iHRIS Blog: Dispatches from the Global Team

International Standards Adopted in Zimbabwe for National Health Worker Registry

These programmers see the light, embrace international standards for the Zimbabwe Ministry of Health and Child Care’s new national health worker registry.

HiTracZimbabwe

The registry is a database that will pull together a basic set of data on health workers from various information systems in the country.

Once the data are available, health leaders can use them to make all kinds of decisions that can improve the health of Zimbabweans—from influencing health workforce policy to improving the delivery of clinical services.

But first, the computer programmers in this photo had to figure out how to make the different systems “talk” to the registry, or share agreed-upon information.

That’s why IntraHealth joined Zimbabwe’s Health Informatics Training and Research Advancement Center (HITRAC) and Jembi Health Systems to hold a one-week “OpenHIE coding academy.” All three organizations are members of OpenHIE, an open source community that helps countries strengthen their health information and developed the model registry on which Zimbabwe’s is based.

Most of the programmers work for HITRAC, which is leading the work that’s funded by the Health Information Public-Private Partnership.

During the week, the programmers created a plan for integrating information from the ministry’s health workforce information system and other information systems in the country, like those managed by the health professional councils, TrainSMART (which tracks in-service training for health workers), and DHIS2 (which tracks service delivery info and disease statistics).

The plan ensures that the registry is compatible with the international Care Services Discovery standard, a defined way to exchange data that makes it easier to access and merge health workforce data from various sources, and that data-sharing is secure.

IntraHealth’s Carl Leitner co-authored the Care Services Discovery standard and facilitated the academy (he’s sixth from the right in the photo above). He explains why all this matters:

“If countries follow international standards, they open themselves up to innovative health workforce information tools developed by other countries that follow the same standard,” Leitner says. “What is really exciting is we have opened up the possibilities for the ‘appification’ of health workforce and health services data. In other words, we are creating a market opportunity for country and regional software developers to make use of health service data in their own apps.

The model health worker registry is based on IntraHealth’s iHRIS and OpenInfoMan software platforms developed under the IntraHealth-led and USAID-funded CapacityPlus project. Other current implementations include Nigeria and Rwanda.

By Carol Bales and Dr. Carl Leitner

Read more about the coding academy.

Read more about why data standards are important.

Photo courtesy of Carl Leitner.

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OpenHIE- Bridging information systems and mobile applications with common standards

What is OpenHIE (Health Information Exchange)? And what does it mean to the iHRIS community?

OpenHIE is a framework that allows for sharing information across different health information systems. For iHRIS users, it’s an opportunity to contribute to and access a much bigger picture of their nation’s eHealth landscape.  One of the major components of OpenHIE is a national health workforce registry. A Health Worker Registry (HWR) serves as the central authority for maintaining the unique identities of health workers within a country. The registry not only provides a big-picture view of the country’s health workforce, but also enables numerous uses cases for analysis, validation, and interoperability within the larger health information system, eHealth architecture, or health information exchange. It harmonizes data gathered from various sources that categorize and store information differently from one another, resulting in higher-quality data. This improved data quality supports more refined analysis of the health system for quality measurement, reporting, and research, with the aim of improving health outcomes.

OpenHIE and the HWR represent a natural progression along  the continuum that iHRIS has followed since its inception. Ten years ago, iHRIS began helping countries move from paper to electronic record keeping. Now that the data are captured electronically, the iHRIS community has been focusing on learning how to use that data most effectively. Part of that process entailed classifying and categorizing the data, essentially creating electronic  lists to help analyze the information.

“We’ve created a set of technical tools for iHRIS users,” said Carl Leitner. “Now we need to build a culture of using those tools. Typically we’ve been working within one organization. But now the question is, ‘How do we work across multiple organizations?’”

Complex questions about governance and policies arise when you work across organizations, as well as fears about ownership of data. “How can we best mitigate some of the issues and fears that people have about sharing data?” said Leitner. “How do we open up people’s perception so that they see it’s beneficial to share this data? What solutions have people found to overcome some of these innate fears that people have?”

Nigeria provides a good precedent for how a nation can go about this. Nigeria spent two years developing a minimum data set of health worker information, agreed upon by the federal Ministry of Health, as well as by the other national stakeholders and states. “Everybody got together and developed this minimum data set. One we had that, all we had to do was adapt the health worker registry to make sure that those minimum data set fields were captured.” According to Leitner, the technical aspects of it are relatively small. The trick is getting the consensus; for example, getting everyone to agree on the definition of the term “facility.”

