Strengthening Health Information System in the context of Malaria Elimination in Southern Mozambique (SISMAG)
The World Health Organisation (WHO) has encouraged countries to monitor and assess malaria surveillance systems, particularly high burden countries. Weak surveillance systems, characterised by poor quality and inaccurate data, are shown to be inefficient for decision-making and ineffective for malaria control. In Mozambique, the health information system at the district level was widely underutilised, particularly as a tool for local data analysis, interpretation and use. In 2015, the Ministry of Health adopted the District Health Information System 2 (DHIS2), a powerful web-based open-source information system. This project worked with the government to increase the uptake of the DHIS2 at multiple levels of the health system – regional, sub-regional and community level.
This project has supported the ongoing malaria elimination efforts in Gaza Province in Southern Mozambique, while also strengthening capacity within the overall health system. The Manhica Foundation has provided Ministry of Health staff with training on DHIS2 implementation while building the capacity of health workers to use DHIS2 reporting systems to generate, aggregate and report malaria data. The project adopted a behavioural change approach and focused on improving the ‘data culture’ in the system.
The project also provided IT equipment for District Health Directorates and trained district-level managers and planners on how to use data for decision-making. The Manhica Foundation provided supervision and feedback to health facilities and community health workers so that these lower levels of the health system understand the need for high-quality data and are encouraged to provide it in a timely manner. The project also engaged the District Health Information System Unit to develop Data Quality Assurance protocols and a Data Quality Improvement strategy to ensure the institutionalisation of data quality monitoring and improvement.
Key successes and learnings
The successful devolution of data collection and use
This project extended the DHIS2 down to the health facility level using mobile-phone technology. This has improved the maintenance and use of health management information systems at district level. The establishment of District Data Quality Assurance Committees has also increased the ownership and sustainability of the project by local health authorities.
Promoting a stronger ‘data culture’ at all levels of the health system
The project has promoted discussion and sensitization on the good practices for both data users and data producers, enabling them to work together and address barriers to data use and improve the sharing of data resources. The project has supported managers and decision-makers to more consistently and effectively use HMIS reports for routine monitoring, quality improvement, and planning.
Data quality assessments and activities integrated into existing systems
As a result of the project, data quality reviews have been institutionalised at the district level in order to routinely review the validity of data reported in facilities. The Manhica Foundation, with the support of local authorities, advocated for the project's activities to be included in the Social and Economic Plan at district and provincial levels for these data assessments to continue beyond the Partnerhsip.
214 frontline workers have been trained to date (including 53 health facility managers, 82 health systems managers and focal points, 75 community health workers, 8 health systems managers and 4 district statistical officers
All staff, trained through the programme report that they: - Know what malaria-related data to record and where to record it - Know how to access DHIS 2 derived data and interpret it - Value the timely submission of data into the system
Four district Data Quality Assessment Committees have been created, with 33 members trained in 4 districts