Field trip and on job training in Jessore (UHC and Community Clinic)

Report on“Field trip and on job training in Jessore (UHC and Community Clinic)

1. Background:

In Bangladesh, HMIS (Health Management Information System) is being used from government run health facilities. The HMS systems are District Health Information System (DHIS2) software, Human Resource System, Attendance System, Complain Suggestions box, Health System Strengthening etc. icddr,b continues working closely with government to strengthen capacities to generate flawless health data from different tiers of health facilities. As part of this initiative, SHARE (Strengthening Health Applying Research Evidence) project, EU funded Project providing intervention in jessore district to strengthen HMIS system. As a part of it baseline study has been already completed. Project is observing and providing guideline in the monthly district coordination meeting and field visit to observe the progress of HMIS current status and also on job training based on their current issues and provides guideline to improve the HMIS system so that the managers are using HMIS systems data and take decision accordingly.

1. Summary of the trip:

1. 
   Description of trip:

1. Jhikorgacha Upazila Health Complex

Jhikargachha Upazila Health Complex is one of the UHC in Jessore district. Dr. Md. Shariful Islam, UH&FPO stated us the current HMIS status of his health complex. The facility was ranked 116 in HSS (Health System Strengthening) just one month ago. For the capacity building, intervention and initiative it is now ranked ninth position in Upazila Health Complex category. Now need to improve the BOR (Bed Occupancy Rate). The rate is comparatively low because of lack of consultant. On the other hand they need to improve on HRM data especially completeness of data for individual provider such as email address and other basic profile information. The health manager UH&FPO now using the HMIS system dashboard, checked email from DGHS regularly from his laptop and mobile. He said that after three-day intensive training organized by MIS, DGHS and supported EU funded SHARE project, icddrb build the capacity for moving forward to improve the service using HMIS.

On job training: Before the last visit of this facility in October 2016 it was found that they had created very few of their own created dashboard but now this visit we found that they have their own created dashboard in different categories. In the on job training we trained that how to represent the dashboard for proper interpretation. They have some dashboard compare data element with some unrelated data elements. So we provide the on-job training how to appropriately represent reporting rate in graph like Stake graph and BCG given, BCG rate and coverage, BCG crude coverage, Birth registration rate reported in EPI etc. They have community clinic dashboard. They have created this dashboard in the three-days training but the dashboard was not cover all the necessary information for monitoring. We provide the guideline how to on the community clinic dashboard. For event capture senior staff nurse is capturing the data. They have done their event capture data entry for this year but don’t have data entry 2016 so they are now capturing the backlog data.

2. Kashipur Community Clinic, Jhikargachha

Kashipur Community Clinic is one of the community clinics in Jhikargachha. Provider CHCP Mrs. Shathi akter described us the detail activity of that facility and the overall HMIS status. This facility has no HA (Health Assistant) like other Community clinics. They are managing that HA activities with other community clinics HA and FWA. Apart from the individual tracking program, they have to submit four aggregated form in every month in Dhis2 such as Form-1 Community Clinic general patient report, Form-2 monthly child health report, Form-3 monthly maternal health report, Form-4 Community mobilization report in community clinic activities. She got the last training on DHIS2 tracking in last training 2016 MIS organize by COIA (Commission on Information and Accountability for Women’s and Children’s Health). They maintain 3 type of register general, child and pregnant woman for Individual tracker capture. Max average patient of that community clinic approximately 10-15. They got their laptop in early 2015. Sometimes they have network problem then entry capture data after office hour. According to our question, she showed us how many registration or service done yesterday from DHIS2 tracker system.

On job training: Hands on training on event Report and dashboard and also provide training on how to view the local health bulletin of that respective community clinic

3. Sharsha Upazila Health Complex

Finally, we went to Sharsha Upazila Health Complex is one of the UHC in Jessore district. In the visit UH&FPO Dr. Ashoke Kumar Saha described us the current status of that facility. Currently, they don’t have the c-Section. For that reason, they got some less point in HSS scoring system. He said that they are hardly tried to start at least one c-section very soon. In the visit, we solve some current technical problem in DHIS2, HRIS and Dashboard. In DHIS to we show how to get the report from the event report and how to represent reporting rate and other graph and pivot table representation in a meaningful way.  We have also provided on the job training on Community clinic dashboard and Local Health Bulletin.

1. Observations and Findings

• Three-days intensive training organized by MIS, DGHS and supported EU funded SHARE project, icddrb building the capacity to improve Health Management Information System. We found the significant improvement of HSS scoring before the training and after the training was conducted.
• All the health managers are very much concern of how to improve their HSS scoring and have positive competitions with another facility which help to increase service facility. For example Jhikorgacha helth complex ECG machine was out of order. So they got some less score for that. After that the authority manages to make it functional. Another example is that in Sharsha UHC has no c-Section but the health manager is moving forward to take the step for at least one c-Section to start the service in that UHC to get better scoring which boosts up the performance any facility services.
• Facilities are now creating their category-wise own dashboard but representation of data in the dashboard needs to be improved such as compare with related data element, not too much information in the graph etc
• Completeness of HRM data such as email address
• Community clinic dashboard is not up to the mark for their proper monitoring. So need to improve the CC dashboard.
• In community clinic adolescence age group should be incorporated in general patient register book.