Zimbabwe Health Information and Support Project (ZimHISP)

Improving health service delivery through a national health information system and mobile-based disease reporting

The Republic of Zimbabwe hopes to one day eliminate the threat of HIV and tuberculosis (TB) within its borders. This is a tall order, given that prevalence of both diseases in Zimbabwe rank among the highest in the world.

According to a report from the Joint United Nations Programme on HIV/AIDS, about 15 percent of adults aged 15 and above in the country have HIV. Improved prevention programs, health care, and support services have brought the rate of infections down in recent years, but there are still an estimated 1.3 million people in Zimbabwe living with HIV and AIDS as of 2013, and more than 700,000 orphan children who have lost one or both parents to the disease.

The World Health Organization estimates there are 78,000 new cases of TB in Zimbabwe annually, many of them occurring in people living with HIV, and about 5,700 deaths each year attributed to TB.

ZimHISP Establishes New National Health Information System and Mobile-Based Disease Reporting

The ZimHISP project offers technical assistance to the Government of Zimbabwe’s Ministry of Health and Child Care (MoHCC) in health information systems strengthening to achieve three objectives:

• Increase the capacity of the MoHCC National Health information and Surveillance Unit (NHISU) to independently coordinate and conduct effective health information system–strengthening activities
• Increase health data dissemination and use for decision making at the national, provincial, district, and facility levels
• Strengthen information and communication technology (ICT) capacity to develop and maintain the national health information system (DHIS-2), patient-level systems, and other related information systems.

ZimHISP has helped the Government of Zimbabwe take major steps in its efforts to improve prevention, care, and support programs for the country’s most burdensome health issues by strengthening the health information system at the national and local levels.

Technology offers valuable opportunities to improve health service delivery by providing an efficient means to gather, analyze, interpret, and disseminate data. As early as 1985, Zimbabwe had an electronic-based data collection systems for health information. However, over time it became too slow and inefficient to keep up with big data needs and lacked the capacity for mobile integration. The ZimHISP project gave Zimbabwe a robust web-based system, DHIS-2, with tools for data collection, management, and analysis to track national health indicators and monitor diseases and events of national significance.

The cornerstone of ZimHISP is the rollout of DHIS-2 as Zimbabwe’s national health information system. Introduced during 2011 and 2012, and after making improvements to integrate parallel and vertical information systems, an updated DHIS-2 rolled out to all district health offices, city health departments, provincial health offices, and the MoHCC national head office in 2013. Since then, HIV, TB, psychiatric, and village health worker data have been integrated into DHIS-2.

Reporting Disease Surveillance Data by Mobile Phone

Another key product of ZimHISP is the mobile-phone-based Weekly Disease Surveillance System (WDSS), available to more than 75 percent of health facilities nationwide. RTI supported the customization and training of the two-way mobile messaging system used for disease and event reporting, developed using FrontlineSMS, an open-source software. User-friendly electronic forms enable facilities to easily transmit data via SMS text messaging to a central server that automatically transfers the data to DHIS-2.

The mobile-phone-based reporting system is also being used to relay HIV Early Infant Diagnosis information between health facilities and Zimbabwe’s National Microbiology Reference Laboratory, as well as laboratories at the Mutare and Mpilo hospitals—providing vital information to prevent mother-to-child transmission of HIV. Using this system, nurses notify the national lab of samples collected in the field, and receive results on their mobile phones. The infant’s caregiver is also notified when results are available at their health facility. The system allows timely relay of results to facilities and is increasing treatment rates for babies.

The mobile system is being adapted for other reporting needs, including malaria indoor residual spraying, HIV viral load, and voluntary medical male circumcision.

Improvements to National Health Status Reporting and Outbreak Detection

Since the successful roll-out of DHIS-2, Zimbabwe’s MoHCC has gathered the data it needed for key overdue National Health Profile reports from 2009 through 2013—the Basic Services Trends Reports, health profile monthly and quarterly monitoring reports, and Weekly Disease Surveillance reports. Timeliness and completeness of health information returns has vastly improved—from an average of 40 percent before implementation to more than 90 percent within the first year after DHIS-2 went online.

DHIS-2 has helped Zimbabwe support collection and analysis of routine health services data as well as non-routine data, such as population estimates and facility workload. The system also allows MoHCC to capture data on service delivery at the health facility level, encouraging more evidence-based decision making regarding Zimbabwe’s health care delivery system.

Similarly, the new Weekly Disease Surveillance System is making vital disease surveillance data accessible to district, provincial, and national health officials for detecting potential disease outbreaks and evaluating public health policies. Prior to the deployment of this new system, the completeness and timeliness of weekly reports from facilities was less than 50 percent. With the cell-phone-based reporting system in place, those numbers have shown steady improvement and now stand at greater than 90 percent. Recent examples of the value of this system include detection of a malaria outbreak in December 2012 and cholera outbreaks in May 2012 and March 2013.