Health Information System in Cameroon:

Contextual Challenge

Presenter: Samain Nkendo Consuelo Tatiana , Matriculation number: 2327524

Module : Global, European and German Public Health
Lecturers: Prof. Dr. Deneke, Dr. AmenaAhmad , Kenneth Asang (MPH), Preeti Vishnani (MPH)
Master of Public Health (MPH), winter term 2017, HAW Hamburg
Date of the presentation : 19th of January 2018
 OUTLINE

• Introduction
• Current situation of NHIS in Cameroon
• Research Questions
• Methods(Literature search)
• Results
• Discussion
• Limitation
• Conclusion/Recommendations
• References
Introduction
• Health Information System is defined as a system that collects data, ensures their overall
quality, relevance, and converts this data into information for evidence based health policy,
health-related decision making and optimal allocation of scarce resources at all levels of the
health system (WHO, 2007).

• Sound and reliable information is foundation for decision making across all building blocks of
the health system (1,2,).

Function of HIS (2):

• Essential for monitoring and evaluation

• Provides alerts and warning of health issues

• Supports health facility management

• Enables evidence-based planning

• Permits Trends analysis of health issues

• Supports global reporting

Ideal HIS consist of 6 key components (Health
Metrics Network) (2,3)

HIS Governance and Leadership

Serve multiple array
HIS Management
• Individuals
• Community
HIS Data Sources
• Health providers
HIS Data Quality
• Policy-makers
• Donors, NGO

HIS Data Management

HIS Data Use and Dissemination
Current Situation of HIS in Cameroon
• In response to the call for greater accountability and evidence-based health policy and decision
making in 1992, a NHIS was instituted in Cameroon (4,5).

• National Committee was involved in data collection(4)

• The goal being to provide timely and reliable health information that would inform decision
making to aid provision of better health care services.(4,5)

• However, functionality of the system characterized by

• Late and Inadequate reporting

• In addition, the information collected did not always comply with international standards
rendering comparability with other countries difficult.
Current Situation of HIS in Cameroon

• The DHIS was still characterized by late, inadequate , contradictory reporting (6,7)
Purpose of this Review

• To identify the challenges faced in implementing DHIS in Cameroon so as to propose

strategies that would improve the collection of timely and reliable data at all levels of
the system.

Research Questions:
• What are the challenges encountered in implementing the Health Information System in
Cameroon?

• What Strategies can be implemented to strengthen the HIS in Cameroon?

Methods
• A systemic literature search was done to identify relevant articles using keywords according to
PICO scheme from Pubmed database. “Health” and “Information” or “Data” and “Cameroon” or
“Developing countries” and “Implementation” and “Challenges” or “Barriers”

• Additional publications were identified using snowball search on Google Scholar .

• Articles reported in English or French from the year 2000 up to date were included.

Records screened Full articles assessed for

(n=9) egilibility (n=6)
Articles Total number of articles
identified • Exclusion after • After exclusion of articles including google
from Pubmed reading Titles and with only abstracts scholar and snowball
(n=15) Abstracts search (n=11)
Results
 Challenges influencing data collection and reporting

Technical challenges:

• Shortage of qualified staff: In a district of 13 health centers, and together with the district
hospital 14 data units, only one or two personnel are allocated to collect data. This makes it
tedious to collect and process data from all these units per month. This results to incomplete
and late reporting of data (6,7).

• Inadequate funding (6,7)

• Exclusion of private provider (No policy) (8)

• Insufficient availability of equipment for data collection (Registers, Computers) (6,7,8)

Behavioral challenges:

• Top down imposition of decisions (9):

• Down to top data reporting with strict top-down imposition of decisions.

RESULTS
Behavioural challenges cont‘d
• Poor utilization of collected data (8,9):
• Data collection is usually done to fulfill the very demanding reporting requirements of higher
institutional levels (MOH, Donors, and International organizations).
• This makes the lower levels where most of the data are being collected disconnected from
data utilization hence decision making, allocation of resources, and planning in the lower
levels continue in a more or less predicted manner.
• Poor Culture of Accountability(9):
• culture of accountability and evidence-based management in Cameroon is still relatively
new and not well established. Budget allocation to health facilities in accordance to the
national strategic plan usually does not reflect the situation on the ground in terms of data.
There are situations where budget allocations are guided by politics rather than evidence in
form of data.
• Lack of Incentives for Performance(8,9):
• The HIS in Cameroon works in an environment where the incentive system of rewards and
sanctions itself is non-function.
• Lack of proper strategic planning(9):
• strategic plans are based on personal judgments and at times politics with little attention to
existing evidence.
DISCUSSION
• Studies have pointed out limited qualified staff and financial resources as challenges (7,8)

• Interviews with Stakeholders revealed that most facilities at lower levels are just reponding to
pressure from above to provide data (8)

• They do not still understand why this data is collected , where the data is going to and what is
the data used for.

