Table 3 HMIS Ecosystem Challenges and Recommendations

Power difference

1. To harmonize power difference among different actors, the government should have priority in place then all donors, technical and implementing partners will be informed during the meetings. In addition, each stakeholder interested in investing and strengthening the HMIS ecosystem should then be given an opportunity to choose among the existing government priorities.

Power in decision making

2. Decision making on initial investment and strengthening HMIS ecosystem should consider different stakeholders who has shown interest with HMIS ecosystem but the government should take a lead. More involvements of key stakeholders should be considered at the initial designing, execution, and evaluation of the interventions within the HMIS ecosystem.

Technical Capacity and Advancement

3. The government should continue welcoming development and technical partners who are able to capacitate staff on various platforms to ensure integration and interoperability of the systems. As it was noted that ministries have staff who are able to operate technical but lack modern technology and equipment’s for some of the systems

Stakeholders Resistance

4. It is important to engage every stakeholder interested in the HMIS ecosystem by bringing all of them together, discussing and making some plans for future improvement of the HMIS.

5. It is important for the responsible departments at the ministries to call together all the partners in one place and brainstorm together. This will give the opportunity to identify all the data gaps existing for various interventions on going into the country and be able to work together towards integration and interoperability of the systems.

Shortage of Resources

6. The government has deployed ICT personnel in the councils, as well as ensuring availability of office space at the council levels. The government in close collaboration with development partners, technical and implementing partners should ensure the offices are equipped with modern equipment.

7. Stakeholders interested within the HMIS ecosystem in the country should continue to allocate resources (financial, equipment and technical know-how) to aid/supplement the government efforts.

8. To strengthen the HMIS ecosystem in the country there is a need to continue using local experts who know the country’s environment and context.

9. The use of local experts helps to contain costs for strengthening the HMIS ecosystem, though there is a need to build their capacity for sustainability purposes as some of the pilot schemes have been phasing out now and then.

Lack of Political Will

10. It was noted that already there is a circular with instructions from the Hon President that systems available in the health sector should speak to each other. It is recommended that all stakeholders interested in investing and strengthening the HMIS ecosystem should be coordinated to invest in the areas which have already been identified by the government.

Lack of Coordination

11. The government has in place some of the strategic documents such as HMIS investment roadmap where mechanisms for investment/strengthening HNMIS are clearly stipulated. It is important to ensure information contained in the documents are clearly communicated to each stakeholder interested in the HMIS ecosystem in the country.

12. There is a need to strengthening coordination within the ministry and inter-ministerial, ensuring there is a platform where stakeholders can meet and discuss things together

Coding and Labelling of the Systems

13. Capacity building should not only be at the national level, but also at the sub-national level to ensure staff are conversant with the systems

Maturity of the existing systems

14. There is a need to roll out the systems holistically within the healthcare facilities and across levels of care. Meaning that within the facilities all the departments which need to capture information have required tools/equipment to capture information. In addition, systems must be implemented not only at the hospital settings but also at the health Centre as well as dispensary.

Network Connection and Infrastructure

15. Government plans have already been identified and there are policies in place, therefore, the government should make health a priority and set aside funds for improvement and strengthening network connection and the entire HMIS infrastructure.

Staff motivation

16. Motivation of staff working within the HMIS ecosystem in the country is of paramount importance, even though they are being paid salaries and other allowances.

Low integration and interoperability process

17. There is a need to ensure that all initiatives, for HMIS integrations and interoperability serve the intended purpose. There should be post implementation monitoring of the resources invested in strengthening the HMIS ecosystem to ensure value for money. Also, outputs should be monitored to see the actual results of the actual implementation, this will help stakeholders to double check for accountability purposes.

18. Integration and interoperability would reduce duplication of efforts as well as uneven distribution of limited financing resources going to the health sector in the country.

19. For a successful HMIS systems interoperability, integrating peoples/departments (Political will) within sector ministries would expedite the process.

20. Integration and interoperability would allow comparison and standardization of health information generated from the healthcare facilities through the country to inform the decision-making process.

21. Ensuring full integration and interoperability of the HMIS ecosystem will help to alleviate the problem of fragmented tools and indicators which have been created by disease and funding sources in the country. This will also serve the purpose of reducing the workload at the healthcare facilities where healthcare workers have to fill similar information in different systems.