“OpenHIE is the meeting point for different health information system components to agree on standards so that all those systems can talk together.” It can substantially reduce the complexity of data exchange. By taking part in it, iHRIS stands to further realize its mission of national ownership of information. A great place of iHRIS community members to take part is by joining the OpenHIE HWR Community.

“I think we’ve gotten to the point where all of this work we’ve done — getting health worker data from paper into electronic form, cleaning it up, thinking about what  the data standardized lists are — we’re getting to a point where it’s going to start to have some really large impacts on the health system.”

As Nigeria continues its work with OpenHIE, other nations are coming online as well. Zimbabwe, Kenya,  Botswana, and Rwanda are preparing deployments, and other nations will likely come on board soon.

The sky is the limit when it comes to the opportunities that are presented to countries when common standards connect information systems together.

 

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Special Event Showcases the iHRIS Software for Strengthening the Health Workforce

On May 6, CapacityPlus hosted its third knowledge-sharing and dissemination event, Better Data, Stronger Health Workforce: The Open Source iHRIS Approach. Held at the National Press Club in Washington, DC, the event showcased iHRIS, the leading open source software for tracking and managing data on the health workforce.

Through a combination of presentations by USAID and CapacityPlus, interactive roundtable discussions, software demonstrations, and a moderated question-and-answer session, participants experienced each of the five iHRIS applications (ManageTrainQualifyPlanRetain), learned about success stories resulting from countries using iHRIS, and discussed the power of open source approaches for maximizing local ownership, capacity-building, innovation, and partnership. The event featured interactive knowledge café discussions to provide participants with a deeper understanding of iHRIS. Participants also had the opportunity to visit different tables to delve even deeper into features and advantages of each iHRIS software application.

Watch videos and access presentations from the event:

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New Technical Brief on Using Data Standards in Health Workforce Information Systems

CapacityPlus has published a new technical brief, Establishing and Using Data Standards in Health Workforce Information Systems, co-authored by iHRIS team members Dykki Settle, Michael Webba Lwetabe, Amanda Puckett, and Carl Leitner.

Human resources information systems are successful when they support policy and management decisions and when those decisions lead to better health care. However, success depends on the quality of the human resources for health data going into the system. The aim of this technical brief is to convey why data standards matter. The authors review organizational, national, and international data standards that can help ensure data quality, provide country examples, and discuss the key role of multisectoral stakeholder leadership groups in formulating and reaching consensus on standards.

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Serious Fun: Health Workforce Planning and Management in Botswana

Health workforce management and planning is serious business, but it can be fun too! Health decisions-makers at the Botswana Ministry of Health recently cut loose during their annual Back-to-School Day. CapacityPlus’s Twaha Kabocho [from the iHRIS team] was in the country and captured the photo below. 

Botswana Ministry of Health employees dressed as students for Back-to-School Day

Twaha visited the Ministry for several weeks to teach HR managers and data clerks how to use the open source iHRIS software. The Ministry is using iHRIS ManageiHRIS Qualify, and iHRIS Train to track in-service and preservice training of health workers who provide HIV care and services, as well as to inform overall health workforce policy and planning.

He also built capacity for the Ministry’s IT staff to support and update the software. Here are three IT technicians that now keep iHRIS humming.

IT technicians from the IT department at the MoH

This story was originally posted on the CapacityPlus blog.

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Christian Health Association of Ghana Chooses iHRIS

The Christian Health Association of Ghana (CHAG) has begun using the iHRIS software to improve management and support of over 13,500 health workers posted in its health facilities across the country.

With 184 facilities primarily located in hard-to-reach locations—where half the population of Ghana lives—CHAG is a significant provider of health care in the country. According to Samuel Nugblega, CHAG’s technical adviser on leadership, governance, and human resources, CHAG provides 20% of all out-patient and 35% of all in-patient care. Nugblega and his colleagues believe that using health workforce data from iHRIS will improve CHAG’s human resources planning and facility management, as well as boost the quality of service delivery.

Read more about CHAG’s adoption of the iHRIS software on the CapacityPlus blog. Reverend Stephen Kwaku Fokuoh, a CHAG facility director, participated in one of the iHRIS workshops in Ghana and describes his experience in the latest video in the CapacityPlus series, “I’m a Health Worker.”

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Event: Better Data, Stronger Health Workforce: The Open Source iHRIS Approach

To ensure that the right health workers are in the right places with the right skills to deliver high-quality family planning, HIV/AIDS, and other essential health services, countries require current, accurate data on human resources for health. Join CapacityPlus and USAID for a knowledge-sharing and dissemination event on iHRIS—the leading open source software for national health workforce information systems. Participants will experience the iHRIS applications (ManageTrainQualifyPlan,Retain), learn about country success stories, and consider the power of open source approaches for maximizing local ownership, capacity-building, innovation, and partnership.

