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DHIS2 (also spelled DHIS 2, formerly District Health Information Software) is a free and open-source software platform for the collection, reporting, analysis and dissemination of aggregate and individual-level data.

The most common use of DHIS2 is for health data, where it can be implemented for individual health programs and/or as a national-scale Health Management Information System (HMIS). As of the end of 2022, DHIS2 was in use by Ministries of Health in more than 75 low- and middle-income countries (LMICs), with 69 countries using DHIS2 at national scale.

Beyond health, DHIS2 is used in sectors such as education, supply chain and logistics, water and sanitation, nutrition and food security, agriculture and land management, and e-governance, among others. DHIS2 is officially recognized as a Digital Public Good

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As a digital solution for data collection and management, DHIS2 can be used for aggregate data (e.g. routine health facility data, staffing, equipment, infrastructure, population estimates, etc.), event data (e.g. disease outbreaks, survey/audit data, patient satisfaction surveys, etc.), and individual-level longitudinal data (e.g. vaccination records, lab sample collection and testing, patient treatment and follow-up, student progress, etc.).

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The system supports the capture of data linked to any level in an organizational hierarchy at any data collection frequency.

HIS2 includes built-in tools for analytics, including dashboards, charts, pivot tables and maps, as well as data validation and data quality features. It also includes tools to support collaborative data use, such as sharing, commenting and interpretation.

DHIS2 is a web-based platform. The core software and database are hosted on a server, which can be either physically located in the country of ownership or cloud-based. Users can access the DHIS2 through any modern web browser.

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Health

Education

Logistics

Water and sanitation

Nutrition and food security

Data collection, processing, interpretation, and analysis

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DHIS2 is currently in use as a Health Management Information System in more than 75 low- and middle-income countries. 69 of these countries have deployed DHIS2 at national scale. DHIS2 is also used by national health authorities and international health programs and organizations for management of health programs related to specific diseases, such as HIV, TB, and Malaria, among others, as well as for general public health programs such as disease surveillance, routine immunization, and maternal and child health. In addition, during the COVID-19 pandemic, 55 countries rapidly deployed or extended DHIS2 for national pandemic response and/or vaccination

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Since 2019, the HISP Centre( Health Information Systems Programme (HISP)) has worked with six countries to pilot DHIS2 as an Education Management Information System (EMIS.

This use case adapts the core DHIS2 functionality and data model to the education sector for such purposes as student and teacher records, school report cards, and resource allocation

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DHIS2 is used for health logistics data in more than 20 countries in Africa and Asia, where it serves as a last-mile solution for facility-level data capture for health commodities. Most commonly, this involves regular reporting of aggregate data on stocks and usage of common medical supply items such as vaccines, medications, syringes, etc, which facilitates triangulation of health service and commodity data as well as forecasting. In addition, some countries use DHIS2 for vaccine cold chain or other electronic Logistics Management Information System (eLMIS) use cases.

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As a generic software platform, DHIS2 has been adapted for a variety of use cases both within and beyond the health sector. In addition to the most common uses listed above, examples of known DHIS2 projects include water and sanitation, nutrition and food security, agriculture and land management, and e-governance.

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The wider context of HIS can be comprehensively described through the information cycle presented in Figure 1.1 below. The information cycle pictorially depicts the different components, stages and processes through which the data is collected, checked for quality, processed, analysed and used.

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DHIS2 supports the different facets of the information cycle including

Collecting data.

Running quality checks.

Data access at multiple levels.

Reporting.

Making graphs and maps and other forms of analysis.

Enabling comparison across time (for example, previous months) and space (for example, across facilities and districts).

See trends (displaying data in time series to see their min and max levels).

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Hosting DHIS2 on a national scale is a considerable undertaking which requires planning, provisioning, monitoring and management of potentially complex hardware and/or cloud resources. For a full discussion of the various tradeoffs of different approaches see the server hosting section of the DHIS2 implementation guide.

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DHIS2 is licensed under an open source license and is free for everyone to install and use. However, managing a DHIS2 instance involves more than setting up a powerful web server.

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Human resources with skills in relevant technologies such as web servers and database systems

Reliable backup of your system including safe storage at a remote server

Use of SSL (HTTPS / encryption) to keep private information like passwords secure

Monitoring of server resources and application performance.

Stable and high-speed Internet connectivity

Stable power supply including a backup power solution

Secure server environment to avoid unauthorized access, theft and fire

Powerful hardware with potential for scaling together with increased system usage

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A managed hosting service provides the DHIS2 software as a service in the cloud. This means you can start using the system immediately, there is no need to install and maintain the software yourself, and aspects such as backups and security are taken care of. You can also get support and help with configuration, data processing and troubleshooting.

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The following providers offer DHIS2 software as a service

BAO Systems: baosystems.com

Bluesquare: bluesquarehub.com

HISP South Africa: hisp.org

SolidLines: solidlines.io

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The following section describes a list of tips for getting off to a good start when developing a new database.

Quickly populate a demo database, incl. examples of reports, charts, dashboard, GIS, data entry forms. Use real data, ideally nation-wide, but not necessarily facility-level data.

Put the demo database online. Server hosting with an external provider server can be a solution to speed up the process, even if temporary. This makes a great collaborative platform and dissemination tool to get buy-in from stakeholders.

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Make sure to have a local team with different skills and background: public health, data administrator, IT and project management.

Use the customisation and database design phase as a learning and training process to build local capacity through learning-by-doing.

The country national team should drive the database design process but be supported and guided by experienced implementers.

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Indicators represent perhaps the most powerful data analysis feature of the DHIS2. While data elements represent the raw data (counts) being collected the indicators represent formulas providing coverage rates, incidence rates, ratios and other formula-based units of analysis. An indicator is made up of a factor (e.g. 1, 100, 100, 100 000), a numerator and a denominator, the two latter are both expressions based on one or more data elements. E.g. the indicator “BCG coverage \<1 year” is defined a formula with a factor 100, a numerator (“BCG doses given to children under 1 year”) and a denominator (“Target population under 1 year”). The indicator “DPT1 to DPT3 drop out rate” is a formula of 100 % x (“DPT1 doses given”- “DPT3 doses given”) / (“DPT1 doses given”)

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Most report modules in DHIS2 support both data elements and indicators and you can also combine these in custom reports, but the important difference and strength of indicators versus raw data (data element’s data values) is the ability to compare data across different geographical areas (e.g. highly populated vs rural areas) as the target population can be used in the denominator.

Indicators can be added, modified and deleted at any point in time without interfering with the data values in the database.

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Describe the DHIS database

Describe data entry in DHIS

List purposes of DHIS

Describe requirements of hosting DHIS database

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