Shared at the 2017 American Society of Tropical Medicine and Hygiene Annual Meeting

1. This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-
OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF; John Snow, Inc.; Management
Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government.
www.measureevaluation.org
MEASURE Evaluation trained two members of the NMCP team as DHIS 2
administrators, and guided them to develop data entry screens for routine and
non-routine information, including seasonal malaria chemoprevention data.
Table 1: Districts and health centers that were trained and equipped to use DHIS 2
in 2016 and 2017
Figure 2: Monitoring the completeness of reporting of routine malaria information after
the introduction of DHIS 2 in 2016
Targeted Equipped and Trained DHIS 2 Coverage
Regions
District
Health
Centers
Community
Health
Centers
Total
District
Health
Center
Community
Health
Center
Total
District
Health
Centers
Community
Health
Center
Total
Kayes 10 235 245 10 232 242 100% 99% 99%
Koulikoro 10 207 217 10 207 217 100% 100% 100%
Sikasso 10 238 248 10 238 248 100% 100% 100%
Segou 8 203 211 8 203 211 100% 100% 100%
Mopti 8 171 179 8 171 179 100% 100% 100%
Gao 4 71 75 4 18 22 100% 25% 29%
Tombouct
ou
5 90 95 5 10 15 100% 11% 16%
Kidal 4 18 22 4 4 8 100% 22% 36%
Bamako 6 60 66 6 60 66 100% 100% 100%
Total 65 1293 1358 65 1143 1208 100% 88% 89%
Within 12 months of deployment, all the districts (65) and nearly 90% of community
health centers were equipped and trained to use DHIS 2 for routine data entry.
Equipment has been received for the remaining health centers to trained to use DHIS 2
by the end of 2017.
Features that are integrated in the DHIS 2 platform for basic data analysis,
include monitoring completeness of reporting (number of reports entered
into the database out of the expected reports) to identify lower performing
health centers and propose corrective measures. Overall, the rate of reporting
is around 80% over the period from October 2016 to September 2017. This is
encouraging given that DHIS 2 has only been in use for about 12 months.
96% 97% 95%
87%
82%
79% 81% 81% 81%
72%
57%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Integration of Malaria Routine and Surveillance Information
Systems in Mali’s Health Management
Information System: Best Practices and Lessons Learned
Diadier Diallo1, Edem Kossi1, Ignace Traore1, Issiaka Dembele1, Madina Konaté2, Diakalia Koné2, Jules Mihigo3, Aminata Traore1, Ramine Bahrambegi1,
Jean-Marie N’Gbichi1, Erin Eckert3 Alimou Barry1, and Yazoume Yé1,
1MEASURE Evaluation; 2 National Malaria Control Program, Mali; 3United States Agency for International Development/President’s Malaria Initiative
Until 2010, the software platform for Mali’s Health Management Information
System (HMIS) was Microsoft Access. This platform was designed for
quarterly reporting of routine health information and covered only four key
malaria indicators. Due to limitations with this platform, MEASURE Evaluation
helped the National Malaria Control Program (NMCP) in 2011 to develop and
implement an application for routine malaria data reporting using mobile
phones in selected regions. By the end of the 2015, 465 community health
centers were using this application to collect and transfer routine malaria
information. In 2013, this application was adapted for weekly surveillance
of malaria to detect outbreaks and prevent epidemics in several community
health centers. However, Mali’s interest in an integrated HMIS capable of
collecting and analyzing all health data for action strategic planning and
policy development led to the evaluation of the Routine Health Information
System (RHIS) in 2013. Recommendations from this evaluation triggered the
introduction of the District Health Information Software 2 (DHIS 2), which
was developed to support management of district health information.
Introduction
• Initial reluctance of national counterparts to switch to DHIS 2
• Coordinating various aspects slowed down the deployment of DHIS 2
• Harmonization of data collection tools
• Poor internet coverage
• Parallel data collection systems continued over the first 12 months
Challenges
Conclusions
The process to establish an integrated HMIS in Mali using DHIS 2 began in
2015 and used a participatory approach, with the direct involvement of users
under the technical oversight of MEASURE Evaluation. Keys steps involved
in the process were:
• Consensus-building among national and international partners
• Updating of the list of health centers
• Development of a DHIS 2 implementation road map, and creation of
a budget aligned with development partners
• Revision of the HMIS, including malaria indicators and data collection
tools, and integration of the malaria data collection forms in the RHIS
monthly report
• Identification and training of DHIS 2 administrators among
national partners
• Development of data entry screens and dashboards by DHIS 2
administrators, under the technical guidance of MEASURE Evaluation
• Cascade training for users across the health pyramid starting from the
central level
• Provision of equipment (laptops, internet access tools, and solar panels
are required)
• Organization of data entry workshops to clear the backlog of monthly
reports that needed to be entered into the new platform
• Support to national stakeholders for post-training follow-up and
supportive supervision
• Regular monitoring of the database for completeness of reporting
and data quality
Figure 1: The new malaria data entry screen in the DHIS 2 platform
Methodology
Data entry and validation
Routine malaria data is extracted from the registers and entered into the monthly
activity report (Rapport Mensuel d’Activites, RMA) by the health personnel. Data
from the RMA is then entered directly into the DHIS 2-supported database within 15
days of the end of the month by health facility personnel. A copy of the RMA is sent
to the district to cross-check against information entered in the DHIS 2 platform.
District and regional medical teams each have five days to review and validate data
received from the health centers and the districts, respectively. Data consistency
checks are performed at each level of the health pyramid. The database is expected
to be ready for analysis 25 days after the end of month.
Lessons Learned
Effective coordination of partners, combined with a participatory
approach encouraging the involvement of users and stakeholders, was
key to the successful integration of Mali’s HMIS and deployment of DHIS
2—leading to near complete coverage within 12 months of the
beginning of DHIS 2 deployment, which exceeded expectations.
Successful rollout and deployment of DHIS 2 in Mali relied on oversight
committees, good coordination, and trust among partners. The
commitment of health facilities to support Internet fees and to use the
system was also key to this success. Integration on a web-based platform
has empowered the NMCP, because it now has full access to its own data
while benefiting from data from other sources.
A DHIS 2 training workshop at the district level.
Results