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INTRODUCTIONA health management information system (HMIS) is a routine, integrated system for the collection,collation, analysis, presentation, dissemination, and use of relevant health‐related information. It coversother health information system (HIS) sub‐systems, such as the human resources information system,administrative records, integrated disease surveillance and response (IDSR), the logistics managementinformation system (LMIS), registration of births and deaths, population‐based information systems, andresearch-generated health information. It is designed for use at the community and health facility levels,and by district health management teams (DHMTs), local councils, civil society organizations, partners,and the MOHS for planning, allocating resources, and managing and evaluating the healthcare deliverysystem.Definition of the Standard Operating Procedures for HMIS: Data ManagementProcedures ManualThe Data Management Procedures Manual, within the context of the HIS, is a written description of themanagement practices required for effective coordination, monitoring, and supervision of the HIS, as wellas the procedures required to address issues relating to data collection, quality, and accessibility. The DataManagement Procedures Manual should therefore accurately reflect good information managementpractices, be sufficiently practical, and be usable in the HIS sub‐system. Good HIS management practicesrelate to general aspects of HIS management functions, including the following: data collection,compilation, analysis, storage, and processing; records storage; handling of urgent data requests andneeds; and management of the devices, tools, and appliances used to manage the data.RationaleData demand and information use continues to be of high priority for the MOHS and its partners,especially the use of routine data for decision making. However, based on feedback from the quarterlysupportive supervision meetings, the data quality review meeting, and the M&E review meeting, theMOHS noted that the HMIS faced several challenges (DPPI, MOHS 2018; DPPI, MOHS, 2019). Thesechallenges were as follows: poor and incomplete recording of health data; use of multiple non‐standardizedforms at service delivery points; lack of guidance on how to access health data from the producers; lack ofguidance on how to share data produced (e.g., generated through research and program implementation);and unclear roles and responsibilities in the collection, management, and dissemination of health data.In addition, in 2019, MEASURE Evaluation—a project funded by USAID and the PMI—conducted anassessment on the capacity of Sierra Leone’s National Malaria Control Programme (NMCP) for M&E atnational and district levels (MEASURE Evaluation, 2019). The assessment focused on the NMCP as theorganizational unit at the national level and selected DHMT members performing malaria-related functionsat the district level. The assessment consisted of a desk review of existing documentation and primary datacollection through group assessment and individual assessment tools described in the Monitoring andEvaluation Capacity Assessment Toolkit (MECAT) (MEASURE Evaluation PIMA, 2017).MECAT assesses capacity across 12 components of an M&E system1 and captures the capacity ofindividual staff to conduct M&E, as well as the technical and financial autonomy of the organization orThese components are: (1) organizational; (2) human capacity for M&E; (3) partnerships andgovernance; (4) organization’s M&E plan; (5) annual costed M&E work plan; (6) advocacy,1SOPs for the Health Management Information System: Data Management Procedures Manual I1

unit in implementing M&E functions. The findings showed that at the national level, the NMCP has wellestablished structures and tools for M&E that are of relatively good quality. The assessed componentsachieved high scores, with the exception of human capacity for M&E and data demand and use, whichboth scored 5 out of the possible 10 points. Although the NMCP has good capacity for routine M&E,external technical assistance was essential to meet research and evaluation needs. Lower scores wereobserved under financial autonomy for most of the capacity areas. Components assessed at the districtlevel received lower scores. At the district level, systems, structures, processes, and tools are not wellestablished, with the exception of supervision and auditing and the annual M&E work plan, which isintegrated in the annual health work plan. The assessment also revealed weak technical and financialcapacities internally in the DHMTs, portraying high reliance on external support.Against this background and in line with the recommendation from the MECAT findings, the MOHSand its partners developed the Standard Operating Procedures for HMIS: Data ManagementProcedures Manual.GoalThe goal of the Standard Operating Procedures for HMIS: Data Management Procedures Manual is toprovide a standardized system of data management practices for the MOHS and its partners, with theview of reaching maximum data accuracy, correctness, completeness, integrity, and reproducibility in theHMIS in Sierra Leone. The application of the Data Management Procedures Manual requires effectivecoordination and oversight at all levels.ObjectiveThe general objective of the Data Management Procedures Manual is to ensure that the informationgenerated from the routine HIS meets the characteristics of a good quality data. This means that completedata sets of sufficient quality are available at all levels by the agreed-on dates after the end of eachmonthly reporting period. The data should be analyzed using standardized indicators, and all data usersshould be provided with appropriate and regular reports. These include feedback reports from thenational to the district level and from the district level to the health facility level.Therefore, specific objectives are to: Establish a well-coordinated HMIS in the Sierra Leone health sectorMaintain a reliable data quality system for the MOHS and its partnersProvide timely and accurate data that are required at all levels for decision making (servicedelivery area, DHMTs, national level, and partners)Provide a record-keeping system that will help monitor and evaluate the HMISBuild the culture of data use at all levels to improve the quality of data and health service deliverycommunication, and cultural behavior; (7) routine monitoring; (8) surveys and surveillance; (9) nationaland subnational databases; (10) supervision and auditing; (11) evaluation and research; and (12) datademand and use.2SOPs for the Health Management Information System: Data Management Procedures Manual I

