The National Council on Health (NCH) in 2013 adopted District Health Information Software version two (DHIS2) platform for the National Health Management Information System (NHMIS) as the only platform for routine health data reporting in Nigeria. From a routine immunisation (RI) perspective, a major setback of NHMIS was the absence of many data elements necessary to monitor key indicators outlined in the National Routine Immunization Strategic Plan 2013-2015. However, the process of recording or capturing the necessary data to monitor many of these indicators already existed at the health facility level, in RI-specific data collection forms.
To address the challenge, NPHCDA in collaboration with African Field Epidemiology Network – National Stop Transmission of Polio (AFENET-NSTOP) and other immunisation partners commenced the DHIS2 RI Dashboard Implementation Project. The project began in November 2014 with Kano as pilot state.
The over-arching goals of this project are to improve the quality of RI data being generated and encourage the use of this data for action and decision-making whilst promoting ownership at different levels. Specifically the project aims to ensure key RI indicators not previously available on DHIS2 national instance are captured and made accessible on a DHIS2 RI dashboard. The project also seeks to reinforce compliance to the 2013 NCH decision on DHIS2 as the sole platform for routine health data management.
The pilot phase in Kano State ran for a whole year before scale up to more states began. The implementation processes consists of the following steps:
- Advocacy and needs assessment visit to states;
- Training of state, local government area (LGA) and health facility officers on the revised RI data tools and DHIS2;
- Data quality and use supportive supervision training;
- Supportive supervision;
- Post-introduction evaluation.
The project supports states with seed stock of RI data tools. A laptop computer is provided to each LGA immunisation office to support the LGA Immunisation Officer (LIO). In each state, the project employs a DHIS2 Implementation Officer (DIO) to provide support for a minimum period of one year.
The role of NPHCDA
NPHCDA plays the following vital roles in the implementation process:
- Provide technical support toward the development of RI Dashboard on DHIS2;
- Lead development of training modules for the project;
- Provide general coordination of implementation of scale-up project;
- Provide technical support for training at state and national levels;
- Plan and coordinate capacity building sessions within DHIS2 implementation team members on RI data management and general M&E;
- Coordinate activities of the NPHCDA DHIS2 implementation team. The team comprises at least 12 members drawn from the lead department; Planning, Research and Statistics; and the department of Disease Control and Immunisation. Two additional team members are drawn from each of the six zonal offices of the agency to support implementation.
- Coordinate provision of national RI feedback to states and follow-up with states to ensure recommendations are implemented.
- Coordinate and lead advocacy and needs assessment visits to states prior to training on DHIS2.
- Coordinate presentation of monthly updates on the project to national RI and M&E working groups.
There is a subsisting ministerial mandate for training completion nationwide by end of 2017. As of May 5, 2017, training has been conducted in twenty-five states as listed below:
North-East Zone: 2 states – Bauchi and Taraba
North-West Zone: 3 states – Kano, Sokoto and Kaduna
North-Central Zone: 7 states – Nasarawa, Niger, Plateau, Kwara, Kogi, Benue and the FCT
South-West Zone: 4 states – Oyo, Osun, Ogun and Ekiti
South-East Zone: 5 states – Enugu, Abia, Imo, Anambra and Ebonyi (all states completed)
South-South Zone: 4 states – Akwa Ibom, Delta, Rivers and Cross River.
To ensure project activities are linked to outcomes, we are measuring completeness and timeliness of reporting by states. The target is 90% for both domains. In addition, we conduct assessments and operations research on data quality and use.
As with any large scale national undertaking, the DHIS2 RI dashboard implementation project is confronted with some challenges some of which are outlined below:
- Uninspiring leadership by some state team leads which compromises process ownership and makes partnership and coordination difficult to maintain.
- Some states in Nigeria are confronted with internal security challenges that constrain full implementation of the project.
- The morale of health workers in some states is dampened by months of unpaid salaries. This has led to disruptive workers strike and absence from duty posts.
- The capacity of trainees in some states to use computers has been a challenge both for DHIS2 training and actual data management.
- Data use and supportive supervision are frequently poorly funded at both state and local government levels.
- Scheduling difficulties arising from concurrent activities, especially polio outbreak response campaigns have been a bottleneck for the project.
- Poor internet connectivity poses a challenge as training on the DHIS2 dashboard is heavily reliant on stable internet access.
The African Field Epidemiology Network – National Stop Transmission of Polio (AFENET-NSTOP) is our lead technical partner for the DHIS2 RI dashboard implementation project.
Further information please contact:
Sulaiman Etamesor: email@example.com
Dr A. B. Garba: firstname.lastname@example.org