Health System,

Key Performance Indicators

and Reporting System

Wasihun Geletu
Outlines

Health Key
Health System, HIS
Indicator Performance
and HMIS Overview
Indicators (KPIs)

Target Report System

Session One: Health System, HIS and HMIS
1Hr Overview
• Objectives • Rational for HMIS revision

• HIS and HMIS • Revised Indicators

overview
Health System, HIS and HMIS Overview

Objectives
• At the end of this session, participants will be able to:

• Explain health system and its functions

• Describe HIS and its components

• Describe the routine HMIS as part of the bigger HIS

• Understand rationale of HMIS revision

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1. Health System overview

• What is a health system?

• Why health systems matter?

5
1.1 Health system or health care system

• It refers to the organization, institutions, people & resources involved in delivering

health care to individuals. Its primary purpose is to improve health

• Three major objectives

o Improving the health of the population

o Responding to people’s expectations (Responsiveness)

o Providing financial protection against the costs of ill-health (Risk Protection)

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WHO’s Health System Building Blocks

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1.2 Health information system (HIS)

• It refers to a system that captures, stores, manages or transmits information related

to the health of individuals or the activities of organizations, which improves health
care management decisions at all levels of the health system

• Information is crucial to inform on the performance of the health system and about
health challenges

• Heath Information system is required for timely intelligence on the other building
blocks of the health system:

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Components of HIS

Legislative, regulatory, & planning

Making readily framework, personnel, financing, logistics
accessible to decision support, ICT, coordinating mechanisms
makers, ensure
information use
Measures, usually core set
of indicators
(determinants, inputs,
Data translated outputs, outcomes &
to information health status)

1. Population-based sources
(censuses, civil registration,
surveys)
Covers all aspects of data handling, 2. Institution based data (individual,
collection, storage, quality- service & resource records)
assurance, flow, processing, 3. Others: Occasional surveys,
compilation & analysis, research, & information, CBOs, 9
 What are HIS Data sources?
Data Sources components

Institution based Individual records, service records, supplies, resource records, administrative
sources reports
Routine HMIS, supportive supervision, review meetings, inspection, surveillance
Facility-based surveys: SARA, SPA+,

Population-based Census, civil registration, population based surveillance,

sources population surveys (DHS, MIS, MICS, etc) and other program specific surveys and
researches

Data sources by level:

Community, Facility (HCs, Hosp. Private Facilities), Woreda, Zonal and Regional levels, and National level

10
 1.3 HMIS …
• Health Management Information System (HMIS) is the routine collection, aggregation,
analysis, presentation and utilization of health and health related data for evidence
based decisions for health workers, managers, policy makers and others
• Purposes of HMIS
• Availing accurate, timely and complete data to support decision making at each
level of the health system
• Strengthening the use of locally generated data for evidence based decision
making

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1.3 HMIS …

Components of HMIS

1. Information management
• Data collection: Recording of health data using individual and family folder,
registers, tally and reporting formats
• Data processing: is a process of cleaning, entering and aggregation of data.
• Data analysis and presentation: is a process of interpretation and comparison of
generated information in the form of sentence, tables and graphs.

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1.3 HMIS …

2. Using information for management purposes

• Problem identification: identifying problems using key indicators

• Prioritizing problems and decision making : Problems identified should be

prioritized and decide what types of actions need to be taken.

• Action taking: Implementing the agreed action.

• Result monitoring: Assessing the desired result has been achieved.

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 HMIS Indicator Revision (2021)
RATIONALE
▪ Indicator revision has been happening about every 3-4 years so far
▪ The most recent revision was conducted in 2017 following start of HSTP I
▪ HSTP II launched recently and will span 2020-2025
▪ HSTP II comes with additional new programs and initiatives
▪ Some activities of HSTP-I are matured, others are evolved that need to amend the existing
indicators
▪ Need for integration program indicators (eg. KPIs, and other quality indicators)
▪ Therefore, the monitoring and evaluation of HSTP II demands the revision of HMIS
indicators
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Trends of Indicator Revision

