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Message #13359
[Branch ~dhis2-documenters/dhis2/dhis2-docbook-docs] Rev 376: Random grammatical, content and diplomatic changes.
------------------------------------------------------------
revno: 376
committer: Jason P. Pickering <jason.p.pickering@xxxxxxxxx>
branch nick: dhis2-docbook-docs
timestamp: Tue 2011-08-09 09:32:21 +0200
message:
Random grammatical, content and diplomatic changes.
modified:
src/docbkx/en/dhis2_implementation_guide_enduser_training.xml
src/docbkx/en/dhis2_user_man_data_elements.xml
src/docbkx/en/dhis2_user_man_introduction.xml
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=== modified file 'src/docbkx/en/dhis2_implementation_guide_enduser_training.xml'
--- src/docbkx/en/dhis2_implementation_guide_enduser_training.xml 2011-06-18 21:38:16 +0000
+++ src/docbkx/en/dhis2_implementation_guide_enduser_training.xml 2011-08-09 07:32:21 +0000
@@ -1,60 +1,60 @@
-<?xml version='1.0' encoding='UTF-8'?>
-<!-- This document was created with Syntext Serna Free. --><!DOCTYPE chapter PUBLIC "-//OASIS//DTD DocBook XML V4.4//EN" "http://www.oasis-open.org/docbook/xml/4.4/docbookx.dtd"; []>
-<chapter>
- <title>End-user Training</title>
- <para>The following topics will be covered in this chapter:</para>
- <itemizedlist>
- <listitem>
- <para>What training is needed</para>
- </listitem>
- <listitem>
- <para>Strategies for training</para>
- </listitem>
- <listitem>
- <para>Material and courses</para>
- </listitem>
- </itemizedlist>
- <section>
- <title>What training is needed</title>
- <para>In a large system like a country health information system, there will be different roles for different people. The different tasks usually depends on two factors; what the person will be doing, i.e. mainly collect data, or analyse it, or maintain the database, and where the person is located, like a facility, a district office, or at national level. A first task will then be to define the different users. The most common tasks will be:</para>
- <itemizedlist>
- <listitem>
- <para>Data entry</para>
- </listitem>
- <listitem>
- <para>Data analysis processing, preparing reports and other information products</para>
- </listitem>
- <listitem>
- <para>Database maintenance - managing changes to the database</para>
- </listitem>
- </itemizedlist>
- <para>Data entry is typically decentralized to lower levels, such as a district. Data processing takes place at all levels, while database maintenance usually is centralized. The following table gives an example of user groups and what tasks they typically have:</para>
- <para>Note here that many of the tasks are not directly linked to the use of DHIS2. Data analysis, data quality assessment, preparing feedback and planning regular review meetings are all integral to the functioning of the system, and should also be covered in a training strategy.</para>
- </section>
- <section>
- <title>Strategies for training</title>
- <para>To cover the wide array of tasks/users listed above, a training strategy is helpful. The majority of users will be at lower level; entering and using data. Only a few will have to know the database in-depth, usually at national level. The following are useful tips for end-user training strategies.</para>
- <section>
- <title>Training of trainers</title>
- <para>Since the number of units and staff increase exponentially for each level (a country may have many provinces, each with many districts, each with many facilities), training of trainers is the first step. The number of trainers will vary, depending on the speed of implementation envisioned. As described below, both workshops and on-site training are useful, and especially for the on-site training many people will be needed.</para>
- <para>The trainers should be at least at the level of advanced users, in addition knowing how the database is designed, how to install and troubleshoot DHIS2, and some issues of epidemiology, i.e. concepts that are useful for monitoring and evaluation of health services. As the capabilities of the staff increase, the trainers would also need to increase their skills.</para>
- </section>
- <section>
- <title>Workshops and on-site training</title>
- <para>Experience has showed that training both in workshops/training sessions, and on-site in real work situations are complementary. Workshops are better for training many at the same time, and are useful early on in the training sessions. Preferably the same type of users should be trained.</para>
- <para>On-site training takes place at the work-place of the staff. It is useful to have done more organized training session like in a workshop before, so that on-site training can focus on special issues the individual staff would need more training on. Training on-site will involve less people, so it will be possible to include different types of users. An example would be a district training, where the district information officers and the district medical officer can be trained together. The communication between different users is important in the sense that it forms a common understanding of what is needed, and what is possible. Training can typically be centred around local requirements such as producing outputs (reports, charts, maps) that would be useful for local decision-support.</para>
- </section>
- <section>
- <title>Continuation of training</title>
- <para>Training is not a one off thing. A multi-level training strategy would aim at providing regular training as the skills of the staff increase. For example, a workshop on data entry and validation should be followed by another workshop on report generation and data analysis some time later. Regular training should also be offered to new staff, and when large changes are made to the system, such as redesign of all data collection forms.</para>
