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Biometric.md
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# Biometric Attendance System in Health Sector of Bangladesh
## Background
In remote areas of Bangladesh, absenteeism among health service providers at hospitals and health centers was a significant issue. This challenge is common not only in Bangladesh but also in many other countries. To address this, the Management Information System (MIS) under the Directorate General of Health Services (DGHS) introduced biometric time-attendance systems to track office attendance of government health staff at workplaces.
## Implementation of Biometric Attendance System
### Phase 1: Fingerprint Biometric Machines
- **Installation Timeline:**
- Introduced in 2012 and gradually expanded.
- Covered all Upazila Health Complexes (UHCs) and District Hospitals (DHs) in phases.
- **Technical Details:**
- Low-cost fingerprint biometric devices.
- Each device can store up to 30,000 touch encounters.
- **Operational Mechanism:**
- Staff fingerprints are registered during installation.
- Daily attendance is recorded through touch-based fingerprint scanning.
- Attendance data is captured by a central server at MIS-DGHS whenever local computers are connected to the Internet.
- Web-based attendance reports can be accessed remotely.
### Performance Metrics
- **Statistics:**
- In 2015: 423 active devices with 38.21% attendance.
- In 2016: 457 active devices with 51.05% attendance.
- In 2017: 476 active devices with 74.59% attendance.
- **Impact:**
- Attendance rates increased by 36.38% from 2013 to 2017.
- **Pre-COVID-19 Period (Till August-September 2023):**
- Attendance rate reached 92% with data from 600 active devices.
### Impact of COVID-19
- **Pandemic Disruption:**
- Biometric attendance machines were shut down from 2019 to 2021.
### Phase 2: Face Recognition System
- **Introduction:**
- Implemented from September 2023.
- **Upgrades:**
- Face recognition technology replaced fingerprint systems.
- Devices are now required to remain online, connecting directly to the central MIS-DGHS server.
- Attendance confirmation is based on face recognition linked to the HRM ID of employees.
- Face ID registration occurs once per organization, and updates (e.g., transfers) are synchronized automatically.
- **Features:**
- Supports outsourced employees and simplifies processes for reporting, leave management, scheduling, and activation/inactivation.
- Centralized server manages real-time data and reporting.
## Coverage
As of the latest update, the attendance system connects:
- **Institutions:**
- Divisional Health Offices: 8
- Sadar Upazila Health Offices: 60
- District Health Offices: 63
- Chest Hospitals: 11
- Chest Clinics: 41
- Former UHCs, Sadar/District Hospitals, Specialized Hospitals, Medical Colleges, and Medical College Hospitals.
- **Total Coverage:** 787 institutions.
## Current Status
The upgraded system has enhanced operational efficiency and attendance monitoring in government health facilities across the country. Regular attendance data is now being received from all connected institutions, ensuring better accountability and service delivery.
---
This article provides an overview of the biometric attendance system implemented by MIS-DGHS to improve attendance tracking in the health sector of Bangladesh. For further queries, please contact the MIS-DGHS support team.

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HRIS.md
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## HRIS
**Introduction to Central HRIS**
Central HRIS is the single software platform where organizations can manage their staff information systematically with
uniformity and consistency so that the present scenario of the workforce is visible to administration with maximum
details, enabling stakeholders and policymakers to take effective and timely measures based on most recent, up-to-date
facts.
For first time in history such transparency in human resource management has been introduced. A major step towards going
paperless and increase productivity. Designed to meet the need of Government processes. (including ad hoc processes)
Accountability and awareness through media monitoring. Established interoperability with all existing major health
systems. Open data philosophy - Share maximum data through thousands of APIs reducing thousands of hours of data entry
and human effort for other systems.
---
**Core Objectives**
Central HRIS is unique because.
