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Health information, research, evidence and knowledge

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Data are crucial in improving health.[1] The ultimate objective of collecting data is to inform health programme planning as well as policy-making and, ultimately, global health outcomes and equity. A well-functioning health information system empowers decision-makers to manage and lead more effectively by providing useful evidence at the lowest possible cost.

A health information system has been aptly described as "an integrated effort to collect, process, report and use health information and knowledge to influence policy-making, programme action and research". It consists of:

  • inputs (resources)
  • processes (selection of indicators and data sources; data collection and management)
  • outputs (information products and information dissemination and use).

The role of a health information system is to generate, analyse and disseminate sound data for public health decision-making in a timely manner. Data have no value in themselves. The ultimate objective of a health information system is to inform action in the health sector. Performance of such a system should therefore be measured not only on the basis of the quality of the data produced, but also on evidence of the continued use of these data for improving health systems' operations and health status.

The health information system[2]

The availability and use of information enables:

  • improved definition of a population
  • recognition of problems
  • setting of priorities in the research agenda
  • identification of effective and efficient interventions
  • determination of potential impact (prediction)
  • planning and resource allocation
  • monitoring of performance or progress
  • evaluation of outcomes after interventions
  • continuity in medical and health care
  • healthy behaviour in individuals and groups.

It also empowers citizens by enabling their participation in health care, policy and decision processes; and empowers countries and international partners by enabling better transparency and accountability through use of objective and verifiable processes.

Health knowledge gaps are where essential answers on how to improve the health of the people in Lesotho are missing. This is an issue related to the acquisition or generation of health information and research evidence. The “know-do gap” is the failure to apply all existing knowledge to improve people’s health. This is related to the issue of sharing and translation of health information, research evidence, or knowledge. Although there are major structural constraints, the key to narrowing the knowledge gap and sustaining health and development gains is a long-term commitment to strengthen national health information systems.

This section of the analytical profile is structured along the following lines:

Contents

Analytical summary

The health information system in Ethiopia is run under different authorities. The routine health management information system is run primarily by the health sector, while population-based information comes predominantly from the Central Statistical Agency of Ethiopia. Besides the Central Statistical Agency, the Ethiopian Health and Nutrition Research Institute, universities and individual researchers conduct various population and health facility based research activities.

Summary of health information system assessment scores in Ethiopia, September 2011. HIS, health information system

A national health information system assessment was carried out in 2007 using the Health Metrics Network framework and tools and this was updated and validated in 2011 as a step towards developing a national health information system strategic plan.

The results show that indicators and information products are considered adequate but data management is very poor. Health information system resources, dissemination and use, as well as data sources coverage, are also inadequate (see table). The capacity of institutions to generate, analyse, disseminate and use health information differs.

The capacity of the Central Statistical Agency for undertaking censuses and other population-based surveys was considered adequate, but the Ministry of Health still needs more capacity to conduct surveys and to manage effectively the routine health information systems.

Based on these results, the Ministry of Health in collaboration with the Central Statistical Agency, Ministry of Justice and key partners, has developed an 8-year national health information system development strategic plan (2012/13–2019/20)[3] aimed at addressing the main gaps identified through the assessment.


Context

In accordance with its mandate, the Central Statistics Agency of Ethiopia has developed a National Plan for Statistical Development to cover the needs of all sectors and to guide national statistical development. During a recent assessment of the national health information system, it was concluded that, in general, the existing regulatory and legislative situation was fragmented and did not provide a health information framework to cover specific components such as notifiable diseases, private sector data, confidentiality, fundamental principles of official statistics, vital statistics, etc.[4] Also there was no comprehensive health information system policy, legislation and procedures for official statistics. It was concluded that a strong national coordination mechanism with clearly defined roles and responsibilities in health information systems was lacking.

With regard to vital event registration, legal ground work was established nearly 50 years ago – the 1960 Code of Ethiopia states that every member of society has to register births and deaths. However, implementation of this Code is minimal and the country has relied on other sources of data, mainly censuses, sample surveys and indirect methods, for estimations of birth and death rates. At present, there is no official published legal procedure for vital and civil registration in the country. However, the Ministry of Justice has begun work on the necessary legal framework to introduce a vital and civil registration system in the country.