- </section>
- </section>
- <section>
- <title>Material and courses</title>
- <para>There is comprehensive material available for training and courses. The main source will be the three manuals available from the DHIS2 documentation repository, to be found at dhis2.org/documentation</para>
- <para>The user documentation covers the background and purpose of DHIS 2 together with instructions and explanations of how to perform data entry, system maintenance, meta-data set-up, import and export of data, aggregation, reporting and other topics related to the usage of the software. The developer documentation covers the technical architecture, the design of each module and use of the development frameworks behind DHIS 2. The implementation guide is targeted at implementers and super-users and addresses subjects such as system design, database development, data harmonization, analysis, deployment, human resources needed and integration with other systems. The end user manual is a light-weight version of the user documentation meant for end users such as district records officers and data entry clerks. All can be opened/downloaded as both PDF and HTML, and are updated daily with the latest input from DHIS2 users worldwide.</para>
- <para>
-The development of these guides depend on input from all users. For information how to to add content to them, please see the appendix on documentation in the User Documentation. Here you will also find information about how to make localized documentation, including versioning in different languages.</para>
- <para>From 2011, regional workshops and courses will be held at least once a year by the international DHIS2 community. The goal is to have national technical teams working with DHIS2 customization and implementation. Sessions will also include training and capacity building by these teams in-country. End-user training, i.e. training of district M&E officers, should take place in each county by these teams.</para>
- </section>
-</chapter>
+<?xml version='1.0' encoding='UTF-8'?>
+<!-- This document was created with Syntext Serna Free. --><!DOCTYPE chapter PUBLIC "-//OASIS//DTD DocBook XML V4.4//EN" "http://www.oasis-open.org/docbook/xml/4.4/docbookx.dtd"; []>
+<chapter>
+ <title>End-user Training</title>
+ <para>The following topics will be covered in this chapter:</para>
+ <itemizedlist>
+ <listitem>
+ <para>What training is needed</para>
+ </listitem>
+ <listitem>
+ <para>Strategies for training</para>
+ </listitem>
+ <listitem>
+ <para>Material and courses</para>
+ </listitem>
+ </itemizedlist>
+ <section>
+ <title>What training is needed</title>
+ <para>In a large system like a country health information system, there will be different roles for different people. The different tasks usually depends on two factors; what the person will be doing, i.e. mainly collect data, or analyse it, or maintain the database, and where the person is located, like a facility, a district office, or at national level. A first task will then be to define the different users. The most common tasks will be:</para>
+ <itemizedlist>
+ <listitem>
+ <para>Data entry</para>
+ </listitem>
+ <listitem>
+ <para>Data analysis processing, preparing reports and other information products</para>
+ </listitem>
+ <listitem>
+ <para>Database maintenance - managing changes to the database</para>
+ </listitem>
+ </itemizedlist>
+ <para>Data entry is typically decentralized to lower levels, such as a district. Data processing takes place at all levels, while database maintenance usually is centralized. The following table gives an example of user groups and what tasks they typically have:</para>
+ <para>Note here that many of the tasks are not directly linked to the use of DHIS2. Data analysis, data quality assessment, preparing feedback and planning regular review meetings are all integral to the functioning of the system, and should also be covered in a training strategy.</para>
+ </section>
+ <section>
+ <title>Strategies for training</title>
+ <para>To cover the wide array of tasks/users listed above, a training strategy is helpful. The majority of users will be at lower level; entering and using data. Only a few will have to know the database in-depth, usually at national level. The following are useful tips for end-user training strategies.</para>
+ <section>
+ <title>Training of trainers</title>
+ <para>Since the number of units and staff increase exponentially for each level (a country may have many provinces, each with many districts, each with many facilities), training of trainers is the first step. The number of trainers will vary, depending on the speed of implementation envisioned. As described below, both workshops and on-site training are useful, and especially for the on-site training many people will be needed.</para>
+ <para>The trainers should be at least at the level of advanced users, in addition knowing how the database is designed, how to install and troubleshoot DHIS2, and some issues of epidemiology, i.e. concepts that are useful for monitoring and evaluation of health services. As the capabilities of the staff increase, the trainers would also need to increase their skills.</para>
+ </section>
+ <section>
+ <title>Workshops and on-site training</title>
+ <para>Experience has showed that training both in workshops/training sessions, and on-site in real work situations are complementary. Workshops are better for training many at the same time, and are useful early on in the training sessions. Preferably the same type of users should be trained.</para>