1. Fast and effective data driven decision, policy & crisis management.
2. Maximum interoperability to eliminate data duplication and redundancy.
3. Increase productivity of staffs by introducing transparency and accountability.
4. Improve quality of health service for citizen.
---
**One Click Solution To Data Problem**
Central HRIS has instant, one click answers to thousands of questions such as following -
1. How many Jr. Consultants are posts are vacant in under Dhaka division?
2. How many staffs are currently in Leave, Lien and Deputation and when they will be back to service?
3. How many Female Medical Officers are posted in all 31-Bed Hospitals under Barisal division?
4. Where to find all the relevant HR documents i.e. staff’s scanned documents, ACR records, PDS.
5. Where to see a provider’s career changes in a timeline (here, career change refers to Transfer, Promotion, Training,
Publications.. etc).
6. How to get a list of work forces who are retiring next month, or next week, or next year.
7. Based on what information planning and future projection should be done? How many staffs and of which disciplines are
required nationally. And many more ...
Prior to HRIS, it took weeks or months to collect, compile, combine, formulate, cross-check, verify and publish such
report. Now, these answers are one click away.
---
**Resolved Consistency And Authenticity Issues**
Without a central system consistency and quality issues like the following would continuously arise -
1. If similar reports from different sources are obtained, they will not have uniform terminology, code or standard.
2. Aggregated values (for example - vacant and filled up counts) do not match in reports from different sources.
3. Report is not free of human errors that might have occurred during large excel manipulation, emailing, versioning,
manual computation and during merger of data from multiple files.
4. One would realize that one can only make most sense of reports that are generated by his/her own organization.
Reports that you receive from other organizations takes significant time to process and understand.
On the other hand, Central HRIS delivers accurate and consistent report in real time with 100% uniformity.
---
**Increase productivity & utilization of workforce**
Central HRIS significantly reduces human involvement in the process of managing HR data. A minimal input or change
automatically propagates itself meaningfully across the whole hierarchy. For example - If a person is in leave, this
would automatically reflect in manpower calculation, attendance count and all other reports. An intelligent system like
HRIS reduces the chances of human error by automatically suggesting the correct operation and necessary validation. Once
HRIS takes care of the all the above, resources can be engaged in more productive activities where human involvement is
imperative and adds significant value.
---
## Primary registries (Data repositories)
HRIS stands on top of four main* databases also known as Registries
1. **Geolocation Registry**
* Geolocation registry stores the complete administrative area hierarchy of Bangladesh, from Division down to ward level.
All software in the health ecosystem use this single repository as a source for geolocation data.
* Geolocation registry stores the complete administrative area hierarchy of Bangladesh, from Division up to ward level .
* Facilities are placed somewhere in an administrative area. i.e.Union level Hospital.
* This registry is managed centrally and changes occur only due to new Govt orders. Like - creation of new division, merge of two unions etc.
* All other software will use this registry provided by geolocation registry to have identical structure. This will help get rid of all sort of report inconsistency.
2. **Facility Registry**
* Facility registry stores a comprehensive data about health facilities. Information includes -
* Facility type, function, ownership type.
* Administrative information
* Infrastructure details
* Major services
* Posts
* Logistics & Equipments
* Capacity & Manpower
* etc.
Other information about facility
* Level - District level, Upazila level
* Type - Administrative, Service
* Function- Academic, Training.. etc
* Ownership - Fully Government-owned, Government-Semi-autonomous
* Healthcare level - Primary, Secondary, Tertiary
* And many other attributes and information.
3. **Post Registry**
* There is a finite number of posts under the Ministry of Health. In sanctioned post registry these posts are managed.
* A post always belongs to a facility and has additional information attached to it like - designation name, group, payscale, discipline, Bangladesh professional group, WHO professional group etc.
* A post can be empty or a provider can occupy a post by Transfer, promotion or other changes.
4. **Provider Registry**
* All staffs who are employed by MoHFW belong to this registry.
* This database stores identity information, service details and expertise, academic qualifications, awards, achievement and publications of all staffs.
* Staff’s whole life history starting from joining till retirement is visible to manager.
* Staff’s leave, lien and deputation related information are all available along with scanned copy of orders.
* Staffs personal information
* Family information
* Training
* Salary and Benefits
* Educational Qualification
* Achievements
* Publications
* Presentations
* Affiliation
* Awards
* Related Files/Uploads
* Online Applications
* Transfer/Posting
* Leave
* Lien
* Additional role
* Attachment
* Noc
* Deputation
* Retirement
* Promotion
* Disciplinary action
* Death
Many more...
