is functioning.. Depending on how the logistics system operates, these data may also be able to support operational decision-making although a more complete analysis of logistics business processes and users should be conducted first.
Stock data can be transformed into logistics indicators, that can be put into context with other program indicators, for example cross-referencing number of patients treated with a specific pathology and corresponding drug consumption.
Although each country that we look at in the use cases has their own development path towards system integration, some common learnings can be drawn from their experiences. The maturity model below describes an evolutionary approach to cope with integration and interoperability challenges, allowing the different stakeholders in a national Health System to grow professional analytics and data usage habits.
The maturity model suggests moving from aggregate data to transactional data and from stand-alone to interoperable systems (using the example of logistics data).
DHIS2 is often one of the first systems to cover the health administration and several facility levels of a country. At first core disease indicators are covered (for example corresponding to the 100 WHO Core Health Indicators).
In a second phase, different stakeholders seek to complement the disease and service delivery data they are reporting with basic LMIS data. This can be done on an aggregate basis in DHIS2, e.g. by including stock levels and consumption in periodic reports. This will provide high level information on logistics system performance but may or may not provide sufficient insights to support improved logistics system operations.
At a more mature stage, there may be a legitimate need for specialized logistics systems, especially when a very detailed transactional view is wanted to have a more granular control, (e.g. returns, transfers between facilities, batch numbers and expiries, etc.). DHIS2 Tracker can offer some event or patient related data management functions, but cannot always achieve the degree of workflow support provided by other, more specialized solutions.
In a mature technological and managerial environment, the logistics transactions can be shared to DHIS2 in an aggregate form, moving from a stand-alone to an integrated scenario.