+ <para>On-site training takes place at the work-place of the staff. It is useful to have done more organized training session like in a workshop before, so that on-site training can focus on special issues the individual staff would need more training on. Training on-site will involve less people, so it will be possible to include different types of users. An example would be a district training, where the district information officers and the district medical officer can be trained together. The communication between different users is important in the sense that it forms a common understanding of what is needed, and what is possible. Training can typically be centred around local requirements such as producing outputs (reports, charts, maps) that would be useful for local decision-support.</para>
+ </section>
+ <section>
+ <title>Continuation of training</title>
+ <para>Training is not a one off thing. A multi-level training strategy would aim at providing regular training as the skills of the staff increase. For example, a workshop on data entry and validation should be followed by another workshop on report generation and data analysis some time later. Regular training should also be offered to new staff, and when large changes are made to the system, such as redesign of all data collection forms.</para>
+ </section>
+ </section>
+ <section>
+ <title>Material and courses</title>
+ <para>There is comprehensive material available for training and courses. The main source will be the three manuals available from the DHIS2 documentation repository, to be found at <ulink url="http://dhis2.org/documentation";>here</ulink>.</para>
+ <para>The user documentation covers the background and purpose of DHIS2 together with instructions and explanations of how to perform data entry, system maintenance, meta-data set-up, import and export of data, aggregation, reporting and other topics related to the usage of the software. The developer documentation covers the technical architecture, the design of each module and use of the development frameworks behind DHIS2. The implementation guide is targeted at implementers and super-users and addresses subjects such as system design, database development, data harmonization, analysis, deployment, human resources needed and integration with other systems. The end user manual is a light-weight version of the user documentation meant for end users such as district records officers and data entry clerks. All can be opened/downloaded as both PDF and HTML, and are updated daily with the latest input from DHIS2 users worldwide.</para>
+ <para>
+The development of these guides depend on input from all users. For information how to to add content to them, please see the appendix on documentation in the User Documentation. Here you will also find information about how to make localized documentation, including versioning in different languages.</para>
+ <para>From 2011, regional workshops and courses will be held at least once a year by the international DHIS2 community. The goal is to have national technical teams working with DHIS2 customization and implementation. Sessions will also include training and capacity building by these teams in-country. End-user training, i.e. training of district M&E officers, should take place in each county by these teams.</para>
+ </section>
+</chapter>
=== modified file 'src/docbkx/en/dhis2_user_man_data_elements.xml'
--- src/docbkx/en/dhis2_user_man_data_elements.xml 2011-07-02 13:01:52 +0000
+++ src/docbkx/en/dhis2_user_man_data_elements.xml 2011-08-09 07:32:21 +0000
@@ -104,7 +104,9 @@
<para>Data element group sets: Click the check box to activate this option hen choose which data element group sets this data element should belong to. Available data element group sets are displayed din the upper window. Click the desired data element group set, then the <guibutton>"Add selected"</guibutton> button to add the data element to the group set. To remove a data element from a group set, click the data element group set in the lower list, and then click<guibutton> "Remove selected"</guibutton>. </para>
</listitem>
<listitem>
- <para>Calculated: This option is available only when a data element is created. </para>
+ <para>Calculated: This option is available only when a data element is created.<important>
+ <para>As of version 2.3, calculated data elements have been deprecated. Calculated data elements should therefore be implemented as indicators instead.</para>
+ </important></para>
<para>Select the data elements that will be used to define the calculated data element, and then click "Add selected" to add them calculated data element composition list. Fill in the correct factor for the data element calculation component (defaults to 1). Component elements of the calculated data element can be removed from the definition by pressing the "Remove" button.</para>
</listitem>
<listitem>
=== modified file 'src/docbkx/en/dhis2_user_man_introduction.xml'
--- src/docbkx/en/dhis2_user_man_introduction.xml 2011-04-28 16:52:01 +0000
+++ src/docbkx/en/dhis2_user_man_introduction.xml 2011-08-09 07:32:21 +0000
@@ -1,393 +1,375 @@
-<?xml version='1.0' encoding='UTF-8'?>
-<!-- This document was created with Syntext Serna Free. --><!DOCTYPE chapter PUBLIC "-//OASIS//DTD DocBook XML V4.4//EN" "http://www.oasis-open.org/docbook/xml/4.4/docbookx.dtd"; []>
-<chapter>
- <title>What is DHIS 2?</title>
- <section id="mod1_1">
- <title>Background of The District Health Information Software – Version 2</title>
- <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 its implications 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 standardisation 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 Rationalisation of reporting flows</para>
- </listitem>
- <listitem>
- <para>Supports customised 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 on-line 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 on-line 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>
- </section>
- <section>
- <title>Purpose of DHIS 2</title>