The Ministry of Health has put a strong emphasis on strengthening the national health information system to address gaps in information since the introduction of Health Sector Development Programme (HSDP). One of the strategic objectives of the current HSDP IV (2011/12–2014/15)[5] is to improve evidence-based decision-making by harmonization and alignment. The Ministry of Health has prioritized monitoring and evaluation and reforming the health management information system over the past few years. An assessment of the health management information system was conducted in 2006.[4] Based on its findings, a number of reforms have been introduced, piloted and implemented since 2007, including:

  • standardization of data collection procedures, analysis and reporting
  • application of user manuals to standardize data collection analysis and interpretation
  • selection of sector-wide and programmatic indicators with the involvement of all stakeholders
  • design of simplified formats
  • integrated and unified flow of information.

The Ethiopian Information Communication Technology Authority, now the Ministry of Communications and Information Technology, was established in 2003 to institutionalize the use of information and communication technology (ICT) and has developed a national ICT policy.

A national eGovernment policy for eHealth was implemented in 2009. Government programmes and projects, such as the Ethiopian Education and Research Network (EthERNet) initiatives to create a favourable platform for eHealth, SchoolNet and WoredaNet, have been implemented following its establishment.

Three main streams form the basis for the implementation of the ICT in Education Implementation Strategy:

  • the Ethiopian National SchoolNet Initiative
  • the National ICT in Higher Education Initiative
  • the National ICT Education and Training and Awareness Initiative .

The ICT in Education Implementation Strategy and its corresponding Action Plan are now components of a wider Ethiopian National e-Education Initiative.

Installation of a broadband network at district level marked an important development in building infrastructure. In addition, fibre-optic cable was installed in urban and rural areas in 2004. Access to ICT infrastructure is fully available at federal level but although computers are available, their use for health information system purposes is limited. In general, ICT infrastructure is considered to have the best status of all resources of the health information system.[6][7]

Creating and providing health information in an electronic format for the general public commenced in 2003. A National Multiculturalism Policy was introduced in 2004 and selected projects to promote the use of new electronic health materials in multiple languages were launched in 2005.

Access to a national open archive and national electronic journals is available through the National AIDS Resource Center, which disseminates its information through ICT. The Central Statistics Agency of Ethiopia also makes its publications, including censuses and Demographic and Health Surveys, available through its web site,[8] while the Ministry of Health also makes some of its publications available online.[9]

Although the country promotes the use of ICT applications in the health sector, there is a shortage of human resources for ICT. The major challenge in promoting access to electronic health content has been the limited awareness of the use of ICT.[10] ICT training for students in health sciences is available at tertiary level and there is regular continuing education in ICT for health professionals. However, teaching capacity is affected by underdeveloped infrastructure, lack of a policy framework and a shortage of skilled course developers. Generally, there is an increasing awareness of the need for training, deployment, remuneration and career development of human resources in ICT at all levels.[10]

Structural organization of health information

The agencies dealing with the health information system (HIS) in Ethiopia, including the Central Statistics Agency of Ethiopia, the Ethiopian Health and Nutrition Research Institute, the Ministry of Health and the Ministry of Justice, have formal internal structures dealing with HIS and monitoring and evaluation in line with their mandates. There is a functional central HIS Unit in the Ministry of Health and regional health bureaus, which plays a significant role in coordinating, strengthening and maintaining the national HIS. However, it lacks adequate resources to effectively maintain and upgrade the performance of HIS to a level that meets the HIS requirements of the country.[10][11]

The National Advisory Committee, composed of directorates and agencies of the Ministry of Health and Central Statistics Agency and partners supporting or actively engaged in HIS development, was established in 2005. Its primary function is to oversee the process of health management information system (HMIS) reform initiated by the Ministry of Health. Chaired by the Ministry, the National Advisory Committee is at present dealing with HMIS but recently it was recommended to widen its scope to broader HIS development. The National Advisory Committee needs to be strengthened and formalized.