---
**Access HRIS**
Use your username and password to enter HRIS.
at [https://hrm.dghs.gov.bd/](https://hrm.dghs.gov.bd/)

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ICD11.md
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# Bangladesh's Transition from ICD-10 to ICD-11: A Journey Towards Modernized Health Coding
## Introduction
In late 2023, Bangladesh started the journey of transitioning from ICD-10 to ICD-11, aiming to modernize its health information system and improve disease classification and reporting. As part of this transition, a pilot phase was initiated in six hospitals, employing two different approaches for ICD-11 integration based on the existing digital infrastructure.
## The Pilot Phase: Implementing ICD-11 in Six Hospitals
To assess the feasibility and effectiveness of ICD-11, six hospitals were selected for piloting, categorized based on their health information systems:
### 1. OpenMRS-Based Hospitals (WHO ICD-11 API Integration)
Three district hospitals leveraged OpenMRS, integrated with the WHO ICD-11 API to facilitate morbidity (OPD, emergency) and mortality (MCCoD) coding. The hospitals included:
- **Cumilla District Hospital**
- **Nilphamari District Hospital**
- **Barguna District Hospital**
This integration enabled structured coding of patient diagnoses and causes of death.
### 2. DHIS2-Based Hospitals (ICD-11 Codes in Dropdowns)
Three other hospitals incorporated ICD-11 into the existing DHIS2 platform by manually adding ICD-11 codes into dropdown menus. These hospitals were:
- **Cox’s Bazar District Hospital**
- **Khulna Medical College Hospital**
- **Rajshahi Medical College Hospital**
Bangladesh initially planned for an integrated morbidity and mortality tracker within DHIS2. While WHO had already developed a customized ICD-11 application for MCCOD (Medical Certification of Cause of Death), there was no equivalent app available for morbidity coding at the time of piloting. As a result, ICD-11 morbidity and mortality coding had to be manually incorporated using dropdown menus. Bangladesh continued using this approach to maintain consistency while simultaneously requesting WHO to develop a customized morbidity app to enable full ICD-11 integration within DHIS2.
## Challenges Encountered During the Pilot Phase
### 1. Challenges in OpenMRS Implementation
- **Limited Scope of ICD-11 Usage:** The inpatient module of OpenMRS is still under development. Consequently, ICD-11 could only be utilized in outpatient departments (OPD), emergency departments, and for MCCOD.
- **Data Remains Locally Stored:** The lack of centralized synchronization meant that hospitals using OpenMRS continued entering routine health information into DHIS2, leading to a double workload.
- **Limited Use of Postcoordination:** Findings from the pilot phase indicated very little usage of postcoordination in OpenMRS-based piloting areas, suggesting the need for further training and system improvements.
- **Initial Absence of Foundation URI Storage:** Initially, only ICD-11 codes were stored, without keeping the `foundationUri`. Later, it was realized that storing `foundationUri` is essential for usability and data analysis. As a result, this functionality was added to the backend.
### 2. Challenges in DHIS2 Implementation
- **Dropdown Limitations:** Since DHIS2 lacked a built-in API connection for ICD-11, the dropdown approach was used. However, ICD-11 is not designed to function as a dropdown-based classification, making data entry cumbersome and inefficient.
- **Dual Data Entry Burden:** As Bangladesh’s national health statistics are still produced using ICD-10, hospitals using ICD-11 in DHIS2 were also required to enter the same data in ICD-10. This double data entry requirement led to frustration among healthcare workers, resulting in low motivation to input ICD-11 data.
- **Future System Constraints:** Given that ICD-11 was not intended to be used as dropdown selections, it became evident that long-term implementation should focus on full-fledged hospital automation rather than manual input into DHIS2.
### 3. Inconsistent MCCOD Data Entry
In Bangladesh, routine health information system (HIS) data is formulated by a statistician, while MCCOD data entry is performed by a nurse from the inpatient department. Regardless of the HIS platform (OpenMRS or DHIS2), nurses had to enter the same data twice. This redundancy led to minimal data entry for MCCOD. However, OPD and emergency departments performed well because physicians use the automation system in real time, eliminating redundant data entry and additional workload for them.
