Health Network Quality Information System (HNQIS) documentation

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Ensuring the delivery of high-quality healthcare is paramount to achieving positive health outcomes, across both public and private healthcare systems. Recognising this critical need, PSI developed the Health Network Quality Improvement System (HNQIS). The system comprises a suite of evidence-based processes and tools designed to optimise resource allocation for supervisory visits within healthcare networks. HNQIS empowers supervisors to effectively monitor adherence to medical care protocols and standards by healthcare providers, fostering continuous quality improvement and ultimately leading to enhanced patient care and overall network performance.

The HNQIS solution uses a mobile app to undertake observational assessments, which provides consistent feedback across the evaluated areas, and monitors performance improvement. The tool is currently in use in 30+ countries (of which 11 are using it in the public sector), and has been used to deliver over 200,000+ assessments across 15,000+ health providers.

These assessments are in essence checklists that include hundreds of individual items that are verified to ensure the correct execution of medical protocols. For example: do providers insert the IUD correctly against a clinical checklist? Are waste procedures at a clinic followed against guidance? Is a counselling session taking into account best practices for post HIV test clinical counselling standard operating procedures (SOPs)? Are we implementing health services with fidelity?​

PSI opted to use DHIS2 as the main repository for the data generated by these assessments, as well as the associated metadata (the checklists, the questionnaires rendering logic, the scoring mechanisms, the analytics). When the app was initially developed, back in 2014, DHIS2 was not able to support many of the complex data collection rules, or in-app analytics required. Hence, a custom Android app was developed, which is referred as HNQIS v1.0.

HNQIS 2.0, commonly referred as H2, is the latest version of this tool. Deployed during 2023, it now uses the power of DHIS2 modern versions to host and run the complex checklists that are required for the in-depth evaluations conducted at health facilities and providers. The assessment can be conducted either using DHIS2 tracker capture web or the DHIS2 standard android captured app. An enhanced version of the android app is also maintained, referred to as PSI DHIS2 Android Fork, which incorporates feedback functionality to support the health officers during the on-site assessment, and provide information on best practices across various topics. The complex configuration that is needed to support the various calculations is handled through the Program Configuration App, a custom app developed to facilitate and automate the process of setting up and maintaining these checklists.

The solution collects and analyses data in real-time making supervision visits easier, more efficient, and effective than previous paper-based solutions. It also allows the use of raw data to understand patterns across providers and facilities, when analysed at a national level, allowing to design interventions based on actual findings. This ultimately results in better use of resources, which results in a greater return of investment to increase the quality-of-service provision at scale.

In this space, you will find:

1. H2 Web User Manual: how to use DHIS2 standard tracker capture to run a H2 assessment

2. H2 Android User Manual: how to install and use H2 offline on an Android device. The difference between the standard University of Oslo app, and PSI’s DHIS2 Android Fork.

3. H2 technical documentation about the implementation of H2 in DHIS2.