- <para>The purpose of DHIS can be summarised as follows:</para>
- <orderedlist>
- <listitem>
- <para>Provide a comprehensive HMIS solution based on data
- warehousing principles and a modular structure which can easily be
- customised 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
- customised 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 organisation 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>Provision of Geographic Information Systems (GIS).</para>
- </listitem>
- <listitem>
- <para>User management
- module for passwords, security, and access control.</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 adopted by WHO for their HMN implementation</para>
- </section>
- <section>
- <title>Difference between Aggregated and Patient data in a HMIS</title>
- <para>
- <emphasis>Patient data</emphasis> is data relating to a single 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>
- </section>
- <section>
- <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,
- analysed and used.</para>
- <figure>
- <title>The health information cycle</title>
- <mediaobject>
- <imageobject>
- <imagedata width="60%" align="center" fileref="resources/images/dhis2UserManual/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
- customised 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 among the outputs that DHIS 2 can produce, and
- these should routinely be produced, analysed, and acted upon by health
- managers.</para>
- </section>
- <section>
- <title>Overview of DHIS 2</title>
- <section>
- <title>The different modules of DHIS 2</title>
- <para>DHIS 2 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, DHIS 2 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>
- </section>
- <section>
- <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 <abbrev>PHC</abbrev>s, <abbrev>CHC</abbrev>s etc. So, if computerisation 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 run-time 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
- centralised, which enables easy, on-line updating 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
- centralised 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
- scalable because as facilities get Internet connectivity they can be
- hooked up to the network.</para>
- </section>
- <section>
- <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 <abbrev>FOSS</abbrev> 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. <abbrev>FOSS</abbrev>
- 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, customise the software to suit their needs, and release
- improvements to the public for the good of the community. Hence, some
- <abbrev>FOSS</abbrev> 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, <abbrev>FOSS</abbrev> 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>
- </section>
- <section>
- <title>Understanding platform independency</title>
- <para>All computers have an Operating System (OS) to manage it and the
- programs running it. The operating system serves 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>
- </section>
- <section>
- <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>
- </section>
- </section>
-</chapter>
+<?xml version='1.0' encoding='UTF-8'?>
+<!-- This document was created with Syntext Serna Free. --><!DOCTYPE chapter PUBLIC "-//OASIS//DTD DocBook XML V4.4//EN" "http://www.oasis-open.org/docbook/xml/4.4/docbookx.dtd"; []>
+<chapter>
+ <title>What is DHIS 2?</title>
+ <section id="mod1_1">
+ <title>Background of The District Health Information Software – Version 2</title>
+ <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
+ health management information systems (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 its implications 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 standardisation 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 Rationalisation of reporting flows</para>
+ </listitem>
+ <listitem>
+ <para>Supports customised 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 on-line 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
+ freely. This application is currently the national standard in South Africa
+ and being used in all the health facilities in the country. DHIS1.4
+ 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
+ the second version of DHIS. DHIS 1.4 was used primarily as the basis for the functional
+ requirements. Using a modular structure DHIS2, was developed based on data
+ warehousing principles. DHIS2 is built on free and open source (FOSS) Java based frameworks. It is
+ platform independent, can run on both on-line and offline modes, is multi-language enabled and integrated with various other applications such as
+ Geographic Information Systems and Microsoft Excel.</para>
+ <para>The documentation provided in herewith, will attempt to provide a comprehensive overview of the application. Given the abstract nature of the application, this manual will not serve as a complete step-by-step guide of how to use the application in each and every circumstance, but rather will seek to provide illustrations and examples of how DHIS2 can be implemented in a variety of situations through generalized examples.</para>
+ </section>
+ <section>
+ <title>Purpose of DHIS2</title>
+ <para>The purpose of DHIS2 can be summarised as follows:</para>
+ <orderedlist>
+ <listitem>
+ <para>Provide a comprehensive HMIS solution based on data
+ warehousing principles and a modular structure which can easily be
+ customised 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
+ customised 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 organisation 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>Provision of Geographic Information Systems (GIS).</para>
+ </listitem>
+ <listitem>
+ <para>User management
