Since 2003, the US President’s Emergency Plan for AIDS Relief (PEPFAR) has supported implementation and maintenance of health information systems for HIV/AIDS and related diseases, such as tuberculosis, in numerous countries. As the COVID-19 pandemic emerged, several countries conducted rapid assessments and enhanced existing PEPFAR-funded HIV and national health information systems to support COVID-19 surveillance data collection, analysis, visualization, and reporting needs. We describe efforts at the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, Georgia, USA, and CDC country offices that enhanced existing health information systems in support COVID-19 pandemic response. We describe CDC activities in Haiti as an illustration of efforts in PEPFAR countries. We also describe how investments used to establish and maintain standards-based health information systems in resource-constrained settings can have positive effects on health systems beyond their original scope.

Background In their work to end the tuberculosis (TB) epidemic in lower- and middle-income countries, national TB programs need a tool to measure, monitor, and strengthen relevant capabilities to create a continuous transformation of data into action (D2A) to improve TB program results. However, there is a lack of scientific evidence to determine specific measurement dimensions of a D2A continuum that enables TB programs to identify the barriers and enablers of D2A and to guide the selection of interventions appropriate for the context and decision-making capabilities of various TB program actors. Methods A systematic review of peer-reviewed and grey literature was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 48 peer-reviewed publications were selected for data extraction and analysis. Results The findings show that selected publications discussed the health system level, stakeholders involved in decision making, decision type, data system, data sources, data use enablers and barriers, decision-making framework and steps, decision outcome/impact, and how that outcome was measured. The findings highlight barriers and enablers to data use and explain the relationship among data sources, decision type, and stakeholders. Seventeen D2A measurement dimensions were identified. Conclusions Transforming data to action is a continuous process that recognizes that data use indicators vary by type of decisions, decision makers, and the health system level at which decisions are made. As a logical next step, the project team plans to develop and validate a D2A continuum toolkit that will include a measurement scale, implementation guide, and data collection and analysis Microsoft Excel workbook.

Background The Data-to-Action Continuum (D2AC) Toolkit is intended to advance the data use capabilities associated with people, processes, technology, and institutions of national tuberculosis programs (NTPs). It empowers NTPs and stakeholders to measure current capabilities, identify areas amenable to interventions to build future capacities, and helps align the TB information system to better achieve the NTP’s goals. This paper describes the development process of the D2AC Toolkit, whose aim is to enable NTPs and stakeholders—especially the policymakers, program managers, and laboratory and facility managers—to precisely gauge the barriers limiting the use of data for action and devise appropriate interventions to address them. Methods Building on a scientific and grey literature foundation, the D2AC Toolkit was collaboratively developed by a core group of the TB data, Impact Assessment and Communications Hub (TB DIAH) project. The Toolkit was validated by a group of international and country-level experts following an iterative and user-centered process employing mixed methods. Results The expert-validated D2AC Toolkit measures appropriate capabilities required to transform data to action in the context of an NTP at the national, regional, district, and facility levels across five domains and 17 subdomains using a five-point Likert scale: nascent, defined, established, institutionalized, and optimized. Conclusions The continuum describes the status of various domains and corresponding subdomains and enables the identification of future goals for each subdomain. The future capabilities are meant to guide the development of an improvement path toward the desired level of advancement and monitor progress toward the desired goals. By integrating an iterative and user-centered process and using mixed methods, the D2AC Toolkit enables policymakers, program managers, and service providers to gauge current capabilities, identify future priorities, and develop an implementation plan to improve the organizational ability to transform data to action for achieving tuberculosis program goals.