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The Government of Ethiopia started reforms of its Health Management Information System and Monitoring and Evaluation (HMIS/M&E) during its third Health Sector Development Program (2005/06-2009/10) . Assessments showed that there is duplication of efforts and lot of unused data is collected, and that the system lacked standardization and guidelines. It was also found that the HMIS narrowly focused on transferring information principally to MOH, did not support local use of information, and reporting was both incomplete and untimely.
The reform was undertaken using the Business Process Reengineering (BPR) methodology in 2007 involving "As-Is Analysis", new design, pilot testing, and evaluation, and followed by nationwide scale-up. The new design resulted in an integrated and unified HMIS and M&E system focusing on critical success factors including a streamlined, consensus national set of key indicators, based on information requirements for decision making. Tools were designed to foster the integration of reporting tools in single channel, to reduce the burden of reporting, leading to faster transfer of better quality data, that is standardized and yields consistent information. Challenges in implementation included inadequate ownership and follow up, resistance from some health workers and programs to new system and integrated folder; and shortage of resources. Now in place in six regions after piloting, there is emerging evidence suggesting improvements in improved quality of care, reduction of work load on health workers, and reduced data burden from more than 400 to 150 datasets at HC and hospital level, and indicators from more than 250 to 107. Lessons include the need to more clearly define the resource needs and gasp for scale up, wider consultation of stakeholders, periodic review of indicators and disease lists, the need to better capture private sector information, and additional empowerment of leadership at regional and district Level.