Learning Exchange Guiding Questions
How can we foster a culture of data use at all levels of the health system to support better PHC decision-making?
How to monitor and report on whether the most vulnerable are accessing and utilizing quality PHC services.
How can government stakeholders ensure that innovations in PHC data collection and use introduced during the COVID-19 response are further tested, adapted and scaled up in the post-pandemic recovery period?
PHCPI, in collaboration with the Joint Learning Network for Universal Health Coverage (JLN), facilitates two Learning Exchanges under the JLN Network for Open Dialogue and Exchange. The Understanding and Utilizing Data in COVID-19 Response and Recovery Learning Exchange enables sharing of best and promising practices related to PHC data collection and use in PHC decision-making, especially during the COVID-19 response.
Participants in the Learning Exchanges meet monthly to learn from experts in plenary and participate in facilitated peer to peer problem-solving modeled after Feedback Labs LabStorm. Representatives from participating countries bring forward a challenge they are facing and pose 3 questions to the group, who draw on their own knowledge and expertise to provide reflections and possible solutions. Below is a summary of the key takeaways emerging from those discussions.
External Fund and Procurement Tracking to Coordinate Financing for COVID-19 Response in Mozambique
At the onset of the COVID-19 pandemic, donors rushed to mobilize resources, and the government stepped in to coordinate the response. Through this coordination, the government entrusted the procurement of supplies to donors to mitigate the heavy burden of the pandemic. As a result, different funders owned the tracking of funds and procurement and there was a lack of coordination among them, which affected the visibility of the procurement pipeline. A public financial management practitioner from Mozambique introduced challenges related to tracking procurement and funds, asking the following:
- How do we get people to have comprehensive visibility of the procurement pipeline, needs met and gaps in supplies?
- How do we start a mindset shift across institutions to foster a culture of data sharing?
- How do you strike the right balance to communicate new ideas without casting judgement?
establish a centralized system. Participants discussed establishing a centralized system with a government ministry in control. While establishing such a system in an emergency like the pandemic may be difficult, it facilitates an easier procurement process for the country.
The centralization system should have a standard list that procurement agents are drawing from to allow the government to have visibility on the procurement process. Disseminating information, especially to track funds or procurement goods purchased, is also important in this central system. As an example, the PhilGEPS system in the Philippines, a single centralized electronic portal, serves as the primary and definitive source for government procurement. Service providers and NGOs are able to access the database to bid on opportunities with a government body overseeing the procurement process.
cultivate a culture of data sharing. Participants noted that the central and local government can play a role in encouraging a data sharing culture by appointing champions within the government to promote the culture of data usage. In Rwanda, a Community of Practice on health procurement and data brings together different actors to meet and share practices and ideas to foster a culture of data sharing. As a last strategy, policy and regulation can help by setting specific rules around data sharing.
find allies. Innovation and new ideas can be disruptive, thus they must be clearly communicated and understood. Participants noted that sometimes specialists may not have the right skills to communicate technical work. Thus, it is important to find allies and people that may better be able to communicate the message. It is also important to leverage the strengths of other departments in the government or additional structures. As an example, NGOs and key opinion leaders can be utilized to advocate a message and persuade stakeholders.
- IMPACT team: Data Use Culture for Continuous Improvement of Supply Chain
- From Data Visibility to Data Use: The Information Revolution in the Ethiopian Public-Sector Health Care Supply Chain
- Reproductive Health Supplies Coalition: How can the VAN help countries track orders and shipments?
Challenges of the National Health Management Information System: The Nigerian Case
The National Health Management Information System (NHMIS) was developed in 2006 to collect and manage health care data in Nigeria. Though there have been several efforts to strengthen the NHMIS (including a policy revision in 2014), weak data transmission systems, weak governance, fragmentation, and limited infrastructures, financial and human resources continue to plague the system. These challenges lead to poor data quality and uncertainty about data integrity which in turn contribute to low data utilization. For the February virtual Learning Exchange on “Understanding and Utilizing Data”, the Nigerian team, led by Dr. Francis Ayomoh presented these challenges, and posed the following questions to the group:
- What strategies can be adopted to address the HR capacity gaps (Workforce numbers and training) that affect data quality?
