Challenges and opportunities for effective adoption of HRH information systems in developing countries: national rollout of HRHIS and TIIS in Tanzania

Abstract

BackgroundThe establishment of a functional information system for human resource for health (HRH) was one of the major challenges for the Tanzanian health sector. In 2008, the Ministry of Health and Social Welfare developed the HRH Strategic Plan, in which establishment of computerized information systems were one of the strategic objectives. In response to this objective, the Ministry developed two information systems, namely the Human Resource for Health Information System (HRHIS) and the Training Institution Information System (TIIS), to capture information from both the public and private sectors.Case descriptionThe national rollout of HRHIS and TIIS was carried out in four phases during a 6 year period between 2009 and 2014. Together with other activities, the rollout process included conducting system operation training and data utilization training for evidence-based planning, development and management of HRH and social welfare workers and health training institutions.DiscussionHRHIS was rolled out in all 25 regions of the Tanzanian mainland, including 171 districts, and TIIS was rolled out in all 154 health training institutions and universities. Information is captured from both the private and public health sectors with high-data coverage. The authors identified several key factors for the achievements such as using local experts for developing the systems, involvement of system users, positive attitudes among users, focusing on routine work of the system users and provision of operations and data utilization trainings. However, several challenges were also identified such as getting a consensus on sustainable HR information systems among stakeholders, difficulty in obtaining baseline HRH information, inadequate computer skills and unsatisfactory infrastructure for information and communication technology. We learned that detailed situation analysis and understanding of the reality on the ground helped to reduce the “design–reality gap” and contributed to establishing user-friendly systems and to improve sustainability of the systems.ConclusionsThis paper illustrates the successful development and national rollout of two information systems for HRH in Tanzania. The approaches used and activities conducted here and lessons learned could be useful for countries which are planning to establish HR information systems.

Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements

“…The first information system, the Health Management Information System (HMIS), was introduced to the health sector in 1994–1997 [19]. This system captured all information regarding the health sector and not only on HRH.…”

“…This system captured all information regarding the health sector and not only on HRH. The Ministry of Health had no HRH-specific information system and therefore struggled to capture HRH information from other systems operated by other ministries [19]). This system of collecting information from other ministries was less effective, and forecasting and planning of HRH demand became difficult [20].…”

“…This system has two major components: the information system that collects all the information from districts, regions, consultants and referral hospitals, and the Training Institution Information System (TIIS) that collects information from all of the training institutions. The information system captures information from both the public and the private sector [19]. …”

Lessons learned and study results from HIVCore, an HIV implementation science initiative

“…Major efforts have been carried out in many countries to improve district-and facility-level data, including implanting open source software for district health information systems (DHIS2) [35Á39]. However, systems such as DHIS2 have only been effectively nationalized in a few countries [40]. More often, DHIS2 has been implemented at sub-national levels with the support of donors and NGOs, without strong support from the central Ministry level [41].…”

“…However, a key issue is that study resources appear to be skewed towards the measurement of baseline and end-line, often relying on the use of routine service delivery statistics for process data [17]. It is also a reality that service delivery in low-resourced settings is plagued by the endemic lack of adequate funding, staff and other resources [5,39,35], resulting in serious gaps in routine data making the data difficult to use in research [40]. OR study protocols should include plans and budgets for process data collection, in addition to baseline and end-line surveys, and not rely only on service delivery statistics [16].…”