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Business Hours
Days Hours
 Monday - Friday  08:00 - 16:45
 Lunch Time  13:00 - 14:00
* We shall observe all holidays as stipulated by the Government of Swaziland

Physical Address: Cooper Centre Office 106, Mbabane, Swaziland

Postal Address: P.O Box 5 Mbabane, Swaziland

Phone: 2404 7712

Fax: none

HMIS - Our Projects 1

The Health Management Information System (HMIS) unit under Strategic Information Department (SID) of Ministry of Health (MoH) is the custodian of all Health Information Systems in Swaziland. Swaziland has a variety of systems which HMIS is working towards intergrating all these into one system.
This review will not only aid us in understanding what the weaknesses of the routine health information system are, but it will also provide us with the building blocks for the restructuring of information systems in the health sector.", Mrs Zanela Simelane, HMIS Manager – 2012
HMIS Systems Review 2013 :
  1. HMIS Database
  2. RxPMIS
  4. MSDS (Malaria Surveillance Database)
  5. IT Support Database
  6. Immediate Notification System
  7. Human Resource Information System
  8. RxSolution
  9. DR-TB Management System
  10. Commodity Tracking System

HMIS Database

HMIS Database
System Description (copied from Data net report– needs rework)
This system is designed to copy information from verity of paper based data sources (including tally sheets, registers and forms) used during the provision of Health services in the inpatient and outpatient department.

System Modules (copied from Data net report– needs rework)
  • Inpatient
  • Outpatient
  • Reproductive Health Conditions
  • Noticeable diseases
  • Diarrheal Diseases
  • Respiratory Diseases
  • Infectious and Parasitic Diseases
  • Endocrine Nutritional and Metabolic Diseases
  • Other Disease Conditions
  • Ante-Natal Care (ANC)
  • Child Growth Monitoring
  • Post Natal Care (PNC)
  • Food by Prescription
  • Cervical Cancer Screening Services
  • Clients Provided With Family Planning by Methods
  • Miscellaneous Activities
  • Heath Education Sessions
  • Home Visits
  • Clinic Supervisor Visits
  • Expanded Program for Immunization (EPI)

System Platform (copied from Data net report– needs rework)
1. Server Operating System: Windows Server 2008
2. Database: Microsoft SQL Server 2008
3. Programming language: VB.NET Technology: ASP.NET
4. Type of application (Desktop/Web-based/client server/standalone): Web-based/Client server Web server: IIS7
5. Delivery channel: Internet/Extranet/Intranet: Intranet
6. Reporting module: None Comment: uses ODBC to link/export data to external applications
7. Data exchange module: None Comment:
8. Source/Development: Developed In-house

Dimensions of Quality
1. Flexibility: The system is based on widely used and mature  ...more details...  technology. It is also designed based on the separation of concerns software design principle in that the presentation layer, application logic and the data access layer are loosely coupled. Modifying parts of the system to either add new modules or update existing ones would need to follow this streamlined process. It is therefore flexible in this regard.
2. Accessibility: The main users of the system are HMIS and M&E  ...more details...  offices both at the regional and National level of the MOH. There are a few M&E officers stationed at larger Health facilities that require access to this system. Users at regional and facility level require access to the system to capture aggregated data in the form of facility reports. Most of the larger Health facilities are already connected to the Government network.

At the national level however this system is used for aggregating national statistics from the submitted reports. Health data is aggregated from the database tables and organised into multiple subject oriented views that can be linked to Microsoft Excel for analysis. The system therefore currently meets this quality criterion as all users that currently need to access the system are able to do so.
3. Reliability: Data collected using this system is mostly  ...more details...  aggregate data. The system has some validation routines built into the data capture pages of the system. They, however, have obvious short comings in the sense that there is no way for the system to ensure the validity and accuracy of this data without an additional manual process of actually going through source documents during data quality assessments. This is both a time and resource intensive exercise for the HMIS officers. The data in this system is fairly reliable; however, there is room to improve the system to ensure that the data is fit for use by the Ministry for decision making and is also collected in the most efficient and effective way.
4. Efficiency: The pages are designed similar to the paper  ...more details...  based forms and therefore capturing is fairly easy, however the data entry pages are quite lengthy and some of the information is duplicative to some extent. This applies mostly to the patient demographic information. Some time savings can be gained from a patient level record based information system that uses a country-wide unique patient identifier as patient demographic information would possibly have been captured at some point in the health service delivery chain within the country.

