Design and implementation of a health management information system in Malawi: issues, innovations and results

Abstract

As in many developing countries, lack of reliable data and grossly inadequate appreciation and use of available information in planning and management of health services were two main weaknesses of the health information systems in Malawi. Malawi began strengthening its health management information system with an analysis of the strengths and weaknesses of existing information systems, sharing findings with all stakeholders. All were agreed on the need for reformation of various, vertical programme-specific information systems into a comprehensive, integrated, decentralized and action-oriented simple system. As a first step towards conceptualization and design of the system, a minimum set of indicators was identified and a strategy was formulated for establishing a system in the country. The design focused only on the use of information in planning, management and the improvement of quality and coverage of services. All health and support personnel were trained, employing a training of trainers cascade approach. Information management and use was incorporated into the pre-service training curriculum and the job description of all health workers and support personnel. Quarterly feedback, supportive supervision visits and annual reviews were institutionalized. Civil society organizations were involved in monitoring coverage of health services at local levels. A mid-term review of the achievements of the health information system judged it to be one of the best in Africa. For the first time in Malawi, the health sector has information by facility by month. Yet very little improvement has been noted in use of information in rationalizing decisions. The conclusion is that, no matter how good the design of an information system, it will not be effective unless there is internal desire, dedication and commitment of leadership to have an effective and efficient health service management system.

Grafting: Balancing Control and Cultivation in Information Infrastructure Innovation

“…Discussions with staff at sub-district levels also revealed other HMIS-related challenges such as lack of coordination and data sharing across health programs, which have also been reported on previously (Chaulagai et al, 2005 This example illustrates deep-rooted challenges regarding the introduction of viable long-term changes in the Malawi HMIS, even if they are of critical organizational importance. Staff from subdistrict health facilities also revealed that the poor local use of data was caused by a lack of adequate data analysis skills, a lack of motivation by some officers in charge, and, more importantly, a lack of funds to cover expenses and allowances, as was the case with the World Bank-funded initiative.…”

“…Staff from subdistrict health facilities also revealed that the poor local use of data was caused by a lack of adequate data analysis skills, a lack of motivation by some officers in charge, and, more importantly, a lack of funds to cover expenses and allowances, as was the case with the World Bank-funded initiative. HMIS focal persons also complained that sub-district health facilities hardly received any feedback on data submitted to DHOs, which has also been reported on earlier (Chaulagai et al, 2005;Hamre & Kaasbøll, 2008).…”

Assessment on Utilization of Health Management Information System at Public Health Centers Addis Ababa City Administrative, Ethiopia

“…This indicated that the system was not organized well. In the same relation, the study on design and implementation of HMIS in Malaw indicated that there is very little improvement in the design and planning of information system that hampers the implementation of HMIS in the health facilities [35].…”

“…However, in comparison with other East and South African countries HMIS utilization and implementation the result showed poor organizational and rational decision using information. For instance, in Malawi there was good design of information system and encouraging feedback system [35]. In Kyrgyzstan the implement of HMIS bytraining workers with skills to monitor and plan their health information system improved the quality of data [36].…”

Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa

“…8,9 Yet these systems are often the only data sources available for the continuous, routine monitoring of health programmes. 10,11 Efforts have been made to improve the quality and management of public health information systems in developing countries.…”