CapacityPlus is hosting this knowledge-sharing and dissemination event on Tuesday, May 6, 2014, from 12:00–4:30 p.m. at the National Press Club, Holeman Lounge, 529 14th Street NW, 13th Floor, Washington, DC. Lunch is included. RSVP.

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First eLearning Course for iHRIS Users Now Available

iHRIS User – Level 1 eLearning Course is now available via the eLearning program hosted by CapacityPlus’s HRH Global Resource Center. The course is free and requires only that you register with the Global Resource Center.

The iHRIS User – Level 1 eLearning Course provides instructions on how to set up and manage human resources data in the iHRIS Manage database. Information on managing employee and job applicant data, as well as training data, is included. Each module is designed to be used separately, as an online help guide, to teach HR staff and hiring managers how to use the software. Specific modules of this course can be targeted to different staff depending on what they want to do with iHRIS. The modules use audio as well as visual teaching aids to reduce any potential barriers to learning to use iHRIS. Currently, the course is available only in an English-language version.

The User eLearning course was developed as preparation for the deployment of iHRIS Manage in Botswana at the district and facility level.  As new HR staff and other users of iHRIS come into a facility, the eLearning course provides an easy way to offer training without having to sending a trainer out to the facility.  It is also been designed to be a reference guide so that users have an easy way to remind themselves on how to perform a certain process.

The course is largely based on the standard iHRIS Manage user’s manual. It was developed using the open source learning platform Moodle so that it can be easily exported and modified for use in different countries. For example, a module teaching specific customizations for that country can easily be created and added to the full course.

Visit the GRC eLearning page to sign up for the iHRIS Users course!

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Innovative Approach Helps Countries Strengthen Their Health Workforce

Note: This is a reblog of a post originally published on the CapacityPlus blog.

To improve the population’s access to high-quality health care, countries require current, accurate data on their health workforce. Togo is one of 19 countries using iHRIS, the leading open source software for national health workforce information systems.

“iHRIS is used in Togo in order to identify health workers across the country,” says Kadjanta Tchaa of the Ministry of Health. “As the director of human resources, I am the first person to use it. Our minister uses it as well. The system allows us to keep track of the workforce and of the training provided to health workers, and to monitor the staffing and budget needs. Every staff member in the human resources department uses it.”

He continues, “We keep track of health workers’ contact information and the evolution of their careers. We use the system as part of the application process when vacant positions need to be filled. We also use it to monitor careers and training. We update the system when health workers attend in-service training sessions. Finally, we use it for budgeting purposes, mostly at the hospital level.”

A sustainable approach
Because iHRIS is free and open source, local developers can customize it to meet a country’s specific needs. IntraHealth International, through the USAID-funded Capacity Project, launched the first version of iHRIS in 2007. CapacityPlus continues to develop the core iHRIS software, release updates, and partner with countries to roll out the software and provide training.

Other donors and organizations now support country efforts to use iHRIS effectively.

Notably, Togo’s use of iHRIS is not directly supported by USAID. The West African Health Organization helped the Ministry translate the software into French and, along with the World Health Organization, provided some funding for entering information on 10,000 health workers. This approach is aligned with USAID’s Global Health Strategic Framework, which emphasizes strengthening health systems and country ownership. And one key focus of the USAID Forward initiative is on identifying and scaling up innovative solutions—such as iHRIS—to development challenges.

 

Suite of health workforce information software and tools 
The iHRIS suite includes:

  • iHRIS Plan, a workforce planning and modeling tool
  • iHRIS Retain, a tool developed in collaboration with the World Health Organization to cost health workforce retention strategies
  • iHRIS Train, for managing data on the education of health professionals.

 

Event: Better data, stronger health workforce
On Tuesday, May 6, CapacityPlus is hosting a knowledge-sharing and dissemination event on iHRIS. It will take place from 12:00–4:30 p.m. at the National Press Club, Holeman Lounge, 529 14th Street NW, 13th Floor, Washington, DC. Participants will experience the iHRIS applications, learn about country success stories, and consider the power of open source approaches for maximizing local ownership, capacity-building, innovation, and partnership. Join us! Lunch is included.

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Questions for Rosaline Hendricks: Part II

This interview is one in a series introducing the people of iHRIS to the global iHRIS community. To nominate someone to be featured, please leave a reply below.

Rosaline Hendricks is the iHRIS Human Resource Information Systems Advisor in Namibia. This interview is the second part in a two-part series.

