Highlights of Results
Use of Data for Decision-Making
As iHRIS implementations expanded and matured in countries supported by CapacityPlus, national and subnational HRH leaders and managers increasingly began using iHRIS data for decision-making to improve both the accessibility and quality of health services.
Uganda: In collaboration with USAID/Uganda’s Uganda Capacity Program, in 2013, the Ministry of Health (MOH) used iHRIS data, along with data from a rural retention study supported by CapacityPlus, to successfully advocate for an investment of $20 million to fund recruitment and deployment of 7,200 health workers. The increased availability and more equitable distribution of health workers has likely contributed to significant increases in selected HIV/AIDS, family planning, and maternal, newborn, and child health (MNCH) indicators. To inform workforce planning, future deployment, and health worker skill levels, the Ministry’s Human Resources Development department is using iHRIS Train to track almost 30,000 students in preservice education as well as an expanding number of in-service training records. The Uganda Medical and Dental Practitioners Council used iHRIS Qualify to increase relicensure compliance from fewer than 100 to more than 2,300 doctors—providing essential information on qualified medical personnel across the country.
India: In the state of Jharkhand, where CapacityPlus collaborated with USAID/India to support state leaders to scale up iHRIS Manage, data identified Ob/Gyn staffing shortfalls in 60% of health facilities. This finding prompted the Jharkhand principal secretary of health to redeploy 112 specialists with skills in emergency obstetric care and life-saving anesthesia skills and place them in first referral units, which are critical for saving mothers and newborns. As a result, 36 out of 52 first referral units in Jharkhand are now fully functioning, up from 18. The Department of Health and Family Welfare recruited nearly 450 new medical officers between 2012 and 2013 based on iHRIS reports. Estimating that a single medical officer covers 2,000 patients annually, these additional medical officers are increasing access to health services, including obstetric care, newborn care, a full range of family planning services, treatment of sexually transmitted infections, and referral services for 900,000 Jharkhand residents. Now iHRIS is routinely used to assess the distribution and skills of health workers in district hospitals and community health centers in the state. The redeployment of skilled specialists and addition of new medical officers in Jharkhand State based on using iHRIS data for decision-making contributed to significant increases in the availability and utilization of maternal health services across the state. As examples, improvements in the first year included a 740% increase in women receiving three antenatal care visits (from 51,880 to 436,228), a 109% increase in facility births (from 25,557 to 303,876), and a 186% increase in Caesarean sections for women in need of them (from 369 to 7,231). The state also saw improvements in child health and family planning services and use due to a combination of strategic HR deployments and other programs.
Mali: The Ministry of Public Health piloted iHRIS Manage in Sikasso Region, with results showing that urban facilities had disproportionately more midwives than health centers in the rural areas where 63% of the population lives. Taking quick action, regional leaders implemented a rotation system, in which midwives work one week each month in a rural health center to mentor lower-level auxiliary midwives and provide access to long-acting reversible contraceptive methods, including for postpartum family planning. These services are critically important in a country with a fertility rate of 6.1 births per woman and 26% unmet need for contraceptives (Mali Demographic and Health Survey 2014). Building on the success of the pilot intervention, the ministry completed national rollout of iHRIS Manage in 2015. Its HRH Directorate has been using iHRIS data to serve a range of needs, including guiding deployment of newly recruited health workers, identifying experienced supervisors for deployment to a new health center, locating health workers who had fled from the northern regions during the armed conflict in 2012 to offer them grants to return, tracking international commitments, and advocating for more health workers.
“When there was Ebola, the ministry came to the HRH Directorate to have a clear idea about the distribution of health personnel in the affected areas. Since we had iHRIS at hand [we were able] to respond diligently to the request…in relation to the spatial and geographical distribution of health personnel by category and specialty. From there, we could get an idea of the decisions to be taken to respond to the epidemic in our country.”