The Ministry of Health receives service, disease and administrative reports from the regional health bureaus, agencies and federal hospitals (see figure). In addition to the progress report on core plan, the regional health bureaus and hospitals deliver quarterly activity reports. Likewise, the regional health bureaus receive quarterly reports from woreda and regional hospitals, while woreda health offices receive service, disease and administrative reports from primary health care units. The Ministry in turn reports to the Council of Ministers and shares information with partners. The routine flow of information in HMIS is strengthened by the Ministry, following the HMIS reform initiated in 2007.

The routine HMIS reporting flow in the health sector in Ethiopia. FMOH, Federal Ministry of Health; MOH, Ministry of Health; NGO, nongovernmental organization. Source: Ministry of Health, 2008

Regarding the monitoring and evaluation of the sector development programme, the Ministry of Health and its partners developed the Health Sector Development Programme's HSDP harmonization manual[10] to guide joint planning, budgeting and reporting mechanisms and to avoid fragmentation. The Health Sector Development Programme is monitored through regular progress reports, annual review meetings, joint review missions, and final evaluations conducted jointly by the Ministry, other government agencies and stakeholders. An annual consolidated report is presented at annual review meetings. The Ministry also conducts regular supportive supervision at all levels and the reports from this feed in to the HMIS, mainly for planning interventions.

Health Sector Development Programme monitoring and evaluation relies on HMIS data, surveys carried out by the Central Statistics Agency and other agencies, findings of joint review missions, and final evaluation and annual consolidated reports. This is also the basis for reporting the health chapter for the Ministry of Finance and Economic Development's national development reports.

Data sources and generation

In Ethiopia, health information system data are generated from two main areas: population-based health information sources and health-service-based sources. Population-based health information includes census and vital events registration (only as piloting and for a limited time), and population-based household surveys and surveillance.

Health-service-based sources generate data on outcome of health-related administrative and operational activities. There is a wide range of health-service-based data, including:

  • facility-based data on morbidity and mortality among those using services
  • data on use of services delivered, on drugs and commodities
  • data on the availability and quality of services
  • financial and management information.

Most of the health-service-based data are generated routinely in the course of recording and reporting on services delivered.[10][12] The health management information system captures much of its service and disease surveillance data from patient records that health professionals maintain for care and follow-up.

Following the health management information system reform, the Ministry of Health introduced a community health information system to capture basic health and health-related information through health extension workers at household and individual level. The community health information system collects data on basic demographic statistics, health service delivery and utilization based on the health extension package, using a family folder. This is reported to the woreda health offices and then to the Ministry of Health as part of the health management information system.

One of the specialized autonomous agencies of the Ministry of Health, the Ethiopian Nutrition and Health Research Institute, is responsible for public health emergency management and regularly collects data on key epidemic-prone diseases using a standard format developed for Integrated Disease Surveillance and Response. Integrated Disease Surveillance and Response covers 21 epidemic-prone and notifiable diseases. Owing to the nature of epidemics and surveillance, and the need for timely action, Integrated Disease Surveillance and Response is not integrated in to the centralized and integrated health management information system. Integrated Disease Surveillance and Response data are captured in the annual consolidated report and the annual health and related statistics publication.

The Central Statistics Agency of Ethiopia is the major source of population-based statistics. The Agency was established with the objective of collecting, processing, analysing and disseminating socioeconomic and demographic statistical data through censuses, sample surveys, continuous registration and administrative recording systems. The Agency is also required to:

  • provide technical guidance and assistance to government agencies and institutions in their endeavour to establish administrative recording, registration and reporting systems;
  • build the capacity required for providing directives and consultations in database creation and development of administrative records and registration systems.