The system therefore needs to be improved in this dimension of quality to minimize the time and energy that is required to use the system.
5. Effectiveness: The system satisfies most of the reporting needs  ...more details...  of the ministry of health at the regional and national level. Capturing the submitted reports into the system is fairly easy. The system also generates meaningful alerts to end users when a validation rule has been violated.

There is however no self-help or trouble shooting guide or module in the system to help users resolve problems themselves. There is room to improve in this dimension as well.
6. Saliency: The HMIS database has no documentation on the  ...more details...  relationships that exist between the underlying tables and the overall system design. The current database structure itself cannot be normalized to ensure that the system is making optimal use of resources such as disk space.

This system needs a rigorous process of remodelling and documentation. It therefore fared poorly in this dimension of quality.
7. Availability: The system is installed on a central server  ...more details...  accessible over the Government network using most of the available standard web browsers (Microsoft IE, Mozilla Firefox, and Google Chrome). Upgrades are not scheduled; there are changes and bug fixes that occur upon request in an ad-hoc fashion. This system can be said to be fairly easily available.
8. Performance: The surveyed users of the system reported long  ...more details...  periods of outages whenever the Government network goes down. The frequency with which these disruptions occur and why was however not determined with absolute certainty. It can just be noted therefore that there are some performance issues with this system as there are no systems that were found to be in place to monitor the performance capacity of the supporting database and networking infrastructure for this system.

Users however noted that in the event that the incident that caused the disruption requires no interventions from Government computers, the resolution time to get the system back up is minimal.
9. Scalability: The current servers are now outdated and  ...more details...  need to be replaced. Replacement servers have been procured and migration is underway. The current system is a very thin client and can cope with increase in volumes of data from the regions for some time in the near future. Capacity and performance of hardware, however, will need to be monitored and hardware maintenance plans being put in place.
10. Efficacy: The system currently has no module for reporting.  ...more details...  A link is normally created to link to the database or export the data to Microsoft Excel for analysis. The system currently stores all the aggregate facility data in one big database in a Microsoft SQL Server database engine that has not been optimised for querying. Strategies need to be put in place to incorporate user queries in the shortest time possible when the data is required for analysis.

Another finding of this assessment was that some consumers of this information have developed custom tools because the system does not provide the information in the desired level of detail. These include facility managers, programmes and partners amongst others. There are some that have even built parallel systems to support their information needs. The extent to which these systems are aligned with the strategy of the Ministry of health could however not be determined.

The system can therefore be said to be effective in meeting the national reporting requirements of the Ministry of Health but will need a lot of improvements also in this dimension to accommodate all information needs from the different stakeholders as it is the core repository for health information.
11. Security: The system presents a log-in form for  ...more details...  users to sign on, however there are no role based permissions that ensure that logged in users are only able to perform read, write, delete actions only on the modules that they are authorised to access. At database level, permissions are assigned to the entire database using database login security principals, a feature on Microsoft SQL server.

The system may need further security tests to ascertain if it is capable of withstanding SQL injection attacks or whether data is encrypted while in transit over the network.
12. Interoperability: There were no interoperability standards or  ...more details...  services for sharing information with other systems found during this assessment.


System Description
This system was developed with the support from our partner Management Sciences for Health recognizing the need to manage patient-record level data along with the drugs that are dispensed while patients are on HAART.

