The DDDM workshop in Uganda this summer provided the first opportunity for many of the participants to review and discuss reports from the iHRIS Qualify system in the Nurses and Midwives Council. Dr. Pamela McQuide, HRIS leader, said she was extremely excited about participants’ reactions to seeing the reports. “When participants had actual Ugandan data, they erupted in discussion,” she said. She explained that the reports spurred lots of questions and they talked for three or more hours, showing that “they are very hungry for their own data and supporting it.”
One participant said the workshop gave meaning to the data they had been generating and built up credibility and interest in the HR information systems being established in Uganda. “It was the first attempt we had at integrating information from the various sub-systems in HRH and seeing how all these sort of fit together in order to have meaningful information.” He went on to say that the most surprising thing he realized was the amount of data already available. “It was just amazing to know there was so much data already available from different subsystems. I found that overwhelming, it was just phenomenal.” As he stated, a strong HRIS is a phenomenal tool for integrating data, where the sum becomes much more important than the parts.
Another participant said that after viewing the data he realized they already had routine information that they should start taking advantage of. He described how different the situation in Uganda was before HRIS strengthening was initiated, “We were looking at a format that was inaccessible, it was paper-based and in containers, but now that it’s in a database it’s easy to analyze.” He went on to say that the reports presented at the workshop were “able to tell us what was really happening on the ground.”
The HRIS team is in the process of implementing similar systems at the other three Uganda medical licensing bodies (the Pharmacy Council, Medical and Dental Council, and Allied Health Professional Councils). As an outcome of the workshop this summer, bi-annual HR data reports will be produced. The reports will incorporate data from all four councils and other sources, such as data from the EU and will influence annual reporting, budgeting, and strategic planning.
Once data can be integrated from various sources and reports can be generated, it is important that the information is presented in a variety of ways so that decision makers can understand and use it. Dykki Settle, HRIS leader, led a session on data quality and presentation that covered useful techniques to enable decision makers to use data. He emphasized that reports should be timely, tied to policy questions and available to the right people. Colorful reports will not be effective unless, as Ummuro Adano has stated, they are “combined with active leadership, change management, and effective professional development for key decision makers.”
Posted by
Carol Bales on 11/30/2007 • Tags: Africa, Capacity Building, Decision-Making, FOSS, FOSS4G, HRIS, ICT4d, Information Systems, Open Source, Public Health, Sustainability
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Dr. Invocaviths Swai joined the IntraHealth/Capacity Project Tanzania team in September, as an HR Specialist seconded to the Ministry of Health and Social Welfare (MoHSW). With the Ministry’s five year Human Resources for Health Strategic Plan (HRSP) recently approved, he believes his new position came at the right time.
Dr. Swai brings a unique skill set to the HR Specialist position. He is a medical doctor and a community health specialist who has practiced in some of the most underserved areas of Tanzania. For the last few years, he has worked in administrative posts within the MoHSW — as a district medical officer and then in the central Ministry’s training section. While serving as the District Medical Officer in Tanzania’s Rombo district, Dr. Swai worked with data at district level. With that base of experience, he is a strong advocate for establishing a centralized Human Resources Information System (HRIS) that works effectively with the districts in Tanzania. In his present position, he is the liaison between the MoHSW, local Human Resources for Health (HRH) stakeholders, and the Capacity Project as he provides guidance to implement the MoHSW’s HRSP and organizes HRIS stakeholders. He describes his position as “trying to reach consensus for action and helping stakeholders come together.” He says he will continue to “coordinate all those collecting and using HRH data to have harmonized software use that can facilitate data and information sharing.”
The HRIS in Tanzania is currently being established as a component of the existing Health Management Information System (HMIS), which Dr. Swai describes as “well-managed but with some limitations.” For instance, the HMIS was created to track service management and performance, but not to comprehensively cover human resources management. Although some partners and funders have collected their own Human Resources data, this data is not readily available to all stakeholders. In addition to this, maintenance of the current system is time and labor intensive. Dr. Swai believes that these combined factors have created the need for a “unified database using software that facilitates sharing from a common source - one that is more user-friendly.”
