A quick guide to DHIS2 implementation¶

Any implementation of District Health Information Software (DHIS2) should aim at establishing sustainable systems that are flexible to changing needs in the health sector. It is important to acknowledge that this will take many years, with continuous structures for capacity building, best practice sharing, and innovation. This quick guide will provide a very crude overview of the different facets of DHIS2 implementation.

Planning and organizing¶

Structures needed¶

• A DHIS core team (DCT) of 4-5 people will be needed to administer a national HMIS. Their responsibilities and required skills should be clearly defined. The DCT will participate in DHIS2 Academies, organize training and end-user support for various user groups in the country.

• A Technical Steering Committee, or equivalent, will be needed to steer the coordination between health programs, other information systems and development partners and Universities. They will lead integration efforts and make decisions regarding the overall architecture of information systems.

Integration efforts¶

• Throughout the implementation, simultaneous efforts of information system integration and data exchange need to be conducted. The leading principle for this work should be to create a decision-driven and indicator-focused system.

Equipment and internet¶

• An assessment needs to establish the needs for hardware. Desktops, laptops, tablets, mobile phones all have different qualities, and typically a mix of these different technologies will need to be supported.

• Server and hosting alternatives needs to be critically examined with regards to capacity, infrastructural constraints, legal framework, security and confidentiality issues.

• Internet connection for all users will be needed. Mobile internet will be adequate for majority of users doing data collection and regular analysis.

• Options for mobile phone users, bulk sms deals etc, should be examined if appropriate.

Roll-out strategy¶

• The DCT will play a key role here and each member should have clear responsibilities for the roll-out covering: user support, user training, liaison with health programs, etc.

• Broader support structures need to be established to provide support, supervision, and communication with global/regional network of expert users and developers.

• Information use must be a focus area from the start and be a component both in the initial system design and the first round of user training. Data collection and data quality will only increase with real value of the information. District review meetings and equivalent should be supported with appropriate information products and training.

• Training will typically be the largest investment over time, and necessitates structures for continuous opportunities. Plan for a long term training approach catering for a continuous process of enabling new users and new system functionalities.

• Supervision and data quality assessment should be held frequently.

Adapting DHIS2¶

Scope of system¶

• Based on the decisions the system should support (system scope); customization and adaptation of the platform will be needed for DHIS2 aggregate, tracker, and/or events. Each action will need special competence, and should be led by the DCT.

• Assessment of the intended users and beneficiaries is needed, such as related to their information needs, and hardware and network needs.

• An understanding of the larger architecture of the HIS (the "HIS ecosystem") is important; what other systems are there, and how should they interact with DHIS2? Consider what needs there will be for interoperability between electronic systems.

• If there are needs that are not currently supported by DHIS2, an assessment of additional software development is necessary. These can be addressed locally by developing a custom web app or feed into the overall core platform development roadmap process organized by UiO.

Setting up DHIS2¶

• Reporting units: implementing the different reporting units (service outlets) and hierarchies including grouping.

• Data collection needs: Which indicators are needed, what data variables will go into their calculation, and how should this data be collected? Design data elements, disaggregation categories, data sets, and collection forms.

• Information for action (indicators, dashboards, other outputs): what are the information products the various users will need? Tables, charts, maps, dashboards. Routines for dissemination and sharing.

• User management: Create user roles and groups, routines for managing users, define access to features, and appropriate sharing of content.

• DHIS2 governance document (roles by profile, how to change metadata and under what conditions).

Hosting¶

• Hosting DHIS2 on a national scale is a considerable undertaking which requires planning, provisioning, monitoring and management of potentially complex hardware and/or cloud resources. For a full discussion of the various tradeoffs of different approaches see the server hosting section.

Capacity building¶

DHIS core team (DCT)¶

• DCT will need all skills necessary for a sustainable, evolving system. This includes technical skills (DHIS2 adaptation, server maintenance), system knowledge (architectures and design principles), organizational (integration strategies), and project management (organizing structured support and training).

• DCT members should attend the regional/global DHIS2 Academy frequently (e.g. twice a year) to ensure high quality training, continuous communication with the broader expert community, and to make sure the local team is up to date with new functionalities and enhancements in recent releases of the DHIS 2 platform. DCT will be responsible for adapting and cascading this regional training curriculum to a broader group of users within country.

Country training strategies¶

• DCT should offer training in relation to the implementation, and continuously thereafter to meet growing demands, system updates and staff turnover.

• Adapting and developing training material and reference guides to reflect local information needs and local system content is important.

Continuous training opportunities¶

• As user experience is growing, more advanced training should be offered. Information use training for district medical officers and health program managers is crucial early on to enroll stakeholders to use the information in decision making.