DHIS2 has been expanding its reach into many health systems. Starting from its familiar grounds of aggregate data sets for routine data it has included patient related data and then data in the areas of HR, finance, logistics and laboratory management. This is in line with the development of DHIS2 in many country settings, where implementers are pushing the use beyond its originally intended scope.
This is also reflected in the overall system architecture. Since the expanding functionality of DHIS2 reduces the urgency to introduce or maintain other specialized systems, the number of potential data interfaces decreases. This reduced complexity in system architecture is certainly a benefit for a Health System with limited resources.
For several years now, DHIS2 has grown its data management activities organically, allowing the actual usage to lead to sometimes unforeseen solutions. However, there are also limits to where leveraging DHIS2 seems useful. In the following sections, special systems will be described.
Logistics Management Systems (LMIS) or Supply Chain Management Systems (SCM) serve to replace paper systems to increase standardization, transparency, timeliness of procurement, efficiency, safety, cost-effectiveness, and to reduce waste. National SCMS/LMIS can cover such functions as commodity planning, budgeting, procurement, storage, distribution and replenishment of essential drugs and consumables.
b) Implementing LMIS in DHIS2
Supply chains can often be well controlled with aggregate data only, as long as data is provided reliably from all relevant levels and followed up upon. The main indicators intake, consumption and stock level at the end of period can be managed without electronic transactions and often suffice to give the big picture, reducing the needs for system investment. As a rapidly evolving platform, DHIS2 has been adding a lot of functionality over the last years, especially in DHIS2 Tracker. 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. In online mode the form can calculate requisition proposals, offering the facility manager to modify the request and comment on it. 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 decision making, giving commodity and program managers the possibility to accept or modify delivery suggestions.
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.
c) Interoperability Options
LMIS is an area where a multitude of parallel, overlapping or competing software solutions can be found in a single country. As identified in a JSI study in 2012(Ghana Ministry of Health, July 2013: Landscape Analysis of Supply Chain Management Tools in Use), eighteen (18!) different software tools were documented as being in use within the public health supply chain in Ghana alone.
Although a basic LMIS configuration based on aggregate data can take you very far, in some cases a transactional LMIS is necessary if you need to track such detailed operations as returns, transfer between facilities, barcode reading, batch and expiry management. Also some specialized HQ functions such as creating forecasting, replenishment and elaborate control reports are often done in specialized tools.
DHIS2 has integrated aggregate data from external systems such as openLMIS and CommCare through automated data interfaces. As a result, stock data is available in shared dashboards, displaying health service and stock data next to each other.