Health Information System Strategic Plan 2020-21-2024 25

HEALTH INFORMATION
SYSTEM STRATEGIC PLAN

(2020/21-2024/25)
HEALTH INFORMATION SYSTEM STRATEGIC
PLAN (2020/21-2024/25)
CONTENTS
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV
Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V
Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VII
Chapter 1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 2: Situation analysis: Status of the Health Information System . . . . . . . . . . . . . . . . . . . . . . 3
2.1 Content Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.2 SWOT Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.3 Stakeholder analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Chapter 3: Objectives and Strategic Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.1. Vision, Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.2. Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.3. Targets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.4. Strategic Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Chapter 4: Costing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Chapter 5: Implementation Arrangements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Chapter 6: HIS Strategic plan Monitoring and Evaluation (M&E). . . . . . . . . . . . . . . . . . . . . . . . . . 48
6.1 Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Chapter 7: Assumptions and Risk Mitigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
7.1. Assumptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
7.2. Risk Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Annex I. HIS Monitoring and Evaluation (M&E) matrix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Annex II. List of composite Index indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Annex III: Summary of key surveys and assessments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Annex IV: Key HIS governance related documents and status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Annex V: Stakeholders’ Power-Interest Matrix for institutional response. . . . . . . . . . . . . . . . . . . . . . 62
Annex VI: Implementation Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Annex VII. References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
HEALTH INFORMATION SYSTEM STRATEGIC PLAN

(2020/21-2024/25)
FOREWORD
Health information system is among the six building blocks of the health system that plays crucial roles in helping
the health system to provide equitable quality health care through proper use of quality data in service provision,
planning, performance monitoring, evaluation, and evidence-based decision-making. To provide better quality of
care and value for money, several efforts have been exerted on improving the health information systems since the
instalment of reformed HMIS. More investments were also in place in the first Health Sector plan (HSTP I) period
with due attention to the information system by making information revolution (IR) among the four transformation
agendas. Then after, huge improvements have been achieved in health data management, HIS infrastructure,
creating stewardship at all levels and assuring the basic principles of the health management information system
reform that include standardization, integration, simplification and institutionalization. However, there are still
areas for improvements, which include data access, quality and use as well as coordination of efforts in digitalizing
the information system to have proper data storage, evidence generation, visibility, easy communication and use
of information for evidence-based decision.
This required a well thought health Information system strategic plan (HISSP) that is instrumental in making
informed decisions to achieve the health sector’s goals and objectives. Hence, this HIS strategic plan is developed
with successive consultations of key stakeholders with the aim to provide a strategic framework for improving and
strengthening the health information system focusing on enhancing information use culture, harnessing digital
technologies for information and establishing a strong HIS governance system. It details the key strategic directions,
initiatives, performance measures, strategic arrangements, collaboration efforts and investments required.
Therefore, it frames and guides the efforts and investment towards the betterment of the health information
system where all stakeholders will use it as reference for the steps and products to which they are contributing in
the next five years.
Finally, we would like to thank MOH staff and other stakeholders who worked hard to produce this plan and affirm
the full commitment of the MOH to ensure its effective implementation.
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ACRONYMS
CHIS Community Health Information System
CRVS Civil Registration and Vital Statistics
CSA Central Statistical Agency
DHS Demographic Health Survey
DQA Data quality assessment
DTC Drug and Therapeutic Committee
eCHIS Electronic Community Health Information System
eHMIS Electronic Health Management Information System
HER Electronic Health Record
eHRIS Electronic Human Resource Information System
eIFMIS Electronic Integrated Financial Management Information System
eLIS Electronic Laboratory Information System
eLMIS Electronic Logistic Management Information System
EMR Electronic Medical Record
EPHI Ethiopian Public Health Institute
EPI Expanded Program of Immunizations
eRIS Electronic Regulatory Information System
FF Family Folder
GIS Geographic information system
HC Health center
HP Health Post
HDA Health Development Army
HDD Health Data Depot
HEP Health Extension Program
HEW Health Extension Workers
HGIS Health Geographic Information System
HIS Health Information Systems
HIT Health Information Technicians
HITD Health Information Technology Directorate
HMIS Health Management Information System
HRIS Human Resources Information Systems
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HSDP Health Sector Development Program
HSTP Health Sector Transformation Plan
ICD-10 International Classification of Disease (10th version)
ICT Information Communication Technology
IFMIS Integrated financial management information system
IR Information Revolution
IVR Interactive vocal recording system
LQAS Lot quality assurances system
M&E Monitoring and evaluation
MFR Master Facility Registry
MNCH Maternal, newborn, and child health
MoH Ministry of Health
NESB National Enterprise Server Bus
NGOs Non-governmental organizations
PHCU Primary Health Care Unit
PHEM Public health emergency management
PRT Performance Review Team
RCA Root cause analysis
RDQA Routine data quality assurance
RFP request for proposal
RHB Regional Health Bureau
RS remote sensing
SCMS Supply Chain Management System
SNNPR South Nations, Nationalities and People’s Regional State
SARA Service Availability and Readiness Assessment
SPA+ Service Provision Assessment
TE Tele-education
TM Telemedicine
TMS Terminology Management Service
VERA Vital Event Registration Authority
WorHO Woreda Health Office
ZHB Zonal Health Bureau
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EXECUTIVE SUMMARY
This Health Information Systems Strategic Plan is the health Sector’s 5 year plan for the period 2020/21 to 2024/25
(2013 EFY to 2017 EFY). It is prepared as one of the sub-strategies following the development of the second
health sector transformation plan (HSTP II). Its development process was based on a participatory approach
with engagement of key stakeholders including MOH agencies, Directorates RHBs, the private sector, academia,
implementing partners , donors and other HIS stakeholders.
During the first HSTP period (2016-2020), the health sector has been working towards enhancement of evidence-
based decision-making primarily through the development and implementation of the Information Revolution
(IR) Road map and IR model woreda strategy. Encouraging results were registered during this period in terms of
improving data quality, data use for evidence-based decision-making, digitalization of priority health information
systems and governance of HIS. At the end of the HSTP-I period, the reporting completeness has reached more
than 89%, different surveys such as SARA, EDHS, mini-DHS 2019 were conducted and their results have been
used to track the performance of the health sector. In-terms of digitalization, 3,605 health institutions have been
connected to the Health Net, DHIS2 has been implemented in more than 95% of public health institutions,
eCHIS implementation was started, and digital standard systems such as MFR and NHDD were developed and
implemented. Moreover, HIS governance structures were established and progress has been made at national and
regional levels.
Even though the implementation of the IR road map achieved such results, the sector’s HIS has weaknesses and
challenges that need to be strengthened or enhanced in the second HSTP period. The level of data quality at
different levels of the health system is still suboptimal (timeline of reports was 65% and there is a large gap between
survey results and routine reports), the culture of information use for evidence based planning and decision
making is still low at all levels of the health system. DHIS2 is implemented in only 1% of the private health facilities.
Only 5% of health institutions have an adequate number of HIS health workforce. Birth and death notifications
were minimal, with notification coverage of 35% of births and 3.4% of deaths only. Moreover, development and
implementation of patient level digital HIS systems is inadequate and there is fragmented implementation of
different eHIS applications. This calls for a continuous effort to sustain the gains on HIS and to improve areas that
need improvement. Moreover, the achievement of the objectives of HSTP II requires a robust Health Information
System (HIS) to track and improve the utilization of health services and health outcomes using key quality and
equity lenses. Consequently, Information Revolution is selected to continue as a top priority (transformation
Agenda) in the second HSTP-II period.
The overall objective of the HIS strategic plan is to improve service coverage, quality, equity and health outcomes
by enhancing evidence-based decision-making. It also aims at enhancing the use of digital health information
technologies for HIS and improve HIS governance and Leadership at all levels of the health system.
In order to measure the objectives and performance of the plan, ambitious targets are set considering previous
trends, current-status, resources and other factors. Some of the targets include: increase information use index from
52% to 85%, proportion of health institutions that have functional PMT to 100%, service data report timeliness to
96% and completeness to 98%, DHIS2 implementation at private health facilities from 1% to 25%, increase eCHIS
implementation to 50% of health posts, increase birth notification from 35% to 80% and death notification from
3.4% to 35%. The list of HIS indicators and their targets are described in the “Targets” section.
The strategic plan has identified eight strategic directions that include:
SD1: Improve culture of information use: This focuses on enhancing data access, visibility and information use
culture through intensive capacity buildings, creating suitable data access points, establishing and implementing
data warehouse and enhancing in-depth data analysis and triangulation of data from different sources and
strengthening policy analysis and formulation
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SD2: Improve routine data management and quality: This direction is about fulfilling the prerequisites for
HMIS implementation, ensuring adequate logistic supplies, standardization of indicators, recording and reporting
tools and procedures. It also aims to ensure data quality by focusing on assuring standardization and continuous
and/or periodical data quality assessments based on the types of techniques.
SD3: Nurture digitalization for data management and use: This direction focuses on selection, development,
operation and management of digital solutions for the health information system. It aims at implementing different
patient/client level and aggregate level digital HIS technologies at the point of services and at administrative
health units.
SD4: Improve HIS Infrastructure: Aims at improving the required infrastructure for HIS such as medical record
rooms, computers, connectivity and other HIS technology related setup and equipment.
SD5: Strengthen vital statistics, Surveillance, Survey and Research: This direction emphasizes on
strengthening the generation, availability and accessibility of health data from different sources other than routine
health data. It includes vital statistics, surveillance, surveys and research. It also aims at improving innovation in
HIS.
SD6: Improve HIS financing: This direction is about ensuring adequate and sustainable finance for the health
information system. It aims at increasing adequate resources through resource mobilization and proper allocation
as well as ensuring efficient resource utilization, timely liquidation through strengthening the tracking and
controlling system of HIS resources.
SD7: Improve HIS capacity of Health Workforce: This direction focuses on equipping the HIS workforce with
appropriate skill mix, Competency and adequate quantity. It involves endorsement and implementation of HIS
HRH road map, appropriate curriculum, strengthening HIS health workforce structure at all levels, facilitating
continuous capacity building process, deployment of motivation and retention mechanisms.
SD8: Strengthen HIS governance: This direction focuses on the development and/or revision of HIS policy,
strategies, legislation and regulatory documents that will enforce the functionality of the health system and
enhance standardization, integration, legitimacy, data security and confidentiality.
To operationalize the plan, a set of implementation arrangements are identified. The main arrangements are
through the following five ways:
• Information Revolution Model Health Institution Strategy

