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Message #02058
[Branch ~dhis2-devs-core/dhis2/trunk] Rev 686: DHIS2 user documentation Module 1 added in DocBook format with HTML files
------------------------------------------------------------
revno: 686
committer: Jason P. Pickering <jason.p.pickering@xxxxxxxxx>
branch nick: dhis2
timestamp: Sat 2009-09-12 16:30:17 +0200
message:
DHIS2 user documentation Module 1 added in DocBook format with HTML files
added:
docs/dhis2_user_man_mod1.xml
docs/dhis2_user_manual_mod1_en.htm
docs/images/dhis2_information_cycle.png
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=== added file 'docs/dhis2_user_man_mod1.xml'
--- docs/dhis2_user_man_mod1.xml 1970-01-01 00:00:00 +0000
+++ docs/dhis2_user_man_mod1.xml 2009-09-12 14:30:17 +0000
@@ -0,0 +1,512 @@
+<?xml version="1.0" encoding="UTF-8"?>
+<!DOCTYPE article PUBLIC "-//OASIS//DTD DocBook XML V4.2//EN"
+"http://www.oasis-open.org/docbook/xml/4.2/docbookx.dtd";>
+<?altova_sps http://www.altova.com/sps/Template/Publishing/docbook.sps?>
+<?xml-stylesheet type="text/xsl" href="C:\Program Files\Altova\XMLSpy2008\Stylesheets\docbook\html\docbook.xsl"?>
+<article>
+ <articleinfo>
+ <date>12/09/09</date>
+
+ <title>What is DHIS 2?</title>
+
+ <author>
+ <surname>Unknown</surname>
+
+ <affiliation>
+ <orgname></orgname>
+ </affiliation>
+ </author>
+
+ <revhistory>
+ <revision>
+ <revnumber>1</revnumber>
+
+ <date>12/09/09</date>
+
+ <authorinitials>JPP</authorinitials>
+
+ <revdescription>
+ <para>Initial conversion from MS Word format to DocBook</para>
+ </revdescription>
+ </revision>
+ </revhistory>
+ </articleinfo>
+
+ <sect1>
+ <title>Background of The District Health Information Software – Version 2
+ (DHIS 2)</title>
+
+ <para></para>
+
+ <highlights>
+ <para>After reading this chapter you will be able to understand:</para>
+
+ <itemizedlist>
+ <listitem>
+ <para>What is DHIS2 and what purpose it serves with respect to
+ HMIS</para>
+ </listitem>
+
+ <listitem>
+ <para>What is the difference between patient based and aggregate
+ data.</para>
+ </listitem>
+
+ <listitem>
+ <para>What are the different modules in DHIS 2.</para>
+ </listitem>
+
+ <listitem>
+ <para>What is Free and Open Source Software (FOSS), platform
+ (in)dependency, and itsimplications for HMIS.</para>
+ </listitem>
+
+ <listitem>
+ <para>What is FOSS, platform (in)dependency, and their implications
+ for HMIS.</para>
+ </listitem>
+ </itemizedlist>
+ </highlights>
+
+ <para>Computer based HMIS allows for a transition from a data (and paper)
+ based HMIS to and action led HMIS. Particular strengths of a computer
+ based HMIS enumerated below:</para>
+
+ <itemizedlist>
+ <listitem>
+ <para>Promotes streamlining and standardization of data
+ records.</para>
+ </listitem>
+
+ <listitem>
+ <para>Promotes streamlining and standardization of data
+ records.</para>
+ </listitem>
+
+ <listitem>
+ <para>Promotes streamlining and standardization of data
+ records.</para>
+ </listitem>
+
+ <listitem>
+ <para>Allows creation of an integrated warehouse, which supports
+ combining data from different sources and conducting cross
+ analysis.</para>
+ </listitem>
+
+ <listitem>
+ <para>Facilitates Rationalization of reporting flows</para>
+ </listitem>
+
+ <listitem>
+ <para>Supports customized reporting.</para>
+ </listitem>
+
+ <listitem>
+ <para>Makes possible various kinds of indicator based analysis</para>
+ </listitem>
+
+ <listitem>
+ <para>Allows integration of various software applications such as GIS
+ and Excel.</para>
+ </listitem>
+
+ <listitem>
+ <para>Provides functionality to conduct data quality
+ validation.</para>
+ </listitem>
+
+ <listitem>
+ <para>Allows immediate online transmission of data / reports as and
+ when required by the user</para>
+ </listitem>
+ </itemizedlist>
+
+ <para>The District Health Information Software – Version 2 (DHIS 2) is
+ Free and Open Source Software (FOSS) HMIS designed and developed under a
+ global research and development initiative (called Health Information
+ Systems Project – HISP) originating from the Department of Informatics,
+ University of Oslo, Norway. The first version of DHIS application (DHIS
+ 1.3/1.4) was developed and subsequently upgraded on an ongoing base
+ continuously upgraded in South Africa by HISP South Africa since 1997.
