Across Tanzania, health providers often face the same problem: a lack of access to the data they need to make informed decisions and deliver high-quality care. Since the 2013 launch of the country’s National eHealth Strategy, the national government has made an earnest commitment to reverse this trend.
The 2012-2018 Strategy has an audacious aim to “deliver the eventual benefit of a safer, high-quality, equitable, efficient, and sustainable health system that is equipped to respond to emerging health sector cost and demand pressures.” At the heart of the strategy is the enterprise architecture approach, which aligns an organization’s information systems with its mission, goals and objectives, and leverages information and communication technology.
Why is this important? Because enterprise architecture enables connected multi-way availability and use of data among all health system actors for planning, management and delivery of health services.
Recently, the Government took a big step in the operationalization of this strategy by designing and creating an ambitious system that integrates critical healthcare information using an interoperability layer. Led by the Ministry of Health, Community, Development, Gender, Elderly, and Children (MoHCDGEC) and supported by MCSP, the Tanzania National Health Information Exchange (TzHIE) ensures that information and data needed for policy development and the delivery of health care is readily available and used.
Before launching the TzHIE, the MoHCDGEC faced several challenges – nationally scaled but silo-ed health information systems, limited point-to-point integration, key architectural gaps, and limited governance of individual systems. Most of the data from different sources was also manually aggregated and not error-corrected. As a result, it was hard to make informed and reliable service delivery and management decisions.
MCSP supported the MoHCDGEC to create a system that would enable the exchange of data between systems while also minimizing errors. “When strengthening interoperability among multiple information systems, we focused on a broader systems approach,” said Edwin Nyella, an MCSP Heath Information Systems Advisor. “We’ve been supporting the Ministry to improve the health information system with technical assistance and training over the last five years. The change management and technical integration has been led by a governing team comprised of Ministry officials and partners responsible for determining health sector priorities and system design.”
There are two critical components at the core of the interoperable health information systems:
- Health Information Mediator (HIM), which is a data exchange and translation system that can accept data from different systems, exchange the data so that the individual systems all have the same information, and enable health managers to readily analyze the data and use it in their decision-making; and
- Health Data Repository (HDR), which collates patient level data from health facilities and generates reports and dashboards for decision makers in the health sector to use.
The ultimate goal is to connect the electronic information systems of all health facilities in the country. At present, the HIM supports the seven largest national hospitals to share patient data – such as reason for admission, services received, and cause of death, if applicable – as well as bed occupancy rates and revenues generated by each hospital. This data is sent to the central data repository via the HIM.
William Chimwege is the System Administrator at Muhimbili National Hospital, a 1,500-beds hospital in Dar es Salaam and the largest hospital in the country. The hospital was one of the first health facilities to use the HIM and HDR.
Chimwege has been uploading data to the HDR, including records that describe services provided to a particular patient on a given day. This data is then uploaded to the HDR through the HIM. By the end of this month, he will have processed data from September 2018 to the present for analysis and use.
“Our biggest success is automating the sending of the data to the HDR through the Health Information Mediator. There are a lot of decisions that can be made from the data we are sending to the HDR,” Chimwege said. “Top managers can understand which services are in most demand in these seven hospitals.”
He gives the example of tracking death-by-disease: “If we have a sizeable number of deaths from a certain disease in a certain time-period, then we can query why this is happening and address the problem. We were never able to do this before! The HIM and the HDR is transforming how we understand the healthcare system both for the hospital and the country.”
The hospital is also transmitting financial data such as charges, exemptions and revenue, which allows the Ministry to more accurately allocate funds to the hospital. As a result, staff are better able to direct scarce resources toward the most critical problems. Chimwege is looking forward to supporting other hospitals to similarly automate and send their data to the exchange, he said, “so that we can understand the big picture.”
The Government of Tanzania is truly a trailblazer in championing the development and use of the HIM and HDR in this way. “What’s amazing is that the Tanzania team has created the most advanced health information exchange in sub-Saharan Africa”, said Jonathan Metzger, Director of JSI’s Center for Applied Technology. “The system is exchanging tens of thousands of health records per month.”
Previously, this information usually couldn’t be shared. If it was, it would take ages to analyze and share results with senior Ministry of Health officials. Now, these same officials can examine transaction level data and aggregate it any way they want, and also display data through dashboard views and detailed reports from the HDR.
“They can trust the data, because error codes can be analyzed if, for example, duplicate entries are made, data fields are missed, et cetera,” Metzger added. “What is transformational is that data is available now, and it can be trusted.”
Strong Government leadership and the establishment of a multi-partner governance mechanism for planning, directing and monitoring implementation of the TzHIE were critical to the success of this initiative. Led by the Government, the TzHIE Technical Working Group is a diverse set of stakeholders that includes public and private institution representatives, USAID, MCSP, and other development and implementing partners.
Officials from key areas of the MoHCDGEC have been involved at every step of TzHIE planning, design and implementation process, while MCSP worked with the technical working group to facilitate consensus and ensure government ownership of all decisions related to the TzHIE. And while the progress to date has been remarkable, a lot is still needed to scale the initiative throughout the country.
“We now have 13 systems exchanging data and starting to improve decision making for health workers at all levels,” said Silvanus Ilomo, MoHCDGEC’s Acting Head of Information and Communication Technology. “To sustain these achievements and momentum, we – in collaboration with partners – will continue to operationalize the shared vision of the Tanzania Health Roadmap and strive to have a shared health record for all 7,500+ health facilities in the next few years.”