NAMIBIA HEALTH INFORMATION SYSTEM (HIS2K)

Description, Documents, Manuals, Forms Download

A national health information system that gathered data from government facilities using standard forms was first introduced in Namibia in 1992, shortly following independence. That system underwent a major revision in 1994, with the newly designed forms, procedures and computerized system starting use on 1 January 1995. After five years of use, the system was revised again - its features expanded - in 2000. HIS2K began operating on 1 January 2001.

This site provides an overview of the current Namibia HIS, some of its more important features, and permits downloading of the user's manual, diagnostic coding lists, and copies of the forms that the system uses.

The Namibia HIS is a routine health and management information system that uses manually-completed standard forms to gather a host of data each month on services, morbidity and mortality from all government health facilities - forty hospitals, 32 health centres, 271 clinics, and their scores of mobile/outreach service points. Tally sheets are used at the point of service delivery. Summary data from them is transcribed to monthly report forms. Copies of the tally sheets and summary monthly report forms are available, below, to be downloaded. Standard registers, retained at the facility, are used to provide a permanent record of client/patient encounters in more detail than what is reported to the HIS.

Using a very user-friendly computerized system, data is entered from the standard form at health district (35) level. Data files are passed by diskette or by Internet e-mail to (13) regional administrative level offices, and then to national level. At each level analysis can be performed, and a series of preformatted reports can be viewed or printed, using variables selected and (dis)aggregated for the specific needs of the user.

SOME HIS2K HIGHLIGHTS/FEATURES
* The HIS in Namibia was originally designed to replace a number of vertically structured data gathering systems in order to standardize procedures and format for reporting and processing routinely- reported data

* Recognizing the importance of decentralized health services, the system was designed to give as much ownership and responsibility of data to health districts, the most peripheral management level of the Namibia health services. Data must be entered and corrected at the district level (if suitable staff or computer equipment is not available, district data may be entered at the supervising regional level). All corrections must be made at the district level. Changes/corrections to data made above the district level are overwritten during data updating. Districts are responsible for entering population data and updating it each year. Because data entry is done at the district level, the burden of data entry on staff time is minimal,  and computer analyzed data may be instantly used by the district managers, and easily fed back or shared with facilities.

* Population data (for each facility catchment area, health district and region) for four age groups: Under-1, Under-5, 5-17 Years, 18 and Older (the latter two are dictated by the age groups used on Outpatient Department data collection forms), women of child-bearing age (15-49 years), Total, can be maintained in two different categories - Official, and Estimated - to accommodate differences that health workers recognize between what official sources count as population, and reality in calculations for coverage and other population-based analysis such as coverage.

* Although the entries are not used by the HIS for analysis and statistical purposes, recognizing the need for standard registers to be used throughout the country, the HIS2000 revision introduced standard registers for Antenatal Care, Outpatient Services, and Inpatient Department. The registers replace hand-drawn books that were far from uniform throughout the country, and serve as the facility's record of services delivered (patients retain health passports or specific service record cards). HIS2000 staff advised Immunization/EPI and reproductive health staff on the design of registers for those programmes.

* HIS2000 (re)introduced diagnostic/cause of death coding for all hospital discharges (the previous HIS reported each discharge diagnosis as one of three dozen general diagnostic categories), using a set of 219 ICD diagnostic codes. The coding lists are available in A3 format and in an A4-sized booklet for use at Ward nursing stations and in an A4 triple-folded pocket edition. Up to two diagnostic/cause of death codes may be entered for each patient discharge.

* The Daily Ward Census/Discharge Report forms (separate forms for Adult/Paeds, and Maternity) serve facility management purposes as well as capturing HIS data. Copies of the report (on carbonized paper) are retained by the Ward and the facility's Matron. The HIS has no need for patient names and registry numbers - sections of the copy of the form used for HIS data entry that include unneeded information are blacked-out to maintain patient anonymity.

* Along with discharge diagnosis/death coding, HIS2000 captures specific variables for each inpatient discharge from a hospital or health centre that accepts curative or maternity patients. The previous HIS did not capture anything but the very general diagnostic category. Each patient's age (in days, weeks, months, years), sex, date of admission (to calculate length of stay), if they were a private patient, if Major or Minor Surgery was performed during the stay, if the patient was referred to another facility, if the patient died while an inpatient (in which case the diagnosis code(s) become the cause of death) are captured for every patient.