+ This version was developed on Microsoft Office platform, and distributed
+ free. This application is currently the national standard in South Africa
+ and being used in all the health facilities in the country. Further, this
+ application is being used in many countries in Africa such as Ethiopia,
+ Nigeria, Botswana, Tanzania, Zambia, and, various other countries.</para>
+
+ <para>In 2005, based on the various comments and feedback from the field
+ level use, the University of Oslo initiated the process of developing
+ Version 2 of DHIS, which used DHIS 1.4 as the basis for the functional
+ requirements. Using a modular structure DHIS 2 was developed based on data
+ warehousing principles. DHIS 2 is built on Java based frameworks. It is
+ platform independent, can run on both online and offline modes, is multi
+ language enabled and integrated with various other applications such as
+ Geographic Information Systems and Excel. </para>
+
+ <para>The WHO and HMN (Health Metrics Network) are currently using DHIS 2
+ for implementing an integrated solution in the first HMN country – Sierra
+ Leone. While DHIS 2 will be used for the aggregated statistics component
+ of the HMIS, it will be integrated with a free software application called
+ Open MRS for patient based management, and the WHO created Open Health for
+ GIS and Web pivot tables.</para>
+
+ <para>In this training manual, we will take the DHIS 2 as the basis to
+ illustrate the various functionalities that a computer based HMIS should
+ provide.</para>
+
+ <sect2>
+ <title>Purpose of DHIS2</title>
+
+ <para>The purpose of DHIS can be summarized as follows: </para>
+
+ <orderedlist>
+ <listitem>
+ <para>Provide a comprehensive HMIS solution based on data
+ warehousing principles and a modular structure which can easily be
+ customized to the needs of different health systems - nations,
+ states, districts, and facilities. </para>
+ </listitem>
+
+ <listitem>
+ <para>Provide data entry facilities which can either be in the form
+ of standard (scroll down) lists (of data elements), or can be
+ customized to replicate paper forms – to make easy the process of
+ data entry. </para>
+ </listitem>
+
+ <listitem>
+ <para>Provide different kinds of tools for data validation and
+ improvement of data quality.</para>
+ </listitem>
+
+ <listitem>
+ <para>Provide different tools for reporting – both for automated
+ routine reports and analysis reports, and in addition provide the
+ user with functionality and flexibility to make their user defined
+ reports</para>
+ </listitem>
+
+ <listitem>
+ <para>A dashboard for monitoring and evaluation of health programs
+ that can allow for the generation and analysis of different
+ indicators, and also carry out data quality analysis.</para>
+ </listitem>
+
+ <listitem>
+ <para>Systems management functions to carry out various operations
+ to manage hierarchy of organization units,
+ addition/deletion/modification of data elements etc.</para>
+ </listitem>
+
+ <listitem>
+ <para>Functionality to design and modify indicators.</para>
+ </listitem>
+
+ <listitem>
+ <para> Functionalities of export-import, so that data entered on an
+ offline version can be exported to the district or higher level
+ systems. Export import can also be made in relation to other
+ applications such as Excel and Epi Info. </para>
+ </listitem>
+
+ <listitem>
+ <para>Integration with other software systems – such as
+ <acronym>RIMS</acronym>.</para>
+ </listitem>
+
+ <listitem>
+ <para>Integration with <glossterm>Geographic Information
+ Systems</glossterm> (<acronym>GIS</acronym>).</para>
+ </listitem>
+
+ <listitem>
+ <para>User management module for passwords, security, and defining
+ authorization.</para>
+ </listitem>
+
+ <listitem>
+ <para>Further modules can be developed (such as for human resources
+ management) and integrated as per user needs. </para>
+ </listitem>
+ </orderedlist>
+
+ <para>In summary, DHIS 2 provides a comprehensive HMIS solution for the
+ reporting and analysis needs of health facilities at any level. It is a
+ tried and tested application in various countries, and also now being
+ adopted by WHO for their HMN implementation</para>
+ </sect2>
+
+ <sect2>
+ <title>Difference between Aggregated and Patient data in a HMIS </title>
+
+ <para><emphasis>Patient data</emphasis> is data relating to ONE patient,
+ such as his/her diagnosis, name, age, earlier medical history etc.