System Modules
  • Registration
  • Visits
  • Lab Results
  • Observations
  • Opportunistic Infections
  • TB
  • Nutritional Status

System Platform
1. Server Operating System: Windows XP/Vista/7/Server 2008
2. Database: Microsoft SQL Server 2008
3. Programming language: Delphi Technology:
4. Type of application (Desktop/Web-based/client server/standalone): Desktop/Client server Web server:N/A
5. Delivery channel: Internet/Extranet/Intranet: Local Area Network
6. Reporting module: Digital Metaphors Report Explorer Enterprise Edition Comment:
7. Data exchange module: None Comment:
8. Source/Development: Outsourced

Dimensions of Quality
1. Flexibility: MSH is currently in the process of redesigning  ...more details...  this system. The current version is no longer supported in terms of change request fulfilment and bug fixes. All proprietary rights to the system are currently the sole property of MSH including the source code. The Ministry of Health can no longer make any changes to this system to accommodate new information requirements and updates to existing ones.
2. Accessibility: The system has one main window and various  ...more details...  child screens pop up upon request. The navigation from one section to another is more or less user friendly.

There is also a more or less logical grouping of data entry fields into sections and sub-pages within the main window which makes finding information fairly easy, however the user interface is very clumsy and the system tries to accommodate too many data entry fields in a single window.

The various common action commands (like New, Save, Edit and Delete) do not have any textual caption; rather symbols are used to represent them which require a great deal of learning for a user to get acquainted with the system.

Another finding from this assessment was that reports in the system can only be accessed over the local area network at the facility where the system is installed, which makes it harder to get a national or regional picture just by running one report. Additional processing needs to be done to integrate the data at the national level. This normally results in duplicate patient records which are usually not uniquely identifiable within the national dataset because of the absence of a countywide unique patient identifier for de-duplication or records.
3. Reliability: The data validation logic is inconsistently in  ...more details...  grained in the system, which makes it difficult to ensure that data is of the highest quality possible. Data entry into the system sometimes uses data grids instead of forms which do not make provision for the necessary data validation logic to be executed before data is saved to the database. There are also some fields that store values of varying data types such as integer values and text values. This should be avoided.

Referential integrity is not enforced in the database, which means that the likelihood of orphaned records in transaction tables such as visits, prescriptions laboratory results and observations is very high. The impact of this kind of anomaly is mainly on figures reported from queries generated using these tables. This should be corrected immediately.

The system, therefore, did poorly in this dimension of quality.
4. Efficiency: This system demands a great deal of time to  ...more details...  record medical data because of its complex data entry design and does not ensure a faster processing of information compared to the manual paper based system.

As such the system needs to be improved in this dimension of quality to minimize the time and energy required to use it.
5. Effectiveness: The system throws various alerts which are not  ...more details...  always user friendly. In some operations, it shows messages like "Multiple-step operation generated errors" which is meaningful to a software developer but not to a general user. This should be corrected to ensure that messages thrown by the system are intuitive and guide the user to troubleshoot problems.
6. Saliency: There are no designed documents available for  ...more details...  this system. The design of the system is not fully normalised and therefore not easy to understand for systems administrators. The system has redundant fields in its database design that are there as some kind of storage for temporal processing of results instead of using variables at program run-time. This is very confusing and makes the database design difficult to understand.

This system needs a rigorous process of remodelling and redesign with appropriate design documentation. As a result it failed to meet the minimum quality standards in this dimension..
7. Availability: Facilities make a request through the National  ...more details...  ART programme to have the system installed. A readiness assessment is then done by the programme in conjunction with the HMIS to ascertain the feasibility of running the system at that facility. If the facility is found to meet the minimum set requirements to run and manage the system, it is then installed. No upgrades are planned or currently being done on this system and there are no longer any bug fixes and patches. The system is, however, still being supported by the HMIS in terms of keeping it up and running.

