Configuring DHIS

Together with the newly appointed database administrator for the project, I started working on further configuring DHIS. Our main focus was to config-ure DHIS with the new minimum data set, identify reports to be used with the application and finally populate the database with raw data from the primary health centres and the sub-centres.

We were left with the data-elements from the first Master student in the DHIS application. The plan was to convert already existing data-elements to match the mother and child health (MCH) form (also called ‘form 6’) data-elements.

This form is issued by the department of family welfare and is one of the most important within health care in India. Analysis based on this report tells a lot

about the health status of the region, province, state and country. With health data related to ‘form 6’ we could quickly present raw and analyzed health data.

This was important since we were contracted under the Department of Family Welfare, and thus it was important to get these data-elements registered quickly to demonstrate the flexibility of DHIS, i.e. mapping the paper form to the database. To accomplish the mapping we had to identify which data-elements that was already there and change the name to match the name on the form. This was relatively easy as we got help from the medical doctor from the HISP team. However, we did run into problems of incompatible data-elements between what was already there and what was on the ‘form 6’.

A problem arose when we were about to distribute the new minimum data set to the five primary health centres. Entering of data at the health centres was already underway, because of the pressure to show officials the value of the ap-plication, and so we had to retain the data from the five computers. As we stated this, we soon found out that the data-elements on the different com-puter were different from one other. Consequently, we had to go around to all the computers, collect data, and tell staff to hold the registration until we could make a new master database. This was very time consuming. First, it took us several days to get hold of all the data. Often there were power cuts and often the batteries did not work, so we could not do anything except to come back the next day. Other times, we had simple problems like not having the key to the computer-room. When we finally had collected all the health data and the various primary health centres, we could go back to Bangalore and do another round of name-mapping to build a new master database.

Another disability we faced was access to work on a computer. We were origi-nally allowed (orally that is) to sit in the area hospital on the one computer sta-tioned there, but that proved to be difficult. Other people worked on that computer, training and entering of data was going on there, and we had to get out when the man with the key closed at five o’clock. To let us borrow the key was not possible because of responsibility problems. As we found out that just about nothing could be done in Kuppam, we had to collect as much as possible of data in Kuppam, and then go back to Bangalore to work on a computer we had available there. A laptop or even a designated computer in the apartment would have solved a lot of problems earlier, but this was what we had to work with. There was very little we could do about it, except to try and make the best out of it.

When we thought we had a usable master database, we found out, when one of the coordinators visited, that it were missing about 200 data-elements, identi-fied and agreed on at the last workshop. DHIS had been configured with this minimum data set, but all this had then been overwritten when representatives from Aptech was given the task to install an updated DHIS version. One

can-not blame the people who did this, as they had been given little training and instruction on how to install the software. There were no instructions on where to put the back-end data and Aptech had no experience on how to run a pro-ject like this.

We then had to identify the mapping once again. But as entering had been go-ing on in Kuppam, we had to make some functionality in Access that con-verted the data-element data from the old to the new. In addition to this, the

‘form 6’ schema was changed again, for the third time, so we had to make changes in the database again. A complete and correct minimum data set was implemented in DHIS and finally distributed to the five computers in May, after about four months of work.

Work on the reports was perhaps even more frustrating. We identified as many as 60 reports that were in use within the district. Every report was equally im-portant when you got the explanation of the importance of the report. How-ever, most of these reports are only for checking that persons do their job and the statistics were not used to monitor and improve health care in the area.

Many of the reports used a mixture of names and statistics, so implementing these reports is not possible using DHIS.

A second major difficulty in implementing the reports was the lack of a stable minimum data set to relate to. As we were going through the reports, data ele-ments were either missing or were differently defined in the minimum data set.

It was not possible to change the format of the reports to correlate with the minimum data set in DHIS because the reports were official for the district.

Adding data elements ad-hoc to the minimum data set would create a too large set to manage. This interdependency between reports and the minimum data-set resulted in standardizing a final minimum data data-set and created the reports that were possible to make from this minimum data set.

After this move, some progress on the reports was made. An extra module in Access was made especially for Chittoor district. This module can print various reports and charts for various facilities within the health hierarchy. For exam-ple, ‘form 6’ report can be printed for the sub-centre and the primary health centre.

In addition to all these constraints, the project coordinator from the Indian Institute of Management in Bangalore refused the database administrator and a system developer to travel from Bangalore to Kuppam to work. His argument was that “programmers and should not run around in Kuppam and collect in-formation”. The task of collecting information for the reports should be done by others in the HISP team, and the information should be handed over to the programmers in Bangalore. On my request they were allowed three days in

Kuppam pr month for interviewing and testing purposes. However, this was still inadequate.