The types of reports the existing HMIS is capable of producing only partially answer key policy and management questions. Dr. Swai explains this is not only because important staff information is missing from the current system, but also because there are no regular updates. He would like to see a routine HRIS in place that is capable of generating reports showing the number of staff in each cadre and where they are deployed. Using his experience in the MoHSW’s training section, he would also like to ensure the HRIS monitors current health worker skills, and how this relates to their quality of service. He would also like to be able to analyze information about applicant tracking, interviewing and selection, response to recruitment and attendances to workplace, and would like to see an HRIS that is integrated with payroll.
The MoHSW and the Capacity Project have jointly planned a number of HRIS strengthening activities for the upcoming year, including training the HR department and health managers in HRH information management and developing a data collection tool and software. There are plans to train key, central-level staff on HRH planning and workforce analysis, and HRH leaders at the district level on HR Management. Finally, they plan to establish a comprehensive HR Information System at all levels. Dr. Swai believes a complete HRIS can help ensure data quality by reducing paperwork, and therefore errors, and making development of aggregate reports less labor and time intensive.
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All of us on the iHRIS development team have been pleased with the response we’ve received to our first two offerings in Open Source human resource information systems: iHRIS Manage and iHRIS Qualify. Each system strives to fill a gap in the data collection and storage toolkit for human resource for health (HRH) workers. iHRIS Manage stores data on all health workers employed by a Ministry of Health or other organization, enabling the HR department to manage data about their employees. iHRIS Qualify stores data about health workers in a country for a nursing council, medical board or other licensing entity, enabling all health workers’ qualifications to practice to be tracked.
But what do you do with all this data? Ideally, the data are used to plan for future HRH needs and make policy decisions regarding the health workforce.
This year, we are focusing on developing a new component of the suite: iHRIS Plan. Unlike the other two systems, iHRIS Plan is not an HR information system. Rather, it is workforce modeling software that will enable planners and policy makers to use data from iHRIS Manage, iHRIS Qualify or other sources to model what their health workforce looks like now and what will be needed in the future. The software will also enable planners to try out various interventions and see what effects they will have on the health workforce.
Screenshot from a prototype for the iHRIS Plan software, showing actual health workforce as compared to workforce needs and how interventions can fill the “gap” between the two.
To get started, we are bringing together representatives from USAID, the World Bank, the World Health Organization, the Africa Health Workforce Observatory, the Asia-Pacific Action Alliance in Human Resources for Health and other global organizations working in this area for a two-day workshop next month. Participants will look at existing models for health workforce planning and make recommendations for the HRH data inputs, outputs and algorithms that are optimal for HRH projections in limited-resource settings. These recommendations will form the foundation for the specifications and enable us to start development on software that has already achieved international consensus as the best model for health workforce planning. We will also form an advisory committee from workshop participants who will guide us through development of version 1.0 of iHRIS Plan, slated to be released in the summer of 2008.
Of course, since we will be posting all documentation on our website and the Open Source code on our hosting site, anyone is invited to join in the conversation, provide feedback and help us make the next offering in the iHRIS suite as good as it can be.
Posted by
Shannon Turlington on 11/26/2007 • Tags: HRIS, ICT4d, Information Systems, Software
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As a registered nurse with years of international experience in social policy and human resources management, I find the prospect of using Open Source systems for health care extremely exciting.
Over the years I have seen other types of technology programs in Africa fizzle after projects ended or the funding ran out. An expensive liability is outdated software that cannot be modified or tailored to meet expanding requirements in countries experiencing rapid growth and development.
