Health Information System (HIS): Bangladesh Perspectives
The other day somebody mentioned that data can save lives. How is that possible? Obviously data related to health has no ability to cure disease at all. However, good data on health can lead to better decision making by the stakeholders and thus improve the quality of care and reduce morbidity & mortality. That’s why it is said, “Better information, better decisions, better health.”
Despite the importance of data in the health system being perceived much earlier, the development of the Health Information System (HIS) in Bangladesh started only a few years ago. As part of the current government’s commitment to build up to a digital Bangladesh, the Ministry of Health & Family Welfare has taken various steps to implement HIS since 2008. In collaboration with development partners they launched the Health, Nutrition and Population Sector Program (HNPSP) in 2008, and four key stakeholders started using DMIS (Data Management Information System). They are the Director General of Health Services (DGHS), the Director General of Family Planning (DGFP), the National Nutrition Program (NNP) and the Urban Primary Health Care Project.
All these projects are using DHIS 2 (District Health Information System) software. Recently the DGFP introduced LMIS (Logistic Management Information System) which is unique and has earned an award from the Government. Moreover, the DGHS has been doing disease pattern mapping by using GIS (Geographic Information System) which is another important step. Open MRS (Medical Record System) is also going to be implemented very soon to strengthen the flow of information. In spite of all these efforts, HIS has crumbled with various flaws and extreme fragmentation.
The collection of data and using information is very much fragmented and vertical in nature. There is little or no coordination between those who carry out the process. As a result, there is duplicity and redundancy of data everywhere. It creates wastage of time and resources as different departments are collecting the same data at the same time.
It also affects the quality of the data. The data comes in as paper sheets from community level, which then goes to the Upazilla (subdistricts of Bangladesh). This is then converted into a digital format and sent to the centre. As there are different formats of data collection e.g. paper, excel sheet, word document; the data are invalid for interoperability.
The bureaucratic disparity is also playing a vital role in fragmentation and lack of coordination. In addition, the private sector in not participating in the information system. The quality of data is also questionable. There is a shortage of skilled personnel at every level i.e. data collection, data transformation, data analysis and interpretation.
It is often reported that many data collectors fill up the forms at their home; not going to the community. There is a huge lack of resources: electricity and internet facility are the prelude to implementing HIS. But unfortunately there is low bandwidth and load-shedding problem in the rural areas of Bangladesh. The shortage of skilled IT personnel, public health experts and statisticians makes the situation gloomier. In addition the data collected is not being converted into indicators, so the data is less useful.
In this context the Ministry of health should put more emphasis on the Health Information System. Implementation of the Integrated Health Information Architecture (IHIA) would be a great approach to reduce the existing ‘spaghetti’ condition of health information. It would also minimize duplication, promote data sharing and optimize resource use. Appropriate policy making and capacity building will be vital in implementing IHIA in Bangladesh.
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