Acquiring the system is very easy. There are, however, issues with the system that require work-rounds as support for this system from the developers is no longer available.
8. Performance: Requirements to use this system are very minimal  ...more details...  when a local area network is available at the facility where the system is to be installed. It is, however, a resource intensive system compared to web applications. Larger facilities with high volumes of patients have often reported low performance issues mainly related to hardware.
9. Scalability: The system fares very well for smaller facilities in  ...more details...  in terms of performance. The system may however not be able to cope with the growth in number of patients at larger health facilities. A thin client solution should be considered.
10. Efficacy: The system satisfies most reporting requirements  ...more details...  of the MOH at all levels including partners.

There is a module for reporting. This is however not very intuitive for novice users especially those not familiar with SQL query language and the database structure. Users can therefore not create complex custom reports using this module.

Patient history is also available for patient care; there is, however, no notifications and prompts available for decision support and for automating workflows. Patient level management reports are available and more are added on request by the National HMIS.

The system can therefore be said to be effective in meeting the national reporting requirements of the Ministry of Health and information needs for patient care but will need some improvements in this dimension to accommodate changing information needs to improve patient care.
11. Security: The system is a desktop application installed on  ...more details...  disparate local area networks at the facilities. It uses Microsoft universal Data link to build and persist connection strings to the database server using OLE DB provider for SQL Server. The connection strings are stored in text files in the file system in unencrypted format. There are currently no measures in place to secure the contents of these files such as encryption and access control lists.

Maintenance jobs are scheduled to do regular backups of databases and offsite backups are done by the HMIS and MSH. Back-up procedures are however not documented and logged so they can be verified. Lastly, backup files are not tested regularly to ensure they have not been corrupted.
12. Interoperability: There were no interoperability standards or  ...more details...  services for sharing information with systems found during this assessment.


System Description
This is a system designed to manage TB specimens and various tests results of TB for producing diagnostic reports. It is a windows based system where frontend was developed in Delphi and data stored in SQL server database.

System Modules
  • The main module: WXDISA
  • Results Desk
  • Specimen Reception
  • Laboratory
  • Authorize
  • Instrument
  • Tools

System Platform
1. Server Operating System: Windows Server
2. Database: Microsoft SQL Server
3. Programming language: Delphi Technology: Delphi
4. Type of application (Desktop/Web-based/client server/standalone): Desktop/Client server Web server:N/A
5. Delivery channel: Internet/Extranet/Intranet: Intranet
6. Reporting module: Bespoke reporting application or module Comment:Standard reports available
7. Data exchange module: HL7, DICOM Comment:
8. Source/Development: Out-sourced

Dimensions of Quality
1. Flexibility: The system design employs the concept of a  ...more details...  service oriented architecture which allows for the changing or complete replacement one component of the system without affecting the entire application.
2. Accessibility: Standard reports are available for users to  ...more details...  preview and/or retrieve information to different file formats such as csv, xls and pdf. There is also a specific module for extracting datasets. The user is allowed to choose which information to report (local machine only or all workstations). The system also keeps copies or snapshots of reports that have been previously generated and an audit trail for who generated the report.

The available standard reports are, however, not named in the most intuitive way, and therefore require users to select the report and bring up reference material that explains what the report is and how to run it. This can be time consuming for first time users of the system.

The reporting module also does not allow for ad-hoc and custom reports to be created in the system. The system would need to be strengthened in terms of report design and customization for growing health information needs.
3. Reliability: The system has validation routines before data  ...more details...  is saved. There is also a repository of business rules that users can design and apply globally in the system to prevent data quality issues. The system uses a Master dictionary to manage and replicate all master data records to ensure their integrity at all times. There is also a module that allows for the identification and merging duplicate records even using fuzzy logic.

One challenge that was noted however was the lack of a country-wide unique patient identifier to de-duplicate patient records as duplicate records are very likely to be generated in the system.
4. Efficiency: The system has been designed with the notion of  ...more details...  automation of workflows. There are various services that perform functions such as moving data and files between facilities using the FTP service. It also interfaces with other laboratory instruments to retrieve medical data directly without users having to print and re-capture or transcribe data into the system.