+ module for passwords, security, and access control.</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, DHIS2 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 adopted by WHO for their HMN implementations in various countries.</para>
+ </section>
+ <section>
+ <title>Difference between Aggregated and Patient data in a HMIS</title>
+ <para>
+ <emphasis>Patient data</emphasis> is data relating to a single patient,
+ such as his/her diagnosis, name, age, earlier medical history etc. This data is typically based on a single patient-health care worker interaction. For instance, when a patient visits a health care clinic, a variety of details may be recored, such as the patient's temperature, their weight, and various blood tests. Should this patient be diagnosed as having "Vitamin B 12 deficiency anaemia, unspecified" corresponding to ICD-10 code D51.9, this particular interaction might eventually get recorded as an instance of "Anaemia" in an aggregate based system. 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, and most importantly, strategic planning within the health system. Aggregate data cannot provide the type of detailed information which patient level data can, but is crucial for planning and guidance of the performance of health systems. </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 it is usually impossible to identify a particular person to a aggregate statistic . However,
+ data can still be misused and misinterpreted by others, and should not
+ be distributed without adequate data dissemination policies in place. </para>
+ </section>
+ <section>
+ <title>Use of DHIS2 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,
+ analysed and used.</para>
+ <figure>
+ <title>The health information cycle</title>
+ <mediaobject>
+ <imageobject>
+ <imagedata width="60%" align="center" fileref="resources/images/dhis2UserManual/dhis2_information_cycle.png"/>
+ </imageobject>
+ </mediaobject>
+ </figure>
+ <para>DHIS2 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, DHIS2 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
+ customised user defined forms which can be developed to mimic paper based forms in order to ease the process of data entry.</para>
+ <para>As a next step, DHIS2 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 DHIS2 can run the data through the
+ validation rules to identify violations.</para>
+ <para>When data has been entered and verified, DHIS2 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, DHIS2 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 among the outputs that DHIS2 can produce, and
+ these should routinely be produced, analysed, and acted upon by health
+ managers.</para>
+ </section>
+ <section>
+ <title>Overview of DHIS2</title>
+ <section>
+ <title>Overview of DHIS2 modules</title>
+ <para>DHIS2 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 DHIS2 to be
+ constantly upgraded in terms of functionality, integrated with other
+ applications such as Excel pivot tables and GIS. Thus modularity
+ allows DHIS2 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. Each of these modules will be discussed at greater length in this document. </para>
+ </section>
+ <section>
+ <title>Web-based versus standalone HMIS and their suitability</title>
+ <para>DHIS2 can run both as a web based and offline application. As a
+ web based application, the DHIS2 application can run on a central
+ server and make use of client-server architecture. For example, at the
+ state level, the DHIS2 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 DHIS2 can run as an
+ independent application on individual computers in different sites
+ such as <abbrev>PHC</abbrev>s, <abbrev>CHC</abbrev>s etc. So, if computerisation 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 run-time 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
+ centralised, which enables easy, on-line updating 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
+ centralised 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
+ scalable because as facilities get Internet connectivity they can be
+ hooked up to the network.</para>
+ </section>
+ <section>
+ <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 <abbrev>FOSS</abbrev> 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. <abbrev>FOSS</abbrev>
+ 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, customise the software to suit their needs, and release
+ improvements to the public for the good of the community. Hence, some
+ <abbrev>FOSS</abbrev> 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, <abbrev>FOSS</abbrev> 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>
+ </section>
+ <section>
+ <title>Understanding platform independence</title>
+ <para>All computers have an Operating System (OS) to manage it and the
+ programs running it. The operating system serves as the middle layer between the
+ software application, such as DHIS2, and the hardware, such as the
+ CPU and RAM. DHIS2 runs on the Java Virtual Machine, and can therefore run on any operating system which supports Java. Platform
+ independence implies that the software application can run on ANY OS -
+ Windows, Linux, Macintosh etc. DHIS2 is platform independent, and is
+ extremely useful in the context of public health, where multiple operating systems may be in use. </para>
+ </section>
+ <section>
+ <title>Auxiliary software that can be used with DHIS2</title>
+ <para>A variety of auxiliary software can be run with DHIS2, such as
+ GIS (for mapping), JasperReports (for reporting), Excel (for analysis through
+ pivot table operations), OpenMRS (for patient based management). Being based on Open Standards and an
+ Open Architecture, DHIS2 can build bridges to speak to the other
+ systems. Further, auxiliary modules can be developed and integrated
+ with the core DHIS2 application.</para>
+ </section>
+ </section>
+</chapter>