15
Final revised HMIS indicators

2017_HMIS 2021_HMIS
Total Indicator:131 Total indicators:177

Continued:
103 Modified: 3 Dropped: 25 New:71

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Revised Indicators (2021)
Number of indicators by category (2017 versus 2021)
SN Indicator Category 2017 2021
SN Indicator Category 2017 2021
1 Reproductive and Maternal 14 15 11 Neglected Tropical Diseases (NTD) 2 8
health
12 Non-communicable diseases (NCD) & 3 10
2 PMTCT 7 6 mental Health
3 EPI 13 12 13 HEP and Primary Health care 3 4
4 Child health 8 10 14 Leadership and governance 4 4
5 Nutrition 8 8 15 Health Financing 3 4
6 Hygiene & environmental 2 10 16 Pharmaceutical supply and services 4 7
Health
17 Evidence based decision making 3 6
7 Medical service 12 21
18 Health Infrastructure 4 2
8 HIV/AIDS/Hepatitis viruses 10 15
19 Human Resource Development & mgt 4 3
9 Tuberculosis/TB/ & Leprosy 22 22
10 Malaria 5 8 20 Regulatory system 1 2
Total 131 177
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REVISED REGISTERS AND TALLY SHEETS

S. No Type of Tools Maintained Modified New Total

1 Registers 13 26 18 57

2 Tally Sheets 5 9 7 21

There are changes in data elements (some modified and others added) and
3 Report forms
NTD, TB & Leprosy quarterly changed to monthly

Registers: for HCs/Hosp= 42 For Hosp only =13 For HC only= 1

Geographic Areas specific= 2 Special center=1
NB: Health Post level tools are not included 18
Indicator
• An Indicator is a quantitative or qualitative variable that provides a valid and
reliable way to measure achievement, assess performance, or reflect changes
connected to an intervention.
• Indicators are core set of indicators and related targets for the health information
system.
• Indicators are used in both monitoring and evaluation. Essentially, they are things
which can be measured or assessed to see the progress being made by a project.
• They may be expressed in numbers (quantitative) or through descriptive words
(qualitative).
• Indicators need to include determinants of health, health system inputs, outputs
and outcomes, and health status.
High Quality Indicators

• The indicator is needed and useful.

• The indicator has technical merit.

• The indicator is fully-defined.

• The indicator has been field-testing or

used operationally.

• The indicator set is coherent and

balanced.
Selecting Indicators
• The four steps to select
indicators are:

• Clarify the results statements.

• Develop a list of possible

indicators.

• Assess each possible indicator.

• Select the best indicator(s)

 • Health Key Performance Indicators (KPIs) are specific
metrics used to measure and assess the performance
and outcomes of healthcare organizations, healthcare
providers, or public health initiatives.

Health • KPIs help monitor and improve the quality,

Key efficiency, and effectiveness of healthcare services.

Performan • KPIs are used to evaluate the quality, efficiency,

effectiveness, and impact of healthcare services and
ce interventions.

Indicators • Provide quantifiable data that helps in decision-

(KPIs) making, performance management, and continuous
improvement in the healthcare sector.

• Health Key Performance Indicators (KPIs) can be

categorized into various types based on the aspects of
healthcare they assess.
Health Key Performance Indicators (KPIs)
1.Clinical KPIs: focus on the clinical healthcare providers
aspects of healthcare and measure 5.Population Health KPIs: focus on
the quality of care provided. the health outcomes and well-being
• Patient mortality rate of specific populations or
2.Operational KPIs: assess the communities.
operational efficiency and 1. Immunization rates
effectiveness of healthcare 6.Quality and Safety KPIs: assess
organizations. the quality and safety of healthcare
1. Bed occupancy rate services
3.Financial KPIs: evaluate the 1. Adverse event rates
financial performance and 7.Healthcare Access KPIs: measure
sustainability of healthcare the accessibility of healthcare
organizations. services to individuals and
1. Cost per procedure/Revenue per patient communities.
4.Patient Experience KPIs: measure 1. Specialist referral wait times.
the satisfaction and experience of Monitoring and Evaluation Indicator
 Targets
• Targets are specific goals or benchmarks
that are set for health indicators.
• Targets serve as benchmarks to measure
progress and guide efforts to improve
health outcomes.
• Targets can be set at various levels, such as
global, national, regional, or local, and they
can be time-bound and comparative.
• Setting targets helps policymakers, public
health officials, and healthcare practitioners
to focus their efforts and allocate resources
effectively.
• Targets should be ambitious yet achievable,
based on scientific evidence, and aligned
with broader health objectives.
• Selection of indicators and targets
should consider the specific health
priorities, local context, available data, and
the needs of the population being assessed.
 ቁልፍ አፈጻጸም አመልካች Vs ግብ
ቁልፍ አፈጻጸም አመልካች መለኪያ ግብ
የመጀመሪያ 95 ለማሳካት ኤችአይቪ በደማቸው ይኖራል ተብሎ ከሚጠበቁ ወገኖች ተመርምረው ውጤታቸውን
1 ያላወቁ አዋቂዎች እና የህጻናት ቫይረሱ በደማቸው የሚገኝባቸውን አዲስ ሰዎች በማግኘት የ1ኛ 95 95%
ሽፋኑን
2 የኤች አይ ቪ ደም ምርመራ አገልግሎት ያደረጉና የምርመራ ውጤታቸውን ያገኙ ተገልጋዮች ብዛት 3,664