HIS AND SUBSYSTEMSOverview of the HIS and Its Subsystems in Sierra LeoneThe HIS in Sierra Leone is the principal responsibility of two directorates in the MOHS: the Directorateof Policy, Planning and Information (DPPI) and the Directorate of Health Security and Emergency. TheDPPI is responsible for collecting general data on the operations of the MOHS and also routine healthservices-based data on human resources, use of services, referrals, maternal health and family planning,hospital beds and bed occupancy, routine disease data, and undertaking of healthcare research. TheDirectorate of Health Security and Emergency is responsible for collecting data on epidemic-pronediseases, for immediate action using the IDSR system. Other directorates and programs are responsiblefor the management of specific subsystems of the HIS. The Directorate of Drugs and Medical Supplies(DDMS) is responsible for managing the LMIS, and the Directorate of Human Resources is responsiblefor managing the human resources information system. The Births and Deaths Programme is responsiblefor managing data on vital statistics, and the Directorate of Financial Resources is responsible for thesystem for managing financial data. The Information, Communication, and Technology (ICT) unit isresponsible for providing guidance and setting up the ICT infrastructure for the various subsystems.Outside the MOHS, National Civil Registrations and Vital Statistics is responsible for recording birthsand deaths, among other functions.In Sierra Leone, the HIS consists of the following subsystems: Integrated disease surveillance and responseData generated through household surveysData collection based on patient and service records and reporting from community healthworkers (CHWs), health workers, and health facilitiesProgram-specific M&E (e.g., for tuberculosis, HIV/AIDS, malaria, reproductive health/familyplanning, nutrition, and Expanded Program on Immunization [EPI])LMISAdministration and resource management (including budget, personnel, and supplies)The function of the HIS is to bring together data from all these different subsystems, to share anddisseminate them to the many different audiences for health information, and to ensure that healthinformation is used rationally, effectively, and efficiently to improve health action.Health Data and Information FlowThe HMIS in Sierra Leone is organized into four levels: community, health facility, district, and national.To improve access to healthcare, the health sector is opened up to a wider range of providers, both publicand private, at all levels. Health interventions are packaged and delivered in communities, health facilities,districts, and tertiary and teaching hospitals. Figure 1 illustrates the flow of health data and informationfrom the community and health facilities to districts and from districts to the national level. It alsoillustrates the feedback mechanism from the national level to the district level to health facilities, down tothe community. Each level of service delivery has activities and management functions.SOPs for the Health Management Information System: Data Management Procedures Manual I3

