Integration of Health Information Systems to Support Evidence-Based Decision Making for Strategic Purchasing in Tanzania

The government of Tanzania through its Ministry of Health and Social Welfare provides health care services to its citizens through a network of public and non-public facilities. There are approximately 169 data systems of which 149 (82%) capture specific health data and 29 (18%) capture data beyond the health sector (MTR, 2015-2020). Recently, Tanzania has invested in improvements to data collection from service delivery units and has centralised national databases to improve planning and generate data for strategic purchasing. The objectives were to:

  1. Improve and integrate data collection tools, planning, budgeting and reporting tools across government.
  2. Reduce the burden of collecting HMIS data on health workers by prioritising data elements and expanding the use of electronic tools (HSSP IV).
  3. Make electronic registers available for service provision and electronic medical records to automate reporting.
  4. Disaggregate routine data by cohorts to facilitate decision making

In this blog we review some of these systems and how they are supporting purchasing functions in Tanzania.

Planning and Reporting Database (PlanRep)

PlanRep is a centralised web-based system used by Local Government Authorities (LGAs) as a tool to assist in planning, budgeting, projecting revenue, tracking funds use and reporting financial and non-financial resources. These plans and budgets include individual service providers (facilities) and tracks budget and expenditure allocations. This system also has Management Information System module to aggregate data for several high-level decision makers including the Prime Minister’s Office and Local Government (PO-RALG). PlanRep has been improved to link to delivery of service outputs1 and integrates community plans and the LGA strategic plans. LGA’s use PlanRep to prepare their objectives, targets and activities.  Planning units such as LGAs and councils use PlanRep for budget preparation where they also specify expected service and targets for each service output. These service outputs are matched to budgeted resources earmarked for that particular service output.

In summary, PlanRep enables system users to allocate and reallocate resources and track budgets and achievement of targets. PlanRep is also useful for generating financial and activity reports needed by decision makers at the Ministry of Finance and other line ministries.

PlanRep is integrated with the Epicor accounting system- IFMS (Integrated Financial Management System), which is used to monitor and control expenditures and produce accounting and expenditure reports. Integration between the two systems improves accuracy, consistency and timeliness of data on budget execution. The integration has assisted the central level government and LGAs to receive financial data directly from the point of use-without any need for human intervention- providing accurate and timely reporting to funders, Sector Ministries and other stakeholders.

Facility Financial Accounting and Reporting System (FFARS)

FFARS enables facilities, such as health centers, to input transactions, manage bank accounts, perform internal controls and produce financial reports. Through FFARS, financial systems extend beyond local government level and facilitate planning and budgeting at the facility level. The system offers providers a simple, standardized set of documents and processes that enable them to record facility revenue. FFARS tracks funds’ use and ensures compliance with procurement regulations and reporting requirements. The accounting activities at the facility level are linked to the accounting activities at the council level, ensuring consistency of planning and budgeting at the facility and council levels, i.e. budget codes, cost centers, revenue sources, classification of income and expenditure items are recorded in the same way at both levels.  Because of this, councils are able to track, at the click of a button, actual expenditures at the facility level, consolidate reporting and generate reports as needed. FFARS has also facilitated accountability and transparency using similar auditing processes for both health facilities and councils.

Further, health facilities and LGAs use FFARS for procurements which are aligned with internal controls, enter accounting transactions for facility level funds received and spent, and reconcile bank accounts. Lastly FFARS can automatically send budget execution information to PlanRep & Epicor accounting systems.

The system, has increased levels of revenue received at health facilities and also has reduced the chances of misuse of funds at health facilities. Council Health Management Teams (CHMTs) have been conducting data driven supervisory visits on health commodities and frequent supervisory visits when there is a need to do so. E-LMIS has enabled CHMTs to redistribute commodities in a timely manner based on stock status report obtained through e-LMIS.

Logistics and Management Information System (OpenLMIS)

OpenLMIS is a web-enabled system deployed nationally that supports the requisition and restocking of health commodities in Tanzania. OpenLMIS links health facilities with the Medical Store Department (MSD) to collect and share timely logistics data. The system helps supply chain managers track stock levels and re-order quantities at health facilities. Tanzania introduced this system to enhance the reporting of supply chain data, reduce stock-outs of health commodities at the point of service delivery, and provide better access to medicines to improve patient health outcomes. 

OpenLMIS and DHIS2 interoperability links supply chain to service delivery. Through dashboards, managers are able to easily compare service delivery and consumption data and highlight discrepancies and interdependencies, track trends and identify data inconsistencies that require follow-up. OpenLMIS data mainly serves Ministry of Health, and Community Development (MoHCD) to verify stock levels and consumption and to determine the adequate reorder quantities for the next procurement cycle.

Challenges

Despite these areas of progress, challenges remain. There are over 5000 public health facilities within the country, but fewer than 500 facilities are installed with the systems. Only public facilities are installed with these systems, excluding more than 1650 private and faith-based facilities that form an important part of the health system. Some of these systems have low coverage and some facilities’ systems are only partially installed, which hinders full functionality of these systems.  

Way forward/recommendations

Quality data is important for strategic decisions including strategic health purchasing towards universal health coverage. Electronic data systems can improve and ease data management to provide a system view of health system performance, breaking silos across schemes. By working together across schemes, Tanzanian stakeholders can work together to improve evidence-based decision making and to make further progress on coverage and equity goals.

[1] Service outputs are defined as goods or services that a system or sector produces being education, agriculture, health and others

References

  1. Global Financing Facility: Monitoring the Funding Flow of Investment case (IC) 1. Making sure government and donor funding follow the IC priorities. GFF Private Sector (globalfinancingfacility.org).
  2. Interoperable DHIS2-LMIS in Senegal, Tanzania and Ghana. A three-country case study on Supply Chain, EPI Information Systems and integration with DHIS2. Final Draft, April 3, 2017.
  3. MOHCDGEC. 2019, Mid Term review of the Health Sector Strategic Plan IV 2015-2020, Data systems, Data generation and Data use, Technical report, Ministry of Health, Community Development, Gender, Elderly and Children.
  4. The Center for Health Market Innovations. Electronic Logistics Management Information System (eLMIS), The Center for Health Market Innovations.
  5. Economic and Social Research Foundation, 2017. Training guide for updating and preparation of District Strategic Plans. 592fde0067ab0951120193.pdf (bundatc.go.tz)
Integration of Health Information Systems to Support Evidence-Based Decision Making for Strategic Purchasing in Tanzania

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