• Capacity Building and Mentoring Program (CBMP)
• Instituting Innovation scheme and Centre of Excellence (IICE)
• Strengthen harmonization and collaboration
• Integration of efforts
• Advocacy, communication and culture for HIS
Costing for the plan was done using the OneHealth tool. The total cost required to implement the plan is 1.28
billion USD accounting for 6% and 4.6% for low and high case scenarios HSTP II costing respectively . The plan will
be cascaded to all levels of the health system. Annual operational HIS plans will be guided by this strategic plan.
Its implementation will be regularly monitored using the indicators and targets set for the plan.
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CHAPTER 1: INTRODUCTION
The Ministry of Health (MoH) introduced the second Health Sector Transformation Plan (HSTP II), which aims at
improving the health status and well-being of the population through accelerating progress towards Universal
Health Coverage (UHC), protecting people from health emergencies, contributing towards transformation of
households and improving health system responsiveness. As it was one of the four transformation agendas within
HSTP I, information revolution1 continues to be one of the five priority areas of transformation agendas of HSTP II.
The achievement of the objectives of HSTP II entails a robust Health Information System (HIS) powered by digital
health information technology to track and improve the utilization of health services and desirable healthy
practices using key quality & equity lenses. Multiple data sources will be used to track the HSTP II objectives and
targets and HIS processes and performances. Thus, clear strategic directions and strong collaborative approach
are needed to generate quality data from all health data sources, to enhance data access and informed decision
making at all levels that necessitates the development of HIS strategic plan in consultation with broad-based HIS
stakeholders.
Health Information System (HIS) in Ethiopia is run under different authorities where the routine Health Management
Information System (HMIS) is managed primarily by the MoH, and population-based information comes
predominantly from CSA. Ethiopian Public Health Institute (EPHI), Armauer Hansen Research Institute (AHRI),
Immigration, Nationality and Vital Event Agency (INVEA) and universities are also among other key stakeholders
that manage various epidemiological, biomedical, and clinical and vital statistics data.
During the HSTP I period, the HIS strategic plan, named “Information Revolution (IR) Roadmap”, was developed
and implemented from 2016-2020. Consecutively, this HIS strategic plan that covers the period 2020/21-2024/25,
is developed by building on the successes and lessons learned from the IR road map implementation. More
specifically, this strategic plan is expected to address the limitations of the IR Roadmap which lacked detail on
the population-based, biomedical, clinical and health biotechnology data sources, adequate costing of the HIS
interventions and robust measurement metrics.
This HIS strategic plan was developed in a consultative process by engaging the leadership and staff of MOH,
agencies, RHBs, the private sector, universities, professional associations, donors and implementing partners.
It pursued the Strategic Planning and management (SPM) outline as recommended by the national Plan and
Development Commission and was aligned with the HSTP II. The costing of the interventions and activities of the
strategic plan was done along with the costing of HSTP II using oneHealth tool with additional refinement and
amendment in the process of preparing and finalizing the document.
1
Information revolution refers to transforming the process of data generation, data use culture and evidence-based decision making at all levels of the health system through
harnessing and promoting information communication technology (ICT).
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The scope of this strategic plan is sector-wide which includes routine, population-based, biomedical, and clinical
and health biotechnology. In terms of digital health, it is limited to the health information aspect as other specific
digital interventions such as digital health services are primarily addressed by the Digital Health Strategy document
that is prepared separately. In addition, the scope of the Monitoring and evaluation Framework of this strategic
plan is limited to and focused at the performance of the HIS where monitoring and evaluation of the health sector
processes and outcomes are detailed in a separate document, ‘Monitoring and Evaluation Plan of HSTP II”.
The body of the strategic plan document is organized into seven sections, namely: chapter I is Introduction, chapter
II describes the current state of HIS in Ethiopia. Chapter 3 outlines the objectives, targets and strategic directions
of the HIS strategic plan, chapter 4 includes details on the costing, chapter 5 describes the implementation
arrangement, chapter 6 covers the monitoring and evaluation plan, and chapter 7 describes assumptions and
risks.
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CHAPTER 2: SITUATION ANALYSIS: STATUS OF THE HEALTH
INFORMATION SYSTEM
The Ministry of Health has been working on enhancing evidence-based decision-making and determination of
progress and impacts based on quality of data primarily through the implementation of the Information Revolution
Roadmap. Other stakeholders have also been contributing their part depending on their mandate and scope of
operation to inform policy, program development and monitoring and health service delivery related evidence-
based decision-making. In order to have a well-informed strategic plan, scanning the broader HIS environment and
context, detailed analysis and understanding of past performances and challenges and comprehensive analysis
of key HIS actors or stakeholders is of paramount importance. Thus, these perspectives are detailed under three
subtitles: content analysis, SWOT and Stakeholder analysis. Ahead of the detailed analysis, the performance of key
HIS related indicators of HSTP I and the Information Revolution Roadmap are summarized as follows.
Table 1: Summary of performances of key HIS related indicators of HSTP I and IR Roadmap, MOH, August 2020
No Indicator/Performance measure Baseline Target Performance Remark/Source
* Refers to service
1 Percent of report completeness 72% 90% 89%
data
* Refers to service
2 Percent of report timeliness 84% 90% 65%
data
Proportion of health facilities who conducted Lots
3 36% 85% 48%
quality assurance Sampling (LQAS)
Proportion of health facilities who met the data
4 71% 85% 89%
verification factor within 10% range for SBA
Number of publications produced on peer reviewed
5 90 554
journals
Number of technical reports produced from re-
6 48 100 191
search and surveillance2
As shown in the table, there were some encouraging achievements in terms of data quality and publication related
indicators. However, It should be noted that much remains to be done to achieve optimal data quality of all
dimensions with particular emphasis on disease related data, and report completeness and timeliness of private
health facilities.
2
A technical report (also scientific report) is a document that describes the process, progress, or results of technical or scientific research or the state of a technical or scientific
research problem. It might also include recommendations and conclusions of the research.
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2.1 Content Analysis
This section describes the detailed analysis of HIS based on components of the Health Metrics Network (HMN)3 and
other components relevant to the Ethiopian HIS context.
2.1.1 HIS Governance
During the first HSTP, MoH in collaboration with its agencies, RHBs and other HIS stakeholders has made efforts to
establish HIS governance structures to ensure the HIS implementation in alignment with health system strategies,
to provide leadership and oversight of the accomplishment of the HIS throughout the country.
These HIS governance structures at national level included the HIS steering committee, National Advisory Groups
(NAG) and various technical working groups (TWGs). These HIS governance structures were guided by the national
HIS governance framework which was endorsed by the senior management of MOH.
The status of endorsement of HIS governance framework and establishment of governance structures varies from
region to region. In general, rapid assessment showed that none of the regions have customized and endorsed
their respective HIS governance framework except Gambella region; Tigray and Oromia regions are nearing
customization and finalization. None of the regions has a functional HIS governance structure and the regions
are relying on the sector-wide partners’ forum to deal with HIS issues. There are, however, efforts to revitalize
the previously existing HMIS committees such as in SNNPR. There is limited information and observation on the
existence of functional HIS related governance structures below regional level.
MOH has given due emphasis to HIS during the HSTP I period. The INFORMATION REVOLUTION Road Map was
a clear manifestation that the issue got priority attention and commitment from the government. All regions
have also attempted to customize and implement the roadmap. However, a large part of the road map activities
remained unimplemented mainly due to weak coordination among key HIS stakeholders and limited ownership
at all levels.
The preparation of the health information proclamation nearly a decade ago with a general purpose of legal
enforcement of data management and use to enhance evidence-driven decision-making. The delay was due to
many factors including the debate to define the scope, legal document status and the requirement of endorsement
by entities beyond the control of the health system i.e, Parliament and Minister of council. However, while it is in
draft form, the contents of the Health Information Proclamation was decided to be an integral part of the one
Health Act, which defines legal structures and functions of the health sector. The finalization and submission to the
parliament is expected to happen early during HSTP II.
MOH has prepared the Information Technology Policy in compliance with the umbrella policy of the Ministry of
Innovation and Technology. The policy covers security, “do-no-harm” approach, data sharing, IT equipment use
and others. The policy is yet to be endorsed and implemented at the intended levels.
There are also various HIS governance related documents that are at different levels of development aimed to guide
and standardize the HIS interventions. Among the finalized and/or operational ones are the ‘Connected Woreda’
Implementation strategy, Master Facility Registry (MFR) management and governance protocol and National
HIS governance framework. The documents under revision/development include: Health Harmonization and
Alignment Manual ( HHM), National Health Data Dictionary (NHDD) SOP, NHDD road map, Data Access and Sharing
Directive, eHealth architecture, Guideline on Incentivizing Data Quality, Use, and Performance Improvement,
human resource road map for national health information system.
3
The HMN was a global health partnership focused on strengthening health information systems in low and middle income countries, launched in May 2005 during the 58th session
of the World Health Assembly (WHA) and dissolved on 31 May 2013
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Though several efforts have been exerted to strengthen structural HIS governance prerequisites, there are still
persistent gaps in governing the HIS. Among the gaps are, delayed endorsement of HIS governance framework in
most of the regions, limited functionality of HIS governance structures as per the requirements of the governance
frameworks both at national and regional levels, failure to finalize drafted HIS governance documents, lack of
standards for digital platforms (e.g. EMR), absence of interoperable systems, absence of HIS or sub-component
policies and legal framework to ensure HIS principles and accountability.
2.1.2 Health Information System Resources
Health information workforce: Since the inception of the reformed HMIS, MoH has been exerting huge efforts
to establish a well-functioning HIS through placing HIS structure, deployment and capacity building of the health
information and other health workforce. MoH has also developed curriculum for HITs and health informatics
professionals (Diploma and Degree) and career paths in collaboration with the Ministry of Education and Civil
Service Commission respectively.
Despite the effort to institute a Health Information Technology (HIT) human resource structure in collaboration
with the then Ministry of Public Service and Human Resource, there are still persisting grievances by HITs related
to job grading and career structure that is leading to a high attrition rate.(1)
According to the draft Human Resource Roadmap for National Health Information System of Ethiopia, 2020-2030,
currently there are about 10,344 HIS professionals who are working in the governmental health system structure
from national to lower level which is 58% of the need.(1)
In addition, evidence showed that only 47% and 58% of the Health centers and general hospitals have assigned
the required number of HIS staff respectively. (2) Turnover of HIS related professionals happens in all professional
categories and at all levels with the highest being for diploma HITs with a turnover rate of 22% in the previous five
years of the beginning of 2019. Moreover, there is also poor professional mix, poor attitude, inadequate knowledge
and skill gaps among the HIS staff and weak systems for continuous capacity building, retention, motivation
and poor induction during staff deployment are among the gaps affecting the effectiveness of HIS. (1) Delayed
endorsement of the draft Human Resource Roadmap for the National Health Information System is also one of the
challenges affecting the progress being made.
Infrastructure and logistics:
Key infrastructures such as power, connectivity, electronic devices, data center and servers are essential for
optimal operation of the HIS. Over the last decade, the Ethiopian government, MOH, RHBs, agencies and HIS
stakeholders have made significant investment on digital and other infrastructure at facilities and health offices to
support information system implementation. While the efforts are promising in this regard, a lot more investments
are required to ensure a digital health infrastructure that can shoulder the current aspirations.
Electricity/Power: Only 76% of health facilities (Hospitals and health centers) have access to electricity. (3)
The main grid electricity is intermittent and not capable of nurturing power all the time to very sensitive devices
such as servers. The alternate power generator maintained by the Ministry is operational on working hours in the
absence of electricity and the servers often shut down during the non-office hours where the electricity power
goes off. There is no a dedicated power generator and solar energy that is capable of providing power for the data
center during power outage. The Smart redundant UPSs, which is currently controlling the power management in
the server room, is not adequate for the optimal functionality of the data center, while efforts are currently in the
pipeline to address the gap.
Networking: MOH has made significant investment to improve eHealth connectivity infrastructure both at
national and regional levels. One of the massive initiatives is HealthNet, which is helping regions, zones, woredas
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and facilities to be connected from Ethio-Telecom’s Virtual Private Network (VPN) through ADSL, 3G, tailored
solutions, or VISAT technologies. By the end of EFY 2012, there were 3,605 (1,636 ADSL, 1,944 3G and 25 tailored
solutions) institutions which have been connected to the HealthNet. This initiative will continue to connect all
the remaining facilities based on the available Ethio Telecom infrastructure and electricity. Several endeavors,
including distributing network materials, training and engaging Small and Micro-Enterprises (SMEs), RHB, zonal
and woreda staff have been achieved to connect the different units of the health facilities with data networks that
can ease health information exchange. Based on an administrative report of MoH, nearly 28% of facilities have LAN
set up.
In general, Internet coverage has grown at an annual rate of 45%, which is slower than peer nations. Investment
in network expansion and the acceleration of mobile penetration resulted in an increase in Internet coverage from
1.1% in 2011 to 18.6% in 2017. Rural Internet penetration for Ethiopian farmers has been 4%. This is lower than the
Sub-Saharan African average, as are Ethiopia’s rural literacy rates. (4)
Ethiopia has also evidenced a significant growth in mobile subscriptions with the proportion reaching 60% in 2017
(with 41% active subscription), but again, mobile adoption is still low compared to peer nations. A similar pattern
can be observed for broadband access where active mobile broadband subscriptions stand at 7.1%, compared to
an average 24.8% in the region. (4)
Rooms/desks: There are infrastructure related gaps in fulfilling HMIS prerequisites. Based on the findings
of the PRISM baseline assessment of the CBMP Woredas, only about 60% of the health centers and hospitals
have standardized medical record rooms, 86% of hospitals, 76% of WorHOs and 63% of the health centers have
dedicated desks/offices for HMIS staff. (2)
HIS logistic and hardware/devices: As a common practice, the Ministry of Health prints and distributes data
recording and reporting tools for all regions for one year following every cycle of indicators revision. After the first
year of the revision, it is the responsibility of the RHBs to print and distribute the tools to their corresponding health
facilities except for the four special support regions (Afar, Somali, and Benishangul Gumuz & Gambella). Additional
support regions Debub Omo, Amhara remote area, where MOH continues to provide the tools. Generally, shortage
of recording tools is a common complaint reported by RHBs and lower levels in many forums, which was also
substantiated by the PRISM assessment conducted in the 36 CBMP Woredas and their facilities. Similarly, only
62% of the health centers and hospitals have standard shelves, whereas 87% of WorHOs, 81% of hospitals and
65% of health centers had a functional computer dedicated for DHIS2. (2) This gap is despite the distribution of
significant number of personal desktop computers, printers, laptops, tablets and other gadgets to regions and
service points to promote digital health.
The data center of the Ministry is equipped with low-end to few high-end servers, two smart UPS, a firewall and
cooling systems. As the number of applications to be hosted at the data center is growing in terms of size and
complexity, the existing data center and equipment were not sufficient and as a result, the ministry is currently in
the upgrading process of the existing data center.
Systems Hosting: On top of the local infrastructure of the health facilities, MOH agencies and RHBs, the data
center of the Ministry is currently hosting most implemented applications that are accessible to users via Internet
and HealthNet. Secure Cloud Hosting was also an alternative based on the sensitive nature of the data and the
level of complication of managing the systems. Both local and Cloud hosting will continue to be considered as
applicable based on the hosting parameters set.
Availability and Security: The MOH and partners implemented the body of technologies, processes, and
practices designed to protect networks, devices, programs, and data from attack, damage, or unauthorized access.
As a result, the availability of the systems are progressively increasing. However, there are still lots of gaps to be
addressed in order to enhance the availability and security levels of the hosted systems. Cyber security services
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that include data retention, data sharing, data privacy and encryption protocols have also been implemented to
some extent as part of IT policy implementation, which is yet to be endorsed and implemented in its entirety.
Disaster Recovery Site (DRC) has been built at a different location to resume the operations in case of catastrophic
or unexpected event that may damage or destroy data, software and hardware systems. The DRC will soon go
operational after the servers are deployed and the main data center is synched with it.
Generally, the uneven and limited coverage of HealthNet, limited electrification, shortage of computers and other
logistics/devices and server down time at MOH data center are adversely affecting the effectiveness of the health
management information system functions.
HIS Financing: Globally, there have been very few efforts to calculate the costs of all aspects of a national health
information system. With the available data, it is estimated that health information requires at least US$ 0.53 per
capita in low-income countries and US$ 2.99 per capita in high-income countries. These figures may be on the
low side. Data on the level of investment in health information systems in low- and middle-income countries
are lacking, but anecdotal evidence suggests that, with notable exceptions such as Thailand and Mexico, it is
significantly lower than the 5% of total health resources called for by the Global Health Information Forum (GHIF)
in Bangkok in 2010. It should be noted that 2% of this is to be allocated to sound civil registration and vital statistics
systems. (5)
In Ethiopia, though great attention is given to HIS and improved financing since the implementation of reformed
HMIS, there was inadequate costing of the IR roadmap of 2016-2020, which was only 4.3% of the total HSTP I
cost. (6) The key sources of funding for HIS include government (mostly for recurrent costs), donors (SDG, Global
fund, World Bank (IPF), GAVI, UNICEF, CDC, and USAID) and implementing partners. However, no consolidated
information is available concerning the amount of investment on the health information at national level. A
baseline assessment of the CBPM Woredas indicated that 54% of WorHOs and health facilities have a budget for
HMIS supplies including registers, forms, and guidelines although the specific amount, as a proportion to the total
budget for the institutions was not stated. In addition, only 30% of woredas and health facilities reported having
access to financial and logistics resources for HIS supervision, and less than 30% of woredas have a copy of the
long-term financial plan for supporting HMIS activities. (2)
2.1.3 Indicators
Indicators: The health sector has been making an effort to track the domains of health, which are the health
system, determinants of health, and health status by including impact, outcome, output, process and input
indicators in a balanced way from routine and non-routine sources.
Indicators have been periodically revised over the past two decades driven by local priorities and developments as
well as international standards, priorities and commitments such as Millennium Development Goals (MDG), and
Sustainable Development Goals (SDGs).
Following the HMIS reform in 2008, the number of indicators were 108 then 122 in 2014 and 131 in 2017 HMIS
revisions. During each round of revision, an indicator reference guide has been prepared with the aim of
standardizing and creating common understanding and eventually improving the quality of data and its use.
Presence of many indicators that were rarely analyzed and utilized, lack of clearly defined indicators for some
initiatives such as Woreda Transformation, Compassionate Respectful and Caring (CRC) health workers and
Universal Health Coverage (UHC) were some of the main challenges. Moreover, measurement metrics of HIS
performances were addressed inadequately in the IR road map.
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2.1.4 Data Sources:
This section describes the status of data sources of the health information system in Ethiopia by considering the
two main categories: population-based and institution-based information sources.
2.1.4.1 Population- based Data
The population data is among the foundation of the health information system. The availability of up- to- date
population figures at different administrative levels is crucial to plan health services and measure changes.
Census: Health system in Ethiopia will continue to obtain census data from the Central Statistics Agency (CSA),
which is conducted every 10 years. CSA has been providing a projected target population for each year using
the growth rate for that level. So far, the country has had three censuses in the last four decades, which were
conducted in 1984, 1994, and 2007. The fourth national census was supposed to be conducted in 2017, but did
not happen due to different reasons such as security concerns. Ethiopia is currently relying on the 2007 census
projection result, which may not reflect the reality on the ground due to demographic changes including the rapid
population growth that impacts target setting for coverage indicators.
Survey, surveillance and research
Population Surveys: The Ethiopian Demographic and Health Survey (EDHS) is one of the major sources of
population data on health outcomes and impacts indicators. CSA is mandated to carry out DHS every five years.
So far, EDHS has conducted four surveys (in 2000, 2005, 2011 and 2016). To fill information gaps between series
of major EDHS, the Ethiopia Mini Demographic and Health Survey (EMDHS) has been conducted in 2014 and 2019
led by CSA and EPHI respectively. Limitation of the DHS methodology is the lack of sub-regional level estimation.
Sentinel surveillance: Sentinel surveillance is conducted in selected health facilities and population groups
to generate comprehensive information on trends of common health conditions as a proxy for the general
population. For instance, TB/HIV and ANC /PMTCT sentinel surveillance to respond to the national projection and
estimation figure of HIV/AIDS were conducted during the HSTP I. The sentinel approach is also employed to track
other diseases such malaria, influenza, Schistosomiasis (SCH) and Soil transmitted helminthiasis (STH), climate
sensitive disease and anti-microbial drug resistance.
Among surveillance related challenges are lack of fully functional and standardized event, community and
laboratory-based surveillance and integration of surveillance training into HEW’s refresher training package.
Research: Mainly Ethiopian Public Health Institute (EPHI) and Armauer Hansen Research Institute (AHRI)
conducted basic and operational research on topics relevant to the health sector. Local universities, UN and
bi-lateral agencies, implementing partners, other research and other private institutions, also conduct various
researches.
However, the majority of research technical reports and the articles published in the peer-reviewed journals are
not transformed into synthesized evidence-based information to inform policy and program formulation and
implementation. There is also a weak linkage between research priorities of different agencies and the policy and
strategy directions of the MOH and the health sector in general. Furthermore, there are no institutional incentives
and mechanisms to promote decentralized research by lower health institutions. There is limited collaboration,
fragmented approach and uncoordinated priority setting of research agenda and research activities by academia
and other partners that needs coordination and systemic organization.
Inadequate funding, shortage of human resources and inadequate logistics and sub-optimal publications in
reputable journals are among other major challenges.
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Other surveys, surveillances and rapid assessments: In addition to the above stated surveys and surveillances,
there were other program specific surveys carried out to inform the health system. These include: EMONC (2008,
2016),Health and disease Surveillance System (HDSS), Performance Monitoring and Accountability 2020 (PMA
2020), STEPwise Approach to Surveillance (STEPS) ( National survey in 2015), Malaria Indicator Survey (2007,
2011, 2015, 2019) Ethiopia, , RDQA ( 2016, 2018), SARA ( 2016, 2018), SPA+ (2013/2014), National Health Accounts
(NHA), Welfare Monitoring Survey (WMS), the National ART Effectiveness study, coverage surveys (measles), HIV/
AIDS impact assessment (EPHIA) ( 2017/18), TB prevalence survey (2011), and other rapid assessments that were
conducted at least once during HSTP I. Thus, various surveys and rapid assessments were used as an input for
program implementation and management during the HSTP I period.
In general, there is less utilization of survey, surveillance and research outputs and triangulation with routine data
sources for the purpose of policy formulation, program development and service delivery improvement.
2.1.4.2. Civil Registration and vital statistics system (CRVS)
The information generated from CRVS is of critical importance for policy and planning in many sectors, and is
of particular importance to the health sector. The health sector is expected to notify births, deaths and causes
of death, while INVEA performs registration of these vital events. CSA is mandated to analyze and disseminate
national and sub-national vital statistics data.
The revised proclamation (Proclamation no. 1049/2017 of the Federal Negarit Gazette) of civil registration and vital
statistics law of 2017 has given a clear mandate to the health sector to notify birth, death and cause of death to the
concerned civil registration office. Accordingly, birth and death notification at facility level has been started in most
of the health facilities. However, the implementation process is slow with only 35% and 3.4% of expected births
and deaths are notified respectively. (3) The registration coverage is much lower than this. There are challenges in
vital events notification that includes lack of awareness, shortage of recording tools, poor coordination between
the health sector and INVEA structures at lower levels and lack of ownership. Moreover, community level birth and
death notification is not yet started.
Regarding causes of death registration, it is currently being collected primarily for deaths occurring in health
facilities and coded according to the National Classification of Disease (NCoD) which was customized from
the International Classification of Diseases (ICD -10). Ethiopia has also been piloting the application of verbal
autopsy to determine cause of death at community level, but there is no formal application to date. The Health
and Demographic Surveillance System (DHSS) initiative of EPHI and local universities and Maternal and Perinatal
Death Surveillance and Response (MPDSR) initiatives are among the efforts exerted to determine cause of death
using verbal autopsy.
2.1.4.3 Institution-based data sources
2.1.4.3.1 Individual level data recording
Paper-based recording tools of HMIS/CHIS
Individual level data is captured using individual data recording tools at health facility level. Key data elements
from individual level records are also aggregated onto various standardized registers. These paper-based tools
are the basis for Electronic Medical Records (EMR), paper-based and digital aggregate reporting systems. Although
these tools are prepared and standardized, a significantly larger amount of data is being collected than being
utilized. Only about 10% of the data collected is utilized for the generation of the 131 identified core indicators,
which may require further revision to remove the redundancies. Besides, assessments as well as anecdotal reports
reveal that there are shortages and stock out of these tools that require a sustainable approach to resolve the
problem.
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A community Health Information System (CHIS) is designed and implemented to manage data at health post/
community level and use generated information to promote a family-centered health care delivery through its
innovative community health services extension program (HEP). Initially, it was started in agrarian communities,
which was later customized to urban and pastoral settings too.
Even though agrarian CHIS is implemented in almost all-agrarian community setups, the implementation status
for urban and pastoralist areas is slow and incomplete. Challenges of CHIS implementation include shortage of
tools and lack of clear standardized approach for pastoralist HEP.
Electronic-based individual records
Electronic Medical Record (EMR): With the advent of technologies coupled with ever-growing demand for
individual level data, deploying an electronic medical recording system that meets the minimum data and
functional standards is critical for a health facility.
The EMR system: full-fledged Smartcare_EMR, Smartcare-MRU and later the Smartcare-ART that are desktop and
Microsoft based systems, were introduced in the public health sector during the HSDP IV era, since 2007, and was
implemented in a few selected hospitals. Later on, it focused on patient registration systems as Medical Record
Unit-EMR mainly in hospitals, which lacked linkage with clinical and administrative systems, and on selected
chronic health programs such as HIV. Few private and public hospitals have also made endeavors to have their
own full-fledged EMR system that automates from patient registration all the way to discharge.
Due to its resource intensive nature to sustain the implementation, attitude of health workers, failure to update
the software to the ever-changing user requirements, most implementing sites failed to continue using the system-
except –Ayder referral Hospital in Tigray Region, Bahir Dar Health center in Amhara Region and Jugel Hospital and
most health centers in Harari Region. Even though the full EMR system is not expanded in the country, more than a
thousand sites are using the EMR-MRU module to handle patients’ registration information in their medical record
units. In addition, over 470 ART sites deployed the updated EMR-ART software to keep intake and follow-up records
of PLHIV who are taking antiretroviral medications. On the other hand, some private hospitals run proprietary
electronic medical systems to support the daily operations of the hospitals.
Despite the efforts made to implement EMR, the existing EMR system does not fulfill the requirements of facilities,
most of the health facilities do not have LAN and the digital literacy level of end users is still limited. Lack of
strategic thought on building a national EMR platform, lack of adequate resources, absence of a national standard
and interoperability issues are also other key challenges in the development and deployment of EMR in the health
sector. There is a growing demand to put the EMR standards in place and help data exchange among the EMR
instances in the country.
Electronic Community Health Information System (eCHIS): Electronic community health information system
enables data recording, referral linkage, an automated reporting, monitoring and performance analysis system
and bring efficiency in service delivery by allowing Health Extension Workers (HEWs), their supervisors, health
managers and other healthcare providers to easily review household and individual data to deliver tailored
services to households and individuals.
eCHIS implementation was started in 2018 with two modules, namely family folder and RMNCH modules. Since
then, it has expanded to 1442 health posts in 2019/20. Malaria and tuberculosis modules are under development.
The urban and pastoralist versions of the eCHIS are also planned to be deployed based on the lessons learned
from the agrarian eCHIS.
The major challenges are lack of clear roadmap, inadequate ownership, poor coordination, weak monitoring, and
server related challenges, shortage of tablets, airtime and poor network.
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Laboratory Information System: It is a system that automates the laboratory activities. It was developed in 2007
by Polytech Consulting and development PLC for federal and regional laboratories and is currently in use. Recently
the system has been integrated with the COVID-19 Tracker to ease the data exchange between the case managers
and lab technologists.
Among the challenges, include unable to expand the system to cover all facilities and availability of the service
only at laboratory department, but not to clinicians due to absence of Electronic Medical Record.
Emergency and Referral Information System (ERefIS): ERIS helps to manage the service provision, bed
management, referral management, and emergency management across the health facilities. The system was
developed in 2018 and was deployed at five Hospitals in Addis Ababa for piloting. However, because of the changes
in the requirements the implementation soon got stacked.
Electronic Auditable Pharmaceuticals Transactions and Service (eAPTS): This system delivers information
concerning the types of medicines arrived for patients, therapeutic category, types of programs served, stocks at
hand, consumed, wasted and emergency stocks to control and monitor the services and supplies. The system is
also helpful to manage pharmacy payments and measure staff performance. The development of the system was
started in 2019 and it is underway. It is desk reviewed at St. Peter’s Hospital and ready for pilot implementation at
five selected Hospitals.
Community-based Health Insurance System (CBHI) & Ethiopian National Health Insurance System (ET-
NHIS): The CBHI system was designed to manage enrollment of members of households, the healthcare utilization
of the members, reimbursement for the health facility for health care services provided to the members, and
financial management at Woreda level. An ET-NHIS is a CHAI-supported mobile application (at Kebele level) and
web application (at health offices) newly developed to streamline workflows, automate processes, and handle
the CBHI Agency’s records. The system has been piloted in seven Kebeles of Woreda in Tigray Regional State with
Motorola phones. The development process is ongoing to include some modules required for Hospitals.
Blood Safety Information System (BSIS): The National Blood Bank Service (NBBS) has started using the BSIS
in the national center since August 2017. Currently, the system is functional in the NBBS national center, the new
building center and the collection center at Red Cross. From regional blood banks, Adama and Dessie Blood Banks
are currently using the system to run their daily operations. Work is underway on the finalization and customization
of the system that will allow for an efficient multi-site functionality. Once that version is available, the NBBS will
work with the regional blood banks to implement it. This will help create a network of all the blood banks and
improve the service nationally.
Electronic Vein-to-Vein reporting tools (eVVRT): The report system is applied at 42 blood bank branches
connected with the center (Nation Blood Bank) to collect monthly reports. Blood donation, post donation, blood
request & distribution by ABO mainly focused on the report
eSurveillance and survey Systems: There are electronic systems for ongoing systematic collection, compilation,
analysis, and dissemination of data on reportable diseases and other events that present a potential threat to
public health security. The COVID-19 Response App that has been developed and used by MOH and EPHI is a
typical example. Efforts have also been made to establish other public health systems such as Early Warning
Systems (EWS), Case Tracking Systems, and the HIV/AIDS surveillance system that has been implemented by EPHI
at selected facilities in Addis Ababa.
Disease Surveillance data management: To rapidly detect and respond to epidemics, it is essential to investigate,
analyze and report disease occurrence to responsible authorities for timely response. Under the leadership of
Ethiopian Public Health Institute (EPHI), currently, 23 (15 immediately and 8 weekly) reportable diseases including
MPDSR are coming through disease surveillance reports.
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In addition, any emergency health conditions to the public are included in the report whenever they occur. A
national data management center is established at EPHI to handle the Public Health Emergency Management
(PHEM) information system, research and other health related data. Furthermore, there is a new initiative
started to monitor HIV cases-based surveillance and antimicrobial resistance surveillance. Challenges related to
disease surveillance information systems include: incompleteness, delayed reports, inadequate data utilization,
particularly at low levels, poor coordination and integration with the existing HMIS system.
2.1.4.3.2 Aggregate-level data management system
The reporting forms of the current HMIS includes monthly service and disease reporting forms, quarterly and
annual service reporting forms used by health posts, health centers, hospitals and health administrative units
depending on the HMIS indicators they are expected to report on. These reporting forms are digitized primarily
using DHIS2, which is the major digitization platform of the health sector. However, there are also other digital
platforms, which record and track various aspects of the health administrative activities and support such as
human resource, finance, supply chain and logistics.
District Health Information Software (DHIS2): MOH has been implementing two eHMIS systems between 2012
and 2017 and DHIS2 as major HMIS digital platforms as of January 2017 for the last more than three years.
After iterative testing, implementation and improvements, DHIS2 has now become a stable national HMIS platform.
MOH has registered several significant achievements with regard to DHIS2 development and implementation. This
includes: deployment of online/offline instances, full ownership of DHIS2 customization and implementation by
MOH, upgrading the software to version 2.30 that has more in house-built apps for disease and PHEM report, data
use applications (Scorecard, BNA and action tracker, custom reports) and new features for data quality checks,
dashboards for decision makers. DHIS2 was implemented in online and offline modalities and at the end of EFY
2012, 95% of the public facilities were covered of which 3,065 (67%) of public facilities and health offices were able
to access the online where the remaining are using offline version. Challenges include poor connectivity, frequent
failure of computers, server down time, technical problems etc.
Logistic Management Information System (LMIS): Implemented since 2014, the health commodity supply
management has been supported by the implementation of mBrana, an open source mobile software platform
designed to manage vaccine inventory, VITAS, an enterprise level procurement, inventory and warehouse
management technology system for federal level and 19 EPSA hubs, Dagu, an inventory management system
designed to manage daily transactions at health facilities (Running in about 650 facilities) and Fanos, a supply
chain dashboard to support decision making systems such as stock status for EPSA and EFDA for the last few years
and Fleet Management System, to manage the information on the exchanges of drugs stocks between central
offices and 200 drug centers.
Generally, these systems are Health Commodity Management Information Systems (HCMIS) used to record new
drugs (stock) and vaccines, calculate consumption rate, issue drugs to Units (departments) and manage inventory.
These systems are, however, not interoperable. Most of the systems are also not effectively used due to fragmented
implementation and limited ownership at all levels.
Regulatory Information System (RIS): EFDA is building a technology infrastructure that links the various tasks
under one unbroken chain of information from licensing and registration to import and quality assurance. To
facilitate the registration and import permit process, the Electronic Regulatory Information System (eRIS) was
designed and implemented for EFDA. eRIS is the umbrella system at EFDA composed of multiple components
of sub-systems that work together. The different subsystems of eRIS are: i-import (an open source customized
by EFDA and that allows importers to apply for and receive permits to import medicines online and EFDA staff to
manage these applications online), i-Register (allows importers to apply for market authorization and product
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registration), and i-Licence (allows importers, exporters, wholesalers and Manufacturers to apply for certificate
of competency). Currently, all EFDA employees utilize the software to manage the import process for medical
supplies and pharmaceuticals and over 3000 importers use it.
Human resource information system (HRIS): HRIS is one of the applications developed and implemented at
different administrative health units and in selected hospitals. Its purpose is for managing the health workforces’
detailed profiles, sites of assignment, work experience, and the likes and using the data as a reference for promotion,
professional license, transfer, cost-sharing, etc. has been exercised using the electronic HRIS since 2004. However,
the system is currently not capable of generating required national indicators and sharing of data with the routine
information system. The source code of the previously deployed HRiS system was not also available to incorporate
new requirements and redesign the system. As such, the Ministry decided to customize an open source eHRIS
system called iHRIS to handle the functionalities HR ADMIN, HR Development, and the HR Licensure services.
The features that have been selected for first release include the personnel management, leave management,
performance tracking and dashboard feature. On the HRD side, as a part of early release, graduate tracking feature,
trainee registration and course update is being developed.
Integrated Financial Management Information System (IFMIS): The financial management component of
the information system generates information on annual budget by program, cost center, budget disbursement,
population budget ratio by region, and category of expenditure (salaries, drugs, medical equipment, building
vehicle etc...). MOH has been piloting the Integrated Financial Management Information System (IFMIS) since
2006 EFY. Taking lessons from the pilot implementation, the ministry has expanded the use of the IFMIS system to
the management of grants. IFMIS is currently being used for financial management of almost all grants at MOH.
However, much progress has not been made at the sub-national level.
Medical Equipment Management System
This system was developed with the purpose of alleviating the medical equipment management/handling
problems observed at facilities. It maintains details about the medical equipment, the whereabouts, functionality
status, and maintenance needs, among others. The system development was started in 2018, and is currently on
pilot stage in selected public hospitals.
Interactive Voice Response (IVR): An IVR system has been developed and implemented in selected health
posts to receive voice information on key community health aspects and to provide training to the HEWs and their
supervisors. Dashboard also has been developed on the top of it to help individual directorates/departments get
tailored information on the areas of their concern. As the implementation of eCHIS has started since 2018, the
role of IVR has somehow narrowed. However, the system is still being implemented to enhance quick information
transfer on community level emergencies - including COVID 19 related ones.
2.1.4.3.2: Shared Services/standard-based registries
Master Facility Register (MFR): Master Facility Registry (MFR) has been developed and implemented as an
authoritative list of health facilities and to enhance interoperability. The resource map, the back-end software of
the MFR, is deployed in the MOH cloud, and the landing page is developed to facilitate curation. The MFR public
portal is developed and the MFR management and governance protocol has already been drafted and awaiting
for endorsement. Currently, selected signature domain data of about 60% of health facilities have been entered
into the platform. Regional performance ranges from less than 1% to 100%. Though it was implemented as of
2017, there have been challenges related to system (issues related to the back-end of the platform) , governance,
ownership of development of the platform of system by MOH and Internet connectivity (and lack of offline version
for the app) that hampered its full implementation.
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Health Terminology Management Service (HTMS): The MOH has developed the National Health Data
Dictionary (NHDD) to serve as the authoritative source for indicator and information standards within the health
system. The dictionary provides a common language for clinicians, lab technicians, pharmacists, researchers,
administrators and other stakeholders to communicate and exchange health information to ensure that meaning
is not lost as data is shared or aggregated into reporting systems. The NHDD harmonizes data definitions from
multiple programs and facilitates the mapping of definitions to international standards, such as the International
Classification of Diseases (ICD-10), the Systematized Nomenclature for Medicine (SNOMEDCT), or the Columbia
International eHealth Laboratory (CIEL) interface terminology. NHDD operations Procedures and NHDD roadmap
were drafted, but not finalized. The NHDD Pocket (a mobile app of the NHDD) was developed and implemented
to facilitate offline access to the dictionary by clinical and public health practitioners. Currently, the National
Classification of Diseases (NCoD) and HMIS indicators are published in the NHDD. The inclusion of drugs formulary,
immunization lists, and lab tests is underway.
While it was implemented since 2017, the number of domains included in the terminology management service
are very limited. The full utilization of what it meant to serve was not realized as the interoperability service is
not up and running. Absence of finalized and endorsed NHDD road map with a clear phased approach to design
the HTMS and lack of mix of skills to design the TMS are the major challenges, which slowed down the NHDD
development progress.
2.1.4.3.3 System administration/ general-purpose systems
Online Ticket Registration System (OTRS): A system used to provide an interface for internal maintenance and
support. Using this application, users request hardware and software maintenance and troubleshooting by filling
a form. While the system was implemented and evaluated as of 2018, the level of utilization of the system has been
minimal.
Fleet Management System: MOH implemented a fleet management system to manage office-based and rental
vehicles effectively. Originally, the application was implemented to have a system that can track the whereabouts
of the vehicles at any given time with the GPS-enabled on each car and it served the purpose for about two years
since 2016. The fleet management system is currently not operational due to the need for maintenance on the
system.
2.1.5 Data management and Information Products
Data repository/ data warehouse: Within Ethiopia’s health system, data are collected and managed at different
levels and the available data sources are siloed or stored in separate systems. Currently, the health system has
no less than 77 unique electronic sub-systems deployed to meet specific requirements. (7) These systems are
standalone, transaction-based systems that are not adequate to address advanced decision support, data mining,
knowledge discovery, and business intelligence demands. This siloed approach has created barriers for seamless
analysis from a single window and the use of data from across the health system in a combined or triangulated
manner and has limited the types of research and decisions that could have been supported. To solve this problem,
MOH has started the development of the data warehouse (DWH) in a step-by-step manner (i.e., based on priority
use cases and mindful of the massive cost of a national DWH) and realize the bigger DWH over the coming few
years.
Accordingly, the RMNCH domain came out as a priority use-case with a huge multi-sectoral data demand for
the first Data Mart. The functional and non-functional requirements have been collected and documented and
data source mapping has been completed. A comprehensive scope of work has been prepared and reviewed
for the data warehouse design, implementation, and deployment. Data warehouse implementation requires a
multidisciplinary approach but engaging all relevant players on a continuous basis has been a challenge. The
subsequent analytics and business intelligence tasks will also be coupled with this effort during HSTP-II.
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Health Information exchange and data processing
Once data has been collected and stored, it needs to be processed and compiled in such a way that the data
can easily be compared and collated with information drawn from other sources so that data is not duplicated,
mistakes are identified and corrected, and accuracy and confidence levels are measured. Efforts have been made
to ensure that different information systems and applications to access, exchange, integrate and cooperatively use
data in a coordinated manner. In this regard, the Ministry has developed a draft e-health architecture document
outlining the different components and the mechanisms how these components exchange data among
themselves. The eHealth Architecture (eHA) is the foundational plan or blueprint that creates a framework for how
the HIS subsystems interact. With respect to the technology that enables the components to be interoperable, a
landscape analysis was done to seek solutions, which have been implemented in other countries, and to choose
the ones that fit the country requirements. Based on the set criteria, MOH has selected OpenHIM to pilot the data
exchange between different systems. Few examples of data exchange efforts include the MFR/DHIS2, the eCHIS/
DHIS2 and DHIS2 tracker and Laboratory Information System. The digital health Systems App Inventory has been
conducted and the findings are published in the WHO Digital Health Atlas (DHA).
However, the magnitude of the integration and interoperability agenda is at an early stage and data sharing
between the EMR and DHIS-2 has not yet been done. Furthermore, data-warehousing approach, which lies at the
core of an e-health architecture, is currently not functional.4 Preliminary tasks are underway to conduct the HIS
and Interoperability Maturity assessment for key health information systems. As a way forward, a concert effort is
needed so that the Interoperability and messaging standards to ensure systems speak to each other.
Ethiopia Health Data Analysis Platform (EHDAP), an integration and interoperability platform was also developed
as a one stop shopping for integrated access of data and analyzing it as per the user’s needs by creating easy
access to the different datasets. However, this system was not maintained due to the proprietary nature of the
system and as it was not properly handed over by the developer.
Data quality: To effectively collect and report on data of acceptable quality, various interventions were
implemented. Among these are standardization of indicators, recording and reporting tools and procedures,
development of various SOPs, manuals and guidelines, audio visual self-learning materials in the area of recording
and reporting, capacity building on data quality and information use, review meetings and institutionalization of
data quality review and assurance techniques. The major mechanisms of data quality review were LQAS at facility
level; Routine Data Quality Assessment (RDQA) at health administrative levels, Data Quality Review (DQR), setting
validation rules for data entry digital platforms such as DHIS2 and desk review techniques.
Consequently, key successes on data quality were registered. Facility report completeness has markedly improved
from 72% in 2007 to 89% by end of EFY 2012 ;( 3) where the HSTP I target of 90% has been nearly achieved. Data
accuracy has also shown improvement for instance in the proportion of health facilities who meet the data
verification factor within 10% range for SBA improve from 71% in 2007 EFY (6) to 89% in 2011 EFY (8), the ratio of
data gap between routine HMIS and survey has been narrowed down for some indicators. For instance, SBA from
2.66 in 2016 EDHS to 1.6 in 2019 Mini EDHS; for ANC4 from 2.39 in EDHS 2016 to 1.6 in 2019 Mini EDHS.(9)
However, despite an extensive reform and redesign of the national HMIS by MOH and some gains in data quality
improvement, the Health Data Quality Review of 2018 revealed major data quality gaps in nearly all dimensions
mainly at lower levels of the health system. (8) Timeliness of service delivery data was below the expected 90%
target of HSTP I for most regions by the end of EFY 2012. Both completeness and timeliness of disease data are
lower than service delivery figures, which is a major data quality concern.
4
MOH, Comprehensive Report of Mid Term Review, Vol 1, December 2018.
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There is no composite index to measure data quality in more rounded way and presenting the ‘big picture’ in a way
for better understanding by audiences and for better monitoring and evaluation of investments
Information product: Although data are the raw materials of a health information system, they have little intrinsic
value in themselves. Only after data has been compiled, managed and analyzed do they produce information
that is of far greater value, especially when it is integrated with other information and evaluated in terms of the
issues confronting the health system where it becomes evidence that can be used by decision-makers. (11) Hence,
MOH, agencies, RHBs, lower health administrative structures and health facilities have used different formats like
report, special bulletins, Health and Health Related Indicators, Newsletters (e.g. Tenachen), fact sheets, posters,
quarterly magazine, presentations on press conferences & seminars, messages on websites and social media, etc.
to make analyzed and synthesized data available for stakeholders for informed decision making. Currently, the
use of dashboards is becoming the key feature of digital platforms particularly of DHIS2. DHIS-2 is optimized with
critical data analytics features such as Scorecard, GIS, data visualizers, Bottleneck analysis, etc. Dashboards were
prepared for some programs. Though not optimal, promising improvements from MOH program experts in using
DHIS-2 for data analysis was witnessed.
Apart from the regular reports, the generation and utilization of other types of information products are less
practiced at RHB and as we go down to lower levels of the health system. At the facility level, only 30% of facilities
reported producing summary reports or bulletins based on HMIS data. (2)
Features such as action tracker, bottleneck analysis, league table and geospatial data (Partly due to lack of up- to-
date and complete shape file! ) are either not well developed or utilized even at higher level of the health system
including MOH which need to be strengthened
2.1.6 Information Dissemination and use
To enhance information use at all levels, various platforms were in place to strengthen key decision-making mainly
through Annual Review Meetings (ARM), Joint Steering Committee (JSC), Planning forums and Performance
Monitoring Team (PMT) meetings. There are also program-specific review meetings including HIS and other
sector-wide and program specific platforms, which use information for decision making in varying levels of depth.
To facilitate information use at various levels, the connected Woreda strategy and information use guidelines and
training modules were prepared and training were cascaded to lower levels. Regarding information use, different
assessments showed different results. According to the 2018 DQR report, 68% of Woredas made programmatic
decisions based on analyzed data/results. (8) The PRISM study in 2019 done across 36 CBMP WorHOs shows that
although more than 90% of WrHOs claim to conduct monthly PMT, a full cycle of PMT including root cause analysis
and follow up action items is a major gap at all levels. At the facility level, PMTs are available at 89% of health
facilities; however, just over 70% of these facilities hold meetings regularly. About 34% of health posts conduct
PMT meetings and only 32% of health posts reported using CHIS data to produce analytical reports. Although the
information use and dissemination was better at the Woreda health office level, the overall averaged score for
data dissemination for CBMP woreda is 49%, indicating data dissemination is low. (2) Observations show that no
functional PMT exists at MOH and many of the RHB levels.
There are no nationally representative studies and standardized tools to assess and inform the status of information
use at different levels across health institutions. In the face of many data use platforms and practices, there is also
no agreed upon measurement metrics or index to monitor the progress of data/information use.
Web portals from Ethiopian Health Data Analytics Platform (EHDAP) and social media outlets have been tried out
to enhance information exchange and dissemination. Less than 20% of health facilities shared their performance
data with the general public. Tools for data visualization, analysis and dissemination are limited, impeding the
ability of managers to use the information for action. (10)
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1.1.7. Knowledge Management ( KM)
Knowledge is the ability of people and organizations to understand and act effectively. It is a fluid mix of
framed experience, values, contextual information, and expert insight that provides a framework for evaluating
and incorporating new experiences and information: Knowledge management is the explicit and systematic
management of vital knowledge-and its associated processes of creation, organization, diffusion, use and
exploitation in pursuit of business objectives. Knowledge Management is based on the idea that an organization’s
most valuable resource is the knowledge of its people. Therefore, the extent to which an organization performs
well will depend, among other things, on how effectively its people can create new knowledge, share knowledge
around the organization and use that knowledge to best effect.
During HSTP I, many efforts were made to establish knowledge management in the health sector. These include
the development of a knowledge management strategic plan (2016-2020), knowledge harvesting tools and
methods and a draft guideline on document preparation and concept note to set up the KM system at MOH. There
is an online collaboration application to create an online repository at MOH, which is under user acceptance test.
A knowledge management (KM) unit is established at EPHI and AHRI.
There is no functional coordination mechanism at various levels to ensure a process of creating, capturing, storing,
retrieving, sharing, and managing knowledge and effectively using it for informed decision-making. In general,
the health sector is lacking a systematic/institutional management of an organization’s knowledge assets for
creating value and meeting tactical and strategic requirements that requires a strong emphasis to institutionalize
and promote knowledge management at all levels, finalize the fragmented efforts and leverage on the existing
practices of different stakeholder.
1.1.8. Implementation status of connected Woreda strategy
The connected Woreda strategy is designed to realize the goals of the information revolution at the lower levels in
the health system. It operationalizes data-use innovations through instituting a tiered pathway for facilities and
Woredas as a whole to achieve the highest standards in data quality and use where Woredas selected for Woreda
transformation were targeted to transform in data management and use through establishing connected Woredas.
Moreover, an initiative called Capacity Building and Mentoring Program (CBMP) has been instituted engaging
local public universities to enable the provision of technical support through training, mentorship and research
services based on the gaps identified. Accordingly, MOH has signed a contract with the six universities where each
university is responsible to work in selected Woredas to create 36 model Woredas on IR as demonstration sites.
To date, no full-fledged connected Woreda was achieved based on self-assessment of WorHOs and health facilities
underneath. However, few health facilities were assessed to the level of model facility where some improvements
were seen in others based on documented changes from the baseline status in terms of progression from ‘emerging’
to ‘candidate’ and from either ‘emerging’ or ‘candidate’ to model status. Some best practices like introduction of
data week at Woreda level in CBMP Woredas, integrated data review in the morning sessions at hospitals and
formation of a joint team between the HIS/PMT and QI teams in the hospital were documented and shared.
To this end, though many efforts were exerted so far, the implementation of connected Woreda strategy was not
successful as per the expectation due to several challenges. The major challenges were:
• Lack of common understanding on the connected Woreda strategy among key stakeholders
• Poor coordination and lack of clarity on selection and scale of Woredas at national level
• Poor ownership at all levels and slow progress of implementation
• Weak project management system and slow progress of CBMP implementation
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• Failure to implement tailored interventions based on identified gaps
• Weak documentation of lessons learnt and best- practices
• Absence of database to track and monitor the CW related performances
2.2 SWOT Analysis

