By Amber Sheets, Senior Technical Advisor, Digital Health & Monitoring, PSI and Cristina Lussiana Senior Program Manager, Digital Health & Monitoring, PSI 

To increase the quality of health service, improve health outcomes and meet their Sustainable Development Goal (SDG) targets, countries need supportive supervision—which can be difficult and expensive to track.  

Enabling out-of-the-box DHIS2 can support health service quality improvement by providing face-to-face coaching between health providers and health supervisors. This enables behavior change while allowing Ministries of Health (MoHs) to collect and analyze data in real-time, making it easier to reallocate resources effectively—which leads to better health outcomes at scale. Until now, out-of-the-box DHIS2 couldn’t perform this trick alone. 

PSI in partnership with the University of Oslo is developing a tool that makes this possible. Building on lessons learned from use of the Health Network Quality Improvement System (HNQIS) custom Android app (in the public and private health sectors), PSI has built HNQIS 2.0. This new tool enables out-of-the-box DHIS2 to cost-effectively improve quality of healthcare. It does this by allowing Quality Assurance Officers (QAOs) to assess and improve providers’ knowledge and skills in health service provision, plan supportive supervision visits where and when they are most needed, and monitor quality trends over time. In addition, thanks to DHIS2 analytics capabilities, health system managers will be able to identify common and recurring gaps of health service provision and geographic priority areas of intervention—informing their decision-making processes. 

Built entirely in DHIS2 and available to all DHIS2 users worldwide, HNQIS 2.0 aims to overcome the following challenges:  

Quality assurance systems take a long time to improve health outcomes; this delays achievement of SDG targets. Supports quality improvement of healthcare in a cost-effective manner, at scale 
Supportive supervision visits do not offer real-time scoring and on-site tailored feedback. Collects and analyzes data in real-time, making supervision visits easier, more efficient and effective than paper-based solutions 
Provides immediate on-site tailored feedback to improve providers’ quality of health service provision 
Supportive supervision visits are resource-intensive and difficult to sustain. Better targets resources, resulting in a greater return of investment to increase quality of service provision at scale 
Data from supportive supervision visits are not available in the HMIS. Ensures all data collected is available in DHIS2 and analyzed in tables to support health system managers’ decision-making 
Ensures that data from supportive supervision visits can be overlaid with other data sources (i.e. patient volumes, availability of health commodities, etc.) 

How does it work?

  1. Quality Assurance Officers (QAOs) access HNQIS 2.0 from their Android tablets or from a Google Chrome tab on their laptops. QAOs then conduct supportive supervision visits using HNQIS 2.0, going through its four modules during their visits: Assess, Improve, Monitor, Plan. 
  1. Thanks to tailored analytics capabilities, health system managers – accessing HNQIS 2.0 data from DHIS2 on a Google Chrome tab on their laptops – navigate tailored dashboards to monitor program performance and support their decision-making processes. These include resource allocation, identification of common weaknesses, planning of activities and more.  

Currently built in DHIS2 v2.33, and available on the DHIS2 Android Capture app, HNQIS 2.0 relies on DHIS2 Tracker Program features. This configuration is highly customizable to different health area needs in assurance/improvement assessments. 

Future development 

Still in the making, the HNQIS 2.0 roadmap is expected to deliver a user experience for QAOs composed of: 

  • A monitor module: directly available in HNQIS 2.0 to QAOs at the end of an assessment to monitor providers’ quality of care over time 
  • A plan module: automatic scheduling of future supportive supervision visits based on a prioritization matrix that takes into account providers’ quality of care scores and patient load 

PSI also plans to offer: 

  • A configuration app: to make it easy for DHIS2 system administrators to configure and maintain HNQIS checklists in DHIS2 Tracker Programs 
  • Analytics: to offer health system managers a package of key performance indicators displayed on charts, tables, and maps to support their decision-making processes 

Since 2017, HNQIS has been used to assess 8,389 health facilities; over 84,000 facility evaluations and health worker observations have been conducted in over 29 countries. Now, the flexibility of HNQIS 2.0 allows for both Chrome and Android-based data entry. Within a unique health pilot in Zimbabwe, it also worked in supporting virtual and in-person quality assessments, which reduced disruption at the health facilities involved and reduced in-person congestion thus decreasing COVID-19 transmission risks. Owing to the success of this pilot, additional testing has commenced in the DRC, Kenya, Lesotho, Madagascar and Malawi, using this new, exciting version of HNQIS. The learnings from HNQIS 2.0 are also being leveraged to develop and strengthen PSI’s Routine Data Quality Assessment (RDQA) DHIS2 work, ensuring that the data collected is of the highest standard. Through the experience of additional implementations of HNQIS 2.0, PSI will be able to continue to expand development, incorporate new use cases and share learnings back into the DHIS2 community. 

Join our DHIS2 Symposium session on HNQIS 2.0 on September 28, 2021 to learn more about the use of this tool. 


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