- What strategies can be used to nudge stakeholders to increase utilization of existing data even as efforts to increase data quality are in progress?
- What has been done in your country that worked or did not work to increase data reporting at facility level?
BUILD CAPACITY IN DATA MANAGEMENT. Kenya addressed gaps in training by developing a standardized Health Information System (HIS) program designed to build capacity. The program includes specific modules such as data collection, analysis, and visualization to address knowledge gaps in those key areas. These modules are provided free of charge and participants can receive a certification upon completion. In Ghana, frequent data entry errors were observed among private providers. As a solution, health specialists trained in reporting go to facilities experiencing data quality issues and support those staff in reporting data to build their capacity.
ENHANCE THE UTILITY OF THE DATA SYSTEM. In Kenya, the government has pushed for the use of DHIS2 as the primary reference to enhance the utility of the data system. This has a cascading effect of encouraging stakeholders to utilize DHIS2 data, and. since it is prioritized by stakeholders, DHIS2 data is increasingly used to drive decision-making. As more partners rely on those data and generate demand for them, the more data quality improves, and the data system becomes more robust to respond to partners’ needs.
REGULATIONS AND INCENTIVES ARE CRUCIAL. As a participant from Colombia noted, providing incentives has been a large enabling factor to increase data reporting. Kenya was able to address gaps in training by providing online modules free of charge to the health workforce. In the Philippines data reporting is connected to licensing. Facilities may not keep their license to operate if they do not report facility level data. Similarly, in Colombia, providers are subject to fines and other penalties if they do not report data and accreditation of facilities by the government is tied to fulfilling the data reporting requirements.
CHALLENGE: Improving Access and Utilization of COVID-19 Patient Related Data in Kenya
The COVID-19 pandemic has revealed several challenges within the Kenyan health system. Kenya has a highly fragmented electronic health records (EHR) ecosystem. Though the District Health Information System (DHIS) is well implemented, many partners—and the 47 counties—have developed their own EHR systems with low or no interoperability between systems. The lack of data sharing, both between the systems and with the DHIS poses a challenge, and additionally limits the availability and usage of COVID patient level data to support decision-making. Kenya has 80,000 cases of COVID-19 as of early December 2020 with 1,500 deaths. However, many cases go unreported.
During this collaborative problem-solving session, participants were able to share their own experiences to help address the lack of COVID patient-level data to support decision-making in Kenya. The key questions asked during the sessions were:
- Do you identify with this example and if so, how has your country addressed it?
- Based on your experience/knowledge how can Kenya utilize routine data collection infrastructure to improve access and utilization of COVID-19 patient-related data?
- Based on your experience/knowledge, how can Kenya address the challenge of fragmented and non-interoperable EHR systems?
MANAGING DATA SHARING. A key emerging theme was the use of laws and regulations to support the integration of systems. Countries such as Ghana and Argentina have passed regulations involving the usage of data and interoperability. In Argentina a sub-secretary was developed and tasked with the integration of systems between the different sub-sectors in the country. Ghana additionally passed regulations for private health facilities to enter data in DHIS. Participants also reflected on interoperability between the DHIS and platforms they use for COVID-19 data. In Colombia, apps have been used to increase information sharing around COVID patient-related data.
MANAGING THE POLITICS OF DATA. A second theme during the session was around the broader ramifications of data sharing. Participants reflected on the sensitive nature of COVID related data that governments may not want to share. A solution to this issue as brought forth by a representative from Ghana is to establish Memoranda of Understanding (MOU) between different systems on a need-to-know basis to share data.
Interoperability is possible. Interoperability remains a challenge, however there are a few success cases. During the session, participants additionally highlighted that the DHIS2 portal is interoperable with SORMAS, a platform that is being used for COVID 19 reporting. DHIS COVID Success Stories has highlighted diverse country cases from Rwanda to Sri Lanka that could be useful to countries facing similar issues.
Overall, the session highlighted the lack of data sharing in Kenya as well as the role that the government can play to ease interoperability. The Kenyan team appreciated the insights and hope to utilize some of the solutions discussed to address the lack of COVID patient level data.