In 2001, the MoHSPP of Tajikistan mandated the Republican Centre for Statistics and Medical Information (RCSMI) to collect, process, store, and disseminate unified health information, and analyze health status of the population. Other important sources of data related to population health status come through two other national institutions: the Civil Registration Office (CRO) and the Agency of Statistics (AS). The CRO is the government organ mandated to register information on births and deaths. The Agency of Statistics (AS) under the President’s Office conducts the decennial census (last one in 2010) and provides regularly updated population statistics by age and sex, providing denominators for calculating many of the demographic and health-related indictors. The AS also provides socio-economic statistics from population-based surveys conducted periodically, many of which are important for validating routine data.
The overall objective of the project was to contribute to the improvement of the population’s health and to a healthier living environment, supporting health system reforms towards a results-oriented, system-complete, and well-resourced health care sector in the Republic of Tajikistan through strengthening the national HIS by applying a multi-sectoral approach for improving health-related data and by rolling-out a country-wide integrated electronic reporting system and a national data-warehouse.
The purposes of this contract are three fold:
Purpose 1: To integrate reliable, relevant and timely routine data with essential statistical data from other sources i.e. Civil Registration, Agency of Statistics, and vertical programmes, for effective management.
The project aimed at building the national data-warehouse, and installing it at district level in 2-3 years through a timely stepwise approach. The project team installed and put into function the server-related hardware and customized the DHIS2 software, ie, streamlined the reporting forms and defined appropriate periodicity, data elements and sets, as well as tested for feasibility case and name-based modules. DHIS2 software was progressively installed and internet connected in 65 districts of the country as well as at the central level and the target personnel trained. The inventory of facilities available, classified by type of services offered, core personnel, basic medicines, and infrastructure was updated.
Nationwide on-line utilization of DHIS2 started on January 1 2015. The health statistical reports for years 2014 and 2015 were successfully completed in DHIS2 in on-line regime. Since January 1 2015 all 7 civil registration acts have been entered in on-line mode by districts CRO. By the end of the project, approx. 500,000 civil registration acts were entered into DHIS2 system. The module for import of legacy statistical data from previous systems was developed and appropriate data were migrated.
The following training materials have been elaborated and adjusted: Basic Computer skills; ToT on DHIS2 for MoHSPP and CRO; DHIS2 for users for MoHSPP and CRO; Continuous medical education of statisticians; ICD-10 encoding; Use of servers, Java programming language and DHIS2 customization, Data quality and utilization, and evidence based decision making. Nationwide implementation of the system has been prepared through training of 212 specialists from the MoHSPP and 131 from CRO in Basic computer skills; training of 37 DHIS2 trainers from the MoHSPP and 10 trainers for the MoJ; and training of 272 DHIS2 users from the MoHSPP and 235 from CRO.
The Help Desk Hotline software has been identified, configured, and installed with English and Russian interfaces. The Help Desk Hotline has been piloted and the users have been trained to access it. A monitoring system based on the Spice Work Helpdesk tool is being implemented.
Purpose 2: To establish the organizational framework needed to ensure high standards of data quality accessible from an integrated data warehouse.
DHIS2 institutional host was clarified by MoH and human capacity was strengthened, in terms of number and skill mix, for data collection, storage, processing, analysis and dissemination at central, provincial and district levels.
Standardized job descriptions, describing the roles and responsibilities of health statisticians have been developed and approved by the MoHSPP, recommendations for the Districts Hospitals on the organization of the Statistical Units and health reporting in DHIS2 were developed.
The project established quality assurance criteria for checking routine data integrity and validation, and to address errors, inconsistencies and missing values. The percentage completeness of birth and death reporting, and accuracy of cause of death was assessed according to international methods, through joint annual analyses between MoH, CRO and AS. Certification of death and death coding was improved through collaboration with MoH and WHO organizing training activities on ICD-10 encoding for a total of 1,056 medical doctors from all regions. Teaching modules on DHIS2 and data quality and utilization were developed and integrated in the curriculum of undergraduate and postgraduate education.
Purpose 3: To establish effective M&E mechanisms, based on evidence, for assessing health system performance and tracking progress of the NHS 2010-2020.
The project revised the indicators to monitor health performance at every level of service delivery, aligned the primary statistical forms, the reporting and aggregated forms and metadata accordingly, and incorporated them into DHIS2. The optimal reporting periodicity was agreed upon. The local capacities for analysis of health data, assessment of health performance, based on indicators appropriate to each level were enhanced through various training activities on data quality and utilization, evidence based decision making for 360 health managers and medical statisticians, certified refresher training course for 80 statisticians, 5 study tours for a total of 49 specialists from the MoHSPP, MoJ, CRO, AS, MoF, MoEDT, UNDP and SDC to Norway, India and Moldova. Following the annual assessment of HIS Strategic Plan 2011-2015 and a mid-term review in 2013, a policy paper on HIS strategy was elaborated in 2014 as a bridge between the current HIS Strategic Plan and the next one. The Statistical Yearbooks for years 2012, 2013, and 2014 were elaborated and published in Tajik and English languages.
In addition, the project established and maintained a project website http://eu-hmis.tj/index.php/en/ and established the website for the Republican Centre for Medical Statistics and Information http://medstat.tj/