This SWOT analysis of the Health Information System in Ethiopia is developed based on already existing national
health related documents including Mid-term Review of HSTP I report, Annual Review Meeting Report (ARM), review
of health system priorities (HSTP I), the 2018 HIS assessment report, and opinion of experts from key stakeholders.
The most important areas that came out boldly from the desk review and expert’s judgments in terms of strengths
and weaknesses (internal); and opportunities & threats (external factors) of HIS in Ethiopia are depicted as follows.
Table 2: Strength and Weakness Analysis
Strengths Weaknesses
Human resource: • Poor staff motivation and high rate of staff
• Presence of planning/M&E/health information motivation
system/HIT structure at all levels, • Shortage of HIS professional in general and skilled
• Presence of HIT/informatics training curricula, HIT ICT professionals at regional/facility level in
career development. particular
• Presence of IT support staff seconded/embedded • Absence of dedicated IT/Digital Health unit at
by partners several regional health bureaus
Coordination and partnership:
• Limited existence and weak coordination
• Existence of National HIS steering Committee, mechanism at sub-national
National HIS Advisory Group (NAG) that coordinate • Absence of integrated and efficient technical
HIS activities support provision mechanism for all electronic
• The creation of a strong partnership with the systems
academic institutions such as the CBMP initiative
• Absence of HIS road map/plan at sub-national
HIS Planning and governance documents: level
• Poor costing, measurement metrics and M&E
• Availability of five years HIS strategic plan/ framework of the IR road map
roadmap, • Delayed endorsement of HIS governance
• Endorsed national HIS governance framework, documents;
• Presence of draft comprehensive IT Policy • Absence of health information system and e-health
policies, legislations, regulations and directives
Indicator and data sources:
• A well-defined national core indicator set exists

and defined in standardized manner,
• Limited analysis and use of the core set of HSTP I
• Available disaggregation of data by gender, age
and HMIS indicators
and geographical areas to track equity
• Presence of multiple health data sources (EDHS,
SARA, MIS, STEPs, HIV survey, program evaluations
etc) to validate routine health information system
• Limited utilization of DHIS2 for reporting by
Platforms/apps:
private health facilities
Nearly all public hospitals, health centers and health
• Several digital health applications which lack
administrative units have either online or offline access to
standards, not interoperable and not being used
DHIS2
for the intended purpose
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Strengths Weaknesses
Infrastructure:
• Existence of HealthNet for e-Health Systems, • Insufficient maintenance of ICT equipment

• Implementation of both local and Cloud-based • Shortage of computers, printers, and tablets at
hosting strategies, regional, zonal, woreda and mainly facility levels
• Rehabilitation of datacenter and the soon to-be- • Presence of very few national Innovation Centers/
constructed disaster recovery site (DRC); incubation centers to adapt from;
• Establishment of Innovation and Learning Center
at national level
• Poor data management, analysis, dissemination

and data use culture, limited practice of data
triangulation
• Inadequate information dissemination portals to
Data management and dissemination: communicate achievements and important data
to the public at large;
• Existence of eHealth Architecture • Poor data storage, security and backup system
• Availability of regular ARM report, special bulletin, • Absence of central repository or data warehouse
health and health related indicator booklets. for integrating HIS data sources
• Lack of a well-organized knowledge management
system
• Poor data quality: under and over reporting,
untimely, non-complete data
• Fragmented research coordination, limited

Research capacity: Presence of research institutes (AHRI & prioritization
EPHI) • Absence of national standard and regulatory body
for research projects and clinical trials
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Table 3: Opportunities and Threats Analysis
Opportunities Threats
• Demand for health information: There is growing demand • Donor-driven vertical program
for health-related information • Social unrest (Security issue that limited free
• Basic infrastructure: expansion of basic ICT, and electricity movement to project areas to carry out projects on
infrastructure time
• Expansion of social media use • Delay of census to get updated population data
• Rapidly changing demand for more and detailed • Geographic inaccessibility/difficult landscape which
information by stakeholders limits expansion of ICT and electricity infrastructure
• Increasing mobile users which is an opportunity to apply • Unpredicted epidemic/pandemic which restricts
digital health apps movement to support HIS functions
• Existence of satellite solutions to improve connectivity to • Shortage of hard currency to procure expensive ICT
rural communities equipment
• Existence of remote support systems/ technologies • Unpredictability of foreign resources which could
• Prospect of private/ Telecom Companies to operating impact major initiatives if the tie with the donors
in the country that is expected to expedite the loose
implementation of HealthNet • Brain drain (IT, researchers, M&E, epidemiologist,
• Expanding teaching institutions teaching HITs and health statisticians)
information professionals • Frequent shutdown or interruption of internet
• Institutionalization of vital event registration under • Poor mobile network and internet connectivity in
proclamation (No. 1049/2017) the periphery of the country which limit ehealth
• Presence of open source platforms globally developed interventions
and made available to use with simple customization and • Low coverage, slow rate of electrification and
manageable cost fluctuation of power and outages
• The electronic transaction policy at national level which is • Increased price of ICT materials
nearing endorsement • Every stakeholder may create own software which
• The ongoing proclamation for electronic transition that may end up with non-interoperable applications
will help facilities to exchange transactions, receive
payments, and issue receipts electronically
• Existence of public procurement agency pre-agreed with
suppliers that might shorten the procurement process
• Existence of the global community in charge of upgrading
the global DHIS2 systems with new features
• Increasing options of open source platforms to be opted
for in the Ethiopian HIS
• Information from census and e surveys (EDHS) conducted
by Central Statistics
• Conducive constitutional environment for data access and
sharing
• Presence of a body, Ministry of Information and
Technology ( MInT) and Information Security and
Network Agency ( INSA) to consult digital web security
standardization and other security aspects
• Active engagement of different stakeholders
• Globalization: Increasing partnership with National and
international universities and research institutes
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2.3 Stakeholder analysis
To ensure a successful strategic planning process, sufficient attention must be paid to identifying and categorizing stakeholders. In the context of the health information
system, stakeholders are individuals, groups and organizations who are in a position to influence or place demand, who are affected by or who can affect, who have interest
in the health information system or who can lay claim to the health information system.
Table 2. Stakeholder analysis
Likely reaction and impact if

