In 2009, the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) counted over 10 different health facility lists managed by donors, government ministries, agencies and implementing partners. These function-specific lists were not integrated or linked. The ministry's Health Sector Strategic Plan included the development of an authoritative source for all health facility information, called the Master Facility List (MFL). During development, the ministry adopted the term Health Facility Registry (HFR), an online tool providing public access to a database about all officially recognized health facilities (public and private). The MFL, which includes the health facility list at any specific point in time can be exported from the HFR. This chapter presents the Tanzanian case study describing the work and lessons learned in building the HFR—focusing on software development, introducing geographic positioning systems and harmonizing MFL data. MoHCDGEC launched the HFR public portal in September 2015.
TopIntroduction
The World Health Organization (WHO) introduced draft guidelines for countries to create a master health facility list (WHO, 2013). The guidelines explain how, within countries, many different health facility lists exist and differ in terms of the information they contain about health facilities and that have different numbering systems for assigning health facility identification numbers. A national health master facility list (MFL) includes a complete list of all public and private health facilities within a country and includes administrative information, service information, contact information, and a unique identification number per facility. The MFL can be used to more effectively conduct surveys (e.g. the Service Availability and Readiness Assessment).
The Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) Health Sector Strategic Plan III included the development of an authoritative source for all health facility information (the MFL). During development, the ministry adopted the term “Health Facility Registry (HFR),” an online tool providing public access to a database about all officially recognized health facilities (public and private). The MFL, which includes the health facility list at any specific point in time, can be exported from the HFR. Having a single official HFR allows the Government of Tanzania to re-program resources that were used to maintain multiple separate MFLs, including ghost health facilities, and use these resources for improved health service delivery. The launch of the District Health Information System and HFR synchronous integration during November 2016 reduces the resources required for maintaining two separate health facility lists. Also, with the launch of the HFR, the Government of Tanzania has demonstrated having a single authoritative HFR can help with eliminating parallel reporting in HIV/AIDS (Perera et al, 2016).
The Tanzanian HFR was established to meet the needs of the various ministries, departments, and agencies within the Government of Tanzania and a wide range of health sector organizations and stakeholders. As the initiative moved through planning, development, launch, and ongoing management and maintenance, many different funding and implementing partner organizations were engaged and/or contributed over time.
Figure 1. Tanzanian master facility list vision
From 2009 to 2012, the MoHCDGEC made efforts to collate and harmonize all existing health facility lists from different stakeholders and created a Microsoft Excel–based MFL. The ministry then revised the approach to include development of a more functional and manageable MFL. Between 2012 and 2015, the ministry brought stakeholders together following an Agile software development methodology to create a single authoritative source of health facility information for Tanzania, the Tanzanian HFR (Agile Methodology, 2008). The HFR is an online tool used to provide public access to a database of approved information about all health facilities (public and private) in Mainland Tanzania. The MFL, which is the health facility list at any specific point in time, can be exported from the HFR. Figure 1 illustrates the vision of having one centralized authoritative source for the MFL that is then shared with the other illustrative Tanzania health information system.1
During the process from 2012 to 2015, the ministry identified several key thematic areas that had emerged, and the overall HFR team expanded its efforts to include HFR governance, management overhead related to broad stakeholder participation, data cleaning, human resources and capacity building, software development and infrastructure, geographic positioning systems, and geographical hierarchy administration.
This case study focuses on three of these areas. The first of these is the adoption and use of an Agile software development methodology including the related infrastructure components. The second includes the introduction of geographic positioning systems supporting visualizations to encourage data use at multiple levels of the health system. The third is the merging of existing health facility lists and ongoing health facility data cleaning to create a final list of health facilities that can be used to launch the HFR.