Summary Achieving Universal Health Coverage: The Role of Routine Health Information Systems
RHINO Forum, January 15, 2019
As a follow up to its Fall 2018 Health Systems Research Symposium side event, the Routine Health Information Network (RHINO) organized an online forum on January 15, 2019. Tariq Azim, MEASURE Evaluation, and Theo Lippeveld, John Snow, Inc. (JSI), co-presented and co-moderated the webinar and discussion, Achieving Universal Health Coverage: The Role of Routine Health Information Systems. The RHINO forum garnered 201 registrations from 41 countries and 59 individuals from around the globe participated in the event.
Tariq and Theo, with the help of Ghulam Kibria, University of North Carolina, presented on the following:
- Creating accountability in the community
- Building an information culture leading to better data use
- Providing innovative electronic tools for data management and use at the facility level: experience of eMIS for CHWs in Bangladesh
- Use of human-centered design (HCD) as a methodology to help design an information system that accommodates the needs of the people
Both sets of PowerPoint slides are posted on Slideshare and can be found here and here. Post presentations, participants had the opportunity to pose questions and share their country-specific experiences. The full recording can be found here. Below is a summary of the hour-long discussion:
Shared Insight: Noted the many parallels in her domestic work in the US.
Question: Have we done any partnerships with domestic programs? Partnerships are very important and there are many stakeholders (who need to work together, from community level and higher in the health system). Theo shared an example of the Ethiopia Data Use Partnership and how it offers a platform for all stakeholders, including donors and technical agencies. The Bill & Melinda Gates Foundation has set up similar projects in Malawi and Tanzania.
Shared insight: In the charts of health systems and community roles, one thing we are starting to see with advancing use of information and link to community health worker outreach in the US is the importance of health systems – not only sharing and improving data and their health services, but also helping to leverage action and change in the community.
- Opportunities used that already exist at the community level
- Bangladesh example: CHWs and their immediate supervisors have to sit with the community leaders and share their workplans/information. Community provides the venue for organizing satellite clinics.
- Needs to be more formalized and process designed and shown that these are taking place
Shared Insight: Noticed we have not properly/seriously addressed values in the HIS work. He examined the influence of organizational culture in the use of the Routine Health Information in decision-making in rural Burkina Faso. He also explored, together with the interviewees, potential strategies to promote data use including the search for the root causes that were in line with the local culture. That information suggested that understanding such relationships would help promote data use.
Question: Would you be interested in expanding your communities in this area?
Theo and Tariq: Suggested he look at the PRISM tools, in particular OBAT – Organizational and Behavioral Assessment Tool. It has recently been updated and finalized and is available on the MEASURE Evaluation website later this month. The older version is still available on the website now. PRISM tools have been used in approximately 30-40 countries. The OBAT tool helps to highlight the local values, motivations, and attitudes both at organizational and individual levels terms related to what is happening with information use, and how the organization is supporting it. In MEASURE Evaluation, they have been applying those tools and in many places there is now a RHIS strengthening action plan. There is the thought to improve the technical aspect of information, but also the organizational and behavioral.
Question: Related to using incentives for data use and more specifically performance based financing, in Cameroon, they’re using that to motivate and improve the quality of data and timeliness. The problem/concern is this (performance based financing) came in as a World Bank project, and the main question is what happens when this project comes to an end?
Theo is not a performance based financing specialist, but in the countries where he sees it implemented (i.e. Ethiopia and Liberia), there are still a lot of issues around sustainability. How much of this is driven by the government versus the World Bank. At some point we need to determine if there is government recurrent funding available to sustain it. Performance based financing is known as one intervention, but he’s not sure that this is the only way to move on it.
Shared Insight: Wanted to share some of the practices that a primary health care facility in northern KwaZulu-Natal, South Africa is implementing to improve data quality. In the clinic, the clinic manager is responsible for the collection and to ensure data is of good quality. The clinic manager spends 30 minutes every day to look at the data, and sits with his/her staff as a group to validate the data together at the end of the day. Using praise as the main motivating mechanism, it has improved the quality of the data. The clinic received an award from the National Department of Health and it has been upgraded as an “Idol” clinic in that region. Wanted to show the relevance of leadership and management in improving RHIS performance.
Shared Insight: Wanted to give more details on the sustainability bit from JSI’s inSupply, currently in East Africa with operations in Kenya and Tanzania. They are Implementing a people-centered approach to data use culture. One thing most people don’t realize is how we set up a data use team. It is important to look at the existing structures and give guidelines on how to review the data. It is good to have the data but it must be organized in a way that users can easily interpret it. Use of dashboards is key.
Tariq said he would reach out to her for more details on this specific case study.
Shared Insight: Also used the human-centered design in November 2017 to review RHIS – engaged stakeholders up to the facility level, had a series of meetings for four months with various programs and departments. For the first time ever they are seeing more and more integration in the information system. They already had DHIS2 on national scale, but now are improving it by talking with all stakeholders to gather all user requirements.
Shared Insight: To promote a data culture, they created an annual review where they compare data of all the facilities that they work with and will give an award to the best facility. The annual event has created a friendly competition and staff will make their best efforts to give better services. Another tactic they have employed is using cluster coordination models where 4-5 facilities in close proximity have standing meetings to share their data, performance, challenges, and solutions with each other. Even with above methods, they still have data use challenges, but she appreciates HCD being mentioned in the presentation because she has noticed that a large challenge that still needs to be overcome is end users not being included during the planning stage.
Theo responded that sharing data among facilities is also used in Uganda where district level RHIS indicators were published in the local newspapers. He also emphasized that HCD is a promising approach, but we should take care to avoid it becoming simply jargon and instead practically apply it to involve the end users.
Question: A particular challenge for her working in mental health is how to incorporate quantitative indicators. They currently use many qualitative indicators. How do you make management understand how the system is doing, and how can you design a system where qualitative data can be included?
Theo answered that at service delivery levels, there are methods that can incorporate qualitative elements to identify solutions to improve health services. The Institute for Health Improvement has examples. Tariq also suggested the RED Strategy, which has a methodology for the district level to capture and look at both qualitative and quantitative data in systematic manner. Tariq offered that we can further dig to see if there are qualitative data used at higher levels for decision-making.