Rwanda has implemented centralized health information systems using open-source DHIS2 and iHRIS platforms to support its decentralized health system. DHIS2 integrates routine health, individual, and disease surveillance data from over 700 public and private health facilities nationwide. iHRIS manages human resources data for the health sector. These systems allow all levels from national to community to access and analyze data for monitoring health status and performance. Challenges include changing mindsets around data use and keeping pace with software updates.

1. IMPLEMENTATIONAND USE OF CENTRAL
HEALTH INFORMATION SYSTEMS
SUPPORTING DECENTRALIZED HEALTH
ACTORS
Experience of Rwanda
Adolphe Kamugunga
Management Sciences for Health, Rwanda
December 16-18, 2015
Cotonou,Benin

2. Rwanda Profile
• Eastern Africa Country, bounded by Uganda, Tanzania,
Burundi, and DRC
• Population 10.537 millions (2012 census)
• 5 Provinces with 30 Districts
• 42 District Hospitals and 508 Health centers (HMIS 2015
public facilities only)
• Per capita utilization of health facilities : 0.9 visits per
inhabitant/year
• Mobile phone network coverage at 98% (RURA 2015)
• Phone usage penetration rate at 70.6% (RURA 2015)

3. Rwanda Health System Structure
National
Province
(5)
District
(30)
Sector
(412)
Cell&Village
(2148)
MOH, Rwanda Biomedical Centre,
Referral Hospitals (8), TWGs
Provincial unit in charge of social
affair and governance, Provincial
Hospitals (4)
District Health, DHMTs District
Hospitals (42)
Health centers(508)
CHWs(45,000) in 500
Cooperatives
HMIS & Program
Data managers and
M&Es
Provincial data
quality Officers
DHMTs, District
Health Unit staff
(M&E, statistician,
etc), and Hospitals
Data managers,
M&E, Supervisors
HC coordinators,
Data managers,
Management
Commitee
CHWs and Cell
coordinators
Levels Operational Actors HIS Actors

4. Data elements selection and collection
Data variables selection and reporting is guided by:
• HSSP III M&E data requirements
• National published indicators (MDGs, EDPRS)
• Partners and stakeholders data needs
• Needs of data to measure health outcomes and health status at
decentralized levels
• Vertical programs data needs
• Performance contracts
• All health actors work towards the national targets
• Every actor sign performance contract with supervisory unit/ institution

5. HIS solution selection process
Hard to find HIS solution that
• can respond to all levels data needs
• can minimize the workload to data collection levels
• Supports and empowers coordination and supervisory mechanisms in place
• is less demanding in terms of time, resources(HR, Money, Materials)
Before 2012, MOH has been using standalone application (SQL &
VB.net) as HMIS solution of routine health data management
At that time Vertical programs were using different systems
• Burden to decentralized levels collecting and managing data
• Contributed to resources and efforts misuse
Resource-related data (HR, materials, and infrastructure) were
collected through Excel sheets, and compiled to generate a national
Excel database
• Doesn’t improve data sharing and use at all levels
• ICT skills gaps challenge the quality of data sent

6. HIS solution selection process
To respond to these data needs
The MOH together with partners adopted DHIS2 platform since
2012 as then national data management system
DHIS-2 is an open source software:
• Globally implemented in more than 47 countries
• Supports health systems integration
• Runs on every device (PC, Tablets, etc)
• Supports data management and analysis at national and decentralized
levels
• Strong capacity building mechanisms through DHIS2 Academy and
global community of developers
Also the Ministry adopted iHRIS software to support the
management of health sectors staff at all levels,
• Open source product for Human Resource information management

7. Use of DHIS2 as integrated HIMIS
R-HMIS is DHIS2 bases data collection and reporting
system.
It is integrated health data management system
It combines routine health data, case based and
individual data
HMIS Database
• Holds routine aggregated health data from public & private health
facilities countrywide (approx. 700 HFs)
• TB quarterly data from all CT and CDTs
• Malaria data
• Weekly child deaths reports
• Immunization, FP, NCDs monthly reports

8. Use of DHIS2 as integrated HIMIS
HIV/AIDS database
• HIV/AIDS monthly reports on VCT,ART,PMTCT, etc from all health
facilities
Health Financing Database:
• Community based monthly reports
• Support the billing process for Community Performance based
financing (Community PBF
Individual Records database:
• collects all details on neonatal and child deaths cases
• TB patients tracker during treatment period
IDSR database:
• Diseases surveillance case reporting, and management
Rwanda PBF database
• Support PBF management
• Quarterly PBF payments calculation
• Reports