+ Patient based data is important when you want to track longitudinally
+ the progress of a patient over time. For example, if we want to track
+ how a patient is adhering to and responding to the process of TB
+ treatment (typically taking place over 6-9 months), we would need
+ patient based data. </para>
+
+ <para><emphasis>Aggregated data</emphasis> is the consolidation of data
+ relating to multiple patients, and therefore cannot be traced back to a
+ specific patient. They are merely counts, such as incidences of Malaria,
+ TB, or other diseases. Typically, the routine data that a health
+ facility deals with is this kind of aggregated statistics, and is used
+ for the generation of routine reports and indicators. </para>
+
+ <para>Patient data is highly confidential and therefore must be
+ protected so that no one other than doctors can get it. When in paper,
+ it must be properly stored in a secure place. For computers, patient
+ data needs secure systems with passwords and restrained access.</para>
+
+ <para>Security concerns for aggregated data are not as crucial as for
+ patient data, as there are no ways of relating it to a person. However,
+ data can still be misused and misinterpreted by others, and should not
+ be distributed uncritically. A data policy needs to be established by
+ the managers about who gets access to what data.</para>
+ </sect2>
+
+ <sect2>
+ <title>Use of DHIS 2 in HMIS: data collection, processing,
+ interpretation, and analysis. </title>
+
+ <para>The wider context of HMIS can be comprehensively described through
+ the information cycle presented in Figure 1.1 below. The information
+ cycle pictorially depicts the different components, stages and processes
+ through which the data is collected, checked for quality, processed,
+ analyzed and used.</para>
+
+ <figure>
+ <title>The health information cycle </title>
+
+ <mediaobject>
+ <imageobject>
+ <imagedata fileref="images/dhis2_information_cycle.png" />
+ </imageobject>
+ </mediaobject>
+ </figure>
+
+ <para>DHIS 2 supports the different facets of the information cycle
+ including:<itemizedlist>
+ <listitem>
+ <para>Collecting data.</para>
+ </listitem>
+
+ <listitem>
+ <para>Running quality checks.</para>
+ </listitem>
+
+ <listitem>
+ <para>Data access at multiple levels.</para>
+ </listitem>
+
+ <listitem>
+ <para>Reporting.</para>
+ </listitem>
+
+ <listitem>
+ <para>Making graphs and maps and other forms of analysis.</para>
+ </listitem>
+
+ <listitem>
+ <para>Enabling comparison across time (for example, previous
+ months) and space (for example, across facilities and
+ districts).</para>
+ </listitem>
+
+ <listitem>
+ <para>See trends (displaying data in time series to see their min
+ and max levels).</para>
+ </listitem>
+ </itemizedlist></para>
+
+ <para>As a first step, DHIS 2 serves as a data collection, recording and
+ compilation tool, and all data (be it in numbers or text form) can be
+ entered into it. Data entry can be done in lists of data elements or in
+ customized user defined forms based on the paper forms. </para>
+
+ <para>As a next step, DHIS 2 can be used to increase data quality.
+ Firstly, at the point of data entry, a check can be made to see if data
+ falls within acceptable range levels of minimum and maximum values for
+ any particular data element. Such checking, for example, can help to
+ identify typing errors at the time of data entry. Further, user can
+ define various validation rules, and DHIS 2 can run the data through the
+ validation rules to identify violations.</para>
+
+ <para>When data has been entered and verified, DHIS 2 can help to make
+ different kinds of reports. The first kind are the routine reports that
+ can be predefined, so that all those reports that need to be routine
+ generated can be done on a click of a button. Further, DHIS 2 can help
+ in the generation of analytical reports through comparisons of for
+ example indicators across facilities or over time. Graphs, maps, reports
+ and health profiles are amongst the outputs that DHIS 2 can produce, and
+ these should routinely be produced, analyzed, and acted upon by health
+ managers.</para>
+ </sect2>
+
+ <sect2>
+ <title>Overview of DHIS 2.0</title>
+
+ <sect3>
+ <title>The different modules of DHIS 2</title>
+
+ <para>DHIS is based on a modular approach of design. A module can be
+ seen as an independent component of application that is capable of
+ both processing inputs as well as outputs, that is used to communicate
+ with other modules. The modules are flexible enough to allow changes
+ in one module without having any effect on other modules. As long as
+ input and output stays the same, it doesn’t matter what happens inside
+ a module. A module can then be changed without affecting other
+ modules, which will be working as long as the output from the first
+ module comes out as normal. This modular feature allows DHIS 2 to be
+ constantly upgraded in terms of functionality, integrated with other
+ applications such as Excel pivot tables and GIS. Thus modularity
+ allows DHIS 2 to be flexible, and changes can take place in the
+ different modules without affecting others.</para>
+
+ <para>Currently, DHIS2 has several modules for functions such as data
+ entry, data quality checks, report generation etc. These modules have
+ been categorised and presented under two core categories namely
+ Maintenance and Services. The Services module supports data record,
+ analysis, report generation etc. And the Maintenance module allows you
+ to set the content and structure of the Services module.</para>
+ </sect3>
+
+ <sect3>
+ <title>Web-based versus standalone HMIS and their suitability</title>
+
+ <para>DHIS 2 can run both as a web based and offline application. As a
+ web based application, the DHIS 2 application can run on a central
+ server and make use of client-server architecture. For example, at the
+ state level, the DHIS 2 can run on a server, and the different
+ districts act as clients, drawing upon the server application through
+ the Internet for local use of the application. </para>
+
+ <para>In a standalone application, the DHIS 2 can run as an
+ independent application on individual computers in different sites
+ such as PHCs, CHCs etc. So, if computerization is taking place at the
+ Block level, then the DHIS 2 will be installed separately on each of
+ the block level computers. The disadvantage of a standalone
+ application is that of platform dependency – where the application
+ needs to be configured to the platform on each of the respective
+ machines. A thick client requires a local runtime environment. For
+ example a Windows Form application will only run on a Windows platform
+ with the .Net framework installed. The major advantage of the offline
+ version is that it can run without any dependency on the Internet.