There is also an elaborate searching module for easy retrieval of existing data. Users are also given the option to create notes that appear as pop-ups when the event that created them is later triggered. The system also allows for sending of results via SMS to phone or printer, fax and Email.
5. Effectiveness: The system has modules for self-help, and  ...more details...  error/warning messages are very intuitive. There is also a notice board for any updates from systems administrators to users.
6. Saliency: The database structure is very complex. There  ...more details...  were no documents that were found to define the underlying plumbing of the system. Batch files are used to install the system. Configuring the system also requires very particular attention to detail as this would go on to affect the overall behaviour of the system. There needs to be a way to abstract this layer from administrators of the system using wizards or installation packages that are easy to understand for systems administrators.
7. Availability: The system is a desktop application that needs  ...more details...  to be installed and configured for every workstation on which it is to run. Development was outsourced and upgrades or bug-fixes are only available on request. Each workstation that needs to have the system needs to acquire a license that is renewable every year. There are currently 2 facilities running the system; which are Mbabane Government Hospital and TB Hospital?
8. Performance: The system is currently running at 2 facilities  ...more details...  (Mbabane Government Hospital and TB Hospital) over the Government network infrastructure. There is currently no performance issue reported with the hardware supporting the system.
9. Scalability: The system is to be rolled out to 4 additional  ...more details...  sites; which are Mankayane, Matsanjeni, Dvokolwako and Siphofaneni. There may be a need to increase the bandwidth for data lines to these sites as the system needs to use FTP services to move data and PDF files between these sites.
10. Efficacy: The following are the needs that it was  ...more details...  envisaged would be met by the system:
  • Streamline and standardize operations of the laboratories and optimize services offered to the patients.
  • Efficient specimen management and resulting.
  • Maintenance of the highest levels of quality control and quality assurance.
  • Timely production of consistent, reliable and quality analytical statistics vital for accurate decision-making and patient management.
  • Efficient and accurate management of stock and equipment inventory at the laboratories.

The system design currently meets all the needs that it was set out to meet. It can be however noted that some of the modules such as the Quality Assurance module are available. in the system but are not yet in use.
11. Security: Users are presented with a log-in screen for each  ...more details...  the different services available in the system. An audit trail is also kept on who accessed the system and performed which changes or viewed which report. It could not be determined however how the system ensures security when moving data over the network. All computers accessing the system are also required to have an anti-virus program installed.

It was also noted that no database security permissions have been set-up in MS SQL Server to ensure only that only authorized users can access the database.
12. Interoperability: The system uses the HL7 and DICOM standards  ...more details...  for sharing information and digital imagery with other systems.

MSDS (Malaria Surveillance Database)

System Description
This system collects information on the four major intervention areas, Case Management, Vector Management, Surveillance and Information, Education and Communication (IEC).

The Malaria Surveillance Database System will be an upgrade of an existing system. The current system being used by the NMCP is that of several MS Access databases for capturing the information required, i.e. IRS data, ITN data, Active and Passive Detection data etc. sitting on local machines and not communicating with one another. The Malaria Surveillance Database System will replace this old system by combining all these databases into one system

System Modules
  • Malaria Case Module – stores information about lab slide results, keep track of slides and RDT's sent for quality assurance
  • Prophylaxis Module – stores information on prophylaxis usage.
  • Study Sites Module – keeps GPS information on all health facilities, schools, and homesteads with active case patients, potential breeding sites and vector transmission sites.
  • Spraying Module – stores information about sprayed homesteads, number of structures sprayed and the number of cans used while spraying.
  • ITNs Module – stores information about distributed nets; name of homestead, Region, Inkhundla, Locality, coordinates of homestead, number of people in homestead etc.
  • Investigation Module – keeps a record all investigated cases and of all households with positive RDT results identified during active case detection.
  • Survey Module – stores survey data.
  • Training Module – stores information on workshops conducted, attendees of all malaria training, this will include the following groups: Healthcare workers, Key malaria programme partners, Community stakeholders and Temporary NMCP employees. The database will include, the name of the event, the venue and date it was conducted at, the attendees names, contact information, location (e.g. health facility, Inkhundla), and the results of the post-training competency assessment of all trainees.
  • Window trap Module – keeps record of window trap data; the date, number of mosquitoes caught categorised into breeds etc.
  • Inventory Module – stores inventory data for items procured by the NMCP
  • Modeling support: Maintenance and reporting of uncertainty or error in spatial components of GIS data, and in modeling output. Reporting of uncertainty may take place on an individual sample basis, on a method of procedural basis, or on an entire database.