Name/groups of stake- Their demand/ Expectation/ Why they should be How they Should be
Behaviors/role we Desire expectation is not met/ Resis-
holders interest Engaged Engaged/Engagement strategy
tance Issues)
Reaction - Are the source of primary

- Dissatisfaction, less interest & data on which health actions
- Engagement in planning, - Planning, Implementation &
lack of trust, depend
implementation and - Active engagement in monitoring
- Less engagement and - Are the subjects of the health
monitoring of HIS, planning & monitoring - As member of governance
support information system/digital
- Provide accurate infor- process of HIS structures including as HF
- Exert influence politically health solutions
Public/ Community/ CSO mation during data col- - Access to Quality data & board members
Impact - Understanding needs and
lections assured confidentiality - Consultation and consensus
- Poor HIS design & implemen- engagement is crucial for ef-
- Use of information for - User friendly data use/vi- mechanisms
tation fective and efficient HIS and
action ( Public portal & sualization tools - To test the systems as appli-
- Poor data quality & use, digital services
health messages) cable
limited access to data/infor- - As an expression of social ac-
mation countability
- Planning/joint vision, imple-
- Execution of key gover- - Engagement in planning, mentation, Monitoring and
nance functions implementation, and Reaction Evaluation
- Understanding needs and en-
- Conform to HIS policies, monitoring & evaluation - Dissatisfaction, less interest & - As member of governance
gagement is crucial for effec-
regulations and guide- of HIS poor ownership of HIS structures
MOH staff/directorates, tive and efficient HIS
lines - Properly governing the - Lack of trust in the HIS’s data - Continual updates and secure
Management, Agencies - Have political/regulatory and
- Active engagement in HIS Impact approval/endorsement
and RHBs, WorHOs, resource leverage
planning, implementa- - strong M&E system in - Poor HIS functions - Capacity building/support
Zones and HFs/health - Are implementers of HIS/digi-
tion & monitoring of HIS place - Poorly funded HIS, - Share reports and feedback;
professionals tal health systems
- Production of quality - Access to quality data, - Poor data quality, limited ac- create champions.
- Are sources of use cases
data, timely reporting and use of information cess to data & poor informa- - Engage in Use Cases identifica-
and use of information - User friendliness of tion use tion and prioritization
for informed decision systems - System development/Users
Acceptance Test
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tance Issues)
- Ratification of policies - Timely report, & access to

- Dissatisfaction, less interest - Understanding needs and en-
and legislations quality data
and support and ownership gagement is crucial for effec- - Planning, implementation,
- Active engagement in - Use of information for
Parliament, Prime of HIS tive and efficient HIS Monitoring and Evaluation
planning, requirement policy formulation,
Minister Office, MoF, Plan - Lack of trust in the HIS/data - Have political/ regulatory and - Share the required reports as
for report & use of health resource allocation and
commission - Exert influence politically resource leverage per the plan.
data monitoring, efficient use
- Allocate inadequate budget - Owners of multi-sectoral sys-
- Resource allocation & of budget
for Health tems
timely release of budgets
Reaction
- Support and engagement - Dissatisfaction, less interest - Are sources of popula-
- Conducting surveys, sur-
in surveys/ surveillance/ & lack of trust tion-based, geo-spatial
veillances & researches
research - Less engagement, support sources of data and vital
- Open access to the find- - Planning, Implementation &
CSA, INVEA, universities - Facilitate capacity build- and poor cooperation statistics
ings/data/information monitoring
,research institutions/ ing process Impact - Capacity building (pre- &
- Supports on capacity - As member of governance
research professionals, - Facilitating platform for - Poor HIS design and imple- in-service training, & men-
building activities structures including as HF
Ethiopia Geospatial information dissemina- mentation torship)
- HIS human resource board members
Information Institute tion - * Weak transfer of knowledge - Generation of evidences
development
- Proper use of survey/ and skill through survey/ surveillance
- Innovation and transfer
Surveillance and research - Poor data quality, limited & research
of knowledge
findings access to data and poor
information use
- Clear and realistic
- Responding to queries for - Failure to render timely and
demand
MCIT/ Ethio telecom, infrastructures develop- quality service/ infrastructure - Suppliers of telecom and - Multi-sectoral forums and
- Execution of commit-
Ministry of Water, Irri- ment (for connectivity & - Terminate contracts/agree- electricity services that are close communications
ments
gation and Electricity / power) ments critical to improve data quali- - Share strategic/annual plans
- Efficient, prudent and al-
Ethiopia Electric Utility - Monitor and ensure - Weak digitization of the HIS ty, use and health outcomes Contractual agreement
ternative use of resources
( EEU) the functionality of the - Poor data quality, use and - Strong feedback mechanism
- Constructive feedback to
systems in place health outcomes
improve the services
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tance Issues)
- Adhere to HIS policies, Reaction

legislations, directives - Dissatisfaction, less interest, - Understanding needs and
- Conducive policy and - Planning, implementation,
Private health/digital and guidelines/protocols & lack of trust in HIS & fail to engagement is crucial for
legislative environment Monitoring and Evaluation
sectors (Owners/asso- - Participation and en- cooperate effective and efficient HIS
- Engagement in HIS policy - As member of governance
ciations)/Professional gagement in planning, Impact design, implementation &
documents development structures (NAG, TWGs)
associations (Health, implementation and - Poor HIS Planning, imple- monitoring
- Engagement in HIS plan- - Public-Private partnership and
Health Informatics, IT, monitoring of HIS/Digital mentation & monitoring - Contribute to substantial
ning, implementation & engagement platform;
Computer Science ...etc )/ health, - Fragmented and duplicated health data
monitoring - Ensure deliberate participation
Health-related business- - Contribute in the digital efforts - As an expression of social
- Access to quality data of the private sector/associa-
es; Suppliers and vendors health endeavors - Using unstandardized accountability
- Technical support and tion in key initiatives.
- Submission of quality systems - Providers for digital health
guidance
data & timely reports - Poor data quality, access and infrastructure and solutions.
- Use of information use
Reaction
- Dissatisfaction, less interest,
- Conducive policy and & lack of trust in HIS - Planning, implementation,
- Conform to HIS policies,
legislative environment - Refused to donate resources Monitoring and Evaluation
legislations, directives
- Engagement in HIS plan- and fail to cooperate with the - As member of governance
and guidelines/protocols - Understanding needs and
ning, implementation, sector structures (HIS steering
- Active engagement in HIS engagement is crucial for
monitoring & evaluation Impact committee, NAG, TWGs,
Development partners/ design functionality of HIS
- Access to quality data, - Poor HIS design, implemen- Partners’ forum/ joint review
donors, Implementing - Provide technical and/or - Have great contributions in
timely responses for their tation & monitoring forums)
partners, NGOs FBOs financial support trans- resource allocation (techni-
queries & guidance - Fragmented and duplicated - Share with strategic plan
parently cal. Materials and financial
- Use of information for efforts documents/priority areas of
- Bring innovations and supports)
policy formulation, - Shortage of resources investment
best experiences
resource allocation, and - Using unstandardized - provide regular performance
- Quality & timely reports
efficient use of budgets systems reports and get feedback
- Poor data quality, access and
use
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tance Issues)
- HIS human resource devel-

Reaction
opment and management
Others( Civil Service - Technical support & - Develop sector demand - Less interest and fail to coop- - Planning, Implementation &
and guidance during plan-
Commission, Ministry Guidance in HR for HIS erate/support monitoring
ning and monitoring
of Science & Higher - Include health informa- - Enlist health informa- Impact - Review of health researches
- HIT infrastructure and infor-
Education ( MoSHE), tion/digital health in their tion related issues to - Ineffective & inefficient HIS - As member of HIS governance
mation security
Information Security and policies, legal frame- be incorporated in the structure structures
- For guidance on health
Network Agency ( INSA) works, guidelines, plans polices, legal frameworks, - Weak transfer of knowledge - Consult in the course of the im-
research ethics
and Ministry of innova- and operations guidelines and plans and skill plementation of key initiatives.
- umbrella
tion and Technology ( - Innovation and skill - Access to quality data, - Poor data quality, insecure - share bigger initiatives/agen-
- For policies and procedures
MInT) transfer constructive feedback data, limited access to data das
for technology implemen-
and poor information use
tation, standards and security
- Establish good relationships
with the available insurance
- Termination of contracts - Own resources and insurance companies
Insurance companies - Confirm to agreements - Confirm to agreements
- Legal measures coverage expertise - Get insurance coverage for
mega digital health invest-
ments.
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CHAPTER 3: OBJECTIVES AND STRATEGIC DIRECTIONS
3.1. Vision, Mission
Vision
To see a healthy, productive and prosperous society through evidence- based decision-making.
Mission
To ensure evidence-based decision making through improving and promoting access to and use of quality data at
all levels of the health system by nurturing digital health information technologies, mobilizing adequate resources
and improving management of the health information system.
3.2. Objectives
The overall goal of this strategic plan is to improve health service coverage, quality, equity and health outcomes by
enhancing evidence-based decision-making.
To realize this goal, the HIS strategic plan comprises the following objectives:
1. Enhance evidence-based decision making

2. Enhance the use of digital health information technologies
3. Enhance HIS governance
Description of objectives
1. Enhance evidence-based decision making
This objective focuses on improving evidence-based decision making at individual, households, communities and
all levels of the health system through generating, sharing, analysis, synthesis, dissemination and use of quality
data with effective utilization of the existing and newly introduced digital solutions. It promotes use of data from
institution and population-based data sources that comprises census, civil registration and vital statistics (CRVS),
surveys, facility based assessments, surveillance, routine health information systems (RHIS), research, and other
systems.
It also focuses on enhancing the data demand through intensive capacity building, improving data access and
visibility. More efforts will be exerted to bring behavioral (knowledge, skills and attitudes) changes among health
workers and managers at all levels in data management and use, change their mindset to value data and adhere
to making informed decisions that enhance information use culture for continuous improvement.
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2. Enhance the use of digital health information technologies
This objective intends to select, develop, pilot, and scale up digital solutions for HIS using the opportunity of
technology advancement, which includes applications to record, analyze, visualize, share, report, and store health
data. It also focuses on ensuring the integration and interoperability of different digital solutions in HIS to improve
their functionalities, better data exchange and usability.
In summary, this objective entails the standardization, development/upgrading, and utilization of different
digital solutions for HIS (client and aggregate levels), ensure integration and interoperability of diverse eHealth
information subsystems, assure ICT infrastructure; and establish HIS application administration, management
and support.
3. Enhance HIS governance
This objective is aimed to strengthen the HIS leadership and governance to maximize its efforts to lead, manage
and coordinate HIS activities. HIS governance will carry out mandates based on the levels of the health institutions
where the roles and responsibilities vary from level to level in the health sector. It includes strengthening HIS
structures, governance frameworks, HIS policies, legislations and accountability mechanisms.
3.3. Targets
The targets are set for HIS outcomes and selected HIS outputs, processes and inputs considering available baseline,
previous trends, national and international standards, anticipated availability of resources and technical capacity.
Expert opinion and wider consultation with stakeholders was used during the target setting process. The targets
are set for the year EFY 2017 (2024/25). The performance of the HIS strategic plan will be measured against these
targets.
Improve culture of information use
1. Increase information use index from 52.5% to 85%

2. Increase proportion of health institutions that have functional PMT to 100%
3. Increase proportion of RHBs which conduct HIS specific review meetings at least once per year from
64% to 100%
4. Increase proportion of administrative health units (RHBs/ZHDs/WorHOs) that have health sector
strategic plan to 100%
Improve Routine Data Management and Quality
5. Increase percent of service delivery reports received on time from 65% to 96% (public health
facilities)
6. Increase percent of service delivery report completeness of public health facilities from 89% to 98%
7. Increase percent of disease report timeliness from 56% to 90% (public health facilities)
8. Increase percent of disease report completeness of public health facilities from 85% to 95%
9. Increase percent of reporting completeness of private health facilities from 27% to 80%
10. Decrease ratio of HMIS to EDHS data of SBA from 1.6 to 0.9-1.1
11. Proportion of health facilities met data verification within 10% range for SBA (from 89% to 95%)
12. Increase proportion of health facilities which conduct LQAS from 48% to 100%
13. Increase proportion of WorHOs/Sub-city Health office which conducted data verification aspects of
Routine Data quality assessments (RDQA) at least biannually from 35% to 95%
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14. Increase proportion of RHBs that conducted comprehensive Routine Data quality assessments
(RDQA) at least annually to 100%.
Nurturing digitalization for data management and use
15. Increase proportion of public health institutions that implement DHIS-2 from 95% to 100%
16. Increase proportion of private health facilities that implement DHIS 2 from 1% to 25%
17. Increase proportion of health facilities which have been inspected and their signature and service
domain data updated within the previous one year to 75%
18. Increase proportion of administrative health units that implement iHRIS to 100%
19. Increase proportion of health posts that implement comprehensive agrarian eCHIS (all eCHIS
targeted modules) to 50%
20. Increase proportion of public health facilities implemented HCMIS/Dagu from 7.5% to 87.5%
21. Increase the proportion of regional laboratories, hospitals and health centers that implement
Laboratory Information System (LIS) to 100%, 75% and 40% respectively
22. Increase proportion of public health facilities implemented “Electronic Public Health Emergency
Monitoring System (ePHEMS) using DHIS2 to 60%
23. Increase proportion of health administrative units implemented “Electronic Public Health
Emergency Monitoring System (ePHEMS) using DHIS2 to 80%
24. Increase of number of NHDD domains fully developed and institutionalized from 2 to 5
25. Increase the proportion of digital health applications having messaging standards from 0% to 40%.
26. Increase number of applications/sub-systems which are interoperable to 6
27. Increase Electronic Vein-to-Vein Reporting Tool (eVVRT) reporting completeness of regional/branch
blood banks from 50 % to 100%
28. Increase Blood Safety Information System (BSIS) coverage/access from 2.3% to 100% (from 1 to 43
blood banks)
29. Increase the proportion of public hospitals implementing the Emergency and Referral information
System (eRefIS) system to 100%.
30. Increase the proportion of WoHOs that implemented eMRIS to 100%
31. Increase proportion of CBHI schemes implementing digitized health insurance systems to 40%
32. Increase number of Federal and regional EFDA branches which use i-license from 1 to 13
Improve HIS Infrastructure
33. Increase the proportion of health facilities (health centers and hospitals) with Medical Record units
fulfilling minimum room area/space from 60%to 100%
34. Increase proportion of health facilities (Hospitals and health centers) that have connectivity via
HealthNet from 65% to 95%
35. Increase proportion of health facilities that have LAN connectivity 28% to 70%
Strengthen vital statistics, Surveillance, Survey, Research and innovation
36. Increase the number of technical reports produced from 191 to 300
37. Increase the number of publications produced in peer reviewed journals from 554 to 718
38. Increase the number of articles presented in scientific conferences from 5 to 65
39. Increase the number of policy briefs prepared and submitted to 30
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40. Increase the percentage of births notified from 35% to 80% of all births
41. Increase the percentage of deaths notified from 3.4% to 35% of all deaths
42. Increase the proportion of community deaths with causes of death notified (from 0 to 20%)
43. Number of research conducted on top HIS priority areas (at least three implementation research
conducted annually))
Improve HIS Financing
44. Increase proportion of budget allocated to HIS (from the total health budget) from 4.3% to 5%
Improve HIS health workforce
45. Proportion of health institutions with adequate number of HIS health workforce from 5% to 70%
46. Increase health workers HIS core competency index from 77% to 85%
Improve HIS Governance
47. Increase HIS Governance Index from 26% to 80%

48. Increase proportion of functional HIS governance structures at national & regional levels to 100%
3.4. Strategic Directions

Strategic directions are interventions or initiatives that will be implemented to achieve the objectives of the HIS
strategic plan. There are eight strategic directions identified along with their major activities.
1. Improve culture of information use

2. Improve routine Data management and quality
3. Nurture digitalization for data management and use
4. Improve HIS Infrastructure
5. Strengthen vital statistics, Surveillance, Survey, Research and innovation
6. Improve HIS financing
7. Improve HIS capacity of Health Workforce
8. Improve HIS governance
SD1. Improve culture of information use
Description
Information use culture is reflected in an organization’s and individual’s values, norms, and practices with regard to
the management and use of information for decision-making. This direction is about improving the dissemination
and use of information from institution and population-based data for decision-making.
Strong data use culture results when an organization believes in continuous improvement and regularly puts that
belief into practice. Data use promotes and advocates the culture of generating quality data, ensuring transmission,
analysis and synthesis of data from multiple data sources for monitoring and evaluation, and research to improve
access, quality and equity of health services. Hence, increasing use of data leads to improving its quality, which in
turn leads to increasing information use. Similarly, access to data is among the factors that affect the usability of
data generated through a given system. Access to data also creates accountability and transparency among the
actors.
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In general, this direction focuses on enhancing data access, visibility and information use culture through intensive
capacity building, creating suitable data access points and establishing a strong knowledge management system
at all levels.
Strategic initiatives and Major activities
SI1: Ensure the core competencies in data management and use through intensive capacity building using
different approaches and educative platforms
o Strengthen capacity development approaches (in-service) for data use core competencies
o Engage Local Universities and other stakeholders on HIS capacity building program
• Provide capacity building training on advanced data management techniques on data mining/
data science, Machine Learning ( ML)/Artificial Intelligence ( AL), big data analytics, and interactive
data visualization tools
SI2: Strengthen the system of data storage, access, analysis, synthesis and communication
o Establish a national data warehouse with clear roadmap and store data from different research,
surveillance, survey and other sources into a central data repository
o Advance health data analytics, modeling, forecasting, integrated analysis, heterogeneous and
geospatial analysis through development and application of advanced statistical , mathematical,
data mining and visualization methods and tools
o Maximize the use and utilization of local health datasets through guidelines for applying advanced
health data analytics methods.
o Enhance the use of different information communication and dissemination platforms /mediums
such as websites, social media, call centers, e-news...etc.
SI3: Strengthen policy analysis and formulation
o Generation and translation of evidence to policy and action by triangulating data from routine,
survey, surveillance, and research
o Create forums that translate evidence to policy at national and regional levels
o Enhance policy analysis and develop briefs/issues
SI4: Revitalize the IR model health institution strategy
o Revisit the strategy, tools and road map for “IR Model Institutions’
o Ensure coordination and ownership of IR model Institution strategy at all levels
o Strengthen CBMP project implementation
o Strengthen database to track and monitor the IR-model institution performances
SI5: Ensure the availability of measurement metrics, and strengthen planning, monitoring and evaluation
o Develop comprehensive M&E plan for Health Sector Transformation Plan
o Enhance the use of composite index to measure data quality, data use, HIS governance and other
measurements in more rounded way
o Strengthen preparation of Strategic and Woreda-based health sector planning
o Enhance the standardization and implementation of sector-wide, program and HIS specific review
meetings
o Strengthen the functions of Performance Monitoring Team (PMT) at all levels
o Strengthen other data use platforms and forums at all levels
SI6: Strengthen HIS Knowledge Management system
• Strengthen learning and knowledge management system at national and subnational levels
• Ensure availability of updated knowledge management roadmap
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• Strengthen the use of ICT/ online collaboration application to create an online repository at all
levels
• Strengthen/Create Center of excellence universities, health administrative units and health
facilities/Strengthen and/or expand learning academies for different health information
subsystems
• Strengthen the documentation of best practices, success stories and lessons learnt
• Promote experience sharing between facilities/health institutions
• Ensure a functional coordination mechanism to use KM effectively for informed decision-making.
• Integrate knowledge management concepts in the HIS pre-and in-service trainings
SD2. Improve Routine Data Management and Quality
This direction is about fulfilling the prerequisites and ensuring data quality to enable data use for appropriate
decision-making. Prerequisites for HMIS implementation include adequate logistic supplies, standardization
of indicators, recording and reporting tools and procedures. Fulfilling these basic requirements, having clear
definition of indicators and standardization of the tools is a bare minimum prerequisite for the day-to-day HIS
related operations of the health institutions.
It also focuses on ensuring standardization and continuous and/or periodical data quality assessments based
on the types of techniques. Different data quality dimensions and assessment tools will be used to monitor the
quality of data at health facilities, health administrative units and community levels. Improvement in data quality
is expected to increase confidence in the use of the data and vice versa. Therefore, decisions based on quality data
are eventually linked to improved access, quality and equity of service delivery.
SI7: Strengthen routine data collection and aggregation through fulfilling prerequisites, sustaining logistic supply
and ensuring standards
• Strengthen HMIS implementation in all health facilities including private and uniformed Services health
Facilities
• Strengthen Community Health Information System ( CHIS) implementation with emphasis to urban and
pastoralist CHIS
• Standardize core HIS indicators based on HSTP II and in line with Sustainable Development Goals
(SDGs) and UHC and ensure manageable and usable number of indicators needed for the health sector
performance monitoring
• Standardize HMIS/CHIS recording and reporting tools and Procedures
• Standardize paper-based LIS data capturing and reporting at all levels of the lab system
• Standardize and enhance the use of paper-based blood Safety Information System
• Scale up the implementation of paper-based LIS
• Ensure sustainable supply of HMIS/CHIS tools including by ensuring the capacity of regions to take over
and own the quantification and printing of recording and reporting tools
SI8: Enhance Data quality improvement strategies and interventions
• Establish/ Strengthen a mechanism of HIS workforce and health care providers capacity building on
data management and quality assurance
• Improve comprehensive implementation of data quality assurance mechanisms ( LQAS, RDQA, DQR,
PRISM, community data verification mechanisms, Desk review)
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• Enhance Design and implement behavioral change interventions through national movement against
data falsification and other mechanisms
• Enhance validation rules and other data quality tools in digital platforms such as DHIS2
• Enhance data quality feedback mechanisms
SD3. Nurture digitalization for data management and use
Description
This direction focuses on selection, development, operation and management of digital solutions for the health
information system. The health sector has been benefiting a lot from digital solutions and further needs to harness
the rapidly growing technologies in responding to the increasing demand of stakeholders for access to information
and digitizing data management and use. Different digital solutions will be developed/customized, tested and
scaled upon priority health information subsystems.
This direction focuses on creating a harmonized system that aims to support integration and standardization of
digital health information systems through designing digital technologies, standards, and procedures that enable
HIS subsystems to be interoperable. This will be achieved through the development and implementation of
national eHealth Architecture principles, schemes and standards.
To this end, the developed digital systems should be properly operated and managed to attain the intended
objectives. Effective Digitization operations management ensures the availability, efficiency and effective
performance of health information subsystems. In general, this direction is about enhancing the process of ideation,
evaluation, selection, development and deployment of new or improved digital solutions and management
systems through enhancing standardization and integration.
SI9: Enhance Electronic Health Records (EHR) to provide decision support to healthcare professionals in respect of the
rendering of healthcare services to an individual patient and accommodate data exchange
• Develop and implement EHR-core, a component of EHR which contains clinical information
• Integrate disparate systems (stand-alone digital health solutions such as eAPTs, eLIS, MFR, DHIS2, eCHIS,
etc.) with EHR-core systems
SI10: Strengthen Health information dissemination & feedback receiving mechanisms through Web portals,
e-News, Digital Notice Board and Social Media.
• Strengthen the customization and use of the digital media initiatives (social media, e-News,
blogs, Web Portals, etc…) that promote information exchange (dissemination and feedback) in
a bid to healthy behavior at all levels.
• Establish digital information board (notice board, satisfaction rating and queue management)
to promote health services at national, regional and facility level
SI11: Enhance/ Strengthen Electronic Community Health Information System (eCHIS)
• Strengthen the design and development of existing and new eCHIS modules based on the selected
programs
• Scale up the implementation of eCHIS modules at all health posts.
• Integrate eCHIS with other relevant systems (Such as MFR and DHIS2).
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SI12: Enhance electronic Laboratory Information System (eLIS)
• Develop/customize and implement a Laboratory Information System (eLIS) at Regional
Laboratory and public health facilities
• Scale up the implementation of eLIS
• Integrate eLIS with other relevant systems (such as EHR and MFR).
SI13: Establish Electronic Auditable Pharmaceutical Transaction System (eAPTS)
• Strengthen the design/development and implementation of the eAPTS system at all public hospitals and
health centers
• Integrate eAPTS with other relevant systems (Such as eLMIS, EHR, eMPL and MFR)
SI14: Strengthen the District Health Information System version II (DHIS2) platform to plan, monitor and support
evidence- based healthcare and decision-making.
• Upgrade DHIS2 and optimize its features
• Integrate DHIS2 with other systems (Such as MFR, eCHIS, multi-sectoral nutrition, ePHEM and
others).
• Develop and implement a platform for Multi-sectoral Woreda Transformation data entry and
performance management.
SI15: Enhance Electronic Health Commodity Management Information (HCMIS) that ensures essential health
commodities availability and visibility into all functions of the supply chain, such as procurement, warehousing,
inventory, distribution, funding, and policy.
• Strengthen the development and implementation of existing eLMIS components such as