3 በፍቃደኝነት የምክክርና ደም ምርመራ አገልግሎት (VCT) ያገኙ ተገልጋዮች ብዛት 502

4 በባለሙያ አነሳሽነት ምርመራ እና ምክክር አገልግሎት (PITC) ያገኙ ተገልጋዮች ብዛት 2,902
5 በኢንዴክስ ቴስስቲንግ ኬዝ አገልግሎት (ICT) ያገኙ ተገልጋዮች ብዛት 260
6 የኤችአይቪ ደም ምርመራ አድርገው ቫይረሱ በደማቸው የተገኘ ጠቅላላ ድምር ብዛት 40
7 የኤችአይቪ ቫይረስ በደማቸው ከተገኘ ውስጥ ወደ ኤአርቲ ክፍል የተላኩና የተገናኙ ብዛት 38
8 አዲስ የፀረ-ኤችአይቪ መድሃኒት የጀመሩ ብዛት 38
 ቁልፍ አፈጻጸም አመልካች Vs ግብ
ተ/ቁ ግብ
ቁልፍ አፈጻጸም አመልካች መለኪያ

36
አዲስ ኤችአይቪ ቫይረስ በደማቸው የተገኘ እና ወደ ኬዝ
9
ቤዥድ ሰርቪላንስ አገልግሎት የገቡ አዋቂ ተገልጋዮች ብዛት

28
ኬዝ ቤዥድ ሰርቪላንስ አገልግሎት ከገቡ አዲስ ተገልጋዮች
10
ሪሰንሲ ምርመራ የተሰራላቸው ተገልጋዮች ብዛት

3
ሪሰንሲ ምርመራ ከተሰራላቸው ተገልጋዮች ሪሰንት
11
ኢንፊክሽን የሆኑ ተገልጋዮች ብዛት
 ቁልፍ አፈጻጸም አመልካች Vs ግብ
ቁልፍ አፈጻጸም አመልካች መለኪያ ግብ

ሁለተኛውን 95 ለማሳካት ቫይረሱ በደማቸው የሚገኝባቸው ሰዎች የጸረ- 95%

12
ኤች አይቪ ህክምና አገልግሎትን 95% መስጠት ሽፋኑን
በአሁን ወቅት የፀረኤችአይቪ መድሃኒት በመውሰድ ላይ የሚገኙ 95
13
ተገልጋዮች ብዛት
የፀረኤችአይቪ መድሃኒት ከ6 ወር እና ከዚያ (ASM)በላይ የሚወስዱ 62%
14
ተገልጋዮች ብዛት
የፀረኤችአይቪ መድሃኒት ከ6 ወር እና ከዚያ በታች (3MMD) የሚወስዱ 9%
15
ተገልጋዮች ብዛት
የፀረኤችአይቪ መድሃኒት ፈጣን መዳረሻ መንገድ (FTAR) የሚወስዱ 29%
16
ተገልጋዮች ብዛት
17 የፀረኤችአይቪ መድሃኒት ጀምረው ያቋረጡ ሰዎች ብዛት 2%
 ቁልፍ አፈጻጸም አመልካች Vs ግብ
ቁልፍ አፈጻጸም አመልካች መለኪያ ግብ
የሶስተኛው 95 ማለትም የፀረ-ኤችአይቪ መድሃኒት ከሚወስዱ አዋቂዎችና ሕፃናት 95%
18 ውስጥ በደማቸው ያለው የኤች አይቪ ቫይረስ መጠን በሚሊ ሊትር ከ1,000 ኮፒ በታች
የሆኑት 95% ማሳደግ
19 ቫይራል ሎድ ያሰሩ ተገልጋዮች ብዛት 92