System Platform
1. Server Operating System: Windows Server
2. Database: Microsoft SQL Server
3. Programming language: VB.NET Technology: ASP.NET
4. Type of application (Desktop/Web-based/client server/standalone): Web-based/Client server Web server: IIS
5. Delivery channel: Internet/Extranet/Intranet: Intranet
6. Reporting module: Microsoft Reporting Services Comment: uses ODBC to link/export data to external applications
7. Data exchange module: None Comment:
8. Source/Development: Developed In-house

Dimensions of Quality
1. Flexibility: The system has a watered down version (that  ...more details...  uses Microsoft Access as the backend database) available for where data is captured on the field and uploaded back at a later stage. There are routines that are used to import the data and enforce referential integrity. Modifying the system would be somewhat of a challenge.
2. Accessibility: Once the data is captured into the system,  ...more details...  reports can be created and published in a reporting service (using Microsoft Reporting Services). This ensures centralized report design and deployment. It also ensures that reports are accessible anywhere within the Malaria network.

The database platform (Microsoft SQL Server) on which the system is running provides very flexible import and export functionality to various database software and data sources.
3. Reliability: The system uses GPS enabled tablets for location  ...more details...  data. This greatly improves the accuracy of location data. Data validation routines have also been implemented on the data capture screens to ensure that data quality issues are minimized. There is however no data quality reports to track the level of quality of data already in the system. There are also no relationships defined within the tables and referential integrity is therefore not enforced at database level.
4. Efficiency: There are measures that have been take to  ...more details...  ensure improve the efficiency with which data is captured analysed and reported by the system. The use of GPS enabled devices to collect data, the use of a watered down version of the system for data collection in remote places and importing into the central database are some examples. Another example is the use of a single reporting server to improve report deployment time and timeliness of reporting for decision making.
5. Effectiveness: The system gives meaningful alerts and  ...more details...  notifications. All the modules are grouped logically to easy navigate. Once a user initiates a function the system guides the user through the steps required to complete the task.

There is however no self-help module for the user trouble-shoot common problems that may arise with the system.
6. Saliency: The system has some design documents  ...more details...  available which allow administrators to easily understand the design. These documents are continuously being updated and changes are logged.
7. Availability: The system is bespoke and was developed in  ...more details...  house. Requirements to use the system are to have one of the standard web browsers such as Microsoft Internet Explorer versions 6.0, 7.0 and 8.0, Netscape versions 6 and 7, and Mozilla Firefox and a connection to the Malaria Network. Upgrades to the system are however not planned and are available on a needs basis.
8. Performance: The Malaria program has a very robust network  ...more details...  and the internal capacity to support it.
9. Scalability: The existing infrastructure can be thought to be  ...more details...  sufficient to support the future needs of the program. The Malaria program has also made provision for secure VPN connections to their network which could allow the system to move data to various locations within and outside the country. This could greatly improve chances of the system being able to interfacing with other health systems in the future.
10. Efficacy: All the objectives that the system was envisaged  ...more details...  to meet are currently being met by the system within the Malaria Program (internally). There may however be a need for external data sources and information requirements that the system may need improvement at a later stage.
11. Security: The system uses capabilities of the directory  ...more details...  services single sign on for users to gain access the system. There are also role based permissions within the system to ensure authorized users are accessing the information in the system.
12. Interoperability: The system however uses no standards to  ...more details...  ensure interoperability and seamless integration with other systems.