+ This allows the application to run in remote locations where there is
+ limited or no Internet connectivity. </para>
+
+ <para>The main advantage of a web based solution is that it is
+ centralized, which enables easy, online updation and deployment of the
+ application. The only requirements on the clients’ side are to have
+ web browser installed on the used computer and have an Internet
+ connection. The hardware on the server is often more powerful than the
+ single computer. Another advantage of the web application is that is
+ platform independent, allowing the same software to be accessed
+ through a web browser regardless of the client’s operating system.
+ </para>
+
+ <para>Where connectivity is available, and there is need for
+ centralized management, a web based application is useful, and a
+ standalone application is preferred when these conditions are not
+ available or required. However, in most cases, a mix of these two
+ approaches would be required, with a server based deployment working
+ for district-state-national level processing, and a standalone
+ deployment at lower levels where connectivity is limited. The
+ advantage of such an approach is that it is flexible, inclusive, and
+ scaleable because as facilities get internet connectivity they can be
+ hooked up to the network.</para>
+ </sect3>
+
+ <sect3>
+ <title>Free and Open Source Software (FOSS): benefits and challenges
+ </title>
+
+ <para>Software carries the instructions that tell a computer how to
+ operate. The human authored and human readable form of those
+ instructions is called source code. Before the computer can actually
+ execute the instructions, the source code must be translated into a
+ machine readable (binary) format, called the object code. All
+ distributed software includes the object code, but FOSS makes the
+ source code available as well. </para>
+
+ <para>Proprietary software owners license their copyrighted object
+ code to a user, which allows the user to run the program. FOSS
+ programs, on the other hand, license both the object and the source
+ code, permitting the user to run, modify and possibly redistribute the
+ programs. With access to the source code, the users have the freedom
+ to run the program for any purpose, redistribute, probe, adapt, learn
+ from, customize the software to suit their needs, and release
+ improvements to the public for the good of the community. Hence, some
+ FOSS is also known as free software, where “free†refers, first and
+ foremost, to the above freedoms rather than in the monetary sense of
+ the word.</para>
+
+ <para>Within the public health sector, FOSS can potentially have a
+ range of benefits, including:</para>
+
+ <itemizedlist>
+ <listitem>
+ <para>Lower costs as it does not involve paying for prohibitive
+ license costs.</para>
+ </listitem>
+
+ <listitem>
+ <para>Given the information needs for the health sector are
+ constantly changing and evolving, there is a need for the user to
+ have the freedom to make the changes as per the user requirements.
+ This is often limited in proprietary systems.</para>
+ </listitem>
+
+ <listitem>
+ <para>In the health sector, including in NRHM; a key agenda is
+ that of integration, which involves the technical linking of
+ different pieces of software (for example, DHIS 2 and RIMS). For
+ this, the source code needs to be made available to the developers
+ to create the integration. This availability is often not possible
+ in the case of proprietary software. And when it is, it comes at a
+ high cost and contractual obligations.</para>
+ </listitem>
+
+ <listitem>
+ <para>FOSS applications like DHIS2 typically are supported by a
+ global network of developers, and thus have access to cutting edge
+ research and development knowledge. </para>
+ </listitem>
+ </itemizedlist>
+ </sect3>
+
+ <sect3>
+ <title>Understanding platform independency</title>
+
+ <para>All computers have an Operating System (OS) to manage it and the
+ programs running it. Such OS serve as the middle layer between the
+ software application, such as DHIS 2, and the hardware, such as the
+ CPU and RAM. The most popularly used OS is Microsoft Windows, which
+ comes in various versions (such as XP, Vista). However, this OS costs
+ money, and have also been reported to have security issues that makes
+ it vulnerable to virus attacks. Operating Systems like Linux are free,
+ and are more secure with respect to virus attacks. Usually, many of
+ the applications will work on one OS, and not on others. Platform
+ independency implies that the software application can run on ANY OS -
+ Windows, Linux, Macintosh etc. DHIS 2 is platform independent, and is
+ extremely useful in the context of public health when typically you
+ have systems in different places running different kinds of OS.