በዚህ ወር ቫይራል ሎድ ካሰሩ ውስጥ የልኬት መጠኑ 1000ml/copies 87

20
በታች የሆኑ ብዛት
21 አዲስ በቲቢ በሽታ የተያዙ እና ህክምና የጀመሩ ታካሚዎች ብዛት 11
22 አዲስ በቲቢ በሽታ ከተያዙ ውስጥ የኤችአይቪ ደም ምርመራ ያደረጉ ብዛት 11
23 አዲስ በቲቢ በሽታ ከተያዙ ውስጥ ቫይረሱ በደማቸው የተገኘ ብዛት 1
አዲስ በቲቢ በሽታ ከተያዙ ውስጥ ኤችአይቪ በደማቸው የተገኘ እና ወደ 1
24
ኤአርቲ ክፍል የተላኩና የተገናኙ ብዛት
 ቁልፍ አፈጻጸም አመልካች Vs ግብ
ቁልፍ አፈጻጸም አመልካች መለኪያ ግብ
25 አዲስ የነብሰ ጡር (ANC) ክትትል የጀመሩ እናቶች ብዛት 66

26 አዲስ የነብሰ ጡር (ANC) ክትትል ከጀመሩት እናቶች የኤችአይቪ ደም ምርመራ ያደረጉ ብዛት 60

27 አዲስ የነብሰ ጡር (ANC) ክትትል ከጀመሩት እናቶች ኤችአይቪ በደማቸው የተገኘ ብዛት 1
28 የነብሰ ጡር (ANC) ክትትል ከጀመሩት እናቶች ኤችአይቪ በደማቸው ተገኝቶ ወደ ኤአርቲ ክፍል የተላኩና የተገናኙ ብዛት 1
29 ለኤች.አይ.ቪ. ተጋልጠው የተወለዱ ልጆች ብዛት 1
30 ለኤች.አይ.ቪ. ተጋልጠው ከተወለዱት የተመረመሩ ብዛት 1
31 ለኤች.አይ.ቪ. ተጋልጠው ከተወለዱት 2 ወራቸው ላይ የDBS ምርመራ የተሰራላቸው ብዛት 1
32 ለኤች.አይ.ቪ. ተጋልጠው ከተወለዱት 18 ወራቸው ላይ የኤች.አይ.ቪ Antibody ምርመራ የተሰራላቸው ብዛት 1
33 በፍቃደኝነት ላይ የተመረኮዘ የወንዶች ግርዛት አገልግሎት ያገኙ ተገልጋዮች ብዛት 206
34 የወንዶች ግርዛት አገልግሎት ካገኙት ውስጥ የኤችአይቪ ደም ምርመራ ያደረጉ ተገልጋዮች ብዛት 206
35 የወንዶች ግርዛት አገልግሎት ካገኙት ውስጥ ኤችአይቪ በደማቸው የተገኘ ብዛት 2
36 የወንዶች ግርዛት ካከናወኑት ኤችአይቪ በደማቸው ተገኝቶ ወደ ኤአርቲ ክፍል የተላኩና የተገናኙ ብዛት 2
 ቁልፍ አፈጻጸም አመልካች Vs ግብ
ቁልፍ አፈጻጸም አመልካች መለኪያ ግብ
37 የአባላዘር ህክምና (STI)ያገኙ ተገልጋዮች ጠቅላላ ድምር ብዛት 44
38 የአባላዘር በሽታ ከተያዙ ውስጥ የኤችአይቪ ደም ምርመራ ያደረጉ ብዛት 44

39
የአባላዘር በሽታ ከተያዙ ውስጥ በድጋሚ ከ3 ወር በኋላ የኤችአይቪ ደም ምርመራ 22
ያደረጉ ብዛት
40 የአባላዘር በሽታ ከተያዙ ውስጥ የፆታ ተጓዳኛቸውን የመጡ ብዛት 22
41 የViral Hepatitis በሽታ ልየታ የተደረገላቸው ብዛት 405
42 የViral Hepatitis በሽታ ልየታ ከተደረገላቸው የHB ቫይረስ የተገኘባቸው ብዛት 38
43 የViral Hepatitis በሽታ ልየታ ከተደረገላቸው የHC ቫይረስ የተገኘባቸው ብዛት 13