Interview by Adam Gori

Part II

Rosaline HendricksI’m curious to know why you do this work. What motivates you?

I shared with you that what gets me excited about IT is knowing how much it can optimize a process. It can add so much value at all the levels of an organization if you do it right. What excites me about working for an NGO like IntraHealth is that you’re not driven by profit. You’re trying to make a difference. Namibia has got a tremendous shortage of health workers. We don’t know where our health workers are half of the time because our online workforce data is not accurate, or we don’t have electronic workforce data available. We don’t know the skills that our health workers have.

If there were an emergency that required a particular type of skill, you wouldn’t know who to contact, because that information is in an HR file somewhere in the registry. For example, a facility wouldn’t know that one of their registered nurses has done emergency obstetrics, and they wouldn’t call her in to consult on a case.

That’s the kind of thing that makes me excited about working for IntraHealth and working with iHRIS. I can see the value the system can add to the way a hospital plans to ensure they have the right health worker at the right place at the right time. They can extract a list of specialized skills to be consulted in an emergency situation, or even just in planning their shifts and duty rosters, ensuring they have the correct mix of skills on a shift. They can manage their in-service trainings so that health workers attend the required trainings to keep their skills current. Using the system has the potential to impact directly on healthcare delivery, and that is what keeps me motivated.

I was demonstrating iHRIS to some health workers in a hospital management meeting, and in the course of the demonstration, one of the medical officers mentioned that he had done research in a specific area, and that was the first time that his boss, who was also present at the meeting, had ever heard that. He said, “You never told me that.”

It’s exciting to be able to make that kind of information, especially skills and qualifications in a health facility, available to health workers and to management, to know that you can really make a difference by making information available.

What do you hope to achieve through your work?

I’m hoping to achieve a more equitable distribution of health workers in Namibia. The current picture of our health workforce is a bit distorted. It is inflated in some areas, or inaccurate, or it is outdated. We don’t have enough health workers in the rural areas or at the lower-level health facilities, at clinics and health centers, whereas in the cities, often we have too many health workers.

iHRIS, by providing a system as close to the data-capturing source as possible, can increase the accuracy of information at a national level. What I hope to accomplish with iHRIS in Namibia is to provide a national health-workforce registry. A registry will allow us to know how many health workers we have, who is licensed to practice, where they are located, what their skills are and whether those workers are public-sector health workers, FBOs or private-sector workers.

We are still working with information at the individual facility level. But once all our partners have an iHRIS, we can consolidate those different databases. We can even make that information available real-time at the national level. So if they want to search HR information or workforce deployment information, they don’t have to look at last quarter’s statistics. They can actually look at today’s information.

Two of our regions are prone to heavy flooding around February every year. That puts a lot of strain on health workers as there is an influx of injuries and an increased demand for health care. Recently a cholera outbreak demanded additional healthcare workers to address it in a timely manner. Currently it’s difficult to plan adequately or mobilize emergency resources for these types of contingencies because we don’t have accurate and timely regional and national HRH information. If we did, we could make plans at the national level to deploy from areas where they know it’s not going to be so busy. So making the national health workforce information available real-time or as close to real-time as possible is my vision for Namibia.

Why is that important to you? Is there something from your background that makes this type of work part of your make-up?

I grew up in a small town, and have firsthand experience of clinics that only have a few nurses, with traveling doctors and dentists only available certain times of the month. I never saw a specialist until very late in my adult life. Now that I’m working in the city and I have health insurance, health care is very easily accessible. But I know what it looks like in small towns. When I visit our FBO partners based in the rural areas, I still see the queues of my childhood, and that makes we want to help.

I like helping people. I’ve always liked helping people, and what better way to help than by making sure there’s a health worker to treat people when they get to the clinic or the health post or a hospital? I don’t like the spotlight and prefer working behind the scenes to make things happen. Working in IT systems allows me to do that. It is a very powerful tool.

When I was young, I hated giving public speeches, but I was the “head girl,” what you would call the senior class president, so public speaking was required of me. I had to do it, but it was nerve-wracking, and I wouldn’t want to do it again. I prefer working behind the scenes.

It’s interesting that you put yourself in that role.

I know. I was nominated and didn’t think I would be chosen as head prefect, so I accepted the nomination. I hated being up there giving speeches, but I did enjoy having influence and being able to make a difference, and worked hard with my team of nine prefects. I liked making things happen, making them work. That hasn’t changed. If I commit to something, if I agree to it, I get it done. I’m like a bulldog. Once I get hold of something, I don’t let it go.

