Voices From The Capacity Project: From Nightmare To Awakening

At the Uganda Protestant Medical Bureau, executive director Dr. Lorna Muhirwe struggled to get the information she needed to most effectively lead the network of over 250 facilities that play a vital role in the country’s health care. A health management information system (HMIS) was designed to help, but it wasn’t working well: “Data analysis was a nightmare and it was causing us immense challenges.” Her colleague Ambrose Muhumuza, the HMIS officer, uses the same strong language when he describes the difficulty of getting accurate data and using it to make decisions. “This has been a nightmare,” he concludes.

What was haunting these administrators? “We were not able to get timely reports, and worse still, most of the health units sent incomplete reports that are usually unreliable.” explains Dr. Muhirwe. What’s more, “we were not able to see the impact of HMIS in planning and decision-making.” Adds Muhumuza, “UPMB had always faced challenges in providing evidence on the issues affecting its health facility network. It lacked data on staffing, service provision, service utilization, income and expenditure—key in managing health establishments.”

How could they awaken from this bad dream? “Something was going wrong so we approached the Capacity Project, through whose support we have managed to come up with this exciting web-based HMIS,” Dr. Muhirwe recounts. To begin, the Project helped with a needs assessment as the initial step toward aligning management and supervision functions with the needs of local health teams. Records managers identified expected HMIS performance and compiled a list of good practices local teams must have in place to register, compile, analyze, report and use information for decision-making. Project staff developed an Excel-based tool for measuring actual performance and pretested it in ten facilities. Using the tool, health managers then administered a nationwide HMIS performance assessment at 40 facilities.

While low resources were assumed to be responsible for poor HMIS performance, the assessment showed that the main problems were actually weak reporting, data analysis and decision-making. UPMB designed interventions to face these challenges, and the Project is assisting with the development of a web-based tool to make reporting easier and provide automatic analysis of the information. This tool will allow staff to focus on making decisions.

“I am so grateful that we have moved as far as developing a web-based HMIS which allows entering data, data analysis and reporting,” Dr. Muhirwe declares, “which ultimately reinforces decision-making right from health facility levels, dioceses and the secretariat level.”

Muhumuza notes, “The support from the Capacity Project has enabled health workers to clearly understand what is expected of them and why it is important. Health workers now understand the importance of complete and accurate recording in the different HMIS tools. The standards and indicators remind the health workers to keep on track of HMIS performance [and] the trainings helped supervisors in acquiring knowledge and skills in HMIS. The approach helps in monitoring the performance of health workers by the management and in planning jointly to improve the performance.”

A key benefit in having health managers administer the assessment is that the HMIS performance gaps were identified by the same people who will provide the solutions. Accordingly, facilities personnel across the country are enthusiastic about the new online HMIS. In Mbale Diocese, Rev. Mr. Mangali William is delighted that the system “shows a summary of the required information in various ways—for example, plotted graphs—which is great. So this will be like our extra pair of hands! I have also noticed that it facilitates immediate action.”

“It is thrilling to see that we can share data with whoever is interested,” adds Patrick Mpairwe of Ankole Diocese. “We are going to manage our hospital best,” he predicts, “and we shall soon be receiving delegations coming to learn lessons from how we have managed our HMIS.”