ICTworks

The DHIS2 Community Health Information Systems Guidelines aim to serve as a practical guide for national and local-decision makers involved in the design, planning, deployment, governance and scale up of successful DHIS2 based Community Health Information Systems (CHIS) that support community-based health service providers and the communities they work in.

This guide is based on feedback from 25 countries and covers the full information cycle, including: data collection, analysis, dissemination (feedback loops) and use/action taking for improved and equitable community-based health services.

In each chapter, we formulate a set of design and implementation principles which provide takeaways to guide the design, management, implementation and use of CHIS. These principles are not meant to be prescriptive “how to guide“, but rather to highlight a set of issues that a reader must be sensitive to in order to build a CHIS.

Through case studies, examples, exercises, and discussions we seek to provide alternatives on how to approach these different issues and the contextual considerations that need to be incorporated.

Core Benefit of DHIS2 CHIS Guidelines

The DHIS2 Community Health Information Systems Guidelines provides an in-depth review of key questions that should be considered when addressing issues relevant for governance, design, development and use of large-scale CHIS.

It is applicable to countries that are beginning the design process as well as for existing systems that are being strengthened, scaled up or integrated with other information systems such as the facility based or Routine Health Information Systems (RHIS). It is meant to provide general guidelines whose applicability must be considered and adapted to different country and within country contexts.

The DHIS2 Community Health Information Systems Guidelines:

• Provides insights into the building of a CHIS while considering, in a holistic manner, the work context of a community health worker, and the particular complexities of their information needs.
• Adopts an architecture approach to enable viewing the challenge of building a sustainable and well-governed CHIS which is interconnected with other systems such as RHIS, logistics, human resources and others.
• Builds upon a wealth of practical and research experience, and adapts this to the complex particularities of a CHIS.
• Highlights that building a CHIS is a socio-technical and not just a technical challenge, and the people and institutional considerations must be treated with equal importance as the technical.

Who Should Read DHIS2 CHIS Guidelines

The primary audience for these guidelines are the policy makers in Ministries of Health designing sustainable and well governed CHIS that support community health systems and their implementing team, including district, community health managers, and CHWs.

Ministries of Health are ultimately the stewards and owners of the CHIS and key beneficiary in using the information generated from the CHIS for strengthening their CHW programs and achieving global and national health reform goals of Universal Health Coverage (UHC), Sustainable Development Goals (SDGs) and others.

The secondary audience for this guidance includes other relevant stakeholders supporting community health systems and CHIS such as:

• Development agencies and donors who provide technical assistance, governance oversight or financing to community health programs and CHIS.
• Universities and “capacity builders” since many CHIS have their capacity building efforts institutionalized at universities.
• Private sector practitioners, NGOS and other providers of community services who are engaged in bridging the gap between private and public service providers (e.g. BRAC in Bangladesh, or PSI for malaria in Cambodia)

Focus of DHIS2 CHIS Guidelines

The DHIS2 Community Health Information Systems Guidelines focuses primarily on community health workers (CHW) programs and their routine information needs with direct links to the formal health system; starting with information needs of CHWs and other community-based providers and support at facility, district, and higher levels.

While the CHW is the primary focus of our analysis, the guidelines actively consider the linkages of the system of the CHW with other stakeholders at the community and health system levels.

In considering these multi-level linkages, this guide also looks at sustainable governance and advocates an architecture based approach to avoid the problem of the CHIS being considered as a standalone system, rather than as an entity within a broader ecosystem of health information systems which need to speak to each other for an effective CHIS.

We hope this guidance can provide insights on the complexities of CHIS and approaches to their governance and sustainable development, which they can then adapt to their particular use cases.

Evidence Base for DHIS2 CHIS Guidance

The evidence base for this guidance document is derived from the broad experience of the more than two decades of Health Information Systems Program (HISP) research and development, an initiative of the University of Oslo.

Specific experiences of CHIS in different country contexts such as Zambia, India, Ethiopia, Liberia, Uganda, Indonesia and others were examined to build case studies, insights, lessons and practical exercises on different facets of building a CHIS, including monitoring of integrated community case management (iCCM).