* The Supportive Health Services data report form is a single (three page) report for a facility to use to report activity for any of nine programmes/services that may be offered at the reporting facility. The relatively small amount of data/variables being reported for each of these nine services/programmes did not warrant a separate report form for any each service/programme. Some of these programmes are relatively new and their management does not yet know what data they need to collect. Future versions of the HIS may accommodate more detailed data collection and analysis for these services. The nine programmes/services/activities for which data is collected on the Supportive Health Services monthly report form are:
                                    - School Health Services
                                    - Community-Based Health Care
                                    - Rehabilitation
                                    - Orthopaedic Technical Services
                                    - Outreach Services (distances driven for Outreach Services)
                                    - HIV Counseling
                                    - Blindness Prevention Programme
                                    - HFR (High Frequency Rattle) Hearing Screening
                                    - Diagnostic X-ray

* The Chart of Indicators and Progress allows facility-based staff to use data gathered each month and reported to  the HIS manually monitor progress toward any  specified goal or target  on a standard chart format form that can be posted on the facility's wall or bulletin board or used during community meetings. This feature recognizes that, despite protocols and best intentions, data from district or regional levels are often NOT reported back to facilities, and of the desirability of facility staff routinely using data to monitor their own progress.

* The computerised system was developed using dBASE for Windows Version 5.7 because it could operate both in the 16 bit Windows 3.11 environment that about 25% of the district-level computers were using at the time of the introduction of HIS2K as well as for Windows 9x and above that many of the Regional and National level HIS machines were using.  Arguments that Access should have been used as the database for the system were easily dispelled because even when computers were running Win 9x or higher, their memory or hard disk specifications were inadequate to meet Access' demands.

* The computerised system is a highly structured menu-driven format to which users had become accustomed during the five years of use of the former system (developed in dBASE for DOS 5.0).  Many users are not familiar or comfortable with Windows' unstructured approach.  The menu driven approach reduces the opportunities for errors or for attempting to do something that can or should not be done.

THE HIS2K FORMS, THEIR SIZE AND FORMAT
(Click on the o preceding the form name to view an HTML version of the form. Use your browser's Back button to return to this page.)
o  - Family Planning/Antenatal Care/Postnatal Care Tally Sheet, A4, padded, printed two sides
o  - Family Planning/Antenatal Care/Postnatal Care Monthly Summary Report Form, A4, padded, printed
       one side
o  - Antenatal Care Register, A4, landscape, printed across two pages, 100 pages
o  - Immunization and Weighing Tally Sheet, A4, padded, printed two sides
o  - Immunization and Weighing Monthly Summary Report Form, A4, padded, printed one side
     - Outpatient Department Tally Sheet, A3, padded, printed two sides
o  - Outpatient Department Monthly Summary Report Form, A3, padded, printed two sides
o  - Outpatient Department Register, A4, landscape, printed across two pages, 100 pages
o  - Notifiable Diseases Tally Sheet and Monthly Report Form (combined), A4, printed one side
o  - Adult and Paediatrics Ward Daily Ward Census/Discharge Report Form, A4, carbonized paper,
       original and two copies  (original stays in Ward, pink copy to hospital matron, yellow copy used for
       HIS data entry)
o  - Maternity Ward Daily Ward Census/Discharge Report Form, A4, carbonized paper, original and two
       copies (original stays in Ward, pink copy to hospital matron, yellow copy used for HIS data entry)
o  - Maternity Ward Monthly Summary Report Form, A4, printed one side
o  - Inpatient Department Register, A4, landscape, printed across two pages, 100 pages
o  - Supportive Health Services/Activities Monthly Summary Report Form, A4, three pages, printed
       one side
o  - Dental Health Services Monthly Summary Report Form, A4, printed one side
o  - Environmental Health Services, A4, printed one side
o  - Chart of Indicators and Progress, A4, printed one side

OTHER PRINTED MATERIALS
- Forms Instruction and Reference Manual, A4, spiral bound, 80 pages, includes a chapter of
   instructions and examples for each tally sheet and monthly report form, appendices of
   abbreviations and definitions, and a bound-in copy of each standard form
- Inpatient Diagnosis and Cause of Death Codes, A4, booklet
- Inpatient Diagnosis and Cause of Death Codes, A3, laminated, printed two sides
- Inpatient Diagnosis and Cause of Death Codes, pocket edition, A4, laminated, folded in thirds,
   printed two sides

DOWNLOAD FORMS AND DOCUMENT FILES
All the forms files and register format (MS Excel Spreadsheets) files and all the Other Printed Materials, (MS Word Documents/Excel Spreadsheets) listed above, may be downloaded.  The two files are self-extracting ZIPped files.  Once you've downloaded them to a temporary directory, you need only click on them and they will unzip.
Click Here to download NAMHIS2KFORMS.EXE (171.5Kb) 
Click Here to download NAMHIS2KDOCS.EXE (373.5Kb) 

CONTACT NAMIBIA HEALTH INFORMATION SYSTEM PERSONNEL
E. Matroos, Manager Responsible For NAMHIS Operations
J.B. Clark, Information Systems Advisor, Namibia MoHSS

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