The Routine Health Information System (RHIS) in Madagascar suffers from fragmentation. Various vertical health programs including the Malaria Control Program have set up parallel reporting systems because they consider the service delivery data of low quality. Also, service delivery data are reported and managed by a access based application called “GESIS”. This application has been created in the nineties with technical assistance by the “Association Europeenne de Developpement en Sante” (AEDES). Being not web-based, vertical program managers at national level have problems accessing GESIS. But by setting up parallel reporting systems they further contribute to the chaos, creating heavy burden of data collection on the service providers.
At the request of USAID and the Ministry of Health of Madagascar, a team of two MEASURE Evaluation consultants in collaboration with consultants of AEDES and of the University of Oslo examined the potential role of DHIS2 (or other similar web-based platforms) in facilitating timely data access and analysis across all health programs at both the central and the district levels. During their two week visit, the consultants met with members of the USAID Mission, with senior managers of the Ministry of Health, and with representatives of various partners involved in strengthening the RHIS. They also visited a regional health office, a district health office and a primary care facility, where they interviewed care providers including community health workers. They undertook a preliminary assessment of current disease surveillance system, both the Ministry of Health epidemic disease weekly reporting system, as well as the fever sentinel surveillance reporting system, managed by the Institut Pasteur.
The main findings were:
- Heavy fragmentation of the RHIS with duplication in data collection and data quality issues
- No documented RHIS performance measurement on data quality and use of information for decision making
- GESIS as a data management application is access-based, so data transmission is tedious in far away areas and difficult to access at national level by the vertical programs
- Poorly functioning disease surveillance system with low coverage, except in areas supported by UNICEF (9/22 regions) where SMS phones are used for weekly reporting.
Next Steps
Based on these findings the consultants propose to undertake a comprehensive national PRISM assessment (including the disease surveillance reporting) to measure RHIS performance, establishing a baseline and identifying factors to influence performance leading to a strategic and work plan with appropriate and contextualized interventions.
It is expected that interventions to improve data quality and use of the RHIS data as well as building a web-based integrated data repository on a DHIS2 platform, will ultimately not only benefit service providers and health managers at all levels to make evidence-based decisions, but also hopefully convince vertical health program managers to abandon the parallel reporting systems.
June 1, 2015
Theo Lippeveld, Vice President (JSI)
This post originally appeared on JSI.com’s The Pump.