Dagu, VTAS, mBrana and Electronic Medical Equipment Management System (eMEMS) at
health facility stores, EPSA hubs and warehouses
• Integrate HCMIS with other systems (Such as DHIS2 and MFR)
• Develop and implement Enterprise Resource Planning ( ERP) system at central warehouse and
hubs to provide automated interactions and common sources of data
• Integrate ERP and HCMIS/Dagu of health facilities
SI16: Enhance electronic integrated Human Resource Information System (i-HRIS) for HRH administration,
development and health professional licensing.
• Develop/customize an integrated human resource information system to manage HR administration,

development and health professional licensing.
• Implement integrated human resource information system (iHRIS) at all public health institutions (MoH,
RHBs, ZHDs, Woreda Health Offices, hospitals, and agencies)
• Customize and implement the WHO National Health Works Account (NHWA)
• Integrate iHRIS with other systems (Such as DHIS2, NHWA, EHR, eCHIS, MFR)
SI17: Enhance electronic Regulatory Information Systems (eRIS) for regulation of food, medicine, medical devices
and other regulated products
• Expand the eRIS to all functions of the regulatory systems

• Cascade the regulatory information system to branch, region and woreda level
• Enhance/upgrade software/technology of eRIS
• Integration of eRIS with transactional systems
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SI18: Establish Electronic Public Health Emergency Monitoring System (ePHEMS) to enable disease prevention,
surveillance, detection, response, reporting, and control.
• Develop and implement an eSurveillance system for PHEM supporting both aggregate and case-based
surveillance.
• Develop and implement an Early Warning System (EWS) that collects information on epidemic-prone
diseases in order to trigger prompt public health interventions.
• Integrate the eSurveillance and EWS with other systems (MFR, DHIS2)
SI19: Enhance Electronic Referral Information System (eRefIS) to ensure improvements to follow-up care coordination
by the creation of accurate and timely referrals
• Strengthen development and implementation of eRefIS.

• Integrate Electronic Referral Management System with other relevant systems (Such as MPI, EHR and
MFR).
SI20: Establish Electronic Emergency Medical Service (eEMS) Management System to administer medical emergency
responses.
• Develop/customize Ambulance Dispatching System(ADS)

• Establish Emergency call center
• Implement eEMS
• Integrate eEMS with eRefIS, EHR, MFR.
SI21: Establish/Enhance comprehensive health facility, client, clinical coding and other registries with complete and
current information that meets stakeholders’ needs.
• Strengthen the development and implementation of Master Facility Registry (MFR) at WHO, ZHD, RHB
and MoH
• Strengthen the development and implementation of National Health Data Dictionary (NHDD)
• Develop and implement Master Patient Index (MPI) at national level
• Develop and implement GIS repository for location mapping
• Develop and implement Shared Health Record (SHR) at national level
SI22: Establish a data warehouse to foster and support research, analytics and more highly informed decision making
by health system managers and other stakeholders on health sector resources.
• Develop roadmap to ensure a functional data warehouse

• Develop and implement data warehouse at national levels in alignment with the national digital health
platform
• Integrate Data Warehouse with other digital health solutions as required.
SI23: Enhance electronic financial management system to ensure effective collection, allocation and use of health
financial resources at all levels in accordance with health plan priorities.
• Develop/Customize electronic financial management system (eFMS) supporting collection, allocation

and administration of health financial resources.
• Enhance digitized health insurance system
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• Establish Electronic Reimbursement and Procurement Management System
• Integrate eFMS with IFMIS and other systems for budgeting and financing
SI24: Establish an Enterprise Resource Planning (ERP) system that can integrate major processes into single system
This initiative targets the customization & promotion of paper free service provisioning environments & enhanced
helpdesk system to handle operational support for client service requests.
• Customize and Implement eSurvey system

• Customize and Implement Help Desk system
• Customize and Implement planning system
• Customize and Implement Fleet management system,
• Customize and Implement Project Management System
• Customize and Implement eAdministration system (like Document Management System)
• Customize and Implement eService system(both for internal and external)
SI25: Establish digital health standards for data, application, security and technology for information exchange and
protection.
• Establish standards and guidelines for digital health solutions & services (such as EHR, eCHIS, DHIS2…etc)
that can guide the minimum requirements needed to be fulfilled.
• Establish security standards and guidelines for data access, storage, processing, information exchange,
and sharing.
SI26: Develop and Implement interoperability solutions for data exchange among digital health solutions and other
external systems
• Develop and Implement interoperability solutions for Prioritized applications

• Strengthen interoperability across different systems within health and other sectors using/implementing
suitable information exchange tools (implementing Digital Health Platform).
SI27: Enhance blood Safety Information System (BSIS)
• Scale-up the BSIS to all blood banks and collection centers

• Strengthen the capacity of key stakeholders on BSIS
SI28. Enhance electronic Multi-Sectoral Response Information System (eMRIS) to strengthen the data management
on non-clinical HIV/AIDS prevention, control activities, and enhance information use at all health administrative
levels.
• Develop and Implement eMRIS at Health Administrative level using DHIS2 platform
• Integrate eMRIS with DHIS2 platform
SD4. Improve HIS Infrastructure and logistic
Description
This direction intends to advance the health information system through building and administering different
digital health technologies and related infrastructures that are required to operationalize and manage the health
system. ICT infrastructure is a foundation for HIS system that consists of physical and virtual resources supporting
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the flow, storage, processing and analysis of data. These infrastructures will be established centrally within MOH
and sub nationally decentralized and spread across several data centers that will be managed by RHBs and
Agencies. It also includes the communication and networking infrastructures for digital data access and/or device
sharing.
SI29: Strengthen the availability and expansion of ICT infrastructure

o Ensure the availability of computers, tablets, UPS and other ICT accessories
o Ensure the availability of networks/connectivity (such as LAN and HealthNet/WAN) at all health
institutions
o Expand/upgrade the data center to accommodate the growing need
o Enhance continuous and optimal functioning of servers at national and levels sub-national levels
o Enhance system hosting using local and cloud hosting as applicable based on hosting parameters
SI30: Ensure that all health facilities have standard MRU, shelves and HMIS office equipment
o Establish standardize MRU for all facilities
o Fulfilling equipment to the health facilities based on the MRU standards
o Fulfilling office equipment to the administrative units( HMIS )
SD5. Strengthening vital statistics, Surveillance, Survey and Research
This direction emphasizes on strengthening the generation, availability and accessibility of health data from
different sources other than routine health data. It includes vital statistics, surveillance, surveys and research
through inter-agencies and multi-sectoral collaborative approaches that will satisfy the data demand of the health
sector and key stakeholders and maximize information utilization for the improvement of health care delivery.
Strengthening notification and registration of births and deaths will contribute to the improvement of birth and
death reporting coverage, analysis and use of vital statistics. Similarly, surveillance data management focuses on
the collection, management, analysis and use of data from surveillance of diseases and health related conditions.
Health research and survey is also among critically important health data sources that involve different population
and facility-based surveys. Ethiopian Public Health Institute (EPHI), Armauer Hansen Research Institute (AHRI),
universities, MOH and other stakeholders conduct basic and operational research. Thus, this direction deals with
coordinating the efforts of different stakeholders, resources mobilization and facilitating surveys and research as
well as enabling the utilization of findings at all levels in the health sector.
SI31: Strengthen Civil Registration and Vital statistics system focusing on the mandate of the health sector that
include birth and death notification
o Develop and implement CRVS training and verbal autopsy guideline

o Strengthen birth and death notification system at health facilities
o Initiate and expand implementation of community based birth, death and cause of death notification
system
o Establish and implement a data generation system on community cause of death
o Integrate the unique identifier need of the health sector with the effort of INVEA
SI32: Strengthen diseases Surveillance data management and use to enable forecasting, early response and proper
management of diseases and health conditions
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o Expand and strengthen Health and demographic surveillance sites
o Strengthen synthesis, reports and dissemination of the findings for policy, program and practice
recommendations
o Strengthen surveillance of maternal and perinatal deaths
o Introduce reporting of adverse effects after immunization/medications surveillance data
integrated into existing reporting systems
o Establish and strengthen disease registries and Surveillance on NCDs and their risk factors
o Strength public health emergency information management system including the establishment
a real-time and digital surveillance system
SI33: Strengthen health Research and Surveys
● Strengthen research governing bodies ( institutional editorial board, Establish national Health
research council ,Scientific advisory board, community board…etc)
● Develop national public health research priority and evidence synthesis roadmap
● Strengthen research agenda setting, prioritization of research, resources mobilization and
coordinating
● Enhance capacity building on triangulation of health researches with other sources of data
and translation of research to practice with emphasis to regional and lower level structures
● Synthesize evidence-based information (Policy issue/ briefs) to contribute for policy, program
and practice change or improvement
● Strengthen capacity on the use of and strengthen medical research training
● Strengthen Biomedical research, clinical trials, medical biotechnology and Epidemiological
studies
● Strengthen operational researches, translational and implementation science researches
● Strengthen Health Technology Assessment (HTA) mechanism for HIS
● Strength research laboratories to promote medical research
● Strengthen population-based surveys such as DHS to produce sub-regional level estimates
● Institute incentive mechanisms to promote research
● Enhance publication of health researchers in reputable journals, evidence dissemination,
scientific workshop, and congress
● Track, verify, and measure the use of evidence for decision, policy framework, and public
health practice;
● Advocate policy makers and other stakeholders for uptake of scientific evidence for decision
making
● Advocate for the establishment of research-industry links (linked to companies for scale
implementation) to improve uptake of new/improved technologies.
● Strengthen community engagement through community advisory board/community leaders
and public wing in problem identification, resource mobilization, planning, implementation,
research finding dissemination and uptake
● Enhance health research database
SD6. Improve HIS financing
This direction is about ensuring adequate and sustainable finance for the health information system. It aims at
increasing adequate resources through resource mobilization and proper allocation as well as ensuring efficient
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resource utilization, timely liquidation, tracking and controlling of HIS resources. It also focuses on monitoring
program implementation in terms of cost-effectiveness to ensure accountability. This will contribute to enhancing
equitable HIS resource allocation, improvements in HIS resource absorptive capacity and efficiency of the health
information system. Partner mapping and resource mobilization is expected to be integrated with the annual and
strategic planning cycles of the health sector at all levels. For tracking expenditure and liquidation, the engagement
of the finance and admin units is highly essential.
SI34: Enhance coordination and collaboration to mobilize adequate HIS resources at all levels
● Strengthen HIS partnership and resource mapping and resource mobilization

● Coordinate investments across donors and technical and financial support of implementation
partners to maximize alignment and reduce duplication
● Strengthen evidence- based advocacy to increase HIS budget allocation
● Design and implement innovative financing strategies for HIS
SI35: Enhance efficient use of resources
● Strengthen proper and efficient utilization of resources

● Strengthen system to monitor and evaluate HIS investment and resource utilization
● Strengthen timely liquidation and accountability mechanisms
SD7. Improve HIS capacity of Health Workforce
Description:
This direction focuses on equipping the HIS workforce with appropriate skill mix, competency and adequate
numbers. It involves endorsement and implementation of HIS HRH road map, appropriate curriculum that
reflects the needs of the health system, strengthening HIS health workforce structure at all levels, facilitating
continuous capacity building process, deployment of motivation and retention mechanisms. It also focuses on
close monitoring of the HIS workforce using iHRIS. Continuous capacity building will focus on both pre-service
and in-service modalities through training, mentorship, supervision; experience sharing, Continuous Professional
development (CPD) and knowledge management practices.
This strategic direction also gives adequate emphasis to enhance health care workers’ capacity for good record
keeping, data analysis and use, and timely reporting to the appropriate channel. It aims to create ownership at
all levels and enable to maintain data quality and persistent information use through intensive capacity building,
which will also narrow understanding gaps among HIS professionals, health managers, programmers and health
care providers.
In doing these, there will be competent, motivated, accountable and empowered HIS workforce and health care
workers that will improve HIS functions and performances at each level of the health system.
SI36: Ensure the deployment of adequate HIS workforce in numbers, skills, and distribution to run all the HIS
functions
• Revise/endorse the HIS HR roadmap for HIS under the National Human Resource Roadmap
for Health
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• Ensure the deployment of HIS workforce with required numbers and professional mix at all
levels
SI37: Enhance the capacity of HIS staff and health care providers at all levels to capture data, manage and use
for evidence- based decision
• Revise/update HIS training curricula (for pre and in-service)

• Mainstream data management and use in all health professional training curriculum
• Initiate Continuous Professional Development ( CPD) on HIS
• Strengthen mechanisms to improve digital literacy of health care workers
• Enhance supervision and mentorship mechanisms at all levels
SD8. Improve HIS Governance
Description:
This direction focuses on the development and/or revision of HIS policy, strategies, legislation and regulatory
documents that will enforce the functionality of the health system and enhance standardization, integration,
legitimacy, data security and confidentiality. It also focuses on the preparation, revision, finalization and
endorsement of HIS governance framework at national and regional levels, and strengthening harmonization and
alignment among stakeholders.
This direction will result in ensuring a unified HIS implementation through proper functioning of HIS governance
structures, inclusive engagement of HIS stakeholders in a well-coordinated manner and clearly defined roles and
responsibilities of the parties.
SI38: Ensure functionality of the HIS governance’s structure

• Ensure existence of up-to-date HIS governance framework at national and regional level
• Strengthen HIS governance at all levels with due emphasis on lower structures.
SI39: Ensure the availability of governance documents and enforcement mechanisms
• Support the finalization of the health act to ensure adequate HIS related provisions
• Revise and implement health harmonization and alignment manual (HHM)
• Develop/revise and implement HIS policy, e-health policy, ICT policy and strategy, Strategic Plans,
HR roadmap for HIS
• Finalize and implement the data access and sharing document ( guideline, directive)
• Ensure the availability and implementation of Cyber security protocol
• Ensure existence and implementation of standards/guideline/protocols: MFR, NHDD, EMR, eHA,
interoperability standards and others
• Strengthen the monitoring and support mechanisms to finalize and endorse governance
documents
SI40: Enhance accountability to improve data quality and information use
• Develop and implement accountability framework/mechanism

• Design and implement staff retention and motivation mechanism
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CHAPTER 4: COSTING
Costing Methodology
The Cost of HIS strategic plan was prepared using the One Health Tool (OHT). OneHealth is a tool that is used
to inform the development of strategic plans for health sector planning. The OneHealth tool provides a unified
framework to strengthen integrated planning. It is used for health planning, costing and budgeting with a focus
on integrating planning and strengthening health systems. The tool is organized in three components and one of
which is the health system. The OHT also helps to identify the resource requirements, training, supplies and other
aspects of health system management. The health information system was incorporated as a separate module
under the health system and the required inputs were provided to reach the projection. Of the two scenarios
available, the “functional domains” rather than the “HIS dimensions” were used for the costing.
The HIS cost using functional domain estimate is based on the key assumptions that basic infrastructure and
minimum required HIS related staffs are all in place. National protocols/guideline and expert opinion were used
during the costing exercise.
Cost estimation
The total estimated cost of the HIS strategic plan for the five years (2020/21 – 2024/25) is 1.28 Billion USD. The
average yearly total estimated cost is around 256 million USD per year.
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Table 3: Total cost of HIS by Strategic Direction (USD)
No Strategic Directions 2020/21 2021/22 2022/23 2023/24 2024/25 Total
1 Information use 83,201,645 83,820,444 86,020,801 86,487,518 86,739,562 426,269,970
Improve Routine Data Man-

2 23,987,390 24,517,085 19,999,764 20,305,510 19,643,861 108,453,610
agement and Quality
Nurture digitalization for data

3 81,927,630 58,717,112 11,883,267 6,597,113 7,629,792 166,754,914
management and use
Improve HIS Infrastructure

4 27,130,690 32,274,356 32,647,337 32,095,847 32,605,126 156,753,356
and logistic
Strengthening vital statistics,
5 Surveillance, Survey and 30,148,113 30,952,634 31,284,283 32,005,428 33,325,420 157,715,878
Research
Improve HIS capacity of
6 18,088,771 25,290,893 23,911,831 23,863,578 24,518,762 115,673,835
Health Workforce
7 Improve HIS Governance 2,658,204 819,480 0 0 0 3,477,684
8 Program management 16,369,006 19,364,116 41,307,324 43,266,897 25,007,606 145,314,949

Total 283,511,449 275,756,120 247,054,607 244,621,891 229,470,129 1,280,414,196
The Share of HIS from the total HSTP-II cost is 6% and 4.6% for low and high case scenarios respectively. The
average share of HIS, 6.6%, is high at the early periods of HSTP II period, which decreases to 4.6% at the end is due
to ICT infrastructure, digital app development and HMIS revision related investments early in the HSTP II period.
The average per capita HIS cost is 2.44 USD, which is well above a global estimate.
Table 4: Total cost (USD in Million) and Per Capita Expenditure
Year 2020/21 2021/22 2022/23 2023/24 2024/25
Grand Total in USD (Million) 283.5 275.8 247.1 224.6 229.5

Share of HIS from HSTP II (%) 7.5 6.9 5.5 5.3 4.6
Per Capita of HIS per year 2.81 2.68 2.35 2.28 2.10
As depicted in the figure below, the share of information use related cost, 33.3% is the highest among all the
eight strategic direction costs.
Figure 1: Proportion of the total cost by Strategic Direction
0.3
11.3
9.0 33.3
12.4
12.2 8.5
13.0
Information use Routine Data Management and Quality

Digitalization for data management and use HIS Infrastructure and logistic
Vital statistics, Surveillance, Survey and Research Improve HIS capacity of Health Workforce
HIS Governance Program management
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CHAPTER 5: IMPLEMENTATION ARRANGEMENTS
The implementation arrangements of the HIS strategic plan are strategies that facilitate and serve as driving
factors to attain the objectives of this strategic plan. There are six major implementation arrangements identified
that aren’t mutually exclusive, but complement each other with synergistic effects in achieving the advancement
of health data management, information use culture, data visibility and access at all levels in the health sector.
These are:
• Information Revolution: Model health institution Strategy