—Dr. Idrissa Cissé, Director of HRH, Ministry of Public Health, Mali
Ghana: The MOH, Ghana Health Service, and the Christian Health Association of Ghana (CHAG) led the rollout of iHRIS Manage, with support from CapacityPlus. More than 18,500 health worker records are captured in the system, which is being used to plan and adjust facility staffing levels to improve service delivery and to analyze data on issues such as retirement planning.
“With iHRIS you can tell where the vacancies are, and then you base your advertisement on the vacancies. [That] will help to improve distribution, which will have a direct impact on quality of access to health care.”
—Obeng Asomaning, principal human resources manager, Ghana Health Service
Nigeria: The Nursing and Midwifery Council of Nigeria and the Community Health Practitioners Registration Board of Nigeria deployed iHRIS Qualify for registration, certification, and licensing. Up-to-date records are now available for more than 250,000 nurses and midwives and an estimated 90,000 community health workers. The Federal MOH is using the data to inform deployment decisions to provide care in the most underserved areas, identify duplicate health worker records, provide and track education and training, and for budget planning.
Globally, the use of free, open source iHRIS software has saved a calculated $226.9 million in aggregate licensing costs when compared to initial licensing fees from a comparable commercial software product. Each new iHRIS adoption adds to the total saved.
This cost is for the base software license alone and does not include customization of the software, capacity building, infrastructure strengthening, or even all of the functionality offered in iHRIS. (For example, modules such as leave management, benefits, interoperability, and reporting require additional purchases in many commercial product licensing models.) In addition, the global iHRIS community provides ongoing updates and support. If the same degree of updates and support were procured from a commercial HRIS software vendor, it would cost country stakeholders almost $50 million every year.
Independent Uptake and Support from Other Donors
The open source approach to HRIS has also proved its value through independent applications without direct USAID support and implementations supported by other donors, particularly in West Africa. In 2010, the West African Health Organization (WAHO) identified the need for national HRIS for health workers, identified iHRIS as its preferred platform, downloaded and adapted the software, and piloted it in Ghana’s Northern Region without direct support from CapacityPlus. This successful independent pilot application prompted rapid iHRIS uptake in the region through different funding sources. Ghana, Mali, and Nigeria received funding from USAID missions to expand iHRIS through CapacityPlus, while Liberia and Senegal adopted iHRIS through USAID bilateral projects. Mali also received support from the Canadian Cooperation and WHO. Chad, Sierra Leone, and Togo adapted the software with support from the WHO, WAHO, and consultants from Nigeria’s Foundation for Sustainable Development and the University of Dar es Salaam.
In 2012, CapacityPlus started actively supporting the global iHRIS community of software developers and information technologists with an online forum and regular interactive discussions and training sessions. The community has grown to 260 active participants, who have raised and resolved more than 450 technical issues since its inception. The community has contributed code to iHRIS; provided tools, guidance, and case studies for the iHRIS Implementation Toolkit; and translated iHRIS Manage into 16 languages. iHRIS Train represents a good example of how an open source community can empower local information technology teams to adopt, adapt, and deploy new software to address unmet or emerging challenges. Originally developed by a Ugandan team to support preservice education and in-service training, the software was adapted by a Kenyan team to support training institutions, and is being further adapted in Nigeria for the coordination and tracking of participants in PEPFAR-funded HIV in-service training courses.
Developing a Health Worker Registry
To enable countries to link the various systems (including HRIS) in their health information architecture, CapacityPlus led development of a health worker registry for the global Open Health Information Exchange (OpenHIE) program. The registry provides a master list of health workers in a country, pulling information from all health workforce information systems in the public, private, and other sectors. This information is then made available to other digital health systems through open standards and can be used to select groups of health workers for targeted communications that take into account factors such as cadre, location, and services delivered. The registry also enables a health worker to refer a patient to another provider electronically, a service critically important for HIV patients who may need highly specialized services. CapacityPlus supported piloting and scale-up of a prototype registry in Rwanda, and worked with an international standards organization, Integrating the Healthcare Enterprise, to develop a new global standard for exchanging health worker information. The project then supported a local information technology (IT) organization to lead national-level implementation of a registry in Nigeria.