I’m extremely hard on myself. I expect perfection from myself, and I know I drive my team very hard, because our output is a team effort and reflects on us as a team. I’m a perfectionist in my work. It just has to work perfectly. Sometimes I’m not the most liked person because of it.

You seem very likeable actually. I can’t imagine you having a whole lot of friction with your co-workers. 

That’s true, I get along very easily with most people, and people find it difficult to say no when I ask them to do something. I think it’s because I’m always willing to help, but also because I work very hard. But I also play very hard. If the mood in the office feels heavy, I’ll be the one trying to lift people’s spirit and bring some excitement into the office. Who can work when you’re not energized, right?

I’m also very persistent. If I feel you don’t understand me, I’ll go think a little bit about it and then come back and rephrase it until I can get you to see the same picture that I can see and agree with me. Sometimes you might convince me otherwise, and we’ll end up with a different picture. I’m open to that, as well, but you need to know your stuff to convince me otherwise because I do my homework thoroughly. I think my easygoing, collaborative way of working does result in less friction, although there are times when I know I can be quite difficult to work with.

You mentioned that you grew up in a rural area. Do you feel that growing up where you did shaped you in regard to your work now?

It definitely shaped me in that I wanted to be able to be financially independent. When I grew up, you either had to become the school principal or the reverend, or you had to become the doctor to earn a good and steady income, and I don’t like blood, so becoming a doctor was out of the question.

Growing up in a rural area made me very ambitious. I mean, for somebody to have been introduced to a computer in the final year of high school and then decide to choose that as a career, in hindsight, shucks, I really thought a lot of myself. Or I was extremely naive.

Coming from a rural area, I understand how you just have to make do with the little you have. When we did the iHRIS rollout for the Ministry, going out to the regional offices in the rural areas and spending time with the people, I felt I was giving back to my community because the biggest impact we can make is in the rural areas, where people struggle. They have so few resources already, but they are expected to provide quality healthcare services.

iHRIS resonates for me because it’s open source and therefore free of license fees. You just need to have the willpower and the desire to make it work for you. IT systems can be very expensive, and the infrastructure alone requires a huge investment.

I’ve been through very expensive system implementations, so I know a bit of the costs of systems implementations. Typically the main questions that we have at the outset of an implementation are: “Will we be able to support this system afterwards? Can we afford it? What are the license fees?” And it brings joy when you tell them, “Listen this is open source, you won’t have to pay license fees.” And they actually struggle to understand that concept because they’re so used to having to pay for IT systems.

That’s one of the things I like about iHRIS. It was also my first introduction to an open-source system. Here in Namibia, open-source skills are still quite hard to come by. 

As someone who thinks about systems, what value do you think open-source systems hold for Namibia?

Most of the organizations in Namibia run either customized-off-the-shelf systems or very high-end enterprise resource planning systems. Those systems require annual license fees as well as service-level agreements to guarantee continuous support, and they don’t allow for a lot of customization, or they cost a fortune to customize. This makes IT systems unaffordable for small-to-medium-sized enterprises and civil-society organizations like the FBOs in Namibia.

Lack of systems was one of the recurring challenges that was identified by our CSOs and FBOs when we conducted organizational capacity assessments in the past. This creates a unique opportunity for open-source systems in Namibia. We just still need the entrepreneurs to realize it and run with it.

In addition, the Polytechnic of Namibia has changed all their computer labs to run on open-source and is teaching the LAMP architecture as part of their Software Engineering curriculum, so they definitely see the potential as well.  Given the low after-implementation costs for open-source systems, I think it provides a real opportunity for software to be developed for organizations that do not have the means to spend a lot on IT systems. 

One of the main things that we need to put in place for sustainability is to make sure that we have the skills in-house or at least  in Namibia to be able to maintain the software, especially since our FBO partners do not have IT developers on their staff establishment.  We only have two developers now, and we’re adding a third developer to our team. We have visions of becoming the iHRIS support group for the Southern African region.

How do you envision that?

There’s a big scope for iHRIS still in Southern Africa. It’s a perfect opportunity for Namibia to provide that kind of support and resources. There are a few countries, such as Botswana, Lesotho and Swaziland, that are in various stages of implementing one or more of the iHRIS products. But there remain fewer than five competent iHRIS developers in Southern Africa.

The region is very reliant on resources from the USA, Uganda or Tanzania. Air travel is costly in Africa.  Namibia, Botswana, Lesotho and Swaziland are within driving distance of each other, no more than two days at most, and Namibia has the most advanced iHRIS skills. So it makes sense for Namibia to capitalize on that and start providing these skills to our neighbors.

Read Part I of Rosaline’s interview.

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