As no uniform reporting exists in Yemen, the use of Excel was the right decision in order to adapt the software to the individual hospital situation. Programming more sophisticated HIS using data management software (e.g. Access) would have been difficult to design, to maintain and to finance for each hospital. The fact that “only” summarized daily patient data is used proofed to be sufficient for the basic hospital information purpose. The HIS program did become quite popular during the last two years and other hospitals have installed it out of their own indicative. Protecting the software (calculated values, graphs) with a password only the responsible hospital software clerk knows guarantees the integrity of the system. Data entry errors were minor and not distorting the overall information. Showing bed occupancy rates, patient load for staff, and monthly hospital revenue was well appreciated by hospital managers.

A short three-day introductory period that included some training on soft- and hardware, was sufficient for the statistical personnel to perform regular daily data entry. There have been no complaints concerning the performance of the HIS. Reports are printed out regularly, and preparing the HIS for the following year was unproblematic, as the file needed only to be copied and renamed. Very much appreciated was the fact that the HIS gives instant feedback on the performance of the hospital and is not an information system which only reports to the higher administrative levels (e.g. Ministry of Health). The HIS is a low cost computer program and the program is easy to change and adapt, which means that there is no need to outsource software development and/or maintenance.

The Lahj Governorate had been visited again in 2007. All HIS are still used and regularly updated. Other hospitals have adapted the HIS software to their needs without the input of external technical assistance. Reports are used for monitoring hospital performance and monthly income.

Based on these findings an “electronic tally sheet” has been programmed in Excel to serve the following functions:

· Collect summarized data for each ward on a regular, daily basis

· Facilitate accessibility to medical data

· Establish baseline data as core data set (staff and beds)

· Automate calculations to get summarized data per month, quarter, half-year and year

· Present data in easy to understand reports and charts

· Allow for additional analysis which must be performed automatically (e.g. bed occupancy rate)

· Allow for additional modules to process data on vaccination, delivery and infectious diseases

A pilot version of HIS has been developed and tested during a four week period in 2002. Feedback from the users at two hospitals and personal observations were used to adapt the HIS and correct for misunderstandings and technical problems.

The final version of the HIS has been installed in three hospitals (Tawr Al Baha, Lahj, and Al Qatn). These hospitals have bed capacity between 60 and 120 including different number of outpatient- and inpatient wards.

The HIS is a low cost computer program and the program is easy to change and adapt, which means that there is no need to outsource software development and/or maintenance.