To date, the Central Statistics Agency has conducted three national population and housing censuses, and three Demographic and Health Surveys. The reports are accessible to interested individuals at the Agency web site.[13] The primary objective of the Ethiopian Demographic and Health Survey is to provide up-to-date information to policy-makers, planners, researchers and programme managers for guidance in the planning, implementation, monitoring and evaluation of population and health programmes in the country. The first Ethiopian Demographic and Health Survey[14] was conducted in 2000 as part of the worldwide Demographic and Health Survey programme. The second[15] was carried out in 2005 and included several additional topics related to HIV/AIDS, malaria, etc. The third and latest Ethiopian Demographic and Health Survey[16] was conducted in 2011.

The Central Statistics Agency also conducts population-based labour force surveys and household consumption, expenditure and welfare monitoring surveys, and disseminates the results. A number of sample surveys with varying objectives are also undertaken by the Agency to fill any information gap.

In spite of the absence of a strong legal provision towards the registration of vital events, the Agency initiated a series of sample vital events registration programmes called the Sample Vital Events Registration Systems in 1977, 1982–1983 and 1986–1987. However, these undertakings were limited in scope and coverage. In 2005, the Model Vital Events Registration Programme started in three regional states, with financial support from the United Nations Children's Fund. This project was intended to test methods and procedures of vital event registration in the selected experimental regions before being establishing nationwide. However, besides documentation of lessons, achievements are very low. In general, there is no reliable source of nationwide vital statistics in the country.

Besides generating routine health information for the health management information system, the Ministry of Health also conducts surveys. Some of the most important include the Malaria Indicator Surveys, Behavioural Surveillance Surveys, the Expanded Programme on Immunization Cluster Surveys, drug use surveys, HIV surveillance surveys at antenatal care clinics, and nutrition surveys. The results of the surveys are disseminated.

Building on the experience of the Department of Community Health, Addis Ababa University in demographic surveillance systems, six universities are currently running demographic surveillance systems and lately the universities have set up a network of demographic surveillance system sites to standardize and share results, both with each other and with potential users.

Data management

The Central Statistics Agency (CSA) is the statistical arm of the Government of Ethiopia. Since its establishment in 1960, it has been involved in socioeconomic and demographic data collection, processing, evaluation and dissemination for monitoring the country’s socioeconomic development, planning and policy formulation. The CSA conducts a National Integrated Household and Enterprise Survey Programme, regular Demographic and Health Surveys, censuses and ad hoc surveys. It also compiles secondary data from administrative records.

In the context of availability of centralized data with comprehensive information for all stakeholders, the CSA has initiated standard procedures for data management but there are no standards in place in other institutions. The CSA has a data warehouse, which is reflected in the annual statistical abstracts produced over the past two decades. In addition, the CSA has developed a website[17] that gives access to available data. The CSA has been actively involved in conducting censuses, sample surveys of various types, and registration of small-scale vital events. However, it has limited scope, consistency and validation.

The recently updated health information system assessment of 2011, carried out as a step to develop a health information system strategic plan, found that in general data management could be considered “not functional”.[18] The CSA has standard procedures for data management and a data warehouse for each demographic and socioeconomic survey it conducts. However, other institutions have no national data standards. The CSA has a procedure and guidelines to collect, compile, store, and exchange data and information at various levels for its own use but this had not been applied nationwide. The CSA also has data quality assurance mechanisms at various levels, although they are not widely used.

The Ministry of Health and subnational units lack an integrated data warehouse. Although the Ministry of Communications and Information Technology has prepared data management tools, there is no standard definition and data warehouse at national or subnational levels.

Input data for all processes originate from individuals, households, businesses or institutions. A characteristic feature of almost all statistical processes in Ethiopia, whether surveys or administrative collections, is that the input data are collected at local community level. Data are assembled, aggregated and passed on to successively higher levels within the organization responsible for the statistical process, until they reach the national level.[19]

Access to existing global health information, evidence and knowledge

Ethiopia is one of the eligible developing countries to gain access to the Health InterNetwork Access to Research Initiative (HINARI) programme set up by WHO. There are 62 registered universities and professional schools in Ethiopia with access to HINARI.[20]

Universities and researchers can access search engines and open-access journals as per their needs but the overall situation can be considered limited. Six universities have recently established a platform to share Demographic Surveillance Sites and Demographic and Health Surveys.

