Zambia has a population of approximately 17 million people with a health system of about 2700 health facilities. The HIV prevalence rate is about 11.6%. In responding to the care and treatment needs for PLHIV, with the support of PEPFAR, Zambia has scaled up treatment services to about 1,000,000 individuals representing about 80% of HIV infected individuals in need of treatment since 2004. In ensuring that the health system continues to be capable and resilient in providing quality care and treatment services to people in need, among other interventions CDC Zambia through PEPFAR has invested in the development of SmartCare, an Electronic Health Record (EHR) system, to support patient management and improve clinical decisions.
Despite the technical support and technological advancement in developing electronic health information systems like SmartCare, the Zambia Ministry of Health and stakeholders still do not have sufficient access to comprehensive, timely, high quality, staged and subject-oriented data that can be dynamically queried, analyzed and graphically presented. There was a need to have a robust Data warehouse platform that will present interactive analytics that can adequately support timely evidence-based decision-making through linking SmartCare service data to support service data. IHM Southern Africa has partnered with Broadreach Healthcare (the prime awardee) as part of a consortium for a project called “Integrated Decision & Analytics (IDEAS) which aims integrate Health Information Systems (HIS) and HIV/AIDS/ TB services in the Republic of Zambia in order to improve clinical and public health outcomes. IHM scope of work included designing and developing a data warehouse with agreed health program-specific data from multiple source systems.
The Need for a Datawarehouse:
The SmartCare reporting was constrained on the operational side because it was directly linked to Smartcare, so what the IHM Zambian team is doing is pulling all of that functionality out of Smartcare and having an independent system that people can query for reports and build analysis. Initially, the team was mandated to do the extraction and the warehouse but added presentations in order to make sense of the data being collected for the user.
Reporting and Dashboards:
People will have access to clean data in the warehouse and dashboards have been developed to give a one-pager understanding of the health landscape. An example of this is how the team has developed appropriate themes depending on the user at each management levels, so to not make the reports to busy. So at a national level data, there is no need for a user to know the indicator but can view provincial performance. Therefore, storylines have been developed to suit the needs of a respective audience.
User cascades are displayed in the form of dashboards. For example, the national dashboard for Antenatal Care has been developed, displaying high-level data indicating the total visits, age bands and how they factor into the total visits. The user can drill down further into provincial, district and facility reporting. The data sources for the below dashboards are taken from Smartcare and CDC datasets.
Data warehouse access levels:
Once the national data warehouse is fully functional, it will be accessible to anyone interested in health information should have access. There are provisions for 9 types of users. There will be individuals who will want access to the raw data, we have created some links to access this type of data. They will have access to this data without interfering with the structure of the warehouse. The data has been desensitized in order to ensure confidentiality. Any information that can be seen as identification criteria has been removed. This will assist with issues of generating a wider buy-in, as the data is hosted in a central location.
Internal Review of Data warehouse:
On the 14th of February 2018, a demonstration was conducted to an audience comprising of Broadreach Zambia management and representatives from Broadreach Headquarters. The internal review looked IHM ’s progress with the development of the data warehouse for the IDEAS Project. Our IHM Zambia Project Manager William Kunda led the demo highlighting the data warehouse’s the ETL Process for loading data from Smart care, strategies put in place to drive quality assurance, the staging of the data, as well as the reporting of the warehouse.