+ </para>
+ </sect3>
+
+ <sect3>
+ <title>Auxiliary software that can be used with DHIS</title>
+
+ <para>A variety of auxiliary software can be run with DHIS 2, such as
+ GIS (for mapping), BIRT (for reporting), Excel (for analysis through
+ pivot table operations), Open MRS (for patient based management), and
+ CRIS (for HIV/AIDS management). Being based on Open Standards and an
+ Open Architecture, DHIS 2 can build bridges to speak to the other
+ systems. Further, auxiliary modules can be developed and integrated
+ with the core DHIS 2 application. </para>
+ </sect3>
+ </sect2>
+ </sect1>
+</article>
=== added file 'docs/dhis2_user_manual_mod1_en.htm'
--- docs/dhis2_user_manual_mod1_en.htm 1970-01-01 00:00:00 +0000
+++ docs/dhis2_user_manual_mod1_en.htm 2009-09-12 14:30:17 +0000
@@ -0,0 +1,244 @@
+<html><head><meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1"><title>What is DHIS 2?</title><meta name="generator" content="DocBook XSL Stylesheets VSPY V.1 "></head><body bgcolor="white" text="black" link="#0000FF" vlink="#840084" alink="#0000FF"><div class="article"><div class="titlepage">
+<div><h1 class="title"><a name="idarticle145147192"></a>What is DHIS 2?</h1></div><div><div class="author"><h3 class="author">Unknown</h3><div class="affiliation"><span class="orgname"><br></br></span></div></div></div><div><div class="revhistory"><table border="1" width="100%" summary="Revision history"><tr><th align="left" valign="top" colspan="3"><b>Revision History</b></th></tr><tr><td align="left">Revision 1</td><td align="left">12/09/09</td><td align="left">JPP</td></tr><tr><td align="left" colspan="3"><p>Initial conversion from MS Word format to DocBook</p></td></tr></table></div></div>
+
+<hr></div><div class="toc"><p><b>Table of Contents</b></p><dl><dt><a href="#idsect1140843160">Background of The District Health Information Software – Version 2
+ (DHIS 2)</a></dt><dd><dl><dt><a href="#idsect2108621456">Purpose of DHIS2</a></dt><dt><a href="#idsect2177629568">Difference between Aggregated and Patient data in a HMIS </a></dt><dt><a href="#idsect2143099248">Use of DHIS 2 in HMIS: data collection, processing,
+ interpretation, and analysis. </a></dt><dt><a href="#idsect2132995144">Overview of DHIS 2.0</a></dt></dl></dd></dl></div><div class="sect1"><div class="titlepage">
+<div><h2 class="title" style="clear: both"><a name="idsect1140843160"></a>Background of The District Health Information Software – Version 2
+ (DHIS 2)</h2></div>
+
+</div><p /><div class="highlights"><p>After reading this chapter you will be able to understand:</p><div class="itemizedlist"><ul type="disc"><li><p>What is DHIS2 and what purpose it serves with respect to
+ HMIS</p></li><li><p>What is the difference between patient based and aggregate
+ data.</p></li><li><p>What are the different modules in DHIS 2.</p></li><li><p>What is Free and Open Source Software (FOSS), platform
+ (in)dependency, and itsimplications for HMIS.</p></li><li><p>What is FOSS, platform (in)dependency, and their implications
+ for HMIS.</p></li></ul></div></div><p>Computer based HMIS allows for a transition from a data (and paper)
+ based HMIS to and action led HMIS. Particular strengths of a computer
+ based HMIS enumerated below:</p><div class="itemizedlist"><ul type="disc"><li><p>Promotes streamlining and standardization of data
+ records.</p></li><li><p>Promotes streamlining and standardization of data
+ records.</p></li><li><p>Promotes streamlining and standardization of data
+ records.</p></li><li><p>Allows creation of an integrated warehouse, which supports
+ combining data from different sources and conducting cross
+ analysis.</p></li><li><p>Facilitates Rationalization of reporting flows</p></li><li><p>Supports customized reporting.</p></li><li><p>Makes possible various kinds of indicator based analysis</p></li><li><p>Allows integration of various software applications such as GIS
+ and Excel.</p></li><li><p>Provides functionality to conduct data quality
+ validation.</p></li><li><p>Allows immediate online transmission of data / reports as and
+ when required by the user</p></li></ul></div><p>The District Health Information Software – Version 2 (DHIS 2) is
+ Free and Open Source Software (FOSS) HMIS designed and developed under a
+ global research and development initiative (called Health Information
+ Systems Project – HISP) originating from the Department of Informatics,
+ University of Oslo, Norway. The first version of DHIS application (DHIS
+ 1.3/1.4) was developed and subsequently upgraded on an ongoing base
+ continuously upgraded in South Africa by HISP South Africa since 1997.