• Capacity Building and Mentorship Program (CBMP)
• Instituting Innovation scheme and Centre of Excellence (IICE)
• Strengthen harmonization and collaboration
• Integration of efforts
• Advocacy, communication and culture for HIS
1.1 Information Revolution : Model Health Institution Strategy
An IR Model Woreda or facility strategy is a strategy that has been started in HSTP I (with a previous name “connected
Woreda strategy’) and continued to be implemented during HSTP II as information revolution is still among the
five transformation agendas (priorities) of HSTP II. It is a vibrant strategy to realize the “Information Revolution”
at the woreda and facility level. The strategy operationalizes innovations through instituting a tiered pathway for
facilities and woredas as a whole to achieve the highest standards in data quality and use. This pathway begins
with an assessment process where facilities are evaluated and scored against a common set of criteria related to
structure, data quality, administrative and clinical data use.
Facilities and Woredas that meet the highest standards (in terms of data quality and use), and that are able to
access and share data with higher levels through offline mechanisms, are recognized as “Model Facilities” and
“Model Woredas”. Model facilities and Woredas that take this one-step further by enabling online data access and
transmission are recognized as “Connected Facilities” and “Connected Woredas”.
The IR-Model Woreda and Facility strategy aims to support the delivery of quality and equitable health services
through improved access to and use of quality health information for informed decision making at all levels.
Specific objectives include:
1. To improve the quality of data and transformation of health information management at all levels
2. To improve the culture of using health information for decisions at all levels
3. To strengthen HIS infrastructure through improved connectivity and digitalization of HIS tools
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The strategy is implemented in stages where the program expands in the end to connect the zone, the region,
and national health systems following the implementation of the IR model facility and Woreda. The strategy has
pathways and stages (stages 1 and 2), with the objective of making health institutions model, and then connected
to each other and finally creating a connected region and then connected nation. The details of the pathway are
available in the IR-model HI strategy.
IR-Model Woreda Stage 1:
• Establish key structures of the program (e.g., assessment of facilities along the pathway, providing capacity
building to support facility advancement within the program, M&E) to facilitate access, use, and sharing of
high-quality data within and between woreda facilities
• Develop and test digital tools that support data recording, transmission and use for decision-making.
• Sets initial targets for number of IR model Woredas/institutions
IR-Model Woreda Stage 2 is the future evolution of the program and is expected to include:
• Refining assessment criteria / processes based on Stage 1 learnings (e.g., clinic data use)
• Expanding the use of digital tools found to enhance decision-making
• Expanding the number of Model/Connected Woredas and facilities
The IR-Model/connected Woreda is about connecting woreda-level health institutions and people with better
information in order to improve health system performance and ultimately outcomes. The IR-model Woreda
involves communities, patients, health workers, administrators, and decision makers - from communities and
health posts, to clinics and hospitals, to administrative offices at all levels, all the way up to the ministry and its
directorates.
Within the Connected Woreda…

• Communities are connected with better information about services available and their own health
• HEWs and clinicians have access to better data about their patients and communities and use it to deliver
better care
• Woreda administrators have information and tools to support resource planning and supervisory/
mentorship within the PHCU and across the woreda
• Supervisors at health centers provide support to HEWs with supervisory and PMT processes to improve
standard of care
• Doctors and nurses at higher levels have patient history, while HEWs know the care their patients are
receiving.
• Decision makers at higher levels understand the state of health across the woreda and can effectively
support policy and planning for equitable, effective, and safe health care delivery
• The Woreda is able to demonstrate best practices and support sharing and knowledge transfer to other
woredas
The IR-model health institution will be achieved through the integration of innovative, relevant, and resource-
appropriate interventions to support the development of a data use culture and the integration of effective data
management systems, including digitalization.
The IR-model health institutions strategy uses a standardized assessment checklist where health institutions
conduct self-assessment on a regular basis. Based on the self-assessment results, the institutions develop and
implement tailored interventions. The self-assessment and monitoring continues cyclically until they become a
model, which then is verified and accredited by the next higher levels.
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All levels of the health system participate and support the IR Model health institution program at their respective
levels. Key activities include:
• Assessment of IR-model Woreda and facilities

• Leadership and Coordination
• Resource Mobilization and Allocation
• Technical Support Provision
• Coordination of Planning Processes
• Capacity building, supportive Supervision and Mentoring
• Conduct evaluations
• Verify and accredit Model/Connected Woredas and health facilities
1.2 Capacity Building and Mentorship Program (CBMP)
To ensure the critical elements of the Model health institution initiative, strengthening the health workforce
capacity and motivation to collect, analyze and use information is vital. The MOH contracted out responsibility
for implementing the mentorship, capacity building and research components to local universities through the
Capacity Building and Mentorship Program (CBMP), for some selected implementation sites. Universities were
made the focal point of the CBMP partnership considering their capacity and experience to deliver quality training,
mentorship and research services in a sustainable manner. As part of the CBMP program, local universities will
offer HIS courses in pre-service and in-service training for health workers and managers to build their capacity to
manage and use health information as well as to enhance HIS staff career opportunities.
The CBMP partnership with local universities is not limited to individual capacity building via coursework or
training, it also serves as a link from academia to program implementation (organizational Capacity Building)
and provides opportunities to conduct rigorous operational research. The universities are expected to provide
technical assistance to support the RHBs in creating model health facilities and woredas through improvements in
data quality and use of health information for decision-making at administrative units and health service delivery
levels by integrating capacity-building elements and digital tools.
This includes:
(1) Improving the quality of data and transformation of health information at the lower levels in the health system,
(2) Improving the culture of using health information for decisions at the lower levels in the health system,
(3) Transforming HIS at University Hospitals,
(4) Expediting the digitization process by creating awareness and building capacity of the health workforce on HIS
implementation and management, and
(5) Capacity building for RHBs and Zonal Health Departments on data analytics and evidence generation.
CBMP implementation guidelines will be developed to guide work relationships and collaboration among the
health sector and local universities in implementing CBMP programs.
CBMP will continue to be one of the implementation strategies towards the achievement of this HIS strategic plan.
Expansion of CBMP project areas and strengthening collaboration between the MOH and local universities will
continue in this strategic period.
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1.3 Instituting Innovation scheme and Centre of Excellence
Instituting innovation scheme and Center of excellence focuses primarily on harnessing Information and
communication technology (ICT) to support the health sector in nurturing the health information technologies
that enable the attainment of information revolution goals through maximizing the use of digital systems for health
data recording, transmission, access and use of information for informed decision making. Innovation will focus
on inventing, adopting and adapting digital systems for health information system. Innovation laboratories will
be established to promote new ideas, and identify solutions that will help to design and implement interventions
using Human Centered approaches for problem solving.
This strategy has three structures with distinct functions: the innovation facilitating/coordinating body, Digital
health Innovation and learning Centers/laboratories for information, and centers of excellence in digitizing
information subsystems and use of quality information at health administrative unit and health facility levels.
The innovation facilitating and deployment scheme will be in place at national level (separate or within the existing
directorate) to facilitate the inventing of new technology or upgrading the existing digital systems in Innovation
laboratories/centers. This is done by making quality control, testing and approving the developed digital system
for national use and facilitating their deployment as parts of the country’s Health information system. Innovation
scheme Implementation guidelines will be developed to run the innovation activities detailing its organizational
structure, roles and responsibility of the key stakeholders and relationships among these innovation facilitating
bodies and innovation centers, universities and other stakeholders.
Digital health Innovation and learning centers/laboratories will be established and/or strengthened at selected
local universities that will specialize in digitizing specific functions of the health information subsystems. Currently,
some universities have already started to work on customization/development of different digitals where Gondar,
Jimma and Mekele universities are nurturing DHIS2, eCHIS and interoperability apps respectively.
The digital health innovation and learning centers will focus on selection and development of new IT solutions based
on the health sector’s demands by customization and/or upgrading the existing applications and supporting the
deployment of the digital systems in the health institutions through capacity building and provision of necessary
materials and accessories. It will be created for collaborative problem solving, innovation and customization,
experiment/testing, learning/academy space, and think-tank arena related to different digital health subsystems.
Currently, MOH has established a national digital health innovation and learning center at St. Peter’s Comprehensive
Hospital. The Center is working towards leading the realization of innovation in data-driven healthcare by building
and implementing interoperable health information systems that are owned and led by the government. It is also
aspired to serve as a national Digital Health Help-Desk hub with call center facilities, training venue and resource
center. On top of ensuring full functionality of the established Center, similar knowledge incubation and problem
solving centers will be established at regional levels to promote replication of global goods and to come up with
context-sensitive digital health solutions for the health sector. Close collaboration with universities, strategic
partners and research centers will be a pivotal part of the effort to utilize this platform fully.
Centres of excellence in digitalization and data quality and use pillars will also be established in selected health
facilities and health administrative units and mainly managed by regional health Bureaus with technical support
of local universities. These centers will be the learning sites to scale-up the deployment of the specific digital
systems to other health institutions and other data quality and use practices.
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1.4 Strengthen harmonization and collaboration
Multi-sectoral Collaboration
The Health Information system uses several data sources from different sectors that require strong multi-sectoral
collaboration. The aims of strengthening harmonization and collaboration among sectors are to leverage
knowledge, expertise and resources, benefiting from their combined and varied strengths as they work toward the
shared goals of producing quality data and evidence-based decision-making.
The key sectors that have huge contributions in producing quality data for health are CSA, INVEA, Ministry of
Education/Health Science Colleges, Universities and others. Among key areas that require collaboration, not limited
to, are population based survey, Vital statistics, capacity building on data management and use, Surveillances,
operational research and Innovations.
Therefore, to maximize the benefits of multi-sectoral collaboration, there will be mechanisms such as joint
planning, implementation, review and evaluation of HIS interventions at all levels of the health system.
Private Sector engagement for HIS
The private health sector is serving a significant portion of the population both in curative and preventive health
services that has contributed to the achievement of the health goals set by the government. This makes the private
health facilities among the important health data sources that help to monitor the health service coverages,
and evaluate the outcomes and impacts of the health system. Hence, the engagement of the private sector in
strengthening the health information system is essential to ensure regular submission of quality data to the
respective administrative health units based on the prescribed schedule. Besides strengthening paper-based
recording and reporting systems in private health facilities, implementing the digital solutions for HIS will get due
attention in this HIS strategic plan period. Among activities that will be executed to engage the private health
sector in HIS are:
• Capacity building on data management and information use

• Facilitate continuous supply of HMIS tools
• In place accountability framework and meticulous monitoring system
• Facilitate experience sharing and learning platforms
• Engage in planning and monitoring forums
1.5 Integration of efforts
Integrated approach from planning to implementation and evaluation of interventions is a key for an effective and
efficient outcome. However, it is a common practice to see fragmented approaches at all levels of the health sector,
which results in limited success, wastage of resource, burden and conflicting guidance to lower levels. Addressing
this fragmented approach of HIS related interventions within the health sector is crucial to achieve the ambitious
targets of HSTP II and the HIS strategic plan and catch up with the initiatives that have been lagging behind.
Integration of efforts entails combining parts, initiatives, interventions or approaches that can work together for
synergetic results. Integration also implies mainstreaming cross cutting issues such equity and quality as applicable
to HIS. Integration should be exercised between the various units of the health administrative structures and health
facilities and within a given unit of any particular health system structure from the ministry of health down to the
lowest level. Without becoming exemplary role models in terms of integration within the health sector, it is difficult
to call for donors, implementing partners, associations and other HIS stallholders to integrate their HIS related
agenda.
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We should capitalize on practices such as integrated supportive supervision and the attempts to integrate
key functions of the transformation agendas of HSTP I by drawing lessons from the success and challenges
encountered during the process. Some of the key HIS related activities which can potentially be integrated without
much difficulty, but with only a certain degree of focus are training, mentorship, supervision, review meetings and
other platforms, guidelines/manuals, advocacy/sensitization activities and redundant HIS related structures. The
essence of integrating these practices should be given adequate thought right from regular planning cycles.
Among examples of HIS related structures to be integrated are the Performance Monitoring team (PMT),
Management Committee Meetings, and Quality Improvement Teams at different levels.
Moving forward, establishing a strong integration mechanism requires ownership and oversight by health managers
and HIS governance bodies such the National HIS Steering Committee and HIS National Advisory Group (NAG) and
close monitoring of the efforts and results as a key agenda of discourse in HIS related forums.
Much emphasis has to be given to Integration of the five transformation agendas of HSTP II which includes the
Information Revolution as these transformation agendas are investment areas that form the foundation of our
health system and if successfully implemented transform the health sector and enable it to provide competent care
that result in better health for all. Therefore, reviewing and updating the health sector transformation agendas,
integration and M&E guide should also be one of the immediate priorities to enhance the integration processes.
5.6 Advocacy, communication and culture for HIS
To ensure knowledge and commitment towards HIS among policymakers, donors, implementing partners and
other stakeholders including the public at large, communication and advocacy activities have to be carried out
in a conscious and organized manner at all levels of the health sector. In many contexts, the gap in the use
of information for evidence-based decision-making is more related to the attitudes, behavior and values of the
health care managers and health care providers and HIS stakeholders than merely lack of availability of quality
data, tools, technology, system and capacity to use the information.
Advocacy is aimed at the health sector leadership, politicians, donors and opinion leaders who are able to
create an enabling environment by promoting the development of new policies, changing existing governmental
or organizational laws, policies or rules, and/or ensure the adequate implementation of existing policies, to
influence funding decisions for specific initiatives. On the other hand, the goal of communication is to change
the awareness, belief, values, behaviors or practices of other target groups such as HIS professionals, health care
workers, implementing partners …etc.
In general, the HIS related advocacy and communication strategies should be guided by the ‘national health
Promotion and Communication Strategy: 2016-2020” tailored to HIS context and strategies. Important sections
of the national communication strategy such as the conceptual framework and principles of the strategy are
worth considering with contextualization to the HIS situation. The principles such ownership, audience-centered,
partnership and coordination, integration, evidence-based, multiple means of communication and cost-
effectiveness which are stated in the national communication strategy are quite relevant to HIS related advocacy
and communications as well.
A communication and advocacy strategy to be pursued needs to be multi-dimensional, with tailored messages
for different audiences, including the public. One important message that will help to rally public support is that
HIS is not for government purposes alone; it is useful to improve the system and eventually the healthcare quality
and equity and health outcomes. Health information system fosters transparency, but also requires a transparent
environment to function effectively. Obtaining political support for transparency and accountability is an important
component of the communication and advocacy strategy. One way to gain political support is to identify an ‘HIS
champion’, a high level official who can promote the essence of the HIS among his/her peers, to help foster an
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understanding about the importance of investing in quality data for policy formulation and program decision-
making. Advocacy activities should involve the identification of HIS related policies, laws, legal frameworks and
areas of major investments and organization of sensitization and advocacy meetings and the use of various media
as applicable. Existing HIS governance structures such as the national HIS Steering Committee, sector-wide
governance structures such as the national Joint Consultative Forum (JSF) and partners’ forum of regions, Annual
Review Meetings ( ARM) …etc. should be leveraged to carry out advocacy endeavors.
In general, any design and implementation of the advocacy and communication interventions require proper
understanding of the context, the need and behavior of the target audience. Communication media or channels
such as mainstream media (broadcasting and publishing), social media outlets, web sites, official press releases,
regular reports, technical reports, Health and Health related indicators, newsletters/bulletins, community
structures, academic journals and others should be utilized as appropriate.
As much as possible, every effort of advocacy and communication should be done in conjunction and consultation
with the communication and public relation departments of all levels and all these endeavors and strategies
should be part of the country’s HIS strategic plan from the outset.
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CHAPTER 6: HIS STRATEGIC PLAN MONITORING AND
EVALUATION (M&E)
The ultimate goal of the Health Information System (HIS) is to produce quality information for evidence-based
decisions to improve coverage, quality and equity of health care. It is the role of the HIS to track and inform whether
the health sector is doing the right things, does things right, identifies gaps in the management of the health system
and enables the actors to solve the gaps and improve health system performances in a timely manner. In order to
play this role, the HIS should function up to the expectations and in a manner to track and inform the health system
for improvements learning and adaptation. Thus, the proper functionality of HIS should be monitored and changes
attributable to it should be evaluated accordingly. Moreover, efforts planned to strengthen the system should
be tracked meticulously whether the expected resources are available and the planned activities are executed.
Accordingly, the HIS logic model is developed to guide the monitoring and evaluation activities of this HIS strategic
plan. The logic model presents the logical progression and relationship of the strategic program elements (inputs,
activities, outputs, outcomes, impact) and their causal relationships. It provides a linear, “logical” interpretation
of the relationship between inputs, activities, outputs, outcomes and impacts with respect to objectives and
goals. Hence, HIS logic model outlines the specific inputs needed to carry out the activities/processes to produce
specific outputs that will result in specific outcomes and impacts. It forms the basis for monitoring and evaluation
activities for all stages of the Health Information system. As it is described in Figure 1. HIS needs adequate human
resources, finance, technology, premises and HIS structure as inputs to run the system where capacity building;
applications development and deployment; development of policy & legislation documents and standards;
conducting Survey, surveillance & research; and continuous monitoring & evaluation are the expected activities to
be performed. These processes and efforts are expected to result in the existence of a competent HIS work force,
functional IT infrastructure, well established interoperable system, different installed and functioning applications
at all recommended levels, and the existence of binding (HIS proclamation & regulatory) and guiding (policy and
strategy) documents. Besides, the presence of information products that are collated from a range of sources
and synthesized into usable statistics and widespread dissemination of information are the output of the health
information system that is to be monitored accordingly.
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The outcome of the HIS is commonly measured in terms of improved data quality, information use and creation of
strong data quality assurance systems and data access for informed decision making.
Fig. 2. Health Information System (HIS) Logic Model, adapted from HSTP II M&E framework
Tracking the functions of the HIS requires selection of robust indicators inclusive of input-impact of the HIS as
much as possible. This HIS strategic plan has given due focus to this range of indicators. Tracking of the indicators
relies on existing and established data sources. However, if the relevance of the proposed indicators is compelling,
but not being tracked by existing data sources, revision of the data source of interest will be done.
In general, different mechanisms will be used to review HIS performances, measure the effectiveness of the HIS
system and disseminate HIS information for use that could be seen under three subtitles: Monitoring, Evaluation
and Communicating HIS data for use.
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6.1 Monitoring
Performance Monitoring is the continuous tracking of priority information on conducted activities and its indicators
of success in order to identify achievement gaps and lessons learned subsequently leading to the planning and
implementation of corrective measures. HIS performance monitoring should be done at all levels as each level
needs to review the progress and take corrective action if a gap emerges in the HIS implementation process.
Apart from an effort to integrate with sector-wide and program specific monitoring mechanisms, different HIS
monitoring mechanisms will be used to track the HIS implementation progress using one or more mechanisms at
a time depending on the level of the institutions and types of indicators to be monitored that will facilitate data
triangulation. To this end, proper recording, reporting and documentation of best practices and lessons learned
are the key activities that need due attention to facilitate proper monitoring. The common HIS performance
monitoring mechanisms are described as follows.
Report Review: Reporting of the HIS activities and indicators depends on the frequency of the corresponding
type of monitoring mechanisms. It ranges from the monthly reporting of data quality related HMIS indicators
using DHIS2, the six monthly reporting of IR model Woreda assessments, quarterly reporting of monitoring and
reporting/performance monitoring related standards of Hospital KPI, EHSTG and EHCRIG standards. Moreover,
HIS specific administrative reports may be submitted based on the data element required for monitoring those
not included in the routine reporting system. Whatever types of reports are submitted, there will be an established
automated/manual data checks and established routine data audit system to monitor performances and check
data quality.
Supportive Supervision: Supportive supervision is about overseeing and directing the performance of others
and transferring knowledge, attitudes and skills. In the health sector, supportive supervision is undertaken at
different levels to respective lower institutions with the aim of identifying and addressing gaps, sharing experience
and eventually improving performances through data collection, analysis and determining the status of input
availability, verification if the activities are performed with respect to the policy, legislation, and guideline/SOPs
HIS related supportive supervisions commonly take two forms: HIS specific supervision and as part of integrated
Supportive Supervisions (ISS) happening at all levels from MOH to WorHOs. Sometimes, isolated supervision of
HIS sub-components such as eCHIS is also carried out. Program-specific supervisions also include some aspects
of information systems or data related contents.
However, supervision works best when it is done in an integrated way, rather than separately for individual programs
or within an HMIS program, which makes it too fragmented for lower levels such as Woredas and health facilities. It
is also a good practice to perform regular supervision using a standard integrated checklist based on the priorities
of strategic plans and a particular interest in annual plans. The detailed procedure of the integrated supervision will
be based on the national guideline for integrated supervision and the HSTP Transformation Agendas Integrated
Supportive Supervision Guideline. Accordingly, ISS to RHB is expected to be six monthly and more frequent ISS to
subsequent lower levels with the most frequent being to health posts, which are once monthly.
Review meetings: In the health sector, sector-wide and program specific review meetings are practiced. One of
such program-specific review meetings that has been practiced and expected to be carried on is a review meeting
on HIS.
While joint and integrated review meetings are still emphasized, HIS specific review meetings aimed at in-depth
deliberations, bridging HIS related challenges and sharing best practices should be carried out more regularly and
inclusive of all potential key stakeholders.
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Joint review meetings aimed at the transformation agendas of HSTP including the information revolution are also
expected to happen and should be conducted based on the guide to the joint review meeting of the transformation
agendas.
Maintaining the regularity and engagement of key stakeholders in HIS related review meetings, proper
documentation and sharing of the review meeting processes, outcomes, decisions, and follow up on the
implementation of key decisions based-on task sharing with partners are areas of emphasis and improvement.
Assessments: HIS performance monitoring needs different types of assessments to be conducted to track
progress and assure data quality. The most important one is assessment of the IR model (Connected) Woreda
strategy that is carried out using checklists prepared for Woredas, Hospitals, health centers and health posts. It is
expected to follow self-assessment by each level at least six monthly times, which is to be followed by verification
assessment by the next upper levels if a model status is reported or claimed.
Different types of Data quality assurance techniques will be used at different levels to monitor data quality and use.
Data quality techniques that can be used within the health facility are Data Quality Checks using LQAS method,
Visual scanning, cross checking registers with medical records, Cross checking medical records with registers,
Medical record audits and Other health facility assessments (system assessment). Administrative levels can use
techniques of data quality assessment such as Data quality desk review, Routine Data Quality Assessment (RDQA),
Data Quality Audit (DQA) and Performance of Routine Information System Management (PRISM). As appropriate,
other types of rapid assessments will also be conducted to explore reasons behind observed gaps and to provide
remedial actions accordingly.
A self-assessment of the capacity of the health information system will also be carried out in collaboration with
and using the WHO Afro tool.
Other eHealth specific assessments such as Global Digital Health Index (GDHI), which is a self-assessment carried
out annually, will also be employed. GDHI, a tool to help monitor investments in digital health over time and
enables countries to assess their maturity in digital health and benchmark themselves against other countries.
It reflects countries’ digital health development trajectory across five maturity phases and enables countries to
select and benchmark themselves against the global average for each indicator or other phases of maturity. Using
the World Health Organization (WHO) and International Telecommunications Union (ITU) eHealth Strategy Toolkit,
the GDHI is an interactive web-based resource that tracks, monitors, and evaluates the use of digital technology for
health across countries. It assesses the presence and quality of national policies and strategies, investment risks,
and coverage of key digital health platforms while providing countries with a roadmap for maturing over time.
6.2 Evaluation
The evaluation of the HIS is aimed at its impact and outcome levels. However, due to the complexity of methodology,
much focus will be given to track the outcomes of the HIS. As stated above, the outcomes of HIS are described
mainly in terms of improved data quality and use as well as the presence of an improved system to bring about
improvement in data quality and use.
The common methods or techniques to be used for HIS evaluation are Data quality assessments that includes
Routine Data Quality Assessment (RDQA), Data Quality Audit (DQA), and Performance of Routine Information
System Management (PRISM), and Med-term Review (MTR)/End-term Evaluation as a part of other HSTP II
evaluation mechanism.
Moreover, other widely available comprehensive HIS or eHealth specific continuous improvement or maturity
model tools can be used to complement /supplement the PRISM and other assessments as appropriate. These
tools include:
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• HMN framework and assessment tool
• Health Information System stages of continuous improvement ( SOCI) tool kit
• Global Digital Health Index (GDHI)
• Digital health investment review tool
• Global Good maturity model
• Global Digital Atlas (DHA)
• HIS Interoperability Maturity Toolkit
As much as resource and technical capability permits, effort will also be made to explore the impact of
improving the performance of the routine HMIS, in terms of data quality and data use, on improved access to
health services and better health outcomes.
The frequency of evaluations will depend on the cycle of evaluation of the HSTP II, but it will be done at least
every three-five years following a baseline at the beginning of HSTP II.
In addition, information from program specific evaluations which that may directly or indirectly measure the
HIS outcomes can be considered and triangulated.
6.3. Dissemination of HIS Information for use
Dissemination of HIS information is the critical component of HIS that requires proper planning to reach all
HIS stakeholders. The goal of information dissemination is to improve the likelihood that information will be
utilized in some way – whether it is in policy, program, or organizational changes. Hence, HIS information will be
communicated or shared through different mechanisms, which include:
• Printing: Performance reports (Monthly, quarterly and annually), Technical reports, Bulletins, Banners,
Regular newspapers, Health and Health related indicators, Special interest newsletters, Academic journals,
M&E digest,
• Electronic Medias: Radio or TV interviews, Web sites, Social media, SMS etc
• Conferences/Seminars: Review meetings, scientific conferences, Policy briefs/dialogues, Community

