Setting-up a new BNA App¶

The BNA App utilizes available metadata and data in the DHIS2 instance. It is important to ensure that metadata are properly configured prior to installing the app. The development team has put together pre-configured metadata for sample indicators found here. You can download these and use them as an example to setup a local BNA app use case

Best Practices for starting up a new BNA app implementation

The following section describes a list of tips for getting off to a good start when setting up and implementing the bottleneck analysis app.

1. Identify a real life use case to use in the BNA process.
2. Discuss and identify priority indicators to use in the BNA process.
3. Quickly populate a demo instance, include examples of BNA charts, tables and dashboard. Use real data, ideally nationwide, but not necessarily facility-level data.
4. Put the demo database online. Server hosting with an external provider can be a solution to speed up the process, even if temporary. This makes a great collaborative platform and dissemination tool to get buy-in from stakeholders.
5. The next phase is a more elaborate BNA implementation process. Parts of the demo can be reused if viable.
6. Make sure to have a local team with different skills and background: public health, data administrator, IT and project management.
7. The core national team should drive the implementation process but be supported and guided by experienced stakeholders.

Installing the BNA App¶

BNA App can be installed into DHIS 2 system in two ways like other DHIS 2 applications.

1. If the application has been uploaded into the play store, users can browse from DHIS 2 App store to download it. Installation from App store is simply clicking the application and it will be installed. Users can refresh the page to see BNA App in the DHIS 2 menu.
2. If the application has not been uploaded into DHIS 2 App store, users can get the zipped file and upload into the App manager. App Management access needs to be accessed with users who have permission to access and manage Apps. after opening App Management, a user is required to click an upward arrow to get options to select file for uploading.

   

Best practices for configuration 1. Functionality of bottleneck analysis requires to carefully review meta-data before setup and configuration. The review should be led and spearheaded by the core team. 2. Stakeholders are advised to select tracer intervention that will best represent/identify barriers to health care service delivery. 3. Ensure that all required meta-data (data elements, organisation units, datasets and indicators ) are properly configured in the host system. 4. Additional requirements such as data elements for calculating denominators

should be carefully analysed and setup in the host system. In cases where data is to be imported from other legacy systems, an integration process need to be in place. 5. Users and their appropriate roles need to be defined first in the DHIS2 and then in the BNA app for proper management.

BNA Access and Navigation¶

Once installed, BNA App can be initiated by searching it from DHIS 2 menu and click it to open. At the first time if no intervention has been configured, BNA App will load with predefined interventions, with predefined indicators named “indicator 1” for each determinant. Sub-level analysis and root cause analysis will be empty. Predefined interventions are replaced with user defined interventions with configured indicators for each determinant group of every intervention.

Data and Metadata¶

The bottleneck analysis app, works well within existing DHIS2 instance. The app is well supported in DHIS 2 version 2.28 onwards. The app utilizes existing data and metadata in the DHIS2 system to generate BNA charts. BNA app is meant to utilize data reported in DHIS 2 system directly or from external systems after being integrated or imported into DHIS 2. Data from external systems needs to be stored in placeholders created in DHIS 2 for definition of indicators.

Datasets and Data elements¶

Data elements are the most critical part of the DHIS 2. For the bottleneck analysis app to work, it needs indicators generated from data elements within DHIS 2. Data elements are critical for collection, aggregation and analysis of Health data. The DHIS 2 support team needs to ensure that most of the data for BNA app can be generated from the DHIS 2 system.

Some of the data required for the generating BNA charts may be from other sources that are not pushing data in the DHIS2 for example Human Resource for Health data, population data, data from survey report; in such cases, it is important for the support team to create data elements / datasets to act as place holders for data from external sources. Once the datasets have been created, then data can be adequately imported into the DHIS2 system for generating indicators that aid the creation of BNA charts. Data elements and data sets are created in DHIS 2 maintenance App, and can be used for BNA charts and other analysis tools such as pivot tables etc. You can learn more on data element in and Data set in DHIS 2 Documentation.