+ This version was developed on Microsoft Office platform, and distributed
+ free. This application is currently the national standard in South Africa
+ and being used in all the health facilities in the country. Further, this
+ application is being used in many countries in Africa such as Ethiopia,
+ Nigeria, Botswana, Tanzania, Zambia, and, various other countries.</p><p>In 2005, based on the various comments and feedback from the field
+ level use, the University of Oslo initiated the process of developing
+ Version 2 of DHIS, which used DHIS 1.4 as the basis for the functional
+ requirements. Using a modular structure DHIS 2 was developed based on data
+ warehousing principles. DHIS 2 is built on Java based frameworks. It is
+ platform independent, can run on both online and offline modes, is multi
+ language enabled and integrated with various other applications such as
+ Geographic Information Systems and Excel. </p><p>The WHO and HMN (Health Metrics Network) are currently using DHIS 2
+ for implementing an integrated solution in the first HMN country – Sierra
+ Leone. While DHIS 2 will be used for the aggregated statistics component
+ of the HMIS, it will be integrated with a free software application called
+ Open MRS for patient based management, and the WHO created Open Health for
+ GIS and Web pivot tables.</p><p>In this training manual, we will take the DHIS 2 as the basis to
+ illustrate the various functionalities that a computer based HMIS should
+ provide.</p><div class="sect2"><div class="titlepage">
+<div><h3 class="title"><a name="idsect2108621456"></a>Purpose of DHIS2</h3></div>
+
+</div><p>The purpose of DHIS can be summarized as follows: </p><div class="orderedlist"><ol type="1"><li><p>Provide a comprehensive HMIS solution based on data
+ warehousing principles and a modular structure which can easily be
+ customized to the needs of different health systems - nations,
+ states, districts, and facilities. </p></li><li><p>Provide data entry facilities which can either be in the form
+ of standard (scroll down) lists (of data elements), or can be
+ customized to replicate paper forms – to make easy the process of
+ data entry. </p></li><li><p>Provide different kinds of tools for data validation and
+ improvement of data quality.</p></li><li><p>Provide different tools for reporting – both for automated
+ routine reports and analysis reports, and in addition provide the
+ user with functionality and flexibility to make their user defined
+ reports</p></li><li><p>A dashboard for monitoring and evaluation of health programs
+ that can allow for the generation and analysis of different
+ indicators, and also carry out data quality analysis.</p></li><li><p>Systems management functions to carry out various operations
+ to manage hierarchy of organization units,
+ addition/deletion/modification of data elements etc.</p></li><li><p>Functionality to design and modify indicators.</p></li><li><p> Functionalities of export-import, so that data entered on an
+ offline version can be exported to the district or higher level
+ systems. Export import can also be made in relation to other
+ applications such as Excel and Epi Info. </p></li><li><p>Integration with other software systems – such as
+ RIMS.</p></li><li><p>Integration with <i>Geographic Information
+ Systems</i> (GIS).</p></li><li><p>User management module for passwords, security, and defining
+ authorization.</p></li><li><p>Further modules can be developed (such as for human resources
+ management) and integrated as per user needs. </p></li></ol></div><p>In summary, DHIS 2 provides a comprehensive HMIS solution for the
+ reporting and analysis needs of health facilities at any level. It is a
+ tried and tested application in various countries, and also now being
+ adopted by WHO for their HMN implementation</p></div><div class="sect2"><div class="titlepage">
+<div><h3 class="title"><a name="idsect2177629568"></a>Difference between Aggregated and Patient data in a HMIS </h3></div>
+
+</div><p><span class="emphasis"><em>Patient data</em></span> is data relating to ONE patient,
+ such as his/her diagnosis, name, age, earlier medical history etc.