forum, etc
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CHAPTER 7: ASSUMPTIONS AND RISK MITIGATION
Risks and assumptions are major external factors that could significantly affect the success of the HIS. Identifying
critical assumptions, assessing associated risks, and determining how they should be addressed should be part
of any strategic planning process.
7.1. Assumptions
Assumption is a general condition under which the hypothesis or strategy for achieving the objective will hold true.
Assumptions are the answer to the question: “What external factors are not influenced by the HIS operation, but
may affect its implementation and achievement of objectives?”
The opportunities identified above under the SWOT analysis should hold for the successful outcome of the
Ethiopian Health information system. The most critical ones include:
• Commitment by Political leaders to allocate adequate budget for health including for HIS
• Active engagement and commitment of different stakeholders (Development partners and Implementing
partners) to allocate resource and provide technical assistance to the HIS
• Expansion of electricity and ICT infrastructure to remote areas
• Expanding teaching institutions teaching HITs and health information professionals
• Existence of open source platforms and upgraded and sustained support on DHIS2
7.2. Risk Management

Risk is any potential uncertainty, threat or occurrence that may prevent the achievement of the objectives and
results. It may affect timescale, cost, quality or benefits. Assessing risk is a matter of balancing the likelihood that
the critical assumption/opportunity will hold true with the ability of the MOH (PPMED/HITD) and stakeholders to
address the issues.
The threats identified above pose a risk for the successful outcome of the health information system unless a
well thought mitigation plan is in place. If the likelihood of occurrence of the above opportunities/assumptions is
also so less, it also poses a risk for the success of the HIS. Accordingly, the following risk mitigation plans will be
executed to deal with the major risks and threats identified.
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Table 5. Major risks and Mitigation plan
No Major risks/Threats Mitigation plan

• Enhanced fiscal space analysis/resource mapping methods/approaches
• Strong lobbying/advocacy with donors and IPs to secure resource
The unpredictability of foreign
1 • Proactive and systematic effort to mobilize resources from local sources
resources (ex. decreasing funds)
including use of retained revenue
• Stringent measures to use HIS resource efficiently
• Enhanced fiscal space analysis/resource mapping methods/approaches
• Strong lobbying/advocacy with political leaders/ to reprioritize budget for
Unprecedented less budget com-
health sector
2 mitment for the health sector by
• Proactive and systematic effort to mobilize resources from local sources
the government
including use of retained revenue
• Stringent measures to use HIS resource efficiently
• Strong advice/lobbying with office of the Prime minister, members of the
Delayed enactment or ratification council of ministers and/or the parliamentarians
3
of the health act • Prepare guidelines, protocols or directives to address and enforce HIS
related provisions in the health act
• Bulk package procurement and Procurement thru partners which have
4 Increased price of ICT materials
offices in the country of supplier identified
Slow development rate ICT infra-
5 structure (Fiber and mobile tech- • Enhance VPN deployment
nologies)
Frequent shutdown/interruption • Enhance offline systems as a backup Server and Satellite ( E.g VISAT) inter-
6
of internet net technology
Slow rate of electrification, power • Solar power for remote health institutions, Power stabilizer, UPS and Fre-
7
fluctuation and outages quent backup practices
• Procurement through partners which have offices in the country of the
8 Shortage of hard currency
supplier identified
Powerful donor-driven vertical • Sensitization of donors, health managers and HCWs on the implication of
9 programs could create parallel re- parallel channel
porting channel • Enforce legal measures as per the health act
Geographic in accessibility/difficult • Employ solar power and CDMA technology options
10 landscape which limits expansion • Satellite ( E.g. VISAT) internet technology & Virtual mentorship/capacity
of ICT and electricity infrastructure building using available technology
Brain drain (IT, researchers, M&E,
11 • Institute motivation and retention schemes
epidemiologist, statisticians)
• Advocacy/sensitization of stakeholders on the strategic importance of
Delay in conducting popula-
12 population-based surveys
tion-based surveys by CSA
• Provide Technical and other resource support to maintain the regularity
54
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ANNEXES
Annex I. HIS Monitoring and Evaluation (M&E) matrix
(2024/25)
Baseline
Frequency of
Target
Type of Level of Data
Indicator Data Source data collection/
Indicator Collection
Analysis
I Improve culture of information use

IR model institution
WorHOs/
1 Information use index Outcome checklist/PRISM Annual 52% 85%
Facilities
assessment
Proportion of health institutions HFs/WorHOs/
2 Outcome checklist/PRISM Annual NA 100
that have functional PMT RHB/ MOH
assessment
Proportion of RHBs HIS specific
3 review meetings at least once per Outcome RHB/ZHDs Admin reports Annual 64 100
year
Proportion of administrative checklist/ PRISM
WorHO/RHB/
4 health units that have health Input assessment ( To Five years N/A 100
MOH
sector strategic plan be incorporated)/
Rapid assessments
II Improve routine Data management and quality
Percent of service delivery reports Monthly/annual/
DHIS2/RDQA/DQR/
5 received on time (public health Outcome Facility two yearly/mid- 65% 96%
PRISM
facilities) term/end line
Monthly/annual/
Percent of complete reports DHIS2/RDQA/DQR/
6 Outcome Facility two yearly/mid- 89% 98%
received (public health facilities) PRISM
term/end line
Monthly/annual/
Percent of disease report DHIS2/RDQA/DQR/
7 Outcome Facility two yearly/mid- 56% 90%
timeliness (public health facilities) PRISM
term/end line
Percent of disease report Monthly/annual/
DHIS2/RDQA/DQR/
8 completeness of public health Outcome Facility two yearly/mid- 85% 95%
PRISM
facilities from term/end line
Percent of reporting Monthly/annual/
DHIS2/RDQA/DQR/
9 completeness of private health Outcome Facility two yearly/mid- 27% 85%
PRISM
facilities term/end line
Desk review of
Facility/ 2 and ½ years/Five
10 Ratio of HMIS to EDHS data of SBA Outcome DHIS2/EDHS/Mini- 1.6 0.9-1.1
population years
EDHS, data
Proportion of health facilities that
11 met data verification within 10% Outcome Facility DQR/RDQA Annual/Two yearly 89% 95%
range for SBA
Proportion of health facilities DHIS2/RDQA/DQR/
12 Output Facility Monthly/Quarterly 48 100%
which conduct LQAS PRISM
Proportion of WorHOs which
conduct data verification
checklist/ PRISM
13 aspects of Routine Data quality Process WorHOs Biannual 35% 95%
assessment ( To be
assessments (RDQA) at least
incorporated)
biannually
Proportion of RHBs which
conducted comprehensive Rapid assessments/
14 Output ZHDs / RHB Annual NA 100
Routine Data quality assessments PRISM assessment
(RDQA) at least annually
55
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(2024/25)
Baseline
Frequency of
Target
Analysis
III Nurturing digitalization for data management and use

Proportion of public health
Public Health Desk review/DHIS2
15 institutions that implement Output Biannual 95% 100%
institutions platform
DHIS-2
Proportion of private health Private Health Rapid assessment/
16 Output Biannual 1% 25%
facilities that implement DHIS 2 institutions DHIS2 platform
Proportion of health facilities
which have been inspected Health
Rapid assessment/
17 and their signature and service Output administrative Biannual 0% 75%
MFR platform
domain data updated within the units
previous one year
Proportion of administrative WorHOs/ZHD/ IR model institution
18 Output Annual 0% 100%
health units that implement HRIS RHB/ MOH checklist/ PRISM
Proportion of health posts that IR model health
implement comprehensive institution
19 Output Facility Biannual 0% 50%
agrarian eCHIS (all eCHIS targeted checklist/Rapid
modules) assessment
Assessment/Admin.
20 facilities implemented HCMIS/ Output health facilities biannual 7.5% 87.5
Report
Dagu
Proportion of regional
Facility/
laboratories that implement
21 Output regional Assessment/ Report Biannual N/A 100%
Laboratory Information System
laboratorial
(LIS)
Proportion of hospitals Facility/
22 that implement Laboratory Output regional Assessment/ Report Biannual N/A 75%
Information System (LIS) laboratorial
Proportion of health centers Facility/
23 that implement Laboratory Output regional Assessment/ Report Biannual N/A 40%
Information System (LIS) laboratorial
facilities implemented “Electronic Facility/
24 Public Health Emergency Output Administrative Assessment/ Report Biannual N/A 60%
Monitoring System (ePHEMS) units
using DHIS 2
Proportion of health
administrative units implemented Facility/
25 “Electronic Public Health Output Administrative Assessment/ Report Biannual N/A 80%
Emergency Monitoring System units
(ePHEMS) using DHIS 2
Number of NHDD domains fully

26 Output MOH Reports Quarterly 2 5
developed and institutionalized
Proportion of digital health

27 applications having messaging Output MOH Reports Quarterly 0% 40%
standards
Number of digital information
28 sub-systems (functional domains) Output MOH Reports Annual 0 6
which are interoperable
56
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(2024/25)
Baseline
Frequency of
Target
Analysis
Electronic Vein-to-Vein
Reporting Tool (eVVRT) reporting National Blood
29 Output Reports Quarterly 50% 100%
completeness of regional/branch Bank
blood banks
Proportion of blood banks using
National Blood
30 Blood Safety Information System Output Reports Quarterly 2.3% 100%
Bank
(BSIS) coverage/access
Proportion of public hospitals
implementing the Emergency WorHOs/ZHD/
31 Output checklist/ PRISM Quarterly 0 100
and Referral information System RHB/ MOH
Reports
(eRefIS) system
Increase proportion of WoHOs WorHOs/ZHD/ checklist/ PRISM
32 Output Quarterly 0 100%
that implemented eMRIS RHB Reports
Admin report
Proportion of CBHI schemes
WorHOs/ZHD/ checklist/ PRISM
33 implementing digitized health Output Quarterly 0 40%
RHB Reports
insurance systems
Admin report
Increase number of Federal and Federal and
34 regional EFDA branches which use Output regional EFDA Regular report Quarterly 1 13
i-license from 1 to 13 branches
IV Improve HIS Infrastructure
Proportion of health facilities
(Hospitals and health centers)
35 Input Facilities checklist/PRISM Biannual 60% 100%
which have standardized medical
assessment
record room
proportion of health facilities
(Hospitals and health centers) Admin. Report/
36 Input Facility Annual 65% 95%
that have connectivity via Rapid assessment
HealthNet
Proportion of health facilities that
Admin. Report/
37 have established functional LAN Input Facility Annual 28% 70%
Rapid assessment
system
V Strengthening vital statistics, Surveillance, Survey, Research and innovation
Number of technical reports
38 Output EPHI, AHRI Activity reports Quarterly 191 300
produced
Number of publications produced
in peer reviewed journals
Number of articles presented in
scientific conferences
MOH,EPHI,
41 Number of policy briefs prepared Output Activity reports Quarterly NA 30
AHRI
42 Percentage of births notified Output Facility DHIS2 Monthly 35% 80%
Facility/
43 Percentage of deaths notified Output DHIS2 Monthly 3.4% 35%
population
Proportion of community deaths VA/SAVVY
44 Output Population TBD 0 20%
with causes of death notified assessment
Number of research conducted on
45 Output TBD Reports Quarterly NA 15
top HIS priority areas
57
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(2024/25)
Baseline
Frequency of
Target
Analysis
VI Improve HIS Financing
IR model health
Health
institution
Proportion of budget allocated to administrative
46 Input checklist/PRISM 4.3% 5%
HIS (from the total health budget) structures (
assessment ( To be
MOH/RHB)
modified)
VII Improve HIS capacity of Health Workforce
Proportion of health institutions

PRISM/ Special
47 with adequate number of HIS Input Facility mid-term/end line 5% 70%
studies
health workforce
Health workers HIS core HFs/WorHOs/

48 Output PRISM assessment 5 years 77 85
competency index RHB/ MOH
VIII Improve HIS Governance
Health
Desk review/PRISM
administrative
49 HIS Governance Index outcome assessment ( To be Mid-term/end-line 26 100%
structures (
modified)
MOH/RHB)
Health
Proportion national & regional
administrative
50 level functional HIS Governance Input Rapid assessments Annual Nil 100%
structures (
structures
MOH/RHB)
58
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Annex II. List of composite Index indicators
Score/
SN Main Indicator Sub-Indicators
weight
Availability of a functional PMT as per the standard 30-40%
Number of performance review meetings held 10%
Number of assessments conducted and findings disseminated 10%
Display of performance monitoring chart by all units of a health institution 10%
Information Use Display of information products in the compound or at least one public place outside of the
1 10%
Composite index institution
Number of publications disseminated to the stakeholders/public (Newsletters, bulletins…
10%
etc)
Use of multiple data source 10%
Regular clinical audit as per the schedule and implementation of action plans for the
0-10%
identified gaps (Hospitals and Health centers)
Members organized based on the national standard 10%
Regular Monthly meeting 20%
Chairperson and secretary as per the national standard 10%
Comparison of performance versus target 20%
A functional Inclusion of key quality and equity indicators in the performance tracking 10%
2 PMT as per the
standard Identification of Performance gaps by comparing achievement against target 10%
Performed root cause analysis 5%
Preparation of action plan 5%
Action implemented 5%
Meeting minute documented and circulated 5%
% of Health workers demonstrated the ability to check data quality 20%
% of Health workers with demonstrated skills to do basic calculations of indicators 15%
Health workers % of Health workers with demonstrated skill to do basic plotting 10%
HIS core
3 % of Health workers who demonstrated interpretation of information 15%
competency index
( OBAT score) % of Health workers demonstrated knowledge and skill on use of information to solve
20%
problems or make decisions
% of Health workers who demonstrated problem-solving skill 20%
Existence of approved HIS legislation/regulation/directive 15%
Approved HIS policy 15%
Existence of ehealth policy 10%
Existence of up-to-date HIS strategic plan 10%
HIS Governance Existence of up-to-date HIS governance framework at national and RHB levels 10%
4
Index Existence of functional HIS governance structures at national (HIS Steering Committee,
10%
NAG and 3 TWGs) and RHB levels
Existence of endorsed data Access and Sharing protocol/guideline 10%
Number of endorsed HIS governance documents ( MFR governance protocol, HNDD
roadmap, Human resource for national HIS, Interoperability standard, eHEALTH 20%
ARCHITECTURE)
Existence of HIS governance structure 20%
Meetings conducted regularly 20%
Functional HIS Performances gaps identified 20%
5 governance
structure Action plan developed/directions given 15%
Implementation of action plan monitored 15%
Meeting minute documented 10%
59
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Annex III: Summary of key surveys and assessments
Types of surveys/assessments Latest round (G.C) Data collected by
Housing and Population Census 2007 CSA

Ethiopian Demographic Health Survey (EDHS) 2016 CSA/EPHI
Mini EDHS 2019 EPHI/CSA
Service Provision Assessment-(SPA+) 2014? EPHI
Service Availability and Readiness Assessment (SARA) 2018 EPHI
TB Prevalence survey 2011 EPHI/MOH-DPCD
Ethiopia population-based HIV/AIDS impact assessment 2017/18 EPHI/HAPCO
(EPHIA)
Household health service utilization and expenditure survey 2016 MOH-PCD
Malaria Indicator Survey 2019 EPHI/MOH_DPCD
Data Quality Review (DQR) 2018 EPHI
National Health Accounts (NHA7 ( 2016/17) 2019 MOH/PCD
STEPS survey 2015 EPHI
Emergency Obstetric and Newborn Care (EmONC) Assessment 2016 EPHI/MOH-MCHD
ANC/PMTCT sentinel surveillance 2016 EPHI/HAPCO
Routine Data Quality Assessment ( RDQA) 2018 MOH-PPMED
60
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Annex IV: Key HIS governance related documents and status
Period expected to
Name Current status * Remark
serve
*Under development *No specific period
Health Data access and sharing
*Under review by the Legal *open for revision
Directive
Directorate of MOH whenever required.
Not HIS specific governance
Health act/health services document, but includes an important
Under development No Specific period
proclamation aspect of HIS particularly related to
data access and sharing.
Endorsed ( December
National Health Information System
2017), but revised version is No Specific period
Governance Framework
readied for re-endorsement
Human resource roadmap for national
Drafted ( April, 2019), but not
health information system of Ethiopia, Until 2030
approved
2020-2030
Master Facility Registry (MFR): Drafted ( November, 2020), For two years after
Management & governance protocol but not endorsed endorsement
National Health Data Dictionary
Drafted (June 21, 2018), but
Standard (NHDD) operations No specific period
not endorsed
Procedures ( Final)
National Health Data Dictionary Under development
No specific period
Roadmap (November 2018 version)
ETHIOPIA eHEALTH ARCHITECTURE ( Drafted in 2018, but not
Five years
V1.5) endorsed.
Interoperability standard Under development No specific period
Guideline on Incentivizing Data Quality, Under preparation (April

No specific period
Use and Performance Improvement 2020 version)
Connected Woreda Implementation

Draft, 2016 version No specific period
Strategy
Health Data Quality training Modules (
Finalized, June 2018 No specific period
Facilitator’s and participant’s)
Information use training Modules (
Finalized, June 2018 No specific period
Facilitator’s and participant’s)
HMIS Data Recording and Reporting
Procedures Modules ( Facilitator’s and Finalized, June 2018 NO specific period
participant’s)
HMIS indicator reference guide Finalized, August 2017 No specific period
National HMIS mentorship guideline ( Drafted, not finalized ( June
No Specific period
Version II) 2019)
Guideline for integrated supportive
Finalized, 2008 No specific period
supervision
CRVS operational guideline Drafted, march 2016 No Specific period
Governance practice framework for
Under development No Specific period
Digital health activities
MoH IT infrastructure management
Drafted, June 2020 No specific period
guideline
Health Sector WBP documents 2018/19 A year
Agrarian CHIS Manuals & tools 2019 Not yet implemented
Pastoralist CHIS Manuals & tools 2017 Implemented in some regions
Urban CHIS Manuals/ tools 2018 Implemented in six cities
61
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Annex V: Stakeholders’ Power-Interest Matrix for institutional response
Level of Interest
Low High
Ministry of information and Technology(
MOH staff
MInT)
Information Network and Security Agency Research institutions/ Research Professionals
Low
Other Government sectors
Health professionals association
Non-health academic institutions
Insurances NGOs, FBOs
Health-related businesses, Suppliers and vendors
Minimal effort/monitor Keep informed
Ministry of public Service and Human
MOH management. MOH Agencies
Resource
Extent of
Water, Irrigation and Electricity /Ethiopia
power/ RHBs/ZHDs/WrHOs, HFs ( HCWs)
Electric Utility(EEU)
Level of
influ- MCIT/Ethio telecom Parliament/PMO, MoFEC, INVEA, CSA
ence Ethiopian mapping agency Private health sector
Development partners/Donors , Implementing

partners
Ministry of Education/ Health related academic

High Institutions
Universities
Plan commission
Communities/Public
Private sector ( Owners, associations)/Professional
associations
Public health professional
Patients and caregivers
Keep satisfied Key players/Manage closely
62
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Annex VI: Implementation Plan
Strategic Implementation period
NO Major Activities
Directions 2020/21 2021/22 2022/23 2023/24 2024/25
Ensure the core competencies in data management and use through intensive capacity building using different
approaches and educative platforms
Strengthen capacity development approaches
X X X X X
(in-service) for data use core competencies
Engage Local Universities and other stakeholders
X X X X X
on HIS capacity building program
Provide capacity building trainings on advanced
data management techniques such as on
data mining/data science , Machine Learning, X X X X X
interactive data visualization tools and data
triangulation
Strengthen the system of data storage, access, analysis, synthesis and communication
Establish a national data warehouse with clear
X X X
roadmap
Establish public portal for the key digital platforms X X X
Implement and enforce data access and sharing
X X X X X
guideline/directive
Advance health data analytics, modeling,
forecasting, integrated analysis, heterogeneous
and geospatial analysis through development and
X X X X X
application of advanced statistical , mathematical,
data mining and data visualization methods and
tools
Maximize the use and utilization of local health
Improve datasets through guidelines for applying X X X X X
culture of advanced health data analytics methods
1
information Enhance the comprehensive use of information
use X X X X X
products at all levels
Enhance the use of different information
communication and dissemination platforms /
X X X X X
mediums such as websites, social media, call
centers, e-news...etc
Strengthen policy analysis and formulation
Policy analysis, briefs/issues X X X X X
Revitalize the IR model health institution strategy
Revisit the strategy, tools and road map for
X
“connected nation’
Enhance CBMP project X X X X X
Enhance database to track and monitor the IR-
X X
model institution performances
Ensure the availability of measurement metrics, and strengthen planning, monitoring and evaluation
Develop comprehensive M&E plan for Health
X
Sector Transformation Plan
Enhance the use of composite index to measure
data quality, data use, HIS governance and other X X
measurements in more rounded way
Strengthen preparation of Woreda-based health
X X
sector planning
Enhance the standardization and implementation
of sector-wide, program and HIS specific review X X
meetings
63
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Implementation period
Strategic
NO Major Activities
Directions 2020/21 2021/22 2022/23 2023/24 2024/25
Strengthen a functional Performance Monitoring

