Pakistan Nursing Council Implements iHRIS Qualify

The Pakistan Nursing Council (PNC) recently launched new online resources, including a customized iHRIS Qualify system! Implementation of the new registration system, along with a new website containing useful information about the council and registration process, was funded by USAID’s Technical Assistance for Capacity Building in Midwifery, Information and Logistics (TACMIL) project. Development and deployment were addressed in country by representatives from the PNC, TACMIL, Aga Khan University (AKU) and local developers.

Although some work still needs to be completed before the iHRIS Qualify system is fully implemented, progress made in Pakistan thus far is monumental as it is the first time the Open Source iHRIS software has been customized and implemented with only virtual support from the HRIS team in Chapel Hill. The HRIS team, through the Capacity Project and follow-on CapacityPlus, has been supporting this work as a pilot effort to understand the needs, advantages, and challenges of a country when implementing the iHRIS software with only minimal support. Virtual learning and communication was made possible using the online tools Skype and, especially, Elluminate. Elluminate access was provided by AKU.

As part of an official launching ceremony held in November, PNC representatives gave a presentation about the iHRIS Qualify software and discussed future plans for expansion. A packet of materials—including information about iHRIS—was distributed to all participants. Representatives from USAID/Pakistan, Pakistan’s other professional health councils; ministries of health, education, and information sciences; and local nurses attended. Dr. Rafat Jan, associate professor of the AKU School of Nursing and consultant for the PNC implementation, said the PNC took advantage of the event to introduce stakeholders to the system and encourage other councils to also adopt it.

Dr. Rafat Jan and the PNC registrar during Elluminate video conference.
Dr. Rafat Jan and the PNC registrar during an Elluminate video conference.


The Current Registration Process

The PNC registers nurses, midwives, lady health visitors, and nursing auxiliaries to practice in Pakistan. These health workers are required to renew their registrations every five years. In 2006, the PNC began using a simple electronic database for registration, called the Nursing Management Information System (NMIS). As the PNC previously relied on a paper registry, it benefits from the NMIS and now has the ability to issue computerized registration cards and generate limited reports. However, the registration process requires data from many stakeholders and the procedure for sharing and gathering this data using the NMIS is still largely paper-based. To illustrate, NMIS registration involves the following steps:

  1. Individuals send hard copy registration applications to the PNC office.
  2. The country’s four Nursing Examination Boards (NEB) each send examination results to the PNC via hard copy spreadsheets.
  3. Individual training institutions send new student enrollment information and yearly examination forms to NEB. These individual institutions also send this same information to the PNC. 
  4. The PNC uses the above information to verify new registration applications. Once information is verified, the registration and exam information is entered into the NMIS and registration cards are issued to individuals.

As you can imagine, the paper applications, spreadsheets and forms result in surmounting stacks of paper at the PNC. In addition to storage issues, the processing of the paper documents is labor- and time-intensive, requiring many PNC staff members’ attention, and involving duplication of effort. Further, illegible hand writing often present on paper forms increase rates of errors by data entrants, causing longer processing times for registration verification.

Files in the PNC.
Files in the PNC.
Paper documents being entered into NMIS.
Paper documents being entered into NMIS.

The Decision to Implement and Customize iHRIS Qualify

To address NMIS challenges, the PNC decided to adopt a more efficient and effective registration system, and to introduce online registration to NEBs, schools and health professionals. USAID, through TACMIL, sponsored a workshop with stakeholders to discuss system requirements. In June 2009, the PNC decided to implement iHRIS Qualify.

As all countries’ policies and procedures for registering health workers are different, the iHRIS Qualify software required modification to meet the PNC’s needs. For example, the PNC requires a current photo with all registration applications, so they needed the ability to upload photos to health professionals’ records. Also, various fees are associated with registration and renewal, and a Challan (bank draft) must be submitted with applications. Therefore, the PNC required a finance module that would record the type of fee, refund or balance, and Challan details.

The PNC and HRIS teams, along with local developers, began meeting virtually in July to discuss the implementation plan and required customizations. Photo upload capability was already slated for the 4.0.2 release of the software, so the iHRIS developers focused on that while local developers concentrated on the finance module. The local developers also migrated existing NMIS data to the new iHRIS Qualify system; developed a small database to electronically link NEBs with the iHRIS Qualify system in the PNC office to quickly share information for verification; and trained users.

iHRIS Qualify training
Local developers conducting training.

The PNC recognizes the need to eventually electronically link all the stakeholders and sites i.e., from the PNC to the NEBs and schools, and vice versa. This would help with information sharing and pave the way for online registration. In response to this need, the PNC initiated an online registration pilot, and installed iHRIS Qualify in one NEB and one school, with the hope of eventually rolling the system out to all of the country’s 200 nursing training institutions and all four NEBs.

The TACMIL project, along with implementation funding, ended in December. There is remaining work to complete development, switch to the new system and ensure sustainability. The PNC is dedicated to using the new system and is currently working with the iHRIS developers to refine the software code and write essential reports that can be generated easily by PNC staff.

Look for updates about the PNC implementation on our blog. We’ll soon be posting a write up specifically about the PNC’s vision for online registration!

*All photos are from the PNC presentation given at the launch ceremony in November.