+ Patient based data is important when you want to track longitudinally
+ the progress of a patient over time. For example, if we want to track
+ how a patient is adhering to and responding to the process of TB
+ treatment (typically taking place over 6-9 months), we would need
+ patient based data. </p><p><span class="emphasis"><em>Aggregated data</em></span> is the consolidation of data
+ relating to multiple patients, and therefore cannot be traced back to a
+ specific patient. They are merely counts, such as incidences of Malaria,
+ TB, or other diseases. Typically, the routine data that a health
+ facility deals with is this kind of aggregated statistics, and is used
+ for the generation of routine reports and indicators. </p><p>Patient data is highly confidential and therefore must be
+ protected so that no one other than doctors can get it. When in paper,
+ it must be properly stored in a secure place. For computers, patient
+ data needs secure systems with passwords and restrained access.</p><p>Security concerns for aggregated data are not as crucial as for
+ patient data, as there are no ways of relating it to a person. However,
+ data can still be misused and misinterpreted by others, and should not
+ be distributed uncritically. A data policy needs to be established by
+ the managers about who gets access to what data.</p></div><div class="sect2"><div class="titlepage">
+<div><h3 class="title"><a name="idsect2143099248"></a>Use of DHIS 2 in HMIS: data collection, processing,
+ interpretation, and analysis. </h3></div>
+
+</div><p>The wider context of HMIS can be comprehensively described through
+ the information cycle presented in Figure 1.1 below. The information
+ cycle pictorially depicts the different components, stages and processes
+ through which the data is collected, checked for quality, processed,
+ analyzed and used.</p><div class="figure"><a name="idfigure143098152"></a><p class="title"><b>Figure&#160;1.&#160;The health information cycle </b></p><div class="mediaobject"><img src="images/dhis2_information_cycle.png"></div></div><p>DHIS 2 supports the different facets of the information cycle
+ including:<div class="itemizedlist"><ul type="disc"><li><p>Collecting data.</p></li><li><p>Running quality checks.</p></li><li><p>Data access at multiple levels.</p></li><li><p>Reporting.</p></li><li><p>Making graphs and maps and other forms of analysis.</p></li><li><p>Enabling comparison across time (for example, previous
+ months) and space (for example, across facilities and
+ districts).</p></li><li><p>See trends (displaying data in time series to see their min
+ and max levels).</p></li></ul></div></p><p>As a first step, DHIS 2 serves as a data collection, recording and
+ compilation tool, and all data (be it in numbers or text form) can be
+ entered into it. Data entry can be done in lists of data elements or in
+ customized user defined forms based on the paper forms. </p><p>As a next step, DHIS 2 can be used to increase data quality.
+ Firstly, at the point of data entry, a check can be made to see if data
+ falls within acceptable range levels of minimum and maximum values for
+ any particular data element. Such checking, for example, can help to
+ identify typing errors at the time of data entry. Further, user can
+ define various validation rules, and DHIS 2 can run the data through the
+ validation rules to identify violations.</p><p>When data has been entered and verified, DHIS 2 can help to make
+ different kinds of reports. The first kind are the routine reports that
+ can be predefined, so that all those reports that need to be routine
+ generated can be done on a click of a button. Further, DHIS 2 can help
+ in the generation of analytical reports through comparisons of for
+ example indicators across facilities or over time. Graphs, maps, reports
+ and health profiles are amongst the outputs that DHIS 2 can produce, and
+ these should routinely be produced, analyzed, and acted upon by health
+ managers.</p></div><div class="sect2"><div class="titlepage">
+<div><h3 class="title"><a name="idsect2132995144"></a>Overview of DHIS 2.0</h3></div>
+
+</div><div class="sect3"><div class="titlepage">
+<div><h4 class="title"><a name="idsect3132994480"></a>The different modules of DHIS 2</h4></div>
+
+</div><p>DHIS is based on a modular approach of design. A module can be
+ seen as an independent component of application that is capable of
+ both processing inputs as well as outputs, that is used to communicate
+ with other modules. The modules are flexible enough to allow changes
+ in one module without having any effect on other modules. As long as
+ input and output stays the same, it doesn’t matter what happens inside
+ a module. A module can then be changed without affecting other
+ modules, which will be working as long as the output from the first
+ module comes out as normal. This modular feature allows DHIS 2 to be
+ constantly upgraded in terms of functionality, integrated with other
+ applications such as Excel pivot tables and GIS. Thus modularity
+ allows DHIS 2 to be flexible, and changes can take place in the
+ different modules without affecting others.</p><p>Currently, DHIS2 has several modules for functions such as data
+ entry, data quality checks, report generation etc. These modules have
+ been categorised and presented under two core categories namely
+ Maintenance and Services. The Services module supports data record,
+ analysis, report generation etc. And the Maintenance module allows you
+ to set the content and structure of the Services module.</p></div><div class="sect3"><div class="titlepage">
+<div><h4 class="title"><a name="idsect3168551400"></a>Web-based versus standalone HMIS and their suitability</h4></div>
+
+</div><p>DHIS 2 can run both as a web based and offline application. As a
+ web based application, the DHIS 2 application can run on a central
+ server and make use of client-server architecture. For example, at the
+ state level, the DHIS 2 can run on a server, and the different
+ districts act as clients, drawing upon the server application through
+ the Internet for local use of the application. </p><p>In a standalone application, the DHIS 2 can run as an
+ independent application on individual computers in different sites
+ such as PHCs, CHCs etc. So, if computerization is taking place at the
+ Block level, then the DHIS 2 will be installed separately on each of
+ the block level computers. The disadvantage of a standalone
+ application is that of platform dependency – where the application
+ needs to be configured to the platform on each of the respective
+ machines. A thick client requires a local runtime environment. For
+ example a Windows Form application will only run on a Windows platform
+ with the .Net framework installed. The major advantage of the offline
+ version is that it can run without any dependency on the Internet.
