CMC COLLABORATION

This section describes in short terms the involvement I had with CMC Ltd. in Hyderabad. CMC is a software company that are developing a name-based health information system for the family welfare department in Andhra Pradesh, first called the India Health Care Project, but has now been renamed Family Health Information & Monitoring System (FHIMS).

This project started out as a World Bank sponsored project to develop a system for handheld computers (PDA) that can be used by field workers to register primary health care data. Instead of registering data monthly like DHIS does, FHIMS identifies the persons uniquely and registers information directly on

that person. This mean that one for instance can track an infant and see what kind of immunization that unique infant has received, and more important has not received, just as in modern western health care systems. The project has enjoyed good support from politicians and is still ongoing.

The FHIMS application uses the Multipurpose Household Survey (MPHS) database for unique identification. This is a huge citizen database containing over 76 million individual records.

6.5.1 FHIMS pilot

A pilot of this project was conducted in a district called Nelgonda, some three hours drive south of Hyderabad. The PDA part of this project failed consider-able because of the complexities of dealing with 4 to 9 thousand inhabitants on one single PDA. Memory problems and the immense task of updating the MPHS database are the two major reasons for why the PDA part of the project was abandoned. For some sub-centres, almost 50% of the information in the MPHS database had to be corrected and updated.

However, what can be described as a success with FHIMS was the use of the software installed in the primary health centre and particularly the creation of immunization schedules for the field workers. Prior, the field workers had to go through their diary to find out when and what kind of immunization an infant is to receive (the mother has an immunization card also). Now, with the FHIMS software, a schedule is made for the field worker on which infants should receive immunization vaccine for the next month on a paper form. The system that is implemented now, concentrates on the immunization module of the software and instead of using PDAs, a paper-form is used to write down the names of the infants. Two times a month, the field workers should come to the primary health centre with the forms that are then entered into the database, and the field workers receive a new schedule.

6.5.2 Collaboration with HISP

HISP wanted to collaborate with CMC to get access to the health data in the IHCP database and populate the data into DHIS. The argument is that these two systems complement each other on their strengths and weaknesses and thus together they create a powerful tool for capturing primary health care data. In theory, the data on immunization would be more accurate and enter-ing is only done once.

The process of developing a tool for automating the population-process from FHIMS to DHIS has taken a very long time. When a system developer and I went to Hyderabad to test out and try to create such a tool, we received poor support. CMC did not want to collaborate with us because they think of the two systems as competing, but were nevertheless forced to because of political

reasons. We started out with getting involved in budget discussions (in which I had nothing to say naturally) and ended getting a printout of the table-structures of the database. This was of course not sufficient information to cre-ate what we came for. Request for an office and a computer with software on, help from programmers at CMC etc. was promptly denied. All we ended up with was some experience on how to create the tool and a very early prototype that has never been tested.

In later stages, more pressure has been put on CMC to collaborate with HISP on integrating the two systems. This has resulted in giving a team of students from Oslo an assignment (within a course) to make such an integration tool (in which I acted as a coordinator). Though the students and I struggled to a de-gree on creating this integration tool, the outcome was a working prototype which was demonstrated to both project-leaders at CMC and the Family Wel-fare Minister in May 2003. The response was positive from both parties, and plans were under way to work further on integrating the two systems. Hence, HISP has got renewed support from the family welfare ministry and had broadened its network by collaborating more closely with CMC.

6.6 Summary

This chapter started with an introduction on how HISP started up in Kuppam and ended in describing further expansion of the project which is already ongo-ing. I have thus been involved in a wide range of problems on both a vertical and horizontal level.

Infrastructural problems, local resistance and bureaucratic issues are problem-atic in them selves, but interconnected they magnify each other even more.

Thus it has been difficult in adapting and customizing HISP to the Indian con-text. Bureaucracy has influenced how training is conducted, on how DHIS should be configured, how organizational changes should be done, and how an expansion of HISP should be conducted. Local resistance have been magnified because of infrastructural problems and bureaucracy. Infrastructural problems have affected how training and system development have been conducted.

The overall success of the project so far has the ability to “stay alive” for almost two years and a small expansion within the state to two other districts. This may sound like quite limited successes, but HISP has made good progress compared to other health information system projects in Andhra Pradesh. The result of this has been that the HISP network has grown larger, covering local trainers to highly influential political leaders in the state.

The next chapter will analyze the health data captured by DHIS.

7 Analysis of Health Data from the