Health professional associations conduct regular, usually annual, scientific conferences at which research findings are shared. Along with some universities, they produce regular publications which they distribute and share among their members. Unpublished academic research reports can also be accessed from universities, while regular reports from the Ministry of Health and regional health bureaus can be accessed on demand, sometimes from websites.[21]

The Ethiopian Intellectual Property Office regulates and enforces intellectual property rights and this extends to the health sector.

Storage and diffusion of information, evidence and knowledge

The Ministry of Health in Ethiopia publishes a quarterly health bulletin, Policy and practice: information for action, to promote information-sharing, document best practices and support evidence-based decision-making. Universities and the Ethiopian Nutrition and Health Research Institute have health libraries and information centres, but their use is limited to academicians and researchers. Interested individuals can access these, although in practice the use is limited. Common publications are available in English. Most are available as hard copies, while some academic and research publications can also be accessed through websites.

Experience in consolidating and publishing existing evidence for policy-making and decision-making is poor. Although a lot of research, mainly from universities, is published in journals, consolidation of this research, with the aim of using it in policy-making, is limited. The Addis Ababa University School of Public Health and some other universities have published consolidated reports from Demographic and Health Surveys and Demographic Surveillance Site research and student research outputs. Some research reports on priority national themes are published by the Ethiopian Public Health Association. However, although these are made available to policy-makers, their use has been limited.

Research

Health and health-related research in Ethiopia is conducted by the Central Statistics Agency of Ethiopia, the Ethiopian Health and Nutrition Research Institute, universities and individual researchers. Each institution sets its plans for research projects for the coming years and specified units are delegated to regulate and monitor the implementation. Ethical clearance is an inbuilt process in research undertakings in all institutions. Each researcher publishes their outputs while the institutions usually publish individual reports and annual outputs and share with users. Each institution has defined its mission as part of the business process re-engineering of institutions, which has recently been conducted in all government agencies.

Research projects in both the Central Statistics Agency and Ethiopian Nutrition and Health Research Institute are financed by regular funds from the Government of Ethiopia, which may come from treasury or external sources. Both are managed according to government financial regulations. Universities and individuals usually depend on external funding sources, while very limited funds may be allocated by the Government.

The Ministry of Science and Technology also allocates funds to selected priority research projects. Professional associations, particularly the Ethiopian Public Health Association and the Ethiopian Medical Association, also may secure funds, mainly from external sources, and support individual research projects. The majority of the research is applied research.

Stewardship

About half of 30 health research institutions in Ethiopia that were reviewed in 2008 had written policies regarding ethics in health research, and almost the same number had scientific review committees.[22] These institutions also have a clearly stated mission and vision, which was a requirement of the business process re-engineering of their institutions, a reform recently conducted in all government agencies.

The Ethiopian Health and Nutrition Research Institute, under the authority of the Ministry of Health, conducts research on nutrition, traditional medicines and medical practices, and on the causes and spread of diseases. The primary objective of the Institute is to conduct research on priority areas of health and nutrition problems and contribute to the national effort of diseases prevention and control.

The vision and mission of the Institute have been clearly defined to fulfil its mandate as the newly envisioned "Ethiopian Public Health Institute” that will mainly focus on research of public health and nutritional importance and public health emergency management.[10] The mission of the Institute includes research and technology transfer, public health emergency management and a public health laboratory quality system.

The objective of research and technology transfer is to bring high-quality research that addresses community health problems effectively and efficiently in terms of quality, cost and time and customer satisfaction. The core processes of research and technology transfer are research agenda-setting and proposal review; research project execution and technology transfer; dissemination of research finding; as well as cross-cutting issue such as research capacity-building and research partnership. The organizational set up is process based, so that research disciplines are addressed in terms of disease, nutrition, traditional and modern medicine, environmental studies and vaccine production, targeting specific objectives and delivering desired outcomes that are vital for health promotion, disease prevention and control.