## Lessons Learned and Next Steps
The pilot phase provided crucial insights into the strengths and limitations of ICD-11 integration in Bangladesh’s healthcare system. The key takeaways shaped the country’s next phase of implementation.
### 1. Establishing a Central Terminology Registry
Bangladesh is in the process of formulating a **Central Terminology Registry**, which will adopt ICD-11 for coding symptoms, signs, diagnoses, and medications. This initiative paves the way for nationwide expansion of ICD-11 implementation in hospitals equipped with automation systems.
#### Why ICD-11 for the Terminology Registry?
- **Free of Cost** – No licensing fees are required, making it a cost-effective solution.
- **Global Community Support** – ICD-11 is backed by a robust global community, ensuring continuous updates and improvements.
- **Ready Technology** – WHO has provided APIs and tools that facilitate seamless integration with existing health information systems.
### 2. Switching to Localized ICD-11 Deployment
Initially, ICD-11 was deployed using the WHO ICD-11 API. However, Bangladesh is now transitioning to a **localized Docker container deployment**. This shift significantly reduces dependency on internet connectivity, ensuring a more stable and efficient system for hospitals, especially in remote areas.
### 3. Scaling Up ICD-11 to 150 Hospitals
Building on the lessons from the pilot phase, Bangladesh plans to **expand ICD-11 implementation to 150 hospitals** that have hospital automation systems. This expansion will facilitate the integration of ICD-11 data directly into a central shareable health record repository, eliminating the need for duplicate data entry into DHIS2.
### 4. Future of DHIS2 and ICD-11 Integration
- **MCCOD Application Adoption:** In DHIS2, the WHO MCCOD app with ICD-11 API will be adopted for mortality coding.
- **Exploring Custom Morbidity Apps:** If a customized app for morbidity coding with ICD-11 API becomes available, Bangladesh will integrate it into DHIS2. Otherwise, ICD-10 will continue to be used for morbidity coding, but a **mapping system** will be developed to transition ICD-10 data into ICD-11 over time.
### 5. Capacity Building for ICD-11 Data Analysis
Bangladesh recognizes the need for **capacity building** in analyzing data coded with ICD-11. Training healthcare professionals and statisticians in **interpreting and utilizing ICD-11-coded data** effectively will be essential for decision-making and policy development.
### 6. Gradual Phase-Out of DHIS2 for Hospital-Based Coding
Over time, as hospital automation systems expand, **ICD-11 data will be directly recorded in these systems**. DHIS2 will gradually be phased out for individual patient coding but will continue to serve **program-specific purposes and aggregate data collection** at the national level.
## Conclusion
Bangladesh’s transition from ICD-10 to ICD-11 represents a **significant leap** in modernizing the country’s health information system. While the pilot phase revealed implementation challenges, it also provided a roadmap for future scaling. By addressing **data synchronization issues, reducing dependency on internet-based APIs, eliminating redundant data entry, and strengthening capacity building** for ICD-11 data analysis, Bangladesh aims to **enhance healthcare coding efficiency, improve statistical accuracy, and align with global health standards** for morbidity and mortality reporting.

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PrivacyPolicySHR.md
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## Privacy Policy for Shareable Health Record (SHR) Bangladesh ##
**Effective Date:** December 18, 2024
**1\. Introduction**
The Shareable Health Record (SHR) system is a centralized digital platform developed by the Ministry of Health and Family Welfare of Bangladesh.Its purpose is to securely collect, store, and share citizens' health information to enhance healthcare services nationwide.
**2\. Information We Collect**
We collect the following types of information:
- **Personal Identification Information:** Name, date of birth, gender, contact details, National ID (NID), Birth Registration Number (BRN), and Unique Health ID.
- **Health Information:** Medical history, diagnoses, medications, laboratory results, imaging reports, and other health-related data.
- **Demographic Information:** Address, occupation, and other relevant socio-economic data.
