Lessons from implementing a league table application in the health sector

155 Pages·2016·16.89 MB·English

Lessons from implementing a
league table application in the
health sector
A case from Malawi
Kristoffer Adam Tronerud , Martin Theodor Vasbotten
Master’s Thesis Spring 2016

Lessons from implementing a league table
application in the health sector
Kristoffer Adam Tronerud Martin Theodor Vasbotten
18th May 2016
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Abstract
Malawi’s Health Management Information System(HMIS) is currently
going through a strengthening process. Though good progress has been
made, the data in the system receives limited usage and is of poor
quality. As HMISs are dependent on available quality data to support
decision-making, further strengthening efforts are needed to increase the
availabilityofqualitydata.
This thesis and its research builds upon prior research suggesting that
league tables can be used to improve data quality and usage in Malawi’s
routine health management. Earlier research also found that creating
league tables using the existing functionality of Malawi’s HMIS can be
challenging, suggesting that an dedicated application could be a solution.
Hence, this thesis looks at the process of designing, developing and
implementing an app, called the League Tables Application(LTA) in
Malawi’s HMIS. Furthermore, it looks at challenges and opportunities
relatedtotheseprocesses.
Thisstudyhasinvolvedpotentialusersfromalllevelsofthehealthsystem
in the process in order to identify common thoughts and ideas for the
application.
Through demonstrations and users testing the application, feedback
suggests that the LTA was a user-friendly tool to analyse data for
decision-making. It also proved to give motivation as well as stimulating
competition. Though the application showed promise, it also showed a
lackofqualitydataandusagewhichinturnreducedtheanalyticalvalueof
itsresults.
In order to properly utilize data and tools to support decision-making,
effortsneedtobeputintoincreasingdataqualityandusage.
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Acknowledgements
First of, we both would like to give a big thanks to our supervisor
Johan Ivar Sæbø for his guidance and inspiration throughout the project.
Moreover we would like to thank Jens Johan Kaasbøll for arranging
meetings during our stay in Malawi in addition to contributing with his
knowledge and experience. Additionally, we would like to thank Christon
Mesheck Moyo and Mbongeni Chizonda from CMED Malawi for taking
careofusandorganizingourstayinMalawi.
We also want to thank our families for all their support. Furthermore we
want to thank the boys at Assembler for all the nice moments. Lastly,
Kristoffer would like to thank Marthe, who’s always been there for him
withherloveandencouragement.
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Contents
1 Introduction 1
1.1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.4 Researchquestionsandobjectives . . . . . . . . . . . . . . . . 3
1.5 ChapterOverview . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Relevant literature 5
2.1 UnderstandingInformationSystems . . . . . . . . . . . . . . 5
2.1.1 InformationSystemsasSocialSystems . . . . . . . . 5
2.1.2 InformationsystemsasInfrastructures . . . . . . . . 7
2.1.3 TheInstalledBase . . . . . . . . . . . . . . . . . . . . . 8
2.2 UnderstandingHealthInformationSystems . . . . . . . . . . 9
2.2.1 CommonChallengeswithHISindevelopingcountries 10
2.3 LeagueTables&Scorecards . . . . . . . . . . . . . . . . . . . . 12
2.4 Designingforusability . . . . . . . . . . . . . . . . . . . . . . . 16
3 Research Context 19
3.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.2 Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.3 Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.4 HealthSystems . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
3.4.1 Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
3.4.2 HealthManagementInformationSysteminMalawi . 24
3.5 HistoryofLeagueTablesintheMalawiHMIS . . . . . . . . . 28
3.6 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4 Methods 31
4.1 ResearchPerspective . . . . . . . . . . . . . . . . . . . . . . . . 31
4.2 ActionResearch . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
4.2.1 DescriptionofthestepsintheARCycle . . . . . . . . 34
4.3 Prototyping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
4.3.1 Prototypingvariants . . . . . . . . . . . . . . . . . . . . 37
4.3.2 Benefitsofprototyping . . . . . . . . . . . . . . . . . . 37
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4.3.3 Potentialdisadvantagesofprototyping . . . . . . . . . 38
4.3.4 OurapproachtoPrototyping . . . . . . . . . . . . . . . 38
4.4 Methodsinappdevelopment . . . . . . . . . . . . . . . . . . . 39
4.4.1 AgileSoftwareDevelopment . . . . . . . . . . . . . . . 39
4.4.2 Scrumbanindevelopment . . . . . . . . . . . . . . . . 42
4.4.3 Toolsforsupportingdevelopment. . . . . . . . . . . . 43
4.4.4 OurapproachtoAgileSoftwareDevelopment . . . . 44
4.5 Datacollectionmethodsindeployment . . . . . . . . . . . . . 46
4.5.1 Participants . . . . . . . . . . . . . . . . . . . . . . . . . 47
4.5.2 DataAnalysisApproach . . . . . . . . . . . . . . . . . . 50
5 App Development 51
5.1 DistrictHealthInformationSystem2 . . . . . . . . . . . . . . 51
5.1.1 OrganisationUnitsinDHIS2. . . . . . . . . . . . . . . 53
5.1.2 IndicatorsinDHIS2 . . . . . . . . . . . . . . . . . . . . 53
5.1.3 Analyticsresource . . . . . . . . . . . . . . . . . . . . . 54
5.1.4 PivotTableextension . . . . . . . . . . . . . . . . . . . 54
5.2 LeagueTableApplication . . . . . . . . . . . . . . . . . . . . . 54
5.2.1 Mainfunctionality . . . . . . . . . . . . . . . . . . . . . 55
5.3 Ranking&scorecalculations . . . . . . . . . . . . . . . . . . . 60
5.3.1 Totalscore(fororganisationunit) . . . . . . . . . . . . 60
5.3.2 Weighingindicatorscores . . . . . . . . . . . . . . . . 60
5.3.3 Invertingindicatorscores . . . . . . . . . . . . . . . . . 61
5.3.4 Color&trophydistribution . . . . . . . . . . . . . . . . 62
5.4 TechnicalSolutionsDescription . . . . . . . . . . . . . . . . . 62
5.4.1 AngularJS . . . . . . . . . . . . . . . . . . . . . . . . . . 62
5.4.2 HTTP-Calls . . . . . . . . . . . . . . . . . . . . . . . . . 64
5.5 Programmingdetours . . . . . . . . . . . . . . . . . . . . . . . 68
5.5.1 StoringtablesinDHIS2,prev2.21 . . . . . . . . . . . 68
5.6 Prototyping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.6.1 Prototype1 . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.6.2 Prototype2 . . . . . . . . . . . . . . . . . . . . . . . . . 74
5.6.3 Prototype3 . . . . . . . . . . . . . . . . . . . . . . . . . 77
5.6.4 Prototype4 . . . . . . . . . . . . . . . . . . . . . . . . . 80
6 App Deployment 83
6.1 InstalledbaseandtheLeagueTablesApplication . . . . . . . 83
6.1.1 Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . 84
6.1.2 AccessibilitytoMalawi’sHMIS/DHIS2 . . . . . . . . 86
6.1.3 StatusofdatainHMIS/DHIS2(Malawi)orStatusof
HMIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
6.2 ReceptionofLeagueTablesApplication . . . . . . . . . . . . . 94
6.2.1 Rankingperformances . . . . . . . . . . . . . . . . . . 96
6.2.2 Colorsintheleaguetable . . . . . . . . . . . . . . . . . 97
6.2.3 Weightingandinvertingindicators . . . . . . . . . . . 97
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