+ This allows the application to run in remote locations where there is
+ limited or no Internet connectivity. </p><p>The main advantage of a web based solution is that it is
+ centralized, which enables easy, online updation and deployment of the
+ application. The only requirements on the clients’ side are to have
+ web browser installed on the used computer and have an Internet
+ connection. The hardware on the server is often more powerful than the
+ single computer. Another advantage of the web application is that is
+ platform independent, allowing the same software to be accessed
+ through a web browser regardless of the client’s operating system.
+ </p><p>Where connectivity is available, and there is need for
+ centralized management, a web based application is useful, and a
+ standalone application is preferred when these conditions are not
+ available or required. However, in most cases, a mix of these two
+ approaches would be required, with a server based deployment working
+ for district-state-national level processing, and a standalone
+ deployment at lower levels where connectivity is limited. The
+ advantage of such an approach is that it is flexible, inclusive, and
+ scaleable because as facilities get internet connectivity they can be
+ hooked up to the network.</p></div><div class="sect3"><div class="titlepage">
+<div><h4 class="title"><a name="idsect3131702240"></a>Free and Open Source Software (FOSS): benefits and challenges
+ </h4></div>
+
+</div><p>Software carries the instructions that tell a computer how to
+ operate. The human authored and human readable form of those
+ instructions is called source code. Before the computer can actually
+ execute the instructions, the source code must be translated into a
+ machine readable (binary) format, called the object code. All
+ distributed software includes the object code, but FOSS makes the
+ source code available as well. </p><p>Proprietary software owners license their copyrighted object
+ code to a user, which allows the user to run the program. FOSS
+ programs, on the other hand, license both the object and the source
+ code, permitting the user to run, modify and possibly redistribute the
+ programs. With access to the source code, the users have the freedom
+ to run the program for any purpose, redistribute, probe, adapt, learn
+ from, customize the software to suit their needs, and release
+ improvements to the public for the good of the community. Hence, some
+ FOSS is also known as free software, where “free” refers, first and
+ foremost, to the above freedoms rather than in the monetary sense of
+ the word.</p><p>Within the public health sector, FOSS can potentially have a
+ range of benefits, including:</p><div class="itemizedlist"><ul type="disc"><li><p>Lower costs as it does not involve paying for prohibitive
+ license costs.</p></li><li><p>Given the information needs for the health sector are
+ constantly changing and evolving, there is a need for the user to
+ have the freedom to make the changes as per the user requirements.
+ This is often limited in proprietary systems.</p></li><li><p>In the health sector, including in NRHM; a key agenda is
+ that of integration, which involves the technical linking of
+ different pieces of software (for example, DHIS 2 and RIMS). For
+ this, the source code needs to be made available to the developers
+ to create the integration. This availability is often not possible
+ in the case of proprietary software. And when it is, it comes at a
+ high cost and contractual obligations.</p></li><li><p>FOSS applications like DHIS2 typically are supported by a
+ global network of developers, and thus have access to cutting edge
+ research and development knowledge. </p></li></ul></div></div><div class="sect3"><div class="titlepage">
+<div><h4 class="title"><a name="idsect3150776480"></a>Understanding platform independency</h4></div>
+
+</div><p>All computers have an Operating System (OS) to manage it and the
+ programs running it. Such OS serve as the middle layer between the
+ software application, such as DHIS 2, and the hardware, such as the
+ CPU and RAM. The most popularly used OS is Microsoft Windows, which
+ comes in various versions (such as XP, Vista). However, this OS costs
+ money, and have also been reported to have security issues that makes
+ it vulnerable to virus attacks. Operating Systems like Linux are free,
+ and are more secure with respect to virus attacks. Usually, many of
+ the applications will work on one OS, and not on others. Platform
+ independency implies that the software application can run on ANY OS -
+ Windows, Linux, Macintosh etc. DHIS 2 is platform independent, and is
+ extremely useful in the context of public health when typically you
+ have systems in different places running different kinds of OS.
+ </p></div><div class="sect3"><div class="titlepage">
+<div><h4 class="title"><a name="idsect3150775400"></a>Auxiliary software that can be used with DHIS</h4></div>
+
+</div><p>A variety of auxiliary software can be run with DHIS 2, such as
+ GIS (for mapping), BIRT (for reporting), Excel (for analysis through
+ pivot table operations), Open MRS (for patient based management), and
+ CRIS (for HIV/AIDS management). Being based on Open Standards and an
+ Open Architecture, DHIS 2 can build bridges to speak to the other
+ systems. Further, auxiliary modules can be developed and integrated
+ with the core DHIS 2 application. </p></div></div></div></div></body></html>
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