District Nutrition Monitoring System

Problems:
1. Poor quality of data for grass root level health care operations
2. Lack of information for multi sector collaboration for nutrition related interventions
3. Delay in data transmission from field level to multi sector stakeholders
4. Lack of nutritional records with longitudinal relationships

Sri Lanka is a country with a well-established public health system. Public health indicators of the country are comparable to levels of developed countries. In spite of substantial performance in many aspects of preventive healthcare sector, indicators related to nutrition have failed to stay in par with others. Sri Lanka has significant percentages of malnourished children which has resulted in grave consequences to country’s development. Hence, this timely requirement has received due attention from presidential secretariat by initiating the multisector nutrition action plan. District Nutrition Monitoring System (DNMS) is the information system which captures data related to malnourished children at grass root level. This is done by public health midwives who are the field level public health care workers. For the feasibility of this process, the data collection at field level are done by an Android based mobile application using the mobile devices donated to them. Children with malnutrition are registered into the system which also identifies the different nutritional issues they suffer. Routine anthropometric measurements are inserted periodically followed by household risk factors which has led to malnutrition. Captured data is transmitted to the data warehouse, which is a customized instance of DHIS2, a free and open source health management information system which has been implemented in over 70 countries worldwide. The data transmission between DHIS2 and the Android application are achieved using the web API of DHIS2. Field level data managers, Medical Officer of Health (MOH) will have access to validate data entered by midwives using the web interface of DHIS2. The built in analytics module is used to provide automated aggregated and individual analytics of malnourished children to data mangers. The process is efficient in speeding up the data flow and could be utilised for decision making. The system also transmit relevant data to non-health sector institutes which are partners of multi sector nutrition action plan to take necessary measures to undertake non-health related interventions to improve the nutritional status of the children. Data transmission at this level is also processed through the web API of DHIS2. Application has trilingual interfaces and supports obtaining GPS based location information and real time validation of collected data with nutritional colour coding and familiar interfaces used in existing paper based information collection system. Routine work of field level health worker is facilitated by providing longitudinal charting of data with graphical analysis using various built in charts. Application supports offline data entry on a local database synchronised with data ware house periodically, which is a crucial requirement for field level data capture in Sri Lanka in areas with poor mobile network coverage. As part of the implementation plan, the field level healthcare workers are provided with smart phones in which DNMS Android application is installed from Google play store. They will also be provided with an extensive on site in service training on using the device and Android application.

Solutions:
1. To provide nutrition related information to the maternal and child health information system of Sri Lanka
2. To facilitate monitoring as well as implementation of multi sector action plan for nutrition mediated by Presidential Secretariat of Sri Lanka
3. To optimize multi sector collaboration at field level by provision of information