Public health emergency management aims to protect the community from health consequences posed by public health emergencies, including epidemic investigation and response. However, the public health infrastructure needs adequate attention and allocation of resources to be sufficiently prepared to enable early detection, and to respond and recover rapidly from the impacts of these challenges. Financial resources are inadequate, reflecting low priority, while human resources are weak, with a high turnover.

The objectives of a public health laboratory quality system are:

  • standardization and capacity-building at regional and federal laboratories
  • enhancing abilities and quality in performing specialized and referral tests
  • implementing a regional external quality assessment scheme.

Different guidelines, manuals and formats are needed to standardize standards to be set in the laboratory system.[10]

The Central Statistics Agency of Ethiopia also conducts health and health-related research activities on priority issues identified by the Ministry of Health, while broader issues covering both health and beyond are prioritized by the Agency itself. Among its objective are the collecting, processing, analysing and dissemination of socioeconomic and demographic statistical data. Its research activities are also cleared by the appropriate clearance processes.

Financing

Securing research funds in general is considered to be very weak. The Government of Ethiopia allocates a regular budget for research conducted by the Central Statistics Agency of Ethiopia, the Ethiopian Health and Nutrition Research Institute and for those research institutions identified and supported by the Ministry of Science and Technology. Part of the funding for university research projects may also be provided by the Government; however, most individual and university research is assumed to be funded from external sources.

Allocation of funds from Government sources is included and approved as part of the regular annual budget and released as part of the annual plan. Government-funded research is accounted for in accordance with the financial regulations and process of the Ministry of Finance and Economic Development. Universities and individual funding agencies also implement accounting procedures in accordance with their institutional principles and guidelines.

Creating and sustaining resources

Figure 1. Category, working time and sex of human resources in health research institutions of Ethiopia.[10]
In Ethiopia, human resources development in research is carried out in higher education. While the majority of health research is conducted by the public sector, including the academic institutions, there is a concern regarding retention of capable and experienced researchers in this sector.


Figure 2. Level of education of health researchers in Ethiopia.[10]

The majority of the human resources engaged in health research were found to be either technicians or supporting staff and only 21% were considered to be researchers (Figure 1).[10] As shown in Figure 1, 88% were full-time researchers, and 65% of the staff were male, compared with 77% in the rest of the WHO African Region.

Figure 3.Availability of physical resources in health research institutions in Ethiopia.[10]

Figure 2 shows that only 2% of researchers were professional and had research doctorate degrees. The majority of these researchers were young: 75% were below 40 years of age.[10]

Regarding availability of physical resources for conducting research, the research institutions have better resources when compared with the rest of the WHO African Region, with the majority reporting having laboratories and libraries (Figure 3).[10]

Research output

The Ethiopian Health and Nutrition Research Institute is mandated to produce vaccines for major infectious diseases and improve the national public health laboratory system. However, evidence concerning priority public health issues, including data on disease burden, distribution, type and transmission dynamics of various infectious diseases, knowledge about the prevalence of non-infectious diseases and environmental risk factors, as well as occupational hazards is very limited. Only a few reports have been written, describing antimicrobial resistance levels of various drugs used against infectious diseases, as well as on insecticides used to control disease vectors.[10]

The Ministry of Health identifies research topics to be undertaken by the Ethiopian Health and Nutrition Research Institute and these are included in the Institute's strategic and annual plans. In 2010, the Institute conducted the following research on HIV/AIDS, nutrition, and traditional medicine and herbal extracts:

  • a national surveillance study on HIV/tuberculosis coinfection and a national tuberculosis prevalence survey;
  • a study on the efficacy of Coartem for the treatment of falciparum malaria;
  • a study on two herbal extracts for treatment of mites, sheep ked and lice, which cause skin disease in animals;
  • scientific and ethical reviews of work to ensure research projects address the country’s health problems and comply with ethical standards;
  • through the research conducted by the Institute, the efficacy of one herbal extract treatment for hookworms, Strongyloides stercoralis and Hymenolepis nana, has been approved;
  • as a result of the efficacy gained from the herbal extracts treatment for Plasmodium falciparum in vitro, a medium-term toxicity study and a study on the preparation of the herbal extract in the form of a drug have been carried out;[4]
  • linked to the strengthening of the health management information system reform, surveys are expected to be conducted to capture selected sets of data and to triangulate various sources for improving the accuracy of information about the outcomes and impacts of health interventions.[4]

