A process analysis of the Namibian Health System: An exploratory case study


Abstract Background: The Namibian health system is fragmented and data are collected from disparate systems that are not interoperable. Interoperability in this case refers to the ability of health information systems (HISs) to communicate and exchange health-related data at various healthcare levels. The multiplicity of HISs has resulted in limited access to integrated data across the entire health system, leading to duplication of data and under-reporting from primary healthcare facilities, yielding unreliable institution-based data within the health system. Methods: A qualitative approach was employed using a two-phase design. In phase one, a business process re-engineering (BPR) approach was applied to conduct a process analysis of the Namibian health system. A process model is developed to illustrate health inter-level data flows. In phase two, the process model was validated by experts, and semi-structured interviews were conducted as part of a Delphi study to elicit the opinions of experts on challenges and bottlenecks in the data flow process. Interview results were inductively analyzed using the NVivo software to identify themes and patterns from the data. Findings: The national HIS faces pertinent challenges concerning fragmented systems, originating from vertical programmes and donor-funded systems that do not exchange data with the national-level district health information system (DHIS). Findings also highlight that Namibia, among other developing nations, faces similar integration challenges, such as a lack of a trained workforce, different healthcare interoperability standards used by various HISs, an inadequate foundational infrastructure, and an absence of policies, unclear roles and structures that are necessary for driving HIS integration initiatives. Conclusion: There is a need to strengthen collaboration between the national HISs and vertical health systems (VHSs) to address curb the integration challenges. The Ministry of Health (MoH) needs to invest in capacity building projects to train HIS officers on data analysis and use of DHIS 2. In addition, a clear outline of structures and functions needs to be defined to ensure that various MoH units, particularly the IT department, fulfill their primary role of providing IT services, including HIS integration.  [Ethiop. J. Health Dev. 2018;32(4):200-209] Key words: Health information systems, process analysis, business process re-engineering, integration, interoperability, Namibia