44 የViral Hepatitis በሽታ ከተገኘባቸው ውስጥ የኤችአይቪ ደም ምርመራ ያደረጉ ብዛት 51

100
45 ፀረ-ኤች.አይ.ቪ ተጠቃሚ የሆኑ ሴቶች የማህፀን በር ጫፍ ካንሰር ምርመራ ያደረጉ ብዛት
Key Performance
Indicators target
cascading

Command Core 1 Core 2 Core 3 Core 4

Core Core Hospital Division1 Hospital Division2 Hospital Division 3 Hospital

Report System
• Report
• A health report is a document that provides an overview and analysis of an
individual's or a population's health status.

• It typically includes information about various aspects of health, such as

physical, mental, and social well-being, as well as any existing medical
conditions or diseases.

• Purposes
• Availing accurate, timely, and complete data to support decision making at each level of the health system.

• Strengthening the use of locally generated data for evidence-based decision making

• Components
• Information management component and

• Use of the information for evidence-based decision-making.

Cont.…
1. Information management

 Data collection: Recording of health data using individual

and family folder, registers, tally, and reporting formats.

 Data processing: is a process of cleaning, entering, and

aggregating data.

 Data analysis and presentation is a process of

interpretation and comparison of generated information in the
form of sentences, tables, and graphs.
Cont..
2. Using information for management purposes

 Problem identification: identifying problems using key indicators.

 Prioritizing problems and decision-making: Problems

identified should be prioritized and decide what types of actions need to
be taken.

 Action taking: Implementing the agreed action.

 Result monitoring: assessing whether the desired result has been

achieved or not.
Reporting System

• NDFE Report types : By Period and Contains

• NDFE is designed to generate different types of reports which
capture important data elements to monitor and evaluate health
programs.
 Reporting
System
• Types of reports • Types of reports
by period by content
• Monthly reports • OPD morbidity
• Quarterly reports report
• Semi-annual reports • IPD morbidity and
• Annual reports mortality report
• Immediately/Weekly • Service reports
reports • PHEM reports
 Reporting
System
• Each health facility is expected to submit
service and disease reports monthly.
• In addition, diseases that are under
surveillance should be reported on
• A weekly basis or

• Immediately based on the types of

reportable diseases seen in the facility.
 •Report Compilation Procedures
•Hospitals •Administrative health offices
• The report includes data on the services
they provide, the disease cases they see, • The administrative health offices
and administrative data such as human are (Division Health offices, Core
resources, finances, and logistics. health offices, Command Health
• Data are collected by health workers in offices and Health Main
each service unit or supporting Department office)
Reporti department.
• Aggregate and review their data monthly
• Aggregate the data they received
from health facilities, adds their
ng or quarterly
• Data is transmitted through an integrated
own data, monitors their own
performance based on these
System channel to assure standardization,
consistency, and quality control. reported data elements, and
reports to the next level.
• Report to their respective administrative
office monthly, quarterly, and annually
(Division, Core, Command, Central Health
Office).
• They may also report to the local NDFE
offices.
 M&E Tools
• Guideline • Job Aid
• GUIDELINE FOR HIV CASE BASED SURVEILLANCE IN • Asante Step-by-Step Job Aid
ETHIOPIA
• Finger prick Job Aid
• Form
• HIV Case Report Form
• Steps in completing the HIV CBS
• Adverse event reporting form
CRF Adverse Event
• Instruction to complete the case report
• Intra Health Facility Data Flow
form
Confidentiality
• Monitoring Tools
• Health Institute Confidentiality Agreement Agreement

• Site Level Implementation Monitoring Tool

• HIV case-based surveillance CRF Tracking FormCRF Tracking
Form Data Flow•
• Reporting Format
CBS Report

• Registers
• HTS Logbook/ HIV Rapid Testing Register
• HIV RECENCY REGISTRATION BOOK Asante Finger prick
Step-by-Step Job Aid Instruction Site Level
• HIV CBS Weekly Data Verification Log Implementation Monitoring Too

• Site level response tracking register HTS Log book

Recency
Registeration Book
• Index Case testing (ICT) Register
ICT Register
response tracking
register
Thank you!