Team (PMT) meeting at all levels from MOH to X X X X X
health facilities
Strengthen other data use platforms and forums
X X X X X
at all levels
Design and implement behavioral change inter-
ventions to bring cultural transformation on data X X X X X
demand and use
Strengthen HIS Knowledge Management system
Strengthen learning and knowledge management
X X X X X
centers at national and subnational levels
Improve Ensure availability of updated knowledge man-
culture of X X
agement roadmap
information
use Enhance the use of ICT/ online collaboration
X X X X X
application
Create Center of excellence universities, health
X X X
administrative units and health facilities
Enhance the documentation of best practices,
X X X X X
success stories and lessons learnt
Strengthen and/or expand learning academies for
X X
different health information subsystems
Ensure a functional coordination mechanism to
X X X X X
use KM effectively for informed decision-making
Integrate knowledge management concepts in
X X X X X
the HIS pre-and in-service trainings
64
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Strategic
NO Major Activities
Directions
2020/21 2021/22 2022/23 2023/24 2024/25
Strengthen routine data collection and aggregation through fulfilling prerequisites, sustaining logistic supply and
ensuring standards
Strengthen HMIS implementation in all health
facilities including private and uniformed Services X X X X X
health Facilities
Strengthen Community Health Information
System ( CHIS) implementation with emphasis to X X X X X
urban and pastoralist CHIS
Standardize core HIS indicators based on HSTP II
and in line with Sustainable Development Goals
(SDGs) and UHC and ensure manageable and X
usable number of indicators needed for the health
sector performance monitoring
Standardize HMIS/CHIS recording and reporting
X X
tools and Procedures
Standardize paper-based LIS data capturing and
X X
reporting at all levels of the lab system
Standardize and enhance the use of paper-based
X X
blood Safety Information System
Improve
Routine Data Scale up the implementation of paper-based LIS X X X X
2
Management
and Quality Ensure sustainable supply of HMIS/CHIS tools
including by ensuring the capacity of regions to
X X X X X
take over and own the quantification and printing
of recording and reporting tools
Enhance Data quality improvement strategies and interventions
Establish/ Strengthen a mechanism of HIS
workforce and health care providers capacity
X X X X X
building on data management and quality
assurance
Improve comprehensive implementation of
data quality assurance mechanisms ( LQAS,
X X X X X
RDQA, DQR, PRISM, community data verification
mechanisms, Desk review)
Enhance Design and implement behavioral
change interventions through national
x X X X X
movement against data falsification and other
mechanisms
Enhance validation rules and other data quality
x x X X X
tools in digital platforms such as DHIS2
Enhance data quality feedback mechanisms x x X X X
65
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NO Major Activities
Directions 2020/21 2021/22 2022/23 2023/24 2024/25
Enhance Electronic Health Records (EHR) to provide decision support to healthcare professionals
Develop and implement EHR-core, a
component of EHR which contains clinical X X X X X
information benefiting patients and clinicians
Integrate disparate systems (stand-alone digital
health solutions such as eAPTs, eLIS, MFR,
X X X X
DHIS2, eCHIS and etc.) with EHR-core systems
based on maturity and priority
Strengthen Health information dissemination & feedback receiving mechanisms through Web portals, e-News,
Digital Notice Board and Social Media.
Enhance the customization and use of the
X X X X X
digital media initiatives
Establish digital information board (notice
board, satisfaction rating and queue
X X X X X
management) to promote health services at
national, regional and facility level
Enhance/ Strengthen Electronic Community Health Information System (eCHIS)
Enhance the design and development of
existing and new eCHIS modules based on the X X
selected programs
Scale up the implementation of eCHIS modules
X X X X X
at all health posts.
Integrate eCHIS with other relevant systems
X X X
(Such as MFR and DHIS2).
Nurturing
Digitalization Enhance electronic Laboratory Information System (eLIS)
3 for data Develop/customize Laboratory Information
X X
management System (eLIS)
and use Scale up the implementation of LIS X X X X X
Integrate eLIS with other relevant systems (such
X
as EHR and MFR)
Establish Electronic Auditable Pharmaceutical Transaction System (eAPTS)
Strengthen the design and development
X X
eAPTS system
Integrate eAPTS with other relevant
X X
systems(Such as eLMIS, EHR, eMPL and MFR )
Strengthen the District Health Information System version II (DHIS2) platform to plan, monitor and support
evidence based healthcare and decision-making.
Enhance/Upgrade DHIS2 and optimize its
X X X
features
Integrate DHIS2 with other systems (Such as
MFR, eCHIS, multi-sectoral nutrition, ePHEM X X X X X
and others).
Develop and implement a platform for Multi-
sectoral Woreda Transformation data entry and X X
performance management.
Enhance Electronic Health Commodity Management Information (HCMIS)
Strengthen the development and
implementation of existing eLMIS components
such as Dagu, VITAS, mBrana and Electronic X X
Medical Equipment Management System
(eMEMS)
66
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NO Major Activities
Directions 2020/21 2021/22 2022/23 2023/24 2024/25
Integrate HCMIS other systems( Such as
X X
DHIS2 and MFR)
Develop and implement Enterprise Re-
source Planning ( ERP) system at central
X X X
warehouse and hubs to provide automated
interactions and common sources of data
Integrate ERP and HCMIS/Dagu of health
X X
facilities
Enhance electronic Human Resource Information System (i-HRIS) for HRH administration, development and
health professional licensing
Develop/customize an integrated human
resource information system to manage HR
X X X
administration, development and health
professional licensing
Implement integrated human resource
X X X X X
information system(iHRIS)
Customize and implement the WHO Nation-
X
al Health Works Account (NHWA)
Integrate iHRIS with other systems (Such as
X X X
DHIS2, NHWA, EHR, eCHIS, MFR)
Enhance electronic Regulatory Information Systems (eRIS) for regulation of food and medicine
Cascade the regulatory information system
X X X
to branch, region and woreda level
Enhance/upgrade software/technology of
Nurturing X X
eRIS
Digitalization
for data
management Establish Electronic Public Health Emergency Monitoring System (ePHEMS) to enable disease prevention,
and use surveillance, detection, response, reporting, and control.
Develop and implement an eSurveillance
system for PHEM supporting both aggregate X X X X X
and case based surveillance.
Develop and implement Early Warning
System (EWS) that collects information on
X X X X X
epidemic-prone diseases in order to trigger
prompt public health interventions
Integrate the eSurveillance and EWS with
X X X X
other systems (MFR, DHIS2)
Enhance Electronic Referral Information System (eRefIS) to ensure improvements to follow-up care coordina-
tion by the creation of accurate and timely referrals
Strengthen the design and the development
X X X
of eRefIS.
Integrate Electronic Referral Management
System with other relevant systems (Such as X X
MPI, EHR and MFR).
Establish Electronic Emergency Medical Service (eEMS) Management System to administer medical emer-
gency responses.
Develop/customize Ambulance Dispatching
X X
System(ADS)
Establish Emergency call center X X
Implement eEMS X X X X
integrate eEMS with eRefIS, EHR, MFR X X
67
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NO Major Activities
Directions 2020/21 2021/22 2022/23 2023/24 2024/25
Establish/Enhance comprehensive health facility, client, clinical coding and other registries with complete and
current information that meets stakeholders’ needs
Strengthen the development and implemen-
tation of Master Facility Registry(MFR) at WHO, X X X X X
ZHD, RHB and MoH
Strengthen the development and implementa-
X X X X X
tion of National Health Data Dictionary (NHDD)
Develop and implement Master Patient Index
X X X
(MPI) at national level
Develop and implement GIS repository for
X X X X X
location mapping
Develop and implement Shared Health Re-
X X X
cord(SHR) at national level
Establish a data warehouse to foster and support research, analytics and more highly informed decision mak-
ing by health system managers and other stakeholders on health sector resources.
Develop a clear roadmap to ensure a functional
X
data warehouse
Develop and implement data warehouse at na-
tional levels in alignment with the national digi- X X X X
tal health platform
Nurturing Integrate Data Warehouse with other digital
X X
Digitalization health solutions as required.
for data Enhance electronic financial management system to ensure effective collection, allocation and use of health
management financial resources at all levels in accordance with health plan priorities
and use
Develop/Customize electronic financial man-
agement system (eFMS) supporting collection,
X X
allocation and administration of health finan-
cial resources
Develop and implement electronic Health In-
X X
surance Management System (eHIMS)
Enhance digitized health insurance system X X X X X
Integrate eFMS with IFMIS and other systems
X X X
for budgeting and financing
Establish an Enterprise Resource Planning(ERP) system that can integrate major processes into single system
Customize and Implement Fleet management
X X X X X
system
Customize and Implement Project Manage-
X X X
ment System
Customize and Implement eAdministration sys-
X X
tem (Such as Document Management System)
Customize and Implement eService sys-
X X X
tem(both for internal and external)
Customize and Implement Help Desk system X X X X X
Customize and Implement planning system X X X X
68
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NO Major Activities
Directions 2020/21 2021/22 2022/23 2023/24 2024/25
Establish digital health standards for data, application, security and technology for information exchange and
protection
Establish standards and guidelines for digital
health solutions & services (such as EHR,
X X
eCHIS, DHIS2,..) that can guide the minimum
requirements needed to be fulfilled
Establish security standards and guidelines for
data access, storage, processing, information X X
exchange, and sharing
Develop and Implement interoperability solutions for data exchange among digital health solutions and other
external systems
Nurturing Develop interoperability requirement docu-
X X
Digitalization ments for the different interoperable systems
for data Strengthen interoperability across different
management systems within health and other sectors using/
and use X X X X X
implementing suitable information exchange
tools (implementing Digital Health Platform)
Enhance blood Safety Information System ( BSIS)
Scale-up the BSIS to all blood banks and col-
X X X X X
lection centers
Strengthen the capacity of key stakeholders
X X X X X
on BSIS
Enhance electronic Multi-Sectoral Response Information System (eMRIS)
Develop and Implement eMRIS at Health Ad-
X X X X X
ministrative level
Integrate eMRIS with DHIS2 platform X X X
69
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NO Major Activities
Directions 2020/21 2021/22 2022/23 2023/24 2024/25
Strengthen the availability and expansion of ICT infrastructure
Ensure the availability of computers, tablets,
X X X X X
UPS and other ICT accessories
Ensure the availability of networks/connectivity
(such as LAN and HealthNet/WAN) at all health X X X X X
institutions
Expand/upgrade the data center equipment to
X X
accommodate the growing need
Improve HIS Enhance continuous and optimal functioning of
X X X X X
4 Infrastructure servers at national and levels sub-national levels
and logistic Enhance system hosting using local and
cloud hosting as applicable based on hosting X X X X X
parameters
Ensure that all health facilities have standard MRU, shelves and HMIS office equipment
Establish standardize MRU for all facilities X X X X X
Fulfilling equipment ( E.g shelves) to the health
X X X X X
facilities based on the MRU standards
Fulfilling office equipment to the administrative
X X X X X
units( HMIS )
Strengthen Civil Registration and Vital statistics system focusing on the mandate of the health sector that include
birth and death notification
Develop and implement CRVS training and
X X X X X
verbal autopsy guideline
Implement birth and death notification system
X X X X X
at health facilities
Initiate and expand implementation of
community based birth, death and cause of X X X X X
death notification system
Establish and implement a data generation
X X X X X
system on community cause of death
Integrate the unique identifier need of the health
X X X X
sector with the effort of INVEA
Strengthening Strengthen diseases Surveillance data management and use to enable forecasting, early response and proper
vital statistics, management of diseases and health conditions
5 Surveillance,
Survey and Expand and strengthen Health and demographic
X X X X X
Research surveillance sites
Enhance synthesis, reports and dissemination
of the findings for policy, program and practice X X X X X
recommendations
Strengthen surveillance of maternal and
X X X X X
perinatal deaths
Introduce reporting of adverse effects after
immunization/medications surveillance data X X X X X
integrated into existing reporting systems
Establish and strengthen disease registries and
X X X X X
Surveillance on NCDs and their risk factors
Strength public health emergency
information management system including
X X X X X
the establishment a real-time and digital
surveillance system
70
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NO Major Activities
Directions 2020/21 2021/22 2022/23 2023/24 2024/25
Strengthen health Research and Surveys
Strengthen research governing bodies (
institutional editorial board, Establish national
X X
Health research council ,Scientific advisory
board, community board…etc)
Develop national public health research priority
X X
and evidence synthesis roadmap
Strengthen research agenda setting,
prioritization of research, resources X X X X X
mobilization and coordinating
Enhance research agenda setting, prioritization
of research, resources mobilization and X X X X X
coordinating
Enhance capacity building on triangulation of
health researches with other sources of data X X X x X
and translation of research to practice
Synthesize evidence-based information (Policy
issue/ briefs) to contribute for policy, program X X X X X
and practice change or improvement
Enhance capacity on the use of and Strengthen
X X X X X
medical research training
Strengthen Biomedical research, clinical trials,
medical biotechnology and Epidemiological X X X X X
studies
Strengthening Strengthen operational researches,

vital statistics, translational and implementation science X X X X X
Surveillance, researches
Survey and Enhance Health Technology Assessment (HTA)
X X x x X
Research mechanism for HIS
Strength research laboratories to promote
X X X X X
medical research
Enhance population-based surveys such as
X X X X X
DHS to produce sub-regional level estimates
Institute incentive mechanisms to promote
X X X x x
research
Enhance publication of health researchers in
reputable journals, evidence dissemination, X X X X X
scientific workshop, and congress
Track, verify, and measure the use of evidence
for decision, policy framework, and public X X X X X
health practice
Advocate policy makers and other stakeholders
for uptake of scientific evidence for decision X X X X X
making
Advocate for the establishment of research-
industry link (linked to companies for scale
X X X X X
implementation) to improve uptake of new/
improved technologies
Strengthen community engagement through
community advisory board/community leaders X X X X X
and public wing
Enhance health research database X X X X x
71
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NO Major Activities
Directions 2020/21 2021/22 2022/23 2023/24 2024/25
Enhance coordination and collaboration to mobilize adequate HIS resources at all levels
Strengthen HIS partner and resource mapping
X X x X X
and resource mobilization
Coordinate investments across donors
and technical and financial support of
X X X X X
implementation partners to maximize
alignment and reduce duplication
Strengthen evidence- based advocacy to
X X X X X
increase HIS budget allocation
Design and implement innovative financing
X X X X X
strategies for HIS
Enhance efficient use of resources
Enhance HIS
financing Strengthen proper and efficient utilization of
6 X X X X X
resources
Strengthen system to monitor and evaluate HIS
X X X X X
investment and resource utilization
Strengthen timely liquidation and
X X X X X
accountability mechanisms
Ensure the deployment of adequate HIS workforce in numbers, skills, and distribution to run all the HIS functions
Revise/endorse the HIS HR strategy under the
X X
National Human Resource Road map for Health
Ensure deployment of the required numbers
and professional mix of HIS workforce at all X X X X X
levels
Enhance the capacity of HIS staff and health care providers at all levels to capture data, manage and use for
evidence based decision
72
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Strategic
NO Major Activities
Directions
2020/21 2021/22 2022/23 2023/24 2024/25
Revise/update HIS training curricula (for pre

X X
and in-service)
Mainstream data management and use in all
X X X
health professional training curriculum
Train and deploy the required number of health
Improve HIS information systems professionals required at X X X X X
capacity all levels in the health system
7
of Health
Workforce Initiate continuous Professional Development
X X X X X
( CPD)
Strengthen mechanisms to improve digital
X X X X X
literacy of health care workers
Enhance supervision and mentorship
X X X X X
mechanisms at all levels
Ensure functionality of the HIS governance’s structure
Ensure existence of up-to-date HIS governance
X X
framework at national and regional level
Strengthen functional HIS governance structure
X X X X X
with due emphasis to lower structures.
Ensure the availability of governance documents and enforcement mechanisms
Support the finalization of the health act to
X X
ensure adequate HIS related provisions
Revise, endorse and implement health
X X X X X
harmonization and alignment manual (HHM)
Develop/revise and implement HIS policy,
e-health policy, ICT policy and strategy, X X X
Strategic Plans, HIS HRH strategy
Finalize, endorse and implement the data
Enhance HIS access and sharing document ( guideline, X X
8
Governance directive)
Ensure the availability and implementation of
X X
Cyber security protocol
Ensure existence and implementation of
standards/guideline/protocols: MFR, NHDD,
X X X
EMR, eHA, interoperability standards and
others
Enhance the monitoring and support
mechanisms to finalize and endorse X X X X X
governance documents
Enhance accountability to improve data quality and information use
Develop and implement accountability
X X
framework/mechanism
Enforce the accountability mechanisms at all
X X X X
levels
73
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Annex VII. References
1. Ministry of Health, Ethiopia. Human Resource Roadmap for National Health Information System. Addis
Ababa: s.n., 2019.
2. Ministry of Health and Ethiopian Data Use partnership (EDUP). Performance of Routine Information
Management System in CBMP Woredas, in Ethiopia. Addis Ababa, Ethiopia: s.n., 2019
3. Ministry of Health. Health Sector Transformation Plan (HSTP II). Addis Ababa, Ethiopia: s.n., 2019.
4. Ministry of Innovation and Technology. Digital Ethiopia 2025: A Digital Strategy for Ethiopia Inclusive
Prosperity. Addis Ababa, Ethiopia: s.n., 2020.
5. World Health Organization (WHO). Country health information systems: a review of the current situation and
trends. Geneva, Switzerland: s.n., 2011.
6. Ministry of Health, Ethiopia. Health Sector Transformation Plan (HSTP I). Addis Ababa, Ethiopia: s.n., 2015
7. Ministry of Health, Ethiopia. Digital Applications Inventory. Addis Ababa, Ethiopia: s.n., 2018.
8. Ethiopian Public Health Institute (EPHI). Health Data Quality Review: System Assessment and Data
Verification. Addis Ababa, Ethiopia: s.n., 2018.
9. Ministry of Health, Ethiopia. Situation Analysis on Evidence for Decision Making (Unpublished). Addis Ababa,
Ethiopia: s.n., 2020.
10. Ministry of Health, Ethiopia .HSTP mid-Term Review, VOLUME I, COMPREHENSIVE REPORT. Addis Ababa: s.n.,
2018.
11. World Health Organization (WHO). Framework and standards for country health information systems:
second edition. Addis Ababa, Ethiopia: s.n., 2018.
74
(2020/21-2024/25)

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HEALTH INFORMATION

SYSTEM STRATEGIC PLAN

HEALTH INFORMATION SYSTEM STRATEGIC PLAN

CRVS Civil Registration and Vital Statistics

CSA Central Statistical Agency

DHS Demographic Health Survey

DQA Data quality assessment

DTC Drug and Therapeutic Committee

eCHIS Electronic Community Health Information System

eHMIS Electronic Health Management Information System

HER Electronic Health Record

eHRIS Electronic Human Resource Information System

eIFMIS Electronic Integrated Financial Management Information System

eLIS Electronic Laboratory Information System

eLMIS Electronic Logistic Management Information System

EMR Electronic Medical Record

EPHI Ethiopian Public Health Institute

EPI Expanded Program of Immunizations

eRIS Electronic Regulatory Information System

GIS Geographic information system

HDA Health Development Army

HDD Health Data Depot

HEP Health Extension Program

HEW Health Extension Workers

HGIS Health Geographic Information System

HIS Health Information Systems

HIT Health Information Technicians

HITD Health Information Technology Directorate

HMIS Health Management Information System

HRIS Human Resources Information Systems

HSTP Health Sector Transformation Plan

ICD-10 International Classification of Disease (10th version)

ICT Information Communication Technology

IFMIS Integrated financial management information system

IVR Interactive vocal recording system

LQAS Lot quality assurances system

M&E Monitoring and evaluation

MFR Master Facility Registry

MNCH Maternal, newborn, and child health

MoH Ministry of Health

NESB National Enterprise Server Bus

NGOs Non-governmental organizations

PHCU Primary Health Care Unit

PHEM Public health emergency management

PRT Performance Review Team

RCA Root cause analysis

RDQA Routine data quality assurance

RFP request for proposal

RHB Regional Health Bureau

SCMS Supply Chain Management System

SNNPR South Nations, Nationalities and People’s Regional State

SARA Service Availability and Readiness Assessment

SPA+ Service Provision Assessment

TMS Terminology Management Service

VERA Vital Event Registration Authority

WorHO Woreda Health Office

ZHB Zonal Health Bureau

• Information Revolution Model Health Institution Strategy

No Indicator/Performance measure Baseline Target Performance Remark/Source

2.1.1 HIS Governance