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DHIS2 in Action: Zimbabwe

At Population Services International (PSI), DHIS2 is the information source that facilitates data-driven decisions by making relevant health information available in real-time. As a flexible, web-based management information system (MIS) that serves PSI at the global, regional, and country levels, DHIS2 helps PSI go beyond data collection and offers powerful visual analytics that illustrate program trends and presents information to inform program strategy.
PSI Zimbabwe manages one of the most diverse, highly scaled and complex portfolios of health services among all PSI country offices. Over the past year, PSI’s Global Business Systems department has worked closely with the PSI Zimbabwe team to understand their data needs and build a system to integrate the service data the team collects from multiple programs into a single MIS. PSI Zimbabwe’s base DHIS2 system integrates reporting from a variety of different HIV testing, male circumcision, and antiretroviral treatment (ART) programs. DHIS2 PSI Zimbabwe innovations include:
  • Program management dashboards are brought to life as DHIS2 uses the data collected from PSI Zimbabwe’s programs to create rich reports and data visualizations that drive evidence-based decision making to improve service delivery and client satisfaction in country-wide operations
  • Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women (DREAMS) DHIS2 implementation tracks linkages to care, service delivery and referrals to program beneficiaries across all DREAMS partner organizations in the country. It is the first comprehensive cross-partner database for USAID DREAMS indicators of its kind.
  • The Health Network Quality System (HNQIS) uses DHIS2 as the platform by which Zimbabwe is rolling out the Android application (app) in 2017, a mobile technology to provide feedback on quality of care during supervision visits to clinics.
PSI Zimbabwe’s DHIS2 system captures routine monitoring data for the following programs:

HIV Self Testing
PSI Zimbabwe’s UNITAID HIV self-testing (HIVST) project includes the largest evaluation of HIVST in Africa. DHIS2 supports over 200 community based distributors to collect household distribution data on Android tablets. Distributor performance and inventory can be tracked in real-time, improving delivery and preventing stock-outs.

Voluntary Medical Male Circumcision (VMMC) Reach and Conversion
DHIS2 allows PSI Zimbabwe’s VMMC program team to track clients reached through demand creation messaging, including segmentation and appointment booking information. The system closes the loop on demand creation activities when a client is circumcised and the team can track VMMC conversation rates, IPC agent performance and the most effective messaging strategies.
Antiretroviral Therapy (ART) Referral tracking
PSI Zimbabwe uses DHIS2 to track all HIV testing for clients who receive a positive result. The system assists the HTS team in following up with clients and scheduling appointments with healthcare providers, as well as closing the loop with the date of initiation on ART treatment. The HTS team can use reports generated from DHIS2 to track linkage rates to care and loss to follow-up for further outreach by program staff.

Real time HIV testing services (HTS) outreach targeting
Using DHIS2 Android apps, PSI Zimbabwe is collecting geographically tagged information on HTS outreach activities, including operational data and HIV yield rates for each outreach site. Costs such as distances traveled, fuel consumption, and person-days used in support of outreach activities are combined with positive test data to inform program teams on costs per positive result at each site. By identifying high yield areas, the PSI Zimbabwe team can better target and link beneficiaries to HIV treatment while utilizing program resources in the most effective manner possible.

Other DHIS2 programs the PSI Zimbabwe team uses to drive data for decision making include: HIV key population
registration, HIV hotspot mapping for most at risk populations and collecting real-time client level data for HIV testing.
PSI Zimbabwe’s USAID-funded DREAMS DHIS2 configuration tracks linkages to care, service delivery, and referrals to reduce HIV infection among adolescent girls and young women across six partner organizations in Zimbabwe. Data is reported by each partner individually into 14 DHIS2 tracker programs configured on a single server for the specific set of services they provide: HIV testing and counseling, education, pre-exposure prophylaxis and post-violence care. Unique Identifier Codes (UICs) generated for each beneficiary through a custom-built Android app allows DREAMS partners to track clients and completed referrals throughout the continuum of care while preserving the privacy of personal client information. PSI Zimbabwe and other partners can then create DHIS2 reports with custom SQL views to segment the profiles of the clients receiving services. This allows identification of patterns in referral and service linkages across partners and geography. The end result is a DHIS2 system in which the DREAMS project tracks and delivers benefits to clients across different partner organizations, while building beneficiary records to facilitate better informed service provider-client interactions.
PSI Zimbabwe’s HNQIS is a custom-built Android app powered by DHIS2 that provides feedback on quality of care during clinical supervision visits to clinics and helps prioritize follow-up supervision by client load and quality scores. HNQIS in Zimbabwe currently supports quality supervision for:

  • VMMC
  • Family planning
  • Cervical cancer screening and treatment
  • HIV care and treatment
  • Gender-based violence services
  • Sexually Transmitted Infection screenings and treatment
During visits, quality officers observe clinical procedures and answer a series of questions in the app about the provider’s adherence to national guidelines in performing the service. After the procedure is complete, HNQIS generates feedback for the provider tailored to any questions that they may have missed, as well as an overall quality of care score to track the provider’s performance over time. The combination of the provider’s quality of care score and their client load is analyzed by the app to automatically generate a date for the quality officer’s next visit. The app prioritizes providers with low scores and high client levels. Data collected by HNQIS is fed into Zimbabwe’s DHIS2 system, where supervisors can track the performance of providers and quality improvement officers in promoting positive provider behavior change.