In addition, over the past 5 years the Central Statistics Agency of Ethiopia has conducted a census and a Demographic and Health Survey covering priority issues identified by the Ministry of Health. These have gone beyond the traditional topics of a Demographic and Health Survey and include HIV/AIDS, malaria and nutrition, which are of high importance both in policy-making and in the planning and monitoring of health programmes. A Welfare Monitoring Survey, Labour Force Survey and a Household Income, Consumption and Expenditure Survey have also been conducted, from which relevant information for health planning and policy can be generated.

Use of information, evidence and knowledge

In Ethiopia, agencies mandated to carry out research, particularly the Central Statistics Agency of Ethiopia and the Ethiopian Nutrition and Health Research Institute, identify research projects based on assessed priority needs emanating from concerned agencies and directorates. Usually the results are shared and applied for policy-making and action. Research questions are articulated with the involvement of policy-makers and decision-makers and officially approved before implementation, and hence their involvement in research agenda setting is obvious. It can be concluded that policy-makers and decision-makers access and apply the evidence generated from research projects, particularly those identified with their participation.

Academic institutions and individuals select their research projects based on their interest and experience, or when funding agencies take the initiative. In academic institutions, certain criteria for evaluation of research activities and their outputs are established in a way that indicates a need to focus on priority areas of research activities. Research activities supported by the Ministry of Science and Technology are necessarily among the areas defined as national priority issues identified by the Ministry.

Leverage information and communication technologies

In Ethiopia, the health management information system (HMIS) moves data from facilities and administrative offices through the reporting chain to regional and national level. While HMIS reform includes a plan for electronic transmission of data from district level onwards, it was agreed that the first stage of the reform is to develop a clean manual system and then to move to electronic systems based on best practices to be documented over time.[23]

The main feature of the HMIS reform is the integration of all reporting systems and the application of a unified line of transfer of information, as fragmentation, parallel reporting and duplication were a serious challenge to the HMIS before the reform.

Some piloting activities have been introduced to capture health information electronically. There are various efforts in different regions and levels to introduce electronic health information recording and transfer. For example, adaptation of information technology in the health sector using the SmartCare electronic health record system utilizes basic telecommunication infrastructure such as phone – ordinary GSM (Global System for Mobile Communications) or CDMA (Code Division Multiple Access) – and computer to send and receive reports and to update software in selected areas and hospitals. Early benefits of this have been:

  • the creation of a central repository of information leading to better coordination between departments, particularly between care provider, laboratory and pharmacy;
  • capturing financial information at each service point, thereby reducing the number of times a patient/client has to go to a cashier.

Also in one region manually transferred reports were scanned, after which aggregation was undertaken, but this is still considered inefficient because of the need to transfer manual reports all the way from health facilities to the regional centre.

During the development of the National HIS Strategic Plan,[10] it was agreed to review and harmonize all of these efforts. Also it is planned to review and expand eHMIS, to develop eHealth policy, protocol, guidelines and standards for the health sector, and to enhance and strengthen the development and use of an information communication and technology system for health data management and communication (developing metadata dictionary, data repository, interoperability).[10]

Availability of IT solutions


Global Observatory for e-Health

e-Health for women’s and children’s health 2013 survey

National e-health policy or strategy

An e-health strategy is being formulated. A technical working group has been established and a draft e-health policy document addresses women’s and children’s health. The cost of implementation of this policy will be met by the Government of Ethiopia, together with donor agencies.

e-Health systems

Electronic health management information systems (HMIS) have been used in health facilities to register deaths and births since 2011 and all districts up to federal level have one. The Ministry of Health is responsible for HMIS.