9. R-HMIS Organization
R-HMIS
DHIS2-Based Systems
HMIS HIV SIScom
Individual
Records
IDSR
PBF
Rwanda
Rapid
SMS
iHRIS
• HFs have access to these nationwide databases any time for evidence based
practices and monitoring local health status within the catchment areas
• System have built-in data analysis function requiring minimal efforts to generate
charts, map, summary tables, and standard reports

10. Facility level routine data reporting

12. Capture PBF indicators data

13. Quarterly payment adjustments

14. Data analysis, presentation & sharing
• Use built-in analysis and dashboard tools to display health status
• All health sector levels have access rights to monitor status in
catchment area

15. R-HMIS Usage statistics
Automatic Data statistics feature

16. Data warehouse
• It’s for public health data access
• Minimize loads to the already busy system with over 1000
users
Aggregated
data
Individual &
case data
Disease
surveillance
RapidSMS iHRIS
• Routine health data
public &Private HFs
• TB quarterly data
• HIV, Malaria data
• FP& Vaccination data
• Weekly child deaths
• Neonatal & Child
deaths audits
• TB patients
• CHWs 1000days
MCH case reports
• Immediate notification
• Outbreaks data
• Cases reported by HFs
• Immediate notification
• Outbreaks data
• Cases reported by HFs
Data warehouse
• HSSP III indicators
• National published indicators
• MDGS
• EDPRS
Selected variables for national
public indicator portal

17. Use of iHRIS as health sector HR
Information system
• iHRIS is an open source software for human resources
management
• Globally implemented in many countries, and
recommended for resources limited health facilities
• Reference for more details: http://www.ihris.org/
• In Rwanda the platform is customized to help with the
management of human resources for health
• Depending on system access privileges, HR officer at
district can create, enter, edit, view, records and generate
various reports related to employee.

18. Functions implemented
• Employee Registration (education, gender, names, ….)
• Salary information, positions management
• Staff relocation management
• Retirement planning
• Contracts management (ending, status)
• Staff turnover reports by positions
• Different HR reports for any health facility, institution in the
health sector under MOH

19. iHRIS use case and output samples
• Using the built-in tools, the HR can generate the similar
outputs

20. Personnel by cadre summary table at
Health facility

21. Comparison with standards/targets at
Health facility

22. Summary table of Actual staffs vs norms
at District hospital

23. Advantages of using DHIS2 & iHRIS
based systems
• Open source products
• implementation and maintenance cost is moderate
• No licensing and system modification costs
• Availability of technical support within the region
• Customizable, modular products
• Interoperable with other systems (API,…)
• Scalable
• Specific for health
• Used across many African countries
• Strong users community that can provide support for
free

24. How did we reach here?
Consultation meetings to harmonize and optimize data collection tools
• Vertical programs (Malaria,TB, HIV,NCDs, etc)
• Partners(aligning categories, age, gender, definitions)
• District level staffs
• Clinicians
Establish coordination mechanisms and regulations to minimize parallel
and similar efforts
Introduction of integrated planning and M&E to ensure that Districts level
plans and targets fit into/contribute to the national goals and targets
Establishment of Technical working group to regulate and validate new
HIS deployments
• Ehealth TWG
• Planning, Health Financing and HIS TWG
Establishment of HMIS unit for daily system support
• Capacity building plans, and skills development
• Availability of in country technical support
Strong commitment of health actors at all levels

25. How did we reach here?
Ministry commitment to go for evidence based practices
• Meetings presentations should be supported by facts
• Productions of annual statistical booklets
• SOPs development of data management and data use guidelines
for all levels (National, District admin., DHs, HCs, and Community)
• Standardizations of data collection tools countrywide(National,
Decentralized actors, partners
• Health facilities shares on monthly basis data analysis results on
noticeboards with the public
• Production of data analysis quarterly reports with discussion on
strategies and interventions planned to address the issues found
• Data management and use supporting staffs (DM and M&Es) at all
health facilities and District health unit
• Capacity building budgets to support in service capacity building
• Development and adoption of data sharing policy

26. How did we reach here?
Health facility and DHMT commitment
• Leadership
• Every coordination & management meets at HF, data analysis
critical findings should be discussed and actions should taken
• DHMTs hold quarterly meetings to discuss district level health
concerns
• Reinforce supervision and data quality audits of Districts hospitals
to Health centers
• Ensure inclusive and extended DHMT Committee for strategic
decision making
• Train Head of Health Facilities and key staffs on data use and
HMIS bult-in functions of data analysis

27. Challenges
iHRIS
• Changing mind set for HR managers to regularly use and update
data
• Payroll module not implemented within the system, the application
is for planning and routine HR management only
• Some health facilities don’t have fixed numbers of posts
• Turnover of staff
DHIS2
• How to keep pace with DHIS-2 development – new versions every
2 months?
• Refresher trainings. System is dynamic, modifications may be
requested, or some few changes may happed to benefit from the
new versions

28. THANK YOU