BHIMA White Paper

The Basic Hospital Information Management Application (BHIMA) is a free and open source software (FOSS) web application designed to meet the managerial and administrative needs of hospitals in the Democratic Republic of the Congo (DRC). First deployed in 2015, BHIMA has served over 1.7 million transactions for the care of 175,000 registered patients across nine medical institutions in five provinces of the DRC. BHIMA provides a sustainable, adaptable solution for Congolese hospital administrators’ accounting and management needs.

Why implement BHIMA?

The development of BHIMA was initiated after piloting multiple off the shelf software solutions that did not conform to the context and needs of rural hospitals in the DRC. Specific barriers encountered were costly licensing fees, specific operating system requirements, inability to process multiple currencies, lack of French language support, dependencies on internet connectivity, and inability to correctly model the government-mandated accounting norms of the DRC. Sustainable software in the DRC requires low barriers to entry, low cost to maintain, and limited dependency on external infrastructure. BHIMA was implemented to overcome each of these barriers faced, and provide a comprehensive software suite to meet the needs of most medical institutions.

Core Features

• An accounting solution compliant with the Organization for Harmonization in Africa of Business Law (OHADA) standards.
• Pharmaceutical management including automated reorder interval calculation, alerting for low stock and expiry, and stock valuation.
• Human resources and payroll modules designed for either fixed salaried employees or salary distribution based on institution revenue.
• Budget management and reporting to analyze balance versus budget, cashflow, and revenue cycle performance.
• Cost-center analysis tools to rationally allocate costs to revenue generating departments based on either predefined rubrics or dynamically calculated fields, such as hours worked or number of employees.

History

Development on the BHIMA software began in December 2013 as part of the ASSP project funded by the UK Government. It was piloted in HGR Tshikaji until it was stable enough to expand to additional institutions in 2015. Since then, it has been adopted by both private not-for-profit and public medical institutions across northern and western DRC. After being incubated by IMA World Health for over a decade, BHIMA was transferred to the open source community in October 2024, where it is maintained by a team of volunteer contributors, including many of the initial BHIMA developers. Development continues in the organisation Third Culture Software.

System Design

A primary design consideration of the BHIMA software is sustainability. Developed with an open source philosophy, BHIMA is freely available to run without licensing fees or recurring software costs. While BHIMA is built using web technologies, an internet connection is not required to use BHIMA. Rather, the software is designed to be hosted on a single, central server running Linux, while any device with a modern web browser can use the application. This architecture allows for maximum flexibility, scaling from a single device running in a clinic to dozens of laptops, tablets, and phones entering data and viewing reports simultaneously. It also allows for gradual roll out of functionality during installation.

Case Studies

There is evidence that enabling administrators to better track and understand the revenue cycle of their institutions with BHIMA has led to markedly increased revenue. In a recent case study, HGR Kanzala and HGR Tshikapa, the two latest institutions to adopt BHIMA, observed increases in average monthly revenue by 33% and 98%, respectively. Contributing factors to the increased revenue are tighter controls on service prices, enhanced financial transparency in cash management, facilities for individualized debt tracking and recovery, as well as anti-fraud measures. Similarly, in a separate large hospital, patient complaints of discriminatory pricing led to an extensive fraud investigation. By using BHIMA’s tools to track patient transactions and user logs, an audit team was able to validate the patient’s claims, uncover further evidence of payment fraud, determine the precise dates on which the scheme occurred, and sanctioned four hospital employees. In the immediate period following the sanctions, hospital revenue increased by an estimated one hundred dollars per day.

Synopsis

BHIMA fills the critical gap of health facility-level information management in the overall architecture of the health information system of the DRC. In contrast to other health information and management systems deployed in the DRC, such as iHRIS, DHIS2, and InfoMED, BHIMA’s data is both produced and consumed by the same users, resulting in improved accuracy, consistency, and coherence. Through close partnerships with pilot institutions in the Kasai and Kwilu, the development team has tailored the software to fit into the management models of a typical rural hospital, producing commonly used reports and automating routine processes. BHIMA’s sustained use in HGR Karawa for over two years without donor or program support demonstrates its adaptability, low operational cost, and long-term viability. Furthermore, The software has the potential to integrate seamlessly into the national health information system of the DRC by supplying data already generated and used by its users into the national information systems of DHIS2, iHRIS, and InfoMED.