**3\. How We Use Your Information**
The information collected is used to:
- **Create Personal Health Profiles (PHP):** Consolidate all medical encounters into a single, unified health record accessible with your consent.
- **Facilitate Health Information Exchange (HIE):** Enable secure sharing of health data among authorized healthcare providers to improve patient care.
- **Enhance Healthcare Services:** Support data-driven decision-making to improve public health outcomes and policy formulation.
**4\. Information Sharing and Disclosure**
We may share your information with:
- **Authorized Healthcare Providers:** To ensure continuity of care and informed medical decision-making.
- **Government Health Agencies:** For public health monitoring and policy development.
- **Research Institutions:** For health research purposes, with all personal identifiers removed to ensure anonymity.
**5\. Data Security and Privacy**
We are committed to protecting your personal health information through:
- **Encryption:** All data is encrypted during transmission and storage to prevent unauthorized access.
- **Access Controls:** Only authorized personnel have access to your information, based on their role and necessity.
- **Regular Audits:** We conduct regular security assessments to identify and mitigate potential risks.
**6\. Your Rights**
You have the right to:
- **Access Your Information:** View your personal health profile through the SHR platform.
- **Request Corrections:** Seek amendments to any inaccuracies in your health records.
- **Withdraw Consent:** Limit or revoke consent for sharing your health information, subject to legal and operational constraints.
**7\. Changes to This Privacy Policy**
We may update this privacy policy periodically to reflect changes in our practices or legal requirements. Any significant changes will be communicated through our website.
**8\. Contact Us**
If you have any questions or concerns about this privacy policy or your personal health information, please contact us at:
- **Email:** [info@shr.dghs.gov.bd](mailto:info@shr.dghs.gov.bd)
- **Address:** Directorate General of Health Services, Mohakhali, Dhaka-1212, Bangladesh.
By using the SHR system, you acknowledge that you have read and understood this privacy policy and agree to the collection and use of your information as described herein.

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## **Private Hospital Registration**
**Introduction**
The Directorate General of Health Services (DGHS) under the Ministry of Health and Family Welfare of the Government of the People's Republic of Bangladesh is working to ensure health services to all levels of the public in Bangladesh. The Hospitals and Clinics Branch of the DGHS is the regulatory branch of all government hospitals at secondary and tertiary levels and all private hospitals, clinics, diagnostic centers and blood banks in Bangladesh. This branch is working to ensure the quality of health services of the mentioned health service providers by keeping in mind the Sustainable Development Goals (SDGs) and by coordinating with other branches of the DGHS and the departments of the Ministry of Health and Family Welfare. To this end, the Hospitals and Clinics Branch ensures all types of needs of government hospitals with 100 and above beds at the district and divisional levels located within Bangladesh and issues and renews licenses of all private hospitals, clinics, diagnostic centers and blood banks. This branch is working diligently to implement the operational plan called 'Hospital Service Management' in collaboration with the Line Director, Program Manager and Deputy Managers to make the 4th Health, Population and Nutrition Sector Program a success.
**Warning**
Any fraudulent use of this site will be considered a punishable offense under the Information and Communication Technology Act, 2006 or other applicable laws.
**General Instructions**
First, create an account in the name of your organization. Once the account is created, an SMS containing the registration number will be automatically sent to your mobile number. Activate your account using this registration number.
Save the email and password used for later work.
Fill in the fields marked with an asterisk (*) correctly and click on the 'Save' button. Once all the information is filled correctly, click on the 'Complete' tab and click on the 'Final Submit' button. Once you click on the 'Final Submit' button, there will be no opportunity to change any information.
After submitting the application, print the application and save it in your organization.
**Special Instructions for Private Hospital/Clinic**
1. For using the BMDC number of all doctors, use only mathematical numbers in English (Example: 12345).
2. In Payment Info, pay the revised license/renewal fee as per the latest circular issued by the Ministry of Health and Family Welfare and 15% VAT on the said fee as per the government instructions in a separate invoice form.
3. On the Upload page, upload the scanned copy of the owners' National Identity Card, Updated Trade License, TIN (New Organization)/Income Tax Certificate (Old Organization), VAT Registration Number, Environmental Clearance Certificate, Narcotic Permit (where applicable), Waste Management (Harmful and Non-Harmful) Agreement and Invoice.