Figure1. Pictorial representation of the health data and information flowData Management Responsibilities at the National LevelAt the national level, the DPPI receives electronic copies of district health data through the DistrictHealth Information Software, version 2 (DHIS2) 15 days after the end of the month. The districts’monthly health data are processed to provide health information products, such as quarterly bulletins.These bulletins are disseminated to programs and partners. In the DPPI, data management is theresponsibility of two units: the HMIS unit and the M&E unit. The HMIS unit oversees the routine datacollection systems, and the M&E unit ensures that supervision and data quality reviews are carried out.The data management responsibilities at this level include the following: 4The principal M&E specialist is responsible for receipt of all district health data. He or she isresponsible for providing feedback (electronically or by phone) to the DHMT, acknowledgingreceipt of the data.The principal M&E specialist is responsible for ensuring that data received from districts areverified for completeness, correctness, and consistency before analysis and reporting are done. InSOPs for the Health Management Information System: Data Management Procedures Manual I

the area of programs, the program manager is responsible for ensuring that data received fromdistricts are verified for completeness, correctness, and consistency before analysis and reportingare done.It is advisable that a national data validation team reviews and compares the aggregated datareceived from districts before submission to the principal M&E specialist or program manager.The principal M&E specialist and program managers are responsible for final review,endorsement of analyzed data, and reports before submission to programs and partners.Data Management Responsibilities at the District LevelThe DHMT receives hard copies of monthly health data from health facilities no later than the fifth dayafter the end of the month. This submission deadline aims to improve timeliness. The data managementresponsibilities at this level are described in the following sections.District M&E OfficerThe district M&E officer is responsible for the following: Coordinating and supervising all data management practices in the districtEnsuring data quality, including completeness, correctness, consistency, and timely transmissionof district data and reports to the national levelEnsuring that final review and endorsement of district data for completeness, accuracy, andtimeliness before submission to the national level are done on regularly basisEnsuring data safety and proper storage and accessibility at the DHMT level, health facility level,and community levelReceiving forms endorsed by the in-charge of the health facilityVerifying the data from health facilities before sending them to the data entry officer for entry.Dates of receipt, verification, and entry, as well as signatures or initials of the recipient, verifier,and entry clerk should be indicated on each reporting form.Performing post-data verification and validation before dissemination to partners and otherhealth actorsWorking with other DHMT members, such as the district malaria focal person, districtnutritionist, district operations officer, district pharmacist, etc., to ensure credible and reliabledata elements for programmatic data analysis and disseminationUnder the coordination of the district medical officer (DMO), coordinating data harmonizationand verification exercises with DMHT membersData Entry Officer and District Information Officer The data entry officer (DEO) is responsible for receiving verified monthly summary forms fromthe district M&E officer, and the district information officer (DIO) is responsible for receivingverified monthly Report Request and Issue Voucher (RR&IV) summary forms from the districtpharmacist for entry within the data submission period stated by health facilities.The DEO/DIO is also responsible for tracking and safekeeping of all reports, both manual andelectronic, on a monthly basis.The DEO/DIO performs pre-data verification and validation before and after entry intoDHIS2/LMIS.SOPs for the Health Management Information System: Data Management Procedures Manual I5

The DEO is supervised by the district M&E officer, and the DIO is supervised by the districtpharmacist.Data Management Responsibilities at the Health Facility LevelHospital Level For the hospitals, the M&E officer receives hard copies of monthly health data from the wardin-charge and other units in the hospitals no later than the second day after the end of themonth.The hospital M&E officer is responsible for entry of hospital data into DHIS2 before the fifthday of every month.The hospital M&E officer, working closely with the ward in-charges, is responsible for ensuringthat all data collection tools are up to date.The hospital M&E officer is responsible for applying standards and best practices for datacollection and reporting as defined in the Standard Operating Procedures for the HMIS: DataManagement Procedures Manual.The hospital M&E officer is responsible for alerting the district M&E officer promptly on anydata collection issues (e.g., stockout of data collection tools, Internet connectivity issues, unusualdata).Peripheral Health Unit Level (Community Health Center, Community HealthPost, Maternal and Child Health Post)Routine data collected from patient care are first put into standard health facility registers (e.g., generalregister, under-five register, EPI register, mother and neonate register, insecticide-treated net register,RR&IV register). Data are then collated from these health facility registers provided through thestandardized health facility summary forms. To improve timeliness, the compiled monthly reports aresubmitted to DHMTs using the stan

levels pointed out the need to revise and update the Data Management Procedures Manual. In a bid to address these challenges, the MOHS, in collaboration with its partners, developed the Standard Operating Procedures for the Health Management Information System Manual through the Directorate of Policy Planning and Information.