Indicator mapping and configuration¶

Indicator mapping and definition are critical for the BNA process to be successful. Once stakeholders have collaboratively identified interventions and indicators, best practice is to put indicators for each intervention in the document for reference purposes. For each indicator, it is important to identify the numerator and denominator together with their sources. Mapping document will guide the configuration and support team during mapping to know the sources, data element place holders for storing data from external systems and other calculations methods to use. The mapping document should have details of indicators to be collected; numerators, denominators, methods of collection and calculation to provide adequate information to the development team.

Intervention creation¶

BNA App allows administrative user to create interventions. If no interventions created, users will only see the default interventions with “indicator 1” labels but no data. To create new intervention, user needs to click on the blue plus sign button just below list of interventions on the dashboard. Interventions are the ones holding determinants which holds indicators.

Then have to write the intervention name and click create button to save the intervention.

Note: Administrative users are the ones to create interventions and share to other users to manage and view.

Interventions and Indicators configuration¶

Interventions, determinants, and indicators must be properly configured for correct visualization of BNA charts and sub-level analysis. To configure interventions and indicators, administrative user can click the Settings button just below the intervention list on the dashboard to get the setup page.

Clicking the Setting button will present a configuration window for administrative user to set choose who to share intervention with, set the period for BNA presentation and analysis, decision to use indicator short names as display names in the BNA chart, and legends for specified cut-off points for indicator performance. In BNA, administrative user can change the colour of each determinant group indicator(s). Bar chart of every indicator attached to a particular determinant group will inherit the colour of that determinant group. To add indicators into determinant group, just click on the plus sign button to get list of indicators from indicators or functions to add to the determinant group for BNA chart configuration.

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Note: Ticking “Use short names as labels” option

Data entry and storage¶

The BNA app accepts entry of data for the root cause analysis component. The main fields captured include the possible root cause and solutions for the gaps in implementation of an intervention.

The entry of root causes and solutions should follow a comprehensive process of causality analysis usually done during the District Health Management Team meetings. The “ADD” button on the root cause analysis component will facilitate entry and allow you to add as many causes and solutions as possible.

Note: These records will also be useful during the planning cycle where district teams will formulate action plans and a monitoring framework for them.

Configuration data for indicators and data from root causes analysis are stored in the DHIS2 “Data store”. The data store is resident on the server hosting the DHIS2 instance and can be modified using the DHIS2 data store management app. Data contained in indicators are saved in DHIS 2 database.

Note: i. When the BNA App is uninstalled from the DHIS2, the data stored remains, unless if the data stored is removed.

ii. Access to the BNA datastore is limited to system administrators only

Data analysis and presentation¶

Data analysis and presentation on the BNA app is based on the Tanahashi Model for health systems strengthening and strategic planning. The model emphasises 6 determinants of coverage (Availability of Commodities, Availability of Human Resources, Access to health facilities, Initial utilization of health services, Continuous utilization and Effective Coverage.)

Data visualization is interactive with dynamic relative periods and organisation units. BNA charts will also be automatically generated once DHIS2 data has been updated.

Note: The golden rule for analyzing BNA charts is “The demand side cannot be higher than the lowest bar in the supply side” where the denominator is the same. Additional guidance here

Data on the BNA chart is further displayed in a sub-national level tables to show performance of facilities using a scorecard colors (Red, Amber & Green).

Data entered in the BNA app using the root cause analysis feature can be analyzed based on the organisation unit, and period of analysis.

Note: all the data presentation charts, tables and reports can be downloaded to either Excel, PDF or Word.

Rollout and Implementation strategies¶

1. The rollout team should give thought to scale-up of the bottleneck app, following a successful user acceptance testing phase. The rollout should consider sustainability efforts including support within the MoH structure.
2. The core team should 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.
3. Broader support structures need to be established to provide support, supervision, and communication with global/regional network of expert users and developers.
4. 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.
5. District Health Team (DHT) review meetings and or equivalent should be supported with appropriate BNA information packages and training.
6. 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 existing users on new system functionalities.