• At higher levels there is still culture of consuming budget with performance measured in terms
of activities and output rather than outcomes (8,9).

• This review argues that the pressing challenges faced by HIS, is not inadequate staff or limited
finance but failure of the system to utilize the available data and the value the Cameroon HIS
attaches to the data generated.
Discussion
• A Population Health Implementation and Training (PHIT) Partnerships was established in five
sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to
strengthen the district health information systems.(10,11)

• The following strategies were implemented in Tanzania with promising results (11):

 Facilities were encouraged and empowered to use generated data to mobilize their own
resources

 To document their best practices and experiences using their own data

 Websites were created in each facility to encourage sharing of individual data, hospital best
practices through newsletters, hospital journals

 Incentive/Sanction Policy for timely data collection, compilation, reporting and use of data
for decision making

• Such initiative created a learning platform for comparing between facilities hence prompted
demand for timely and reliable data at every level
Limitation
• This review was limited by fact that not all challenges were explored due to lack of access of
some full qualitative studies.

• As a result, this review was based on some reports from MOH, and some qualitative studies
with key stakeholders.
Recommendations/Conclusion
• In addition to limited human and financial resources as the challenges to timely collection and
reporting of reliable data, other pressing strategic challenges include lack of data utilization,
poor culture of accountability, and lack of incentives for performance.

• This review recommends to those engaged in planning interventions to strengthen DHIS to lay
emphasis on a cycle of data utilization at all levels in the health care system.

• Data use that transforms facilities into learning organizations

• This will breed ownership of data that will result to more commitment for future data collection
References
1. World Health Organization: Strengthening Health Systems to Improve Health Outcomes, WHO's
Framework for Action. 2007, Geneva: World Health Organization.
2. World Health Organization: Health Metrics Network Framework and Standards for Country Health
Information Systems. 2008, Geneva: World Health Organization.
3. Simba DO, Mwangu M: Application of ICT in strengthening health information systems in developing
countries in the wake of globalization. Afr Health Sci. 2004, 4 (3): 194-198.
4. Health Analytical Profile 2016 Cameroon. Accessed 2017 Dec 30. Available from:
https://www.humanitarianresponse.info/en/operations/cameroon/document/cameroon-healthanalytical-
profile-2016 .
5. Cameroon: HIS Indicators. Health Information Strengthening Resource Center; Measure and
Evaluation. Accessed 2017 Dec 30. Available from: https://www.measureevaluation.org/hisstrengthening-
resource-center/country-profiles-1/cameroon.
6. Ndongo J, Ongolo-Zogo P. Reinforcing the Health Information System to Step up the Viabilization of
Health District Full report June 2010. Centre for Development of Best Practices in Health Central
Hospital - Yaoundé, Cameroon
References
7. Ministère de la Santé Publique (2008). Rapport d’évaluation du système national

d’information sanitaire par l’outil du Réseau de Métrologie Sanitaire – OMS

8. Ministère de la Santé Publique(2006). Evaluation à mi-parcours de la mise en œuvre de la stratégie

sectorielle de santé 2001-2010: Rapport principal de l’étude. Institut National de la Statistique, GTZ,

Décembre 2006.

9. Ngwakongnwi E, Atanga M, Quan H Challenges to Implementing a National Health Information System in

Cameroon: Perspectives of Stakeholders: J Public Health Africa. 2014 Feb 4; 5(1): 322

10. Mutale W, Chintu N, Amoroso C, Koku-Awoonor W, Baynes C, Taylor A. Improving health information

systems for decision making across five sub-Saharan African countries: Implementation strategies from

the African Health Initiative. BMC Health Services Research ; 2013 (Suppl 2):S9

11. Bryce J, Requejo JH, Moulton LH, Ram M, Black RE, Population Health Implementation and Training -

Africa Health Initiative Data Collaborative: A common evaluation framework for the African Health

Initiative. BMC Health Services Research. 2013, 13 (Suppl 2): S10-10.1186/1472-6963-13-S2-S10.

THANK YOU