Electronic resource tracking for health is in place from programme up to national level and the Ministry of Health is responsible for this. Electronic tracking of expenditure by finance source per capita is carried out at all levels for reproductive, maternal, newborn and child health.

Women’s and children’s health policy or strategy

A policy and strategy for women’s and children’s health is embedded in the National Health Policy but it does not refer to the use of e-health.

Monitoring the status of women’s and children’s health

Eleven indicators of women’s and children’s health are monitored, using both paper and electronic means.

National overview of e-health initiatives for women’s and children’s health

There are e-health initiatives for women’s and children’s health through public and donor funding.

Health services delivery
  • M-health funded by the Government and development partners is in a pilot stage.
  • A telemedicine project for teleconsultation with hospitals in India is also in a pilot phase.
Health monitoring and surveillance
  • An e-HMIS/public health emergency management system for recording and transfer of data on notifiable diseases.
  • An e-HMIS for vital event registration by health extension workers in the communities.
Access to information for health professionals
  • The Ministry of Health uploads all policy documents to its website.
  • An electronic medical records programme has been established, with smart card technology.
Other e-health programmes
  • Nil.
Possible barriers to implementing eHealth services

There are legal, infrastructure, human resources and financial barriers to implementing e-health services. The Ministry of Health is working with the Ministry of Education to train graduates in health informatics.

Knowledge base – e-Health for women’s and children’s health

It is not clear whether the Ministry of Health and other organizations would be willing to share their e-health information.

Information and communications technology (ICT) training for health sciences students

Tertiary institutions offer ICT training.

Continuing education in ICT for health professionals

There is postgraduate training in health informatics.

Internet health information quality

Only voluntary compliance by content providers and website owners is in place for quality of health content. There is no official government website for women’s and children’s health, although the Ministry of Health website hosts data on women’s and children’s health.

Online safety for children

There is no information or education on Internet safety, although there are requirements for security technologies for children.

Privacy of personal and health-related data

There is a draft Health Information System Regulation underway and therein will be a requirement for parental consent to children’s electronic medical records.

Social media and women’s and children’s health

Social media are used for general health issues such as awareness campaigns and information exchange with inbuilt feedback mechanisms.

Endnotes: sources, methods, abbreviations, etc.

References

  1. Everybody’s business. Strengthening health systems to improve health outcomes. WHO’s framework for action (pdf 843.33kb). Geneva, World Health Organization, 2007
  2. Framework and standards for country health information systems, 2nd ed. (pdf 1.87Mb). Geneva, World Health Organization, 2008
  3. National health information system road map 2005–2012 E.c. (2012/13–2019/20 G.c.) (Word 1.0Mb). Addis Ababa, Government of Ethiopia, Ministry of Health, 2012
  4. 4.0 4.1 4.2 4.3 Assessment of the Ethiopian national health information system. Final report. Addis Ababa: Government of Ethiopia, Ministry of Health, Central Statistics Agency, and Geneva: WHO, Health Metrics Network; 2007
  5. Health Sector Development Program IV, 2010/11–2014/15. Final draft (pdf 780.81kb). Addis Ababa: Government of Ethiopia, Federal Ministry of Health; 2010
  6. HSDP harmonization manual (HHM) (pdf 1.06Mb). Addis Ababa: Government of Ethiopia, Ministry of Health; 2007
  7. National HIS Strategic Plan 2012/12–2018/19. Addis Ababa: Government of Ethiopia, Federal Ministry of Health; 2012
  8. Government of Ethiopia, Central Statistics Agency web portal
  9. Government of Ethiopia, Federal Ministry of Health web portal
  10. 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 10.11 10.12 10.13 10.14 10.15 Ethiopia eHealth (pdf 220.76kb). Brazzaville: World Health Organization Regional Office for Africa
  11. National HIS Strategic Plan 2012/12–2018/19. Addis Ababa: Government of Ethiopia, Federal Ministry of Health; 2012
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