4. Prepare a book by adding the following documents (certified) and store it in your organization. Which will be audited during the inspection:-
* List of currently running service activities
* In the case of special services, the number of beds for each, list of specialist doctors, nurses, helpers providing the service, list of equipment
* List of all surgeries currently performed
* List of all the equipment in the operating room with the signature of the head of the organization.
* Name, address, photo of specialist doctor, registration by BMDC, specialist certificate, appointment and joining/consent letter
* Name, address, photo of doctor on duty, registration, appointment and joining letter by BMDC
* Name, address, photo of nurses on duty, registration, appointment and joining letter by Nursing Council
* Name, address, photo of cleaning staff, educational qualification, appointment and joining letter and experience certificate
* Name, address, photo of other officers and employees, educational qualification, appointment and joining letter and experience certificate
**Special Instructions for Diagnostic Center**
1. For all doctors, use only mathematical numbers in English (Example: 12345) when using BMDC numbers.
2. In Payment Info, pay the revised license/renewal fee as per the latest circular issued by the Ministry of Health and Family Welfare and 15% VAT on the said fee as per the government instructions in a separate invoice form.
3. On the Upload page, upload the scanned copy of the owners' National Identity Card, Updated Trade License, TIN (New Organization)/Income Tax Certificate (Old Organization), VAT Registration Number, Environmental Clearance Certificate, Narcotic Permit (where applicable), Waste Management (Harmful and Innocent) Agreement and Invoice.
4. Prepare a book by adding the following documents (certified) and store it in your organization. Which will be inspected during the inspection:-
* List of currently running tests
* Name, address, photo of specialist doctor, registration by BMDC, specialist certificate, appointment and joining/consent letter
* Name, address, photo of report giver, registration by BMDC, specialist certificate, appointment and joining/consent letter
* Name, address, photo, registration certificate, appointment and joining letter of medical technologists
* Name, address, photo, educational qualification, appointment and joining letter and experience certificate of cleaning staff
* Name, address, photo, educational qualification, appointment and joining letter and experience certificate
* Name, address, photo, educational qualification, appointment and joining letter and experience certificate of other officers and employees
**Special Instructions for Blood Bank**
1. For all doctors, use only mathematical numbers in English (Example: 12345) when using BMDC numbers.
2. In Payment Info, pay the inspection fee, license/renewal fee as per Safe Blood Transfusion Rules‍, 2008 and 15% VAT on the said fee as per government instructions in a separate invoice form and provide the information.
3. On the Upload page, upload the owners' National Identity Card, Updated Trade License, TIN (New Organization)/Income Tax Certificate (Old Organization), VAT Registration Number, Environmental Clearance Certificate, Waste Management (Harmful and Non-Harmful) Agreement, Postgraduate Certificate of Blood Transfusion Specialist, Appointment/Joining/Consent Letter of Blood Transfusion Specialist and scanned copy of the invoice.
4. Prepare a book by adding the following documents (attested) and store it in your organization. Which will be inspected during the inspection:-
* Name, address, photo of the specialist doctor, registration by BMDC, specialist certificate, appointment and joining/consent letter
* Name, address, photo of the doctor on duty, registration, appointment and joining letter by BMDC
* Name, address, photo, registration certificate, educational certificate, appointment and joining letter of blood transfusion technologists
* Name, address, photo, registration certificate, educational certificate, appointment and joining letter of nurses on duty
* Name, address, photo, educational qualification, appointment and joining letter and experience certificate of lab attendants
* Name, address, photo, educational qualification, appointment and joining letter and experience certificate of other officers and employees

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openmrs.md
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There are several hospitals have been automated by OpenMRS Plus.
**Automated hospital list:**
# Automated by OpenMRS+ hospital list and Automation Start Dates
# Automated by OpenMRS + hospital list and Automation Start Dates
| S/I | Hospital and Other Information | Automation Start Date | Vendor Information |
|-----|-----------------------------------------------------------------------------|------------------------|----------------------------------|