When I was the principal investigator and project director for the Kenya Nursing Workforce Project researching the possibility of starting a new school of nursing, I went to one of the big Kenyatta University campuses and was told that they already had the necessary equipment for distance learning. I was elated and asked to see the system that was already in place. There was a big room filled with gadgets and an auditorium. It had been set up years before by the World Bank to broadcast training programs from NY to developing countries all over Africa. However I learned that it was only a one-way broadcast from NY. After the World Bank’s training program and funding ended the school had not been able to use the technology, because they did not have the ability to broadcast out. I asked what would it take to use this technology to train nurses in Kenya, and he said we’d have to totally start over and scrap everything. They invested oodles of money to develop a system that is unusable now. What happened with the training program is similar to what often happens when projects depend on proprietary software.
I have become a passionate advocate for Open Source. Open Source technology is a way for Africa in particular to use cutting-edge software in a way that is fiscally responsible. Educational programs in Africa have traditionally used Microsoft software. This has created a big problem because in order for the Ministries of Health and other organizations to sustain the programs after the projects end, they have to pay substantial licensing fees. The advantages of using free Open Source software is clear in countries that are financially restrained like Kenya, Uganda and S. Sudan. These countries cannot afford huge software maintenance costs.
I recognize that there are challenges to switching to Open Source software. Because Microsoft technology is what people are used to, it has been viewed as the only reliable technology. Therefore, people have felt that if the product they were using wasn’t Microsoft, then it was inferior. I’ve been very supportive of using and developing an Open Source method that governments and universities will be able to sustain in the future without these huge licensing fees, but with a network of developers that can keep the system running using advanced technology. I have this very concern about a project that I worked on in Africa, and I’m unsure whether or not the MOH will be able to sustain the licensing fees, as expected, after the project funding ends.
The Ugandan Ministry of Health has been very supportive of the use of Open Source technology and our iHRIS software. We installed iHRIS Qualify at the Nursing and Midwives Council last spring and are now implementing similar systems in the other three councils. The IT expert working there, a consultant for the Capacity project sitting in the Ministry of Health, wants Open Source software to be the standard. He feels Open Source software gets less viruses, and he’s insisted that they use Open Source for all their office programs as well as their HRIS. They have already switched to using Open Office - Linux versions of Word, Excel, and PowerPoint. They have also started on-the-job training for Open Source developers working in the public health system in Uganda.
With Open Source health information systems being created across the country, there is a growing need for local Open Source developers. The Capacity project is planning to start working in nine districts in Northern Uganda in this year of the project. We’re going to need people in different parts of the country who can really implement and facilitate these systems. There is a strong desire in Uganda to partner with Makerere University in Kampala to train developers, and IntraHealth is currently developing programs to help make this happen on a wider scale. IntraHealth already conducts on-the-job training to the growing network of developers working on public health in Uganda.
Open Source technology can protect users from the huge problems created by outdated and prohibitively expensive software. Most importantly, Open Source can be effectively and affordably used by the ministries, councils, universities and professional associations making health service delivery operational in these countries on very limited budgets.
Dr. Pamela McQuide
Posted by
Pamela McQuide on 11/20/2007 • Tags: Africa, Digital Divide, FOSS, HRIS, ICT4d, Information Systems, Open Source, Public Health, Sustainability, Technology
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Once data is available from an HRIS, how can it be used effectively to make decisions? Part of our HRIS Strengthening process is to help managers and policy makers in the countries we work develop necessary skills and techniques for data-driven decision making (DDDM). To achieve this, the Capacity Project is planning a series of DDDM workshops. This past summer, HRIS leaders teamed up with Ummuro Adano, Senior HR Systems Advisor for the Capacity Project, to organize and facilitate the first workshop in Kampala, Uganda. The workshop was attended by 22 human resources for health (HRH) practitioners from different segments of Uganda’s national health system.
Uganda was a perfect choice for the first workshop because data was gradually becoming available from various sources, and preliminary reports were being produced by the iHRIS Qualify system at the Nurses and Midwives Council and the EU HRD project. One participant said that the workshop brought together key people for making decisions and provided the knowledge they needed to better use the information being generated. He described the workshop as timely, “We’ve been in the process of developing different Human Resources databases (and) now we’re in the stage where we should start using the information for planning, for policy making, and for evidence for decisions.”
Ummuro Adano has described DDDM as, “a journey, not a destination,” and has said that there needs to be a process in place for analyzing data and “getting it to the right decision maker at the right time with the power and resources to act on it.” To facilitate the participants’ journey from data to decisions, the workshop began with an activity that demonstrated they were already using data to make personal decisions in their own lives. Participants shared examples of encounters with data from personal or family experiences, and many felt this was a highlight of the workshop. One participant said, “it brought up that most of the time in our life we’re using evidence-based decisions. At times when we ignore it we make errors that we could have avoided.”
Some of the personal examples were about investments or businesses that failed because participants did not do the proper research or collect the right information beforehand. One participant explained his observations of how others related to the principle of the activity, “They actually found out that in our data environments -at home, our interactions with people we work with - we ought to ensure that we get good information, good data, that informs us better before we do an investment, or make decisions. It is important that in our workplace we ensure that we use information to inform ourselves better.” Emphasizing the need for concrete information about the health workforce, the participant added, “and of course get a feel of how many are leaving and for what reasons, and how we can improve on their environments so that we retain them better.” This exercise set the context for the rest of the workshop and established a shared perspective for the attendees, preparing them for the presentations and group work that followed.
Posted by
Carol Bales on 11/14/2007 • Tags: Decision-Making, HRIS, ICT4d, Information Systems
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Shannon recently wrote about mobile technologies and the possibilities that are open to us with the influx of mobile usage in the countries in which we work. What’s equally exciting is what has happened since in the development of open mobile technologies.
Here in the United States we have the worst situation in the world when it comes to openness in our mobile technologies. Our phones are “locked” to particular carriers so that we cannot use them on another provider. This is mostly an historical problem as the carriers originally thought the money would be in selling the devices. While there is some money to make there, the real money comes in selling the service. Nonetheless, we are left with the old model. In the rest of the world the two are separated. One buys a phone then decides which network to go use it on. While most US phones can be unlocked to work with other networks, its not something easy enough for everyone to be able to take advantage of. The disturbing trend set in place by Apple’s iPhone takes the locking another step further to the point where Apple is trying all they can to keep its users from using anything but AT&T.
Enter Google. Google has launched the Open Handset Alliance which has the weight of many companies behind it with the goal of developing an open platform for mobile devices called Android. While they were not the first to start such a task (beaten to it by the OpenMoko folks, they have the name recognition to make a very big splash.
So what does all this news mean for us and our work? I suppose to answer this I go back to IntraHealth’s mission which is to “mobilize local talent to create sustainable and accessible health care.” With an open platform we can more easily introduce the people we are working with in-country to the technologies in which we have developed applications and processes to deliver health care. In this case, applications that can take advantage of the enormous use of mobile technologies in the countries in which we work.
With proper funding the ideas for these application are endless. Imagine a district health care facility with a system that can send a text-message to a patient to let them know a follow-up appointment is needed. Texting is cheaper and easier for most folks in developing countries. Imagine a member of the Nomadic Somali people in North-Eastern Kenya using a mobile phone to schedule an appointment with the health care facility they happen to be closest to on a given day - and then using that same phone to let the provider access their medical history. Imagine a district health office in a very rural area accessing their Ministry of Health’s system via a mobile device when their power goes out. What once was a break in access to communication is now just a switch to another technology. The possibilities are endless, and with an open source platform, they are cheaper to implement and easier to develop on.
Half the fun of accessing these new technologies is coming up with new ways of applying them to old problems. How would you use it?
Posted by
David Mason on 11/13/2007 • Tags: Cellphones, Development, Digital